In Fuckology, the authors contextualize and interrogate Money's writings and practices. The book focuses on his three key diagnostic concepts, “hermaphroditism,” “transsexualism,” and “paraphilia,” but also addresses his lesser-known work on topics ranging from animal behavior to the philosophy of science. The result is a comprehensive collection of new insights for researchers and students within cultural, historical, and gender studies, as well as for practitioners and activists in sexology, psychology, and patient rights.
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Critical Essays on John Money's Diagnostic Concepts
By Lisa Downing, Iain Morland, Nikki Sullivan
The University of Chicago PressCopyright © 2015 The University of Chicago
All rights reserved.
The Matter of Gender
The social history of our era cannot be written without naming gender, gender role, and gender identity as organizing principles. JOHN MONEY, "The Concept of Gender Identity Disorder in Childhood and Adolescence after 39 Years"
In the popular imaginary of the present, John Money is most often cast as the quintessential social constructionist; as someone who claimed that gender is solely an effect of enculturation and, as such, is radically mutable and alterable. For some, Money's purported theory of gender as an effect of nurture (as opposed to nature), made him "one of the gurus of the [second-wave] feminist movement"—a characterization that seems to sit uncomfortably with Money's criticism of what he saw as feminism's "conceptual neutering of gender." For others, Money's clinical attempts to "prove" his theory have—particularly in light of the David Reimer case—shown his ideas to be both flawed and dangerous, and his practice to be unethical. Interestingly, in one of the most influential popular cultural texts on Money, As Nature Made Him: The Boy Who Was Raised as a Girl, John Colapinto's characterization of Money as a constructionist is an inferential effect of the author's narrativization of a world of goodies and baddies, truth and lies, fact and fiction, males and females, rather than something that is convincingly argued through a close engagement with Money's writings. But despite this, Colapinto's text, and in particular his view of Money as a constructionist, seems largely to be taken as gospel.
Money himself would dispute this view of his work, arguing instead that his account of gender identity/role (G-I/R)—a concept I will discuss in detail in due course—is interactionist, that is, it acknowledges the generative effects of both biology and culture. Indeed, it is on this basis that Jennifer Germon has recently argued that "Money's gender offers a third wave of productive potential, one that differs from the second (as in second-wave feminism), precisely because his theories presuppose an interactive relation of cells to environment and to experience(s)." Germon's optimism is challenged, however, by Lesley Rogers and Joan Walsh's much earlier claim that "it is not an interactionist approach to swing towards biological determinism most of the time and then occasionally, when it suits, to swing towards the environmental side." As they see it, insofar as the model of gender attribution that Money and his coauthors articulate is underpinned by extremely conventional assumptions about and attitudes toward sexual difference, any attempt to articulate thoroughly the role of the social in the attribution of gender is wholly undermined. They write: "While Money, Ehrhardt, and co-workers consider the social aspects of gender ... they take for granted that there are two genders, that there are differences between them, and that fundamentally gender is a consequence of a biological blueprint for behavior as well as physique." Similarly, Ruth Doell and Helen Longino have argued that Money's model of gender is more accurately additive than interactionist since it does not explain how biological and social variables work in tandem, but rather, posits the biological as foundational.
There is little doubt that Money's work—in particular his elaboration of "gender"—has been hugely influential, and that rather than being confined to the worlds of scientific research and/or clinical practice, its influence has shaped us all. Consider, for a moment, the extent to which "gender" (however one might conceive it) has become central to everyday life, so much so that it is difficult to imagine how we might function without such a concept. This alone, it seems to me, is reason enough to engage with Money's vast uvre. But further incentive comes from the fact that while competing interpretations of Money's work are readily available to those who choose to seek them out, the popular image of Money as a constructionist abounds. This characterization is an oversimplification of Money's work, and one which can only be maintained through a lack of engagement with his writing. If, as feminists have long argued, ongoing analyses of identity and difference—and in particular, so-called sexual difference—are politically imperative, then a close engagement with Money's highly influential texts, the assumptions that informed his claims, and the ongoing and multifarious effects such claims produce, likewise seems called for. In critically interrogating Money's account of GI/R, my aim in this chapter is not so much to definitively classify his work as either constructionist or determinist, but rather, to trouble the very tendency to see in dimorphic terms since, as Helen Longino has noted, "as long as dimorphism remains at the centre of discourse, other patterns of difference remain hidden both as possibility and as reality."
In popular parlance, gender tends either to be used as interchangeable with "sex" or, alternately, to refer to the social (as opposed to the so-called biological or "sexed") aspects of femaleness and maleness. In both cases, gender is a term that is commonly used to classify others and to refer to our own sense of ourselves as male or female, men or women, neither or both. Despite the fact that such conceptions of gender feel self-evident, they are, in fact, relatively recent. It has been claimed by Money and others that the first use of the term "gender" to refer to something other than feminine and masculine forms within language occurred in Money's 1955 publications "Hermaphroditism, Gender and Precocity in Hyperadrenocortism: Psychologic Findings" and, coauthored with Joan and John Hampson, "Hermaphroditism: Recommendations Concerning Assignment of Sex, Change of Sex, and Psychologic Management." Indeed, it was through his early work with intersex patients that Money came to consider the term "sex" inadequate to describe the lived embodiment of those whose anatomies are either "discordant" or do not appear to match the sex roles associated with masculinity or femininity, and/or the sense of self a particular individual has. For Money, intersexuality challenges the "commonsense" idea that sex (as naturally dichotomous) is a biological characteristic that at once determines genital morphology and can be determined with reference to that morphology, and that sex roles naturally follow from genital morphology and are concordant with it. It is possible, writes Money, "to have the genetical sex of a male ...; the gonadal sex of a male; the internal morphologic sex of a male; the external genital morphologic sex of a female; the hormonal pubertal sex of a female; the assigned sex of a female; and the gender-role and identity of a female." Hence, Money's coining of the term "gender"—or, more precisely, gender identity/role (G-I/R)—to refer to the multivariate character of the "totality of masculinity/femininity, genital sex included," that each person attains even when the multiple aspects of the self (as a "man" or a "woman") are (seemingly) discordant. What we see here, then, is that for Money gender is not synonymous with "sex" (as a set of biological variables), but nor are the five aspects of sex that he identifies in the above quote entirely separable from G-I/R.
Money conceives gender identity and gender role as "obverse sides of the same coin. They constitute a unity." Without this unity, he argues, "gender role ... become[s] a socially transmitted acquisition, divorced from the biology of sex and the brain"; it becomes "desexualized," "cleaned up." As Money understood it, gender identity is the experience one has of oneself as a man or a woman—"the kingpin of your identity" as he and Patricia Tucker describe it—and gender role is the manifestation of this sense of self in one's daily performance of self. In turn, one's performance of gender reaffirms one's gender identity, in particular because it is through gender role, as "everything that [one] says or does to indicate to others ... the degree that one is either male, or female, or ambivalent," that others perceive and position one as gendered (in a specific way). There are, of course, situations in which others' perception of the gender of an individual may not fit with that individual's self-perception, but this is the exception rather than the rule, and it is something I will discuss in more detail in chapter 5.
As Money explains it, gender role is performative in two senses: it is an action or set of actions one articulates corporeally in a world of and with others, and, at the same time, it is constitutive of the self. In other words, gender role makes one be(come) male, female, neither or both, in and through what we might call—although Money himself does not use this term—sedimentation: the more we repeat certain actions, the more naturalized or habituated19 such actions become, and the more they come to appear (both to others and to ourselves) as external expressions of who we "really" are. Clearly, then, while G-I/R may be effected by, for example, gonadal morphology or hormonal activity, it is never wholly determined by what we commonly think of as "biology." But nor, if G-I/R is intercorporeally (re)produced, can it be radically open and/or free, or, at least, that is what one might suppose. For Money, however, the story is a little more confused and confusing as we shall see.
For Money, the ability to acquire a G-I/R is "phylogenetically given, whereas the actuality is ontogenetically given." In other words, while all humans share the ability to acquire a G-I/R, the G-I/Rs we each develop will differ according to context, pre- and postnatal history, morphology, and so on. For Money, then, the ability to acquire a G-I/R—which he refers to as a "phylism"—is, like the ability to acquire language, to breathe, to laugh, or to "pairbond," sex-shared: he writes, "You were wired but not programmed for gender in the same sense that you were wired but not programmed for language." There are, however, phylisms which, according to Money's conceptual schema, are exclusive to either men or women: these are lactation, menstruation, ovulation, and gestation, which are (allegedly) exclusive to women, and impregnation, which is (allegedly) exclusive to men. Money refers to these as "sex irreducible" dimensions of G-I/R and differentiates them, in kind, from what he classifies as the sex derivative, sex adjunctive, and sex arbitrary or sex adventitious dimensions of G-I/R. What begins to emerge here, then, is a categorical distinction between aspects of G-I/R that are universal and somehow determined by sex (as a set of biological variables) and aspects that are context specific and an effect of a particular "society's customary way of doing things." So, for example, while one can acquire the ability to operate a heavy goods vehicle in and through particular cultural processes (e.g., driving lessons), one cannot acquire the ability to ovulate, ontogenetically. A similar ontological move is apparent in Money's claim that phylisms that are sex-shared are sometimes "threshold dimorphic," such that, for example, adolescent boys are more readily aroused by "sexy pin-up pictures" than are adolescent girls. It is possible, writes Money:
that divergent threshold levels are preset as early as in prenatal life when steroidal sex hormones organize bipotential brain regions and pathways to differentiate as predominantly either male or female. From animal experiments, there is abundant evidence that such organization does indeed take place.
Throughout Money's work, the lowering of thresholds is vaguely associated with, although never convincingly connected—at least not in a straightforward causal sense—to prenatal exposure to hormones, most particularly androgen. This is an issue I will engage with at length in chapter 5, but for now I want to suggest that in both the examples discussed we see that for Money G-I/R is never a purely social phenomenon and, while the acquisition of G-I/R necessarily involves what we might ordinarily think of as biological processes, these processes are never wholly determinative. For example, even though the ability to menstruate is associated with women, it does not guarantee a female G-I/R, as the existence of trans men or FTM (female-to-male) transsexuals shows. Conversely, an inability to menstruate does not mean that a person raised as female will not continue to identify and live as a woman once "amenorrhea" becomes apparent. Consequently, Money describes his model of G-I/R acquisition as biosocial or interactionist, and as developmental (and sequential) as opposed to causal.
As I said earlier, Money's proposition that identity does not strictly follow from anatomy, or, even when it appears to, that anatomy is not the cause of G-I/R, is an outcome of his early work with intersexuals, and later, with individuals desiring to undergo "sex reassignment" procedures. The clinical challenge Money faced in both cases was the question of whether or not surgery should be performed, and if so, on what basis its practice might be justified. Central to Money's theory of G-I/R, and to his recommendation that both infants with atypically sexed bodies and adults whose gender identity is (according to normative logic) at odds with their genital morphology should undergo surgical (trans)formation, is his concept of "the critical period of development." Critical periods occur, according to Money, both anatomically and in the development of G-I/R more broadly, and each is marked, metaphorically speaking, by a gate that, once closed, is at best unlikely and at worst impossible to reopen. This closing of gates along a developmental pathway "locks in" G-I/R such that one's sense of self and one's gendered performance becomes increasingly sedimented as one's subjectivity develops: you acquire, developmentally, a "native gender," or, to put it somewhat differently, "bipotentiality becomes monopotentiality." Money writes:
As you approached each gate's sex-differentiation point, you could have gone in either direction, but as you passed through, the gate locked, fixing the prior period of development as male or female. Your gonads, for example, could have become either testicles or ovaries, but once they became testicles they lost the option of becoming ovaries.... In behavior ... at first you drove all over the highway, but as you proceeded you tended to stick more and more to the lanes marked out and socially prescribed for your sex.
In Sexual Signatures, Money and Tucker cite what later became known as the Reimer case (discussed in detail in chapter 3) as "convincing evidence that the gender identity gate was wide open when you were born and stayed open for some time thereafter" and further argue that transsexuals demonstrate that "the gate [is] also open for those who [are] sexually normal at birth" and that "the gender identity gate locks tight once it closes." This conception of the postnatal critical period in which G-I/R becomes "nativized" leads Money to argue in support of sex reassignment surgery (SRS), since the (developmentally "mature") transsexual's sense of self (as male or female) no longer retains the plasticity that the body's morphology will, to some extent, always have (since it is the physical nature of the body to change at the very least at the level of appearance). Money and Tucker write, "Never yet has even the full weight of societal pressure, abetted by intensive psychotherapy, been able to reverse the gender identity of a trans[s]exual after it ha[s] differentiated completely." This irreversibility, supported as it is by examples of patients whose intersex status did not become apparent until puberty but who refused to consider reassignment when "their gender-identities were challenged by their [changing] bodies," leads Money and Tucker to conclude that
the importance of gender identity and the hazards of trying to change it once it has differentiated, make it vitally important to pinpoint the critical period for this stage of development.... Like other stages of development, this one varies somewhat with the individual. In addition, cultural patterns of child training sometimes obscure the gender differentiation process. We can now say, however, that the critical period for gender identity differentiation coincides with the critical period for learning language.
Excerpted from Fuckology by Lisa Downing, Iain Morland, Nikki Sullivan. Copyright © 2015 The University of Chicago. Excerpted by permission of The University of Chicago Press.
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Table of ContentsAcknowledgments
Introduction: On the “Duke of Dysfunction”
Part 1 Mapping
1 The Matter of Gender
2 A Disavowed Inheritance: Nineteenth-Century Perversion Theory and John Money’s “Paraphilia”
3 Gender, Genitals, and the Meaning of Being Human
Part 2 Vandalizing
4 Cybernetic Sexology
5 Reorienting Transsexualism: From Brain Organization Theory to Phenomenology
6 “Citizen-Paraphiliac”: Normophilia and Biophilia in John Money’s Sexology
Conclusion: Off the Map