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A Review of Man & Woman, Boy & Girl
by Kathy Grady
‘Science for the People’ Vol. 9, No. 5, September-October 1977, p. 36–38
Man & Woman, Boy & Girl by John Money and Anke Ehrhardt (Baltimore: The John Hopkins University Press), 1972.
The question of what makes a woman or a man is not an easy one. Ridiculous, you might say. One can always tell who are the women and who are the men. Well, almost always. It’s hard with babies. And with people bundled up in winter clothes. Long hair can be confusing until you see whether the person has a beard (which simplifies the decision a great deal). Forest Hills officials certainly had their problems with the question.
Well, who cares? People are people. We could group people in lots of ways: left-handed/righthanded, employed/unemployed, sinful/pure, revolutionary/counterrevolutionary. Why male/female? When you push people to the wall on this question, you usually get an answer that relates to sexual behavior, more specifically heterosexual behavior. It is extraordinarily common to refer all questions about sex discrimination back to the anatomical differences in reproductive function. At the root of such responses is some version of evolutionary necessity, survival of the species and all that. Thus, the argument goes, this system of categorizing people is fundamentally natural and uniquely biologically based.
It is at this point that science is invoked to provide supporting evidence. The supporters of the status quo have spent at least the last 100 years searching for scientific evidence that would justify the political inequality between the sexes and enforce heterosexuality within that system. Hypotheses about sex differences began with what appeared to be obvious differences in the reproductive organs and quickly moved on to the brain, the nervous system and other physical characteristics, and finally extended to personality or temperament differences and ended with the grand conclusion of resultant social inequalities. Throughout the research and discussion there have been continuing difficulties distinguishing what is, what must be, and what should be.
In Man & Woman, Boy & Girl, Money and Ehrhardt provide a detailed review of their own work at Johns Hopkins and some of the work of other medical and behavioral scientists concerned with those seemingly obvious differences that are the starting place for all other speculation. The book provides a step by step description of the process of gender determination, that is, how one gets to be a male or female The authors lay out the roles of chromosomes, gonads, hormones, and genitalia in painstaking detail. They describe the average course of development in animals and humans and all the deviations from that average: missing or extra chromosomes, missing or malfunctioning gonads, and various distributions of some hormones.
Even at this level, categorizing or “becoming” a male or female is a tricky business. One cannot simply say, for example, that males have XY chromosomes and females XX because there are some people who have what is called a “mosaic variation” like X/XY or XX/XY who may “become” either male or female. On the hormonal level, since most people have some of every kind of hormone, one can only talk about the relative proportions of certain hormones. In practical terms, initial determination of the sex of a newborn depends on the appearance of the genitalia. Overall, Money and Ehrhardt classify not the usual two but four basic gender categories: male, female, ambiguous, or incongruous.
In sum, the startling conclusion is that there does not exist one clearcut way to differentiate only two sexes. Using these basic criteria there are always some number of “left-overs,” some anomolous or ambigous cases whose classification presents problems. No matter how small one estimates this number of people to be, it is clear that in everyday life no categories are provided for them. At some point the individual is “assigned” and occasionally “re-assigned” to one of the two categories male and female, categories which I would argue are more social than biological.
The case histories of individuals with ambiguous or incongruous genitalia provide some of the most interesting reading in the book. The evidence indicates that individuals with the same anatomical characteristics but opposite sex assignment adopt sex roles to match their assignment. In fact, the authors indicate that after about 18 months of age, it is easier to make the physical characteristics match the sex assignment through surgery and or hormone therapy than to try to change the sex-role learning to match the physical characteristics.
One case history which gives stunning evidence for sex-role learning concerns identical twin boys. At 17 months one of the twins had his penis destroyed while being circumcised by cauterization. After much agony, the parents and physicians decided on sex reassignment. Now there are two interesting points to the rest of this story. The first is how technically easy that reassignment was. It required changing the child’s name and clothing. Period. When the child reaches adolescence, she will begin hormone therapy to develop female secondary sex characteristics and at full growth cosmetic surgery will be performed on her genitalia. The second interesting part is the behavioral differences between the twins reported by the parents. By age 4, the twins had different interests, different career plans, and even different personal hygiene according to their mother: “She likes for me to wipe her face. She doesn’t like to be dirty, and yet my son is quite different. I can’t wash his face for anything …. She seems to be daintier. Maybe it’s because I encourage it.” (p. 119).
With all this fascinating evidence for socialization one might well be tempted to assume that Money and Ehrhardt support a cultural interpretation of sex differences. They do not. In fact, they warn “advocates of women’s liberation” not to ignore the evidence presented in Chapter 6. This evidence therefore and its interpretation require careful scrutiny.
Chapter 6 is entitled “Fetal Hormones and the Brain: Human Clinical Syndromes.” As the authors state their task, it is “to see if prenatal androgens may have left a presumptive effect on the brain, and hence on subsequent behavior” (p. 98). It is noteworthy that all data reported is from females although it is mentioned that each of the clinical syndromes also produced children identified and reared as males. One should also note that the “behavior” or “behavioral signs” are not controlled observations of behavior but reports by the subjects and their mothers of behavior, feelings, fantasies, and preferences, sometimes years later. Of course, these subjects and their mothers both know perfectly well that there was a problem concerning an excess of androgen, popularly known as the “male sex hormone.” All of these problems in method raise substantial questions about what conclusions, if any, may be drawn from these data. Nonetheless, we shall press on.
The first study reported compares females with three different kinds of androgen exposure: (1) those who were inadvertently exposed to androgen pre-natally but not post-natally (progestin-induced hermaphroditism); those who because of a defect of function of the adrenal glands were exposed to unusually high amounts of androgen pre- and postnatally (andrenogenital syndrome); and (3) normals. What captures one’s attention, however, are not these categories but the kind of behavioral reports chosen for examination, “tomboyism.” “Tomboyism,” according to the authors, involves energy expenditure, athletic skills, disinterest in clothing and adornment, preferences for boy playmates, cars and guns to “rehearsal of maternalism,” and a priority of career over marriage. Clearly these measures are the most obvious elements of a feminine stereotype. One wonders, however, where the authors came up with a “behavioral sign” (for tomboys) like “their cosmetic of choice is perfume” (p. 10). Since the content of stereotypes can vary from culture to culture, one is left wondering how these specific features of the feminine stereotype could possibly be hormonally determined.
Despite these conceptual and methodological problems, the authors seem to conclude that the “presumptive effect on the brain” of surplus androgen for women is that their behavior is less “feminine.” This conclusion receives further support in a rather surprising way. “Turner girls,” who have no gonada! hormones whatsoever, turn out to be even more “feminine” than normal controls. The authors’ overall conclusion is that “a feminine gender identity can differentiate very effectively without any help from prenatal gonadal hormones that might influence the brain and perhaps, in fact, all the more effectively in their absence” (p. 108).
Now what do we do with that information? Well, it might be that “femininity” does not require a hormonal assist but “masculinity” does. If this is, in fact, the argument, then it would seem all the more critical to have data from individuals with these various syndromes who were reared as males. The only clue offered in this regard is the behavior of individuals with androgen-insensitivity syndrome, that is, an inability of their bodies to absorb and use any available androgen. Reared as females, these individuals appear to develop completely stereotyped feminine interests and fantasies despite the fact that they are genetic males. This result fits in with those already mentioned. Those reared as males are more to the point for the hypothesis, however. The authors are considerably more vague about these males, but they do state that “in this case, the boy differentiates a male gender identity” (p. 113). Although there is then mention of an “impairment to his masculinity” specifically in terms of erotic arousal and functioning, this particular impairment seems predictable enough from his lack of a functional penis. Since he has differentiated a “male gender identity” one would assume that most of his “behavioral signs” are stereotypically masculine.
In a nutshell then, this is the evidence from the famous Chapter 6. It is referred to in the very next chapter as: showing “conclusively” the relationship of hormones to behavior. What is seems to show is that “femininity” occurs in the absence of any hormones, that “masculinity” may be fostered in females by the presence of androgen, but that a “male gender identity” can occur in males in the absence of androgen. It seems to me that other than showing anything conclusively the quality of evidence is so poor at this point that no conclusions are yet warranted about the relationship of androgens to sex-role behavior.
In contrast, the evidence for the effects of simple sex assignment are startling and clear. Whichever sex one is reared to believe one is, more or less stereotypic sex-role behavior will be learned and reported whenever a researcher cares to ask. Money and Ehrhardt take the respectable position that both heredity and environment are important in the development of sex-role behavior, but the impact of the book is to lend dramatic support for a cultural interpretation. Nonetheless, one should not forget that this support is not the authors’ intention, and that they do not interpret these data in this way.
One other word about the authors’ ideological orientation. The treatment of homosexuality throughout the book is conceptually muddied but clear in two respects: its male orientation and value judgment. In general they use the term “homosexual” (incorrectly) to refer only to males; the impression is that male homosexuality is a “problem” of over-riding concern. The value judgment is that homosexuality and bisexuality are “psychosexual pathology” and “psychosexual malfunction.” In addition, there are lots of poetic references to “falling in love,” as in falling in love “in agreement with” one’s gender identity, i.e., heterosexuality,’ and ominous statements about the possibilities of “rehabilitation’~ for those who don’t.
Some say this book is too technical for the average reader, a view fostered by Money himself when he came out with a popularized version, Sexual Signatures with Patricia Tucker (Little, Brown, & Co., 1975). It is true that there is a superabandance of technical terms, names for hormones and so on, and that much of the writing is pompous and antiquated using words like “erstwhile” and “potentiality” and phrases like “nosological convention.” But the intelligent reader can treat the whole thing like a game if one reads with care and keeps a few things in mind. (1) Do not be lulled into inattention by the jargon. Often the key word to understanding the point is in English. (2) Stop and ask yourself, “How do they know this? What did they measure?” (3) Then ask yourself, “Does this make any sense?” The effort is worth it because you can uncover some absolute gems of examples that are abbreviated in Sexual Signatures, and of course, you get the pictures and the ability to follow up to some extent with the references. The book is recommended (for borrowing) for those with a lot of patience, a strong stomach, and a firm commitment to the sex-role revolution.