Often I have heard older students say that while they used to believe gender differences in personality and behavior were learned, and raised their children exactly alike, "he is still a 'typical' boy and she a 'typical' girl." This usually generates vigorous, affirmative nods. What, my students ask, possesses scholars to argue that gender differences are largely learned when it is obvious that they are inborn?

In fact there is evidence aplenty for the role of social context and interactions in shaping gender identities and roles, but the "ace up the sleeve" for social constructionists was a virtually perfect "experiment of nature." Identical twin boys were undergoing a routine circumcision when the penis of one was accidentally cauterized. The parents and a specialist decided on a sex reassignment. It was the ultimate test: two genetically identical children, one raised as a boy, the other as a girl. Success would confirm that gender identity and role are learned. For 13 years, the supervising specialist reported the reassignment a stunning success.

Social scientists know better than to build entire theories on a single case study, but this one was compelling. It confirmed evidence from numerous less well-controlled studies and led to the conclusion that gender identity is entirely learned. There was only one problem: The reassignment was not ultimately successful. At the age of 14, "Joan" insisted on reversing the procedure, and lives today as a man, married to a woman, father to three adopted children. What had happened?

An investigative report of the case by the BBC, and the publication of an article in the Archives of Sexual Behavior in 1982, revealed that not only had "Joan" reverted to "John" at age 14, she had never fully adopted a female gender identity and role. She spent her childhood in confusion, rebellion, and misery until the revelation of her reassignment led almost immediately to her decision to become a man.

While this news should have shaken the scientific community, there was surprisingly little response to the revelation. References to the John/Joan case were quietly dropped. Apart from the article's author, few argued that the outcome of the case suggested an interpretation opposite to the original—that gender identity is largely inborn, rather than socially constructed.

John Colapinto, a freelance writer and reporter, was fascinated by this case. He wondered why doctors had made the original decision to convert "John" into a girl; why the gender reassignment was falsely presented as successful; and why the ultimate revelation of its failure interested the popular media but not the academic community. Most of all, he wondered what the experience had been like for "John/Joan" and his family. Colapinto's dogged pursuit of answers to these questions led to the publication of As Nature Made Him. It is a story of medical hubris and academic rivalry, but most of all it is the story of a person, David Reimer—"John"—who lays bare the most intimate and personal details of his life, in the hope that what happened to him, and others like him, will never happen again.

Drawing on extensive interviews and a thorough examination of relevant research and records, Colapinto weaves together themes that lift the book from the ranks of "tell-all" exposes to offer an incisive challenge to the medical establishment. He enables us to hear David's voice, as well as the love, compassion, and anguish of his parents and the local medical professionals charged with helping David become a woman.

One omission is striking: Colapinto makes virtually no reference to David's twin brother Brian until the very last chapter. Readers will also get the impression that David and his family were isolated, despite the steady stream of doctors involved in the case. In part this isolation was a real consequence of the Reimers' struggles with David and the need to keep his sex reassignment a secret. Still, Colapinto does not address the roles that family, community, and faith might have played in supporting this troubled family.

Colapinto's portrait of the medical establishment's part in this case is compelling, although framed in such stark contrasts that he seems to caricature the two main players. They are Milton Diamond, a reproductive biologist, painted as the very model of the earnest, calm, rational scientist whose observations are unfettered by personal agendas, ambitions, or biases; and John Money, a psychologist at the prestigious Johns Hopkins University and one of most influential North American theorists on the origins and development of gender and sexuality, who is painted as the very model of scientific hubris: arrogant, dogmatic, sexually deviant, abusive, hostile—and unwilling to let the facts get in the way of his theories.

On first impression the book sends a strong biologically deterministic message about masculinity and femininity. David's brother Brian says: "She walked like a guy. Sat with her legs apart. She talked about guy things, didn't give a crap about cleaning house, getting married, wearing makeup. We both wanted to play with guys, build forts and have snowball fights and play army." She was the dominant twin, who fought with her fists, and usually won. She disliked wearing dresses and stood up to urinate. Readers get the impression that such things as posture, preferred activities, and dress are prenatally determined as either male or female.

But Colapinto is far too good an investigative reporter to leave things there. A careful reading of the subtext of the book yields quite a different message. For example, we will never know the extent to which David's rearing as male for nearly two years (his transformation didn't occur until age 22 months), and the experience of being forced into stereotypically female behavior, influenced his sexual identity.

Colapinto also tells the story, albeit too briefly, of the intersexed—that is, people with biological characteristics of both sexes. Once surgeons have determined whether they can more successfully create "normal" male or female genitals, intersexed infants are forced into the corresponding gender identity and role, and are not usually told the reason for their treatments until adolescence. This strategy is based on the assumption that ambiguous genitals always lead to unhealthy psychosexual development (e.g., David could not be a boy without a penis), and that gender identity is fully modifiable during early childhood. Colapinto points out correctly that there is virtually no re search to support these assumptions. What little is available suggests the opposite: that while living with ambiguous genitalia is challenging, intersexed persons can and do develop into well-adjusted adults capable of having intimate, committed sexual relationships without treatment, and further, that the state of the genitals does not accurately predict a person's gender identity and sexuality.

Indeed, the most important implication of David's story, which does not emerge as clearly as it might, is that we simply don't know very much about the origins of gender identity. Social scientists like myself are reminded that the complexities of gender and sexuality cannot be untangled in any particular direction through a single case. The medical professionals who have the authority to pronounce on gender and sexuality should learn from this tale that it is best to refrain from irreversible surgical interventions until the affected children are old enough to make in formed decisions. And all of us need to overcome our discomfort with "ambiguous" genitals and become willing to talk openly about intersexuality so that those who experience these conditions are not isolated or shamed, and will not have to go through David Reimer's hell. As Nature Made Him is a challenge for all, and a gift for many whose journey will be eased because David was willing to let his story be told.

Heather Looy is assistant professor of psychology at The King's University College, Edmonton, Alberta, Canada.

Copyright © 2000 by the author or Christianity Today/Books & Culture Magazine.
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