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You Can't Teach About Intersex Through John/Joan Case

shift focus away from the science and onto people's lives

Forum: WMST-L
Date: 05/31/2005

On 5/27/05 6:39 AM, "Betsy Keller" wrote:

For a film festival on intersex, I highly recommend the one hour film "Sex Unknown" (PBS) which deals with the famous "John/Joan" case. While the child in this case was not intersexed, the doctor who supervised the case was of course the famous Dr. John Money who had pioneered intersex surgical intervention, and the film has much relevance to intersex issues.

Why recommend this program? As you mention, the program has *no* intersex people in it; just a bunch of non-intersex experts talking about intersex based on a single clinical case that is not even an intersex case. The only reason it might be appropriate for an intersex film festival would be to show how not to make a program about intersex.

To PBS's credit, "Sex Unknown" was part of its science series, and it was specifically designed to explore the science of sexual differentiation, NOT to explore the lives of intersex individuals. So there wouldn't have been any problem if they didn't promote the program as *about* intersex. Likewise, I don't have any problem with teachers using that program as a film about the science of the development of gender identity, but I think it's inappropriate to show it as an intersex film.

Also, there's a lot of confusion about what John/Joan study and its failure can tell us about the nature of gender identity or the appropriate course of treatment for intersex. For one thing, you can't use a single case as an evidence for anything, either for nature or for nurture. Also, there are other reported cases in which "normal" males lost penis due to botched circumcision and was raised as female and still to this date live as women.

This morning's (5/31/05) New York Times has an interview with William Reiner, one of the experts involved in the intersex debate. Below is excerpted from the article:

As part of a research study, I've personally seen and assessed 400 children with major anomalies of the genitals. Of those, approximately 100 might be called "intersex." Our findings have been many and complex. The most important is that about 60 percent of the genetic male children raised as female have retransitioned into males.

We also found that of this group there were some genetically male children, who despite genital anomalies were raised as males, and they continued to declare themselves as male.

This number is based on his clinical sample, which has large number of boys born with cloacal exstrophy. Like the subject of "John/Joan" case, these are children who are both genetically and hormonally male. And even among this group, only about 60% of children later transition to live as men, meaning that 40% don't. That's hardly a clear vindication for nature over nurture, though it does suggest somewhat strong biological influence.

Reiner's comment (as quoted by NYT) is misleading, however: it makes it sound as the 60% figure applies to all genetic males, but it clearly doesn't apply to girls born with androgen insensitivity syndrome, who are genetically male but hormonally unresponsive to testosterone and are born with external appearance of female. Among "genetic males" with AIS raised as girls, those transitioning to live as men are pretty rare. Reiner's number does not reflect this because there are ten times as many CE patients in his sample as there are complete AIS patients.

Emi Koyama

-- * Putting the Emi back in Feminism since 1975.