A CRITICAL EVALUATION OF THE ONTOLOGY OF HUMAN SEXUAL BEHAVIOR
Milton Diamond
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Department of Anatomy, University of Louisville School of Medicine, Louisvile
Currently at:
University of Hawai`i at Manoa John A. Burns School of Medicine Department of Anatomy & Reproductive Biology Pacific Center for Sex and Society
Honolulu, Hawai`i 96822
<diamond@hawaii.edu>
Phone: (808) 956-7400
Fax: (808) 956-9481
Published in The Quarterly Review of Biology Volume 40, No. 2, June 1965
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ABSTRACT
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The
classical view of human sexuality holds that man is invested with a
particular sex within which he, as an individual, develops. Recent
attempts to alter this conception and to explain psychosexual
maturation as developing from a neutral rather than a sexual base are
here reviewed and criticized.
Essentially,
a psychosexual neutrality-at-birth theory holds that male and female
patterns of sexual orientation and behavior are attributable
exclusively to learning or imprinting phenomena. This theory is derived
from clinical observations of individuals manifesting morphological
sexual incongruities (hermaphrodites, pseudohermaphrodites, etc.).
This
article defends the view of inherent somatic sexuality organizing man's
psychosexual development by: (a) reviewing man's place on the
evolutionary continuum, and the broad base of sexual behavior within
which this discussion must be considered; (b) presenting normative,
clinical and anthropological evidence inferring a particular sexual
predilection at birth; (c) showing genetic, hormonal. and neural
indications for sexual predisposition; (d) refuting the extent of
imprinting involved in humans; and (e) showing the futility of
separating "nurture" from "nature" in reference to the role of learning
and acquisition of a gender role.
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INTRODUCTION
A
review of the many areas pertinent to the field of sexual behavior over
the last decade reveals the development and elaboration of various
psychosexual medical aspects. This in itself is not surprising in view
of the greater all-round interest in the psychological field coupled
with the increased publicity given to studies bearing on sexual
behavior. What is surprising, however, is a certain direction this
development has taken and the relative ease with which one view has
been accepted.
Starting in 1955, articles
written by John Money and Joan and John Hampson, either in
collaboration or separately, began to appear with regularity. Within
two years these investigators had produced a book and almost a dozen
papers (see list of literature). The content of their articles details
clinical examinations, descriptions, interviews, and therapy of various
individuals with sexual abnormalities. Particular attention was given
to those patients classified as sexually precocious or as
hermaphroditic.
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The
term "hermaphroditic" is broadly used here to indicate sexual deviance
from the normal condition in any two or more of the following ways: (a)
external genital morphology; (b) internal accessory reproductive
structures; (c) hormonal sex and secondary sexual characteristics; (d)
gonadal sex: and (e) chromosomal sex.
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This
work must be considered of value in giving new insight into various
clinical areas previously almost taboo, and in shedding light on some
particularly intriguing questions of human sexuality. The articles went
further, however, into theorization about the ontogeny of human sexual
behavior and its modifiability, and included a reappraisal of classical
notions of sex roles. Probably on the strength of the clinical aspects,
this revised theory seems to have gained favor and gone without serious
challenge.
Essentially the theory advocated by
Money and the Hampsons holds that gender role - all those things that a
person says or does to disclose himself or herself as having the status
of boy or man, girl or woman. respectively, and sexual orientation as a
male or female - is independent of chromosomal sex, gonadal sex,
genital morphology, hormonal balance, or other commonly used indicators
of sex (Hampton and Hampson, 1961; J. L. Hampson, 1964). In their own
words:
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. . in place of a theory of instinctive masculinity or femininity which
is innate, the evidence of hermaphroditism lends support to a
conception that psychologically, sexuality is undifferentiated at birth
and that it becomes differentiated as masculine or feminine in the
course of the various experiences of growing up (Money, Hampson, and
Hampson. 1955b).
Now it becomes necessary to
allow that erotic outlook and orientation is an autonomous psychologic
phenomenon independent of genes and hormones, and moreover, a permanent
and ineradicable one as well (Money, 1961e).
It
is more reasonable to suppose simply that, like hermaphrodites, all the
human race follow the same pattern, namely, of psychosexual
undifferentiation at birth (Money, 1963a).
Thus,
in the place of the theory of an innate, constitutional psychologic
bisexuality . . . we must substitute a concept of psychologic sexual
neutrality in humans at birth (Hampson and Hampson, 1961).
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In
brief. their theory may be called a psychosexual "neutrality-at-birth"
theory, as opposed to a "sexuality-at-birth" theory. Although other
investigators have supported and projected evidence and theory of a
similar nature, the present focus is placed on the works originating
from the authors just cited, since they, starting almost with a formal
challenge to the classical concept of human sexuality (Money Hampson,
and Hampson, 1955b), are perhaps at present most closely associated
with this approach and most prolific and influential it this area of
thought, particularly in regard to clinical considerations.
It
is my present intention to review the evidence relative to this theory.
and to suggest in contradistinction that the very same data may not be
inconsistent with more classical notions of inherent sexuality at
birth. This inherent sexuality, like other biological characters, need
not necessarily manifest itself at birth as it might be first revealed
at puberty or during adulthood. Nevertheless, inherent sexuality may,
from birth, provide a built-in "bias" with which the individual
interacts with his environment.
Generally the
concept of psychosexual neutrality at birth may be considered to draw
support from the following three broad areas: (1) clinical cases; (2)
the imprinting phenomenon; and (3) learning theory. The clinical
material will be considered first, as it has figured most prominently
in the formation and presentation of this theory. Wherever possible,
counter-evidence will be drawn primarily from human data.
CLINICAL EVIDENCE IN SUPPORT OF THE EXISTENCE OF SEXUAL NEUTRALITY AT BIRTH
The
basic arguments in favor of a psychosexual neutrality-at-birth theory
are derived from clinical investigations by Money, Hampson, and Hampson
with patients manifesting various sexual anomalies. Each patient was
rated in regard to the usual criteria of sex assignment, namely,
gonadal sex, hormonal sex, chromosomal sex, and internal and external
genitalia. In addition, these patients were rated as to the assigned
sex in which they were reared and their gender role. Each of the first
five categories was separately compared with the last two, and the last
two were compared with each other.
Gonadal Sex
Among
20 patients in whom a contradiction was found between the gonadal sex
and the sex of rearing, 17 disclosed themselves in a gender role
concordant with their rearing. The gonadal structure was an unreliable
prognosticator of such an individual's gender role (Money, Hampson, and
Hampson, 1955b).
Hormonal Sex
Of
27 patients whose hormonal functioning and secondary sexual body
morphology contradicted their sex of rearing, 4 became ambivalent with
respect to gender role as male or female, but 23 of them established
gender roles consistent with their sex of rearing despite the
embarrassment and worry occasioned by such contradictions (Money,
Hampson, and Hampson, 1955b).
Chromosomal Sex
Without
a single exception among 20 patients, it was found that the gender role
and sexual orientation were in accordance with the socially assigned
sex and rearing rather than in accord with the chromosomal sex (Hampson
and Hampson, 1961).
Internal and External Genitalia
In
22 of 25 individuals, the gender role agreed with the assigned sex and
rearing and was not in accord with the predominant male or female
internal accessory structures (Hampson and Hampson, 1961). And in cases
where the sex of rearing was contradictory to the sex of the external
genitalia, 23 of 25 individuals had been able to come to terms with
their anomalous appearance and to establish a gender role consistent
with their assigned sex and rearing (Hampson and Hampson, 1961).
Assigned Sex and Gender Role
Despite
the extent of the various sexual anomalies and incongruities involved,
only 8 of 131 comparisons (6%o) did not show concordance of assigned
sex and gender role. It seems that the best indication of psychosexual
orientation (gender role) for hermaphroditic individuals is the sex of
initial parental assignment. This would be a better index than
chromosomal sex, gonadal sex, or any other of the five standard
criteria of sex dimorphism (Hampson and Hampson, 1961).
Conclusions and Comments
The
conclusions drawn from evidence such as that cited above are perhaps
stated most succinctly by Money, Hampson, and Hampson (1955b) as
follows:
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In
the light of hermaphroditic evidence. it is no longer possible to
attribute psychologic maleness or femaleness to chromosomal, gonadal or
hormonal origins, nor to morphological sex differences of either the
internal accessory reproductive organs or the external genitalia. . .
From the sum total of hermaphroditic evidence the conclusion that
emerges is that sexual behavior and orientation as male or female does
not have an innate, instinctive basis. In place of a theory of
instinctive masculinity or femininity which is innate, the evidence of
hermaphroditism lends support to a conception that psychologically,
sexuality is undifferentiated at birth and that it becomes
differentiated as masculine or feminine in the course of the various
experiences of growing up.
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During
these experiences of growing up the normal human is assumed [from
hermaphroditic (pathological) data] to be imprinted as well as taught a
sexual role. The first 2 1/2 or 3 years of life are supposedly the
critical period for human imprinting, and cases are cited where
alteration of sex after this age is traumatic (Money, Hampson, and
Hampson, 1955a, 1956, 1957: Hampson and Hampson, 1961; Money, 1961e).
This age is correlated by Money with the development of verbalization.
He believes that the critical period for the imprinting of gender role
and orientation corresponds with a critical period for the
establishment of a native language. Another critical period for limited
modification of gender imprints is postulated to occur at puberty
(Money, 1961e). To further the idea that a psychosexual imprint is
fixed and irreversible, 5 cases of genetic females born with fused
labia and enlarged clitorides are cited. Two of these were reared as
boys and three as girls, and yet all seemed to be psychologically
content in their present sex (Hampson and Hampson, 1961).
The
extent and depth of the imprint and subsequent learning is supposedly
such that alteration after 4 years of age is fraught with psychological
danger and is usually unsuccessful (J. G. Hampson, 1955, 1964). "With
only I exception the 6 patients reassigned later than the first
birthday were rated as inadequately adjusted" (Hampson and Hampson,
1961).
Given the evidence presented, what may
we conclude? It has been shown that hermaphroditic individuals in our
society find it possible to assume sexual roles opposite to their
genetic sex, morphological sex, etc., and they can assume this role so
well that they can function socially as "normal" members of society,
engage in erotic activities. and receive pleasure in their reared
roles. To best assume this role it is most advantageous in our society
for them to start early in life. preferably before the first birthday.
Beyond these conclusions, however,much has been extrapolated. Maybe it
has been strongly demonstrated that humans, particularly hermaphroditic
ones, are flexible when it comes to the assumption of an incongruous
sex role. Yet to assume that a sex role normally is exclusively or even
mainly a very elaborate, culturally fostered deception and imprinting
phenomenon, and that it is not also reinforced by taboos and potent
defense mechanisms superimposed on a biological prepotency or prenatal
organization and potentiation seems unjustified and, from the present
data, unsubstantiated.
CONSIDERATIONS REGARDING INHERENT SEXUALITY AT BIRTH
Any
theory has to contend with various types of data. Whereas the theory of
psychosexual neutrality-at-birth is primarily derived from observations
of clinical deviations from the normal, there is not only clinical but
anthropological, and multidisciplinary experimental evidence for the
existence of psychosexual sexuality-at-birth.
Before further consideration of such data, the following two points are to be regarded as fundamental:
(1)
It should be readily obvious that man and his behavioral parameters
follow the natural scheme of evolution, although it is often difficult
to apply animal data to man. In the face of abundant evidence that
nonhuman species are behaviorally as well as morphologically fixed in a
particular sex at birth, a "neutrality-at-birth" theory would
indirectly infer that man's sexual behavior patterns are different from
those of all other vertebrates by not being instinctively mediated.
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Because
they are often confused and misused, the terms "innate" and "instinct"
are defined for use in this paper as follows: "Innate, a term applied
to differences in genetic character between two members of the same
species that have been raised in the same environment. (It is now
generally acknowledged that the term innate, a technical one in
genetics, cannot properly be applied as synonymous with unlearned or
inborn. and its use in that sense may be expected to become less
frequent- Where it has appeared in the past, innate behavior should now
be read as unlearned behavior or species-specific behavior)."
(Verplank, 1957).
"Instinct,
a hierarchically organized nervous mechanism which is susceptible to
certain priming, releasing, and directing impulses of internal as well
as external origin, and which responds to these impulses by coordinated
movements that contribute to the maintenance of the individual and
species." (Tinbergen, 1951).
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I
will hold that man in regard to his sexual behavior patterns is, like
all other vertebrates, subject to prenatally organized mediation. The
manner or extent of this mediation is not yet clear but is believed to
involve the fetal organization and potentiation of certain neural
tissues which are, within genetic limits, postnatally modifiable but
not to the extent of complete reversal or negation. This effect on the
nervous system is believed primarily to be a function of the
genetically induced endocrine environment of the presexually
differentiated individual. For man as well as most other vertebrates
this is a prenatal occurrence. Ontogenetic experiences are superimposed
on this potentiated nervous system and serve to give emphasis and
further direction to predisposed tendencies. Man is probably more
flexible in regard to this organization than any other species, but
that would not justify our saying he is free of it.
(2)
It is significant that no criteria or definition of human male or
female behavior has found universal acceptability. Humans, as well as
many other species of animal, normally exhibit elements of sexual
behavior usually attributed to members of the opposite sex. The
capability and frequency of such behavior is neither rare nor bizarre.
I will defend the point, that although humans can adjust to an
erroneously imposed gender role, (a) it does not mean that prenatal
factors are not normally influential, and (b) they do so with
difficulty if not prenatally and biologically predisposed.
Beach in a lecture given at Yale in 1948 pointed out that:
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. . laws are violated by the homosexual individual but to describe his
behavior as `unnatural' is to depart from strict accuracy. The
zoological evidence shows that female mammals frequently display
masculine coital behavior when confronted with sexually receptive
members of their own sex. This has been observed in more than a dozen
species and undoubtedly occurs in many others not yet studied. . . .
The physiological mechanisms for feminine sexual behavior are found in
all males and those for masculine behavior exist in all females. The
same stimuli that elicit feminine copulatory reactions in the female
will, under appropriate conditions, produce similar reactions in many
males; and the stimulus configuration evoking masculine responses in
males is the one which most effectively calls forth these same
responses on the part of the female. Human homosexuality reflects the essential bisexual character of our mammalian inheritance.
The extreme modifiability of man's sex life makes possible the
conversion of this essential bisexuality into a form of unisexuality
with the result that a member of the same sex eventually becomes the
only acceptable stimulus to arousal . . . .
Human sexual life is not unique in its susceptibility to modification . . . . (Beach, 1948a [emphasis added.]).
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Kinsey
and colleagues, indeed, report various varieties of heterosexual and
homosexual activities as not uncommon either for males or for females
(Kinsey, Pomeroy, and Martin, 1948; Kinsey, Pomeroy, Martin, and
Gebhard, 1953).
Thus, both normal human beings
or hermaphrodites who exhibit various so-called anomalous sexual
behavior still are performing within the biological continuum
predictable by evolution. Evolving from a highly stereotyped pattern
among primitive organisms, humans are capable of displaying highly
flexible sexual behavior patterns. An evolutionary trend starting with
inflexible stereotyped sexual behavior and progressing to flexibility
in behavior is consistent with modern genetic and evolutionary concepts
(Tax and Callender, 1960). The very considerable extent of this
flexibility, particularly in hermaphrodites, may account for the many
cases of maintained gender role which are incompatible with
morphological criteria of sex. This same flexibility may account for
the erroneous theory of psychosexual neutrality for normal individuals.
EVIDENCE IN SUPPORT OF SEXUALITY AT BIRTH
The
evidence presented in support of the concept of psychosexual
neutrality-at-birth primarily involves hermaphroditic individuals who
have successfully adapted themselves to an assigned gender role
inconsistent with one or more morphological criteria of sex. Once
reared in a malassigned sex past the age of four, these individuals are
supposedly unable to negotiate a change in their gender role without
severe emotional trauma (Hampson and Hampson, 1961). The neutrality
theory is supported by no normative data. A theory that psychosexuality
exists at birth, on the other hand, can use the same evidence and
demonstrate (a) that humans, hermaphrodites in particular, are flexible
enough to maintain an atypical gender role, either by choice or
accident, even when contradictory to their normal external genitalia;
(b) that a gender role, if malassigned may be reassigned after the age
of four without undue trauma; and (c) irrespective of the foregoing
conclusions, that normal as well as hermaphroditic individuals are
predisposed toward a particular gender role at birth.
Studies of Normal Children
Although
the literature is scanty in this regard, various studies of neonatal,
preverbal, and preschool children indicate that there are differences
which may be considered indicative of sexual differences existing from
birth and which are psychosexually predisposing to adult male or female
roles.
Terman (1946), in an extensive review
of normal psychological sex differences in children, wrote: "Sex
differences have been found for almost every physical variable,
including body build, gross and fine anatomy, physiological functioning
and biochemical composition. Indeed, every cell in a human body bears
the stamp of its sex." He then proposed that some of these differences,
such as height, weight, body build, strength, endurance, motor ability,
and rate of maturation, might be expected to reflect themselves
behaviorally. In this regard he lists the following: (a) Body Size
The mean weight of boys at birth exceeds that of girls by approximately
5 per cent and their body length is greater by 1 or 2 per cent. This
superiority continues until about the age of 11. (b) Vital Capacity.
As one of the determiners of the sustained energy output which is
possible for an individual, vital capacity may considerably influence
sex differences in play interests, and other activities. Boys show a 7
per cent superiority in vital capacity by age 6 and rapidly increase
their lead to about a 35 per cent superiority at age 20. (c) Muscular Strength.
Tests of strength in grip, back, and legs show boys to be superior at
all ages tested. At age 7 boys show about 10 per cent superiority and
this increases to a 50 to 60 per cent advantage at age 18. (d) Rate of Maturation.
It is widely recognized that girls generally exhibit more rapid
physical development than boys. In skeletal development girls are
superior to boys at birth and increase this superiority at a fairly
steady rate until growth is complete. "Girls of all races precede boys
on the average by twelve to twenty months in pubertal development, and
their adolescent growth changes are correspondingly accelerated."
These
obvious examples of constitutional differences are reflected in the
individual choice of the more muscular forms of behavior of male
children, such as running, climbing, and wrestling, compared with the
more conservative and sedentary activities of female children, such as
hopping and skipping. This was extensively reported by Lehman and
Witty, as early as 1927, in a classical study involving some 19,000
children. Walker (1962), studying the somatotypes and behavior of
preschool children 2 to 4 years old, has presented much data to
indicate that there is a good correlation between sex-related behavior
traits and body build as rated by endomorphy, mesomorphy, and
ectomorphy. He concludes that "in this group of preschool children,
important associations do exist between individuals' physiques and
particular behavior characteristics. Further, these associations show
considerable similarity to those described by Sheldon for college-aged
men, though the strength of association is not as strong as he reports.
It is suggested that the relations are multiple determined, arising
from primary body conditions (e.g., strength, energy, sensory
thresholds) . . . . In particular, variations in physical energy, in
bodily effectiveness for assertive or dominating behavior. and in
bodily sensitivity appear as important mediating links between physique
structure and general behavior."
In areas such
as conation and cognition we also note early manifest sex differences.
This is especially significant, since these categories are believed to
reflect traits less influenced by culture. There is considerable
evidence that from early childhood boys show more aggression and anger
than girls. Goodenough (1931) reported this to be manifest as early as
7 months of age. In regard to personality Walters, Pearce, and Dahms
(1957) have demonstrated that 2- to 5-year-old girls are significantly
more friendly, sympathetic, and helpful to others ("affectionate") than
are boys of the same age; while boys tend to display more actual or
threatened hostility to others ("aggressive"). Walker (1962) found
similar results for children of the same age range and in fact remarks
that the difference is as great at 2 years of age as later.
Boys
and girls are seen to show different perceptual responses to Rorschach
forms (Ames, Learned, Métraux. and Walker, 1952). They have shown, for
example, that throughout the first ten years of life boys give more
responses than do girls in every category. Girls respond differently to
color than do boys, and they respond more often to the perceived form
alone. The type of response also seems sex-dependent. At 3 1/2 years of
age boys give more responses than do girls and verbalize more. Boys see
more movement in the figures, and boys make more mention of urogenital
structures. At 7 years of age sex differences in perceptual responses
are the most marked. Girls' responses tend to be neater and more
concise. Boys' records are longer and more involved, their comments and
explanations complicated and rambling. Girls give more global
responses, boys more details and tiny details. Boys give more
aggressive responses.
Ames and Learned (1954)
showed significant sex differences in developmental trends in block
building and block construction. Like the Rorschach test, this
block-building and construction test supposedly reveals inherent
differences and forms of behavior not significantly influenced by
culture. Ames and Learned used 350 children equally divided between the
sexes at ages 2 through 6 years. Conspicuous sex differences occurred
at all ages tested For example, at 2 years "boys build in a more
complex and detailed manner than do girls." Boys show more responses
and show more compact designs. At 4 years, "The structures of girls
fall more than those of boys. Twice as many boys as girls make one
large compact structure, and many more boys than girls make scenes." At
6 years: "Nearly twice as many boys as girls build symmetrically. Many
more boys than girls build one large compact structure. Girls show more
interest in size and color. More girls than boys purposely destroy
their products."
Many more normative studies
of similar character could be presented. In effect, the conclusions and
implications of their findings are summarized by the pediatrician
Benjamin Spock. Spock (1964), in an article entitled "Are we minimizing
differences between the sexes?" lists sex differences noticeable from
birth in areas of interest, aptitude, and personality, and concludes:
"In terms of basic temperament and drive there are fairly consistent
differences between the sexes, though they may be accentuated or
obscured by upbringing." He then prescribes that for greater security
in adult roles it is better to capitalize on these differences rather
than to minimize them.
The following section presents cases where these inherent differences were frustrated by improper assignment of sex role.
Flexibility and sex reassignment
Clinical Evidence.
Dicks and Childers (1934) presented a case of a genetic male child with
hypospadias who from birth to the age of 14 was treated and dressed in
every way as a girl. As the individual developed, however, he began to
doubt his sex assignment and his interests became "as nearly those of a
healthy adolescent boy as would be possible under the circumstances."
Despite the insistence of his parents, he had no doubt as to his sex
and urgently demanded a transformation to his proper masculine role.
After a change was initiated no conflict regarding sexual matters was
apparent, and "his social adjustment was so phenomenal that at no time
was there indicated a need for intensive psychotherapy."
Armstrong
(1955) has reported a case of a male pseudohermaphrodite, a male with
undescended testes and hypospadias, who lived as a girl for 13 years.
At the age of 13 years this condition was revealed, and a plastic
repair of the genitalia was performed. The patient subsequently assumed
the male sex very successfully. In reviewing cases of this sort
Armstrong analyzed various problems inherent in this treatment but
said. "It should be our duty as medical practitioners to repair
physical abnormality and advise the patient to assume his or her true
sex."
Ghabrial and Girgis (1962) reported two
cases of males who were reared from birth as females and lived as
females until, when old enough to rebel successfully, declined to
continue their malassigned roles. The first individual changed to a
male role at the age of 14, and when seen a year later seemed cheerful,
happy, and apparently well adjusted. The second underwent this change
of role at the age of 20, despite a penile amputation at birth (it
being confused for a hypertrophied clitoris). Notwithstanding the many
years and opportunity for gender role learning, rehearsal, and
imprinting, both patients insisted on sex reassignment to agree with
the sex to which they felt they belonged.
Norris
and Keetel (1962) presented a case of a female with "a congenital
anomaly of the vagina" who shortly after birth was diagnosed as having
a bifid scrotum with infantile penis. The child was raised as a male,
with corrective surgery to be done at a later date. At puberty the
mistaken diagnosis was revealed and the patient decided, upon advice
from the physicians, to become a female. Plastic repair of the
genitalia was done at age 17. At age 20 a psychiatric examination
revealed "no apparent neurotic modes of adjustment, no distortion of
personality; she related spontaneously and with warmth . . . . a
healthy individual: no indices of a neurotic or psychotic mode of
adjustment were elicited." She was then happily married with a full and
complete sexual adjustment. In regard to general comments in the area
of role assumption, Norris (personal communication) says:
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feel, as a psychiatrist, that people are amazingly flexible in their
ability to handle roles. This is evident in many other aspects of
living. Immigrants come to a new country where they must speak a new
language and adopt a new social and vocational role, and most of them
adapt to this well. Men are taught the harm of aggression and taught
not to kill, but during wars are able to adapt to the concept of doing
so after a few months training, and furthermore, after the war is over,
most return to civilian life with relatively little difficulty, and
certainly here are role changes occurring at a very late age, which
stable people handle without too much trauma.
I don't believe that sexual role changes should be any more difficult, assuming an intact personality.
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Dewhurst
and Gordon (1963), in an extensive survey of 18 patients in whom a
correction of malassigned sex role was made after the age of 4 1/2
years, contend that 15 of the individuals involved assumed the new role
with considerable success. They correlate this with the inherent
feelings of many of the individuals concerned that they were being
reared in the wrong sex. These findings are related to the views of
Money and colleagues and are considered as non-supporting and
contradictory. Dewhurst and Gordon (1963) write:
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. . several parents, including one couple who had badly wanted a child
of the sex in which theirs was being reared, believed that they had
observed behaviour more appropriate to the opposite sex. Arguably, if
uncertainty had not been expressed, these views might not have been
held, but we are inclined to reject this, preferring to believe that
the child's natural tendency to the gonadal sex will sometimes militate
against the sex of rearing and may even overcome it.
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The
following two clinical reports may be considered as crucial for the
theories involved. The first case involves a rare patient who, as an unambiguous
male was raised from birth as a female (Dr. Robert Stoller, personal
communication). If gender role is independent of constitutional factors
and is dependent only on sex of rearing and learning, this individual
should have developed psychosexually into a female. Not only was this
not seen, but in this normal individual rearing seemed to have very
little effect. Stoller writes: "Despite attempts by the parents to make
this child a girl, almost from birth on the child refused to be
comfortable in the assigned sex or sex of rearing, continuously
fighting all attempts from her feminine mother to be a feminine
daughter. At the age of 14 we found her to be a genetically and
endocrinologically normal male. The patient shifted overnight to a
completely normal boy -a most remarkable and successful change." The
second report involves an individual who was raised as a girl and
"appeared to be a girt insofar as social status and outward sex status
was concerned" (Brown and Fryer, 1957). Despite a female sex assignment
without ambivalence and the body habitus to match, the patients "normal
feelings and reactions" in themselves were strong enough to prompt a
medical consultation concerning the true sexual identity (Brown and
Fryer, 1957, 1964). Clinical examination confirmed the suspicion of
mistaken identity and "the patient immediately recast his life," and
received corrective surgery. A follow-up study after 10 years showed
the patient happily married and a proud father (Brown and Fryer, 1964).
More
cases could be cited. In effect they serve to demonstrate that inherent
male or female sexual orientation, feelings, and disposition may
develop despite body habitus, sex of assignment, or rearing. They also
indicate that if an incorrect assignment is made, a change in role may
be possible without pertinent psychological trauma.
It
may be noted that most of the cases involved individuals at puberty.
This is a time when inherent diasthetic sexuality, now spurred by
maturation, would indeed be expected to manifest itself most strongly
even if contrary to a malassigned role. This is what might be predicted
from a theory of inherent sexuality, yet could not be predicted from a
theory of sexual neutrality. It might be asked from what do these
doubts stem, since the family and society are reacting to the
individual as a member of the assigned sex and it is within that
capacity that reinforcement is found and outside of that capacity where
difficulty would be encountered.
To
explain these nontraumatic sex corrections on the basis of a theory of
inherent psychosexual predisposition is no problem. The individual is
settling into a role for which he or she is more suited
constitutionally, and may even feel relief in the new role. On the
other hand, to explain not only the origin of doubt as to proper sex
assignment but the ease of sex correction on the basis of a theory of
psychosexual neutrality would necessitate postulating for the initial
gender assignment incomplete imprinting or misprinting, faulty
learning, other hypothetical conditions, or a combination of these,
none of which can be adequately substantiated. This is especially clear
in the cases presented, since it would be difficult to imagine the
subsequent imprinting or learning necessary for the new sex role to be
more effective than that for the initial sex role.
It
would be theoretically more parsimonious to accept the view that
inherent in each individual is a diasthetic predisposition to a
particular gender role spectrum. If placed in a situation outside of
this particular spectrum, the individual finds difficulty in adjustment.
Anthropological Considerations.
Among societies in which mores permit such changes, an individual may
voluntarily assume a gender role inconsistent with the one in which he
has been reared and an individual may alter his gender role well after
the so-called "critical period;" all in keeping with accepted modes of
their respective societies and thus presumably maintaining
psychological normalcy. Cultures also exist in which, even though
gender roles are not strictly assigned, the development of sexual behavior follows a normal nonambivalent course.
These
societies may thus provide evidence as to the relative roles of
heredity and environment in sex role status. In societies of the first
type the sex of rearing may exert little evident effect upon the
individual's adult choice of sex role, and in societies of the second
type proper sexual orientation occurs despite the lack of strict role
assignment. These situations would seem to indicate an inherent
predisposition that functions despite the presence or absence of strong
environmental ontogenetic influences.
Some of
the American Indians provide an example of a society where sex role
changes are permitted despite strong orientation during rearing (Mead,
1961). Mead says that in tribes where a berdache [transvestite male] was recognized as a possible sex career, "male children were watched and tested
from an early age - were they going to be 'braves' or 'live like
women'? Once the choice was made, elaborate prescriptions of correct
social behavior were available" (emphasis added). The two points to be
made here are the following: (1) that the determiners of the gender
role to be assigned were not based on morphological sex but on innate
and on instinctive self-elaborated behavioral manifestations
of the individual; and (2) that, without trauma to the individual, this
role can be assigned and accepted by society postpubertally.
Mead
(1961) gives an illustrative example: "At the time when his bodily
candidacy was remarked there was no living berdache in the tribe, but
the women began watching this boy, and once undressed him to see if he,
whose behavior appeared to them as feminine, 'really was a male.'
Having satisfied themselves as to his external sex morphology, they then pronounced him to be a berdache. He wore male exterior clothing but female underwear, was unmarried . . ." (emphasis original). Thus the berdache
is a recognized recurrent sex role that seems to arise independently in
an individual who possesses unambiguous male genitalia and is raised in
all ways as a male. These individuals, despite their rearing, begin to
manifest feminine behavior patterns and are assigned to a sex role in
accordance with this inconsistency.
Corroborating
the assertion that gender role assignment may be based on an
individual's behavior rather than be a determiner of it are the various
criteria that have been established among some ethnic groups to aid in
determining just such an assignment. Bravery is the determining
masculinizing point among Plains Indians (males being considered and
treated as females unless brave) (Mead, 1961), and preference for
womanly occupations is the female criterion for males among Samoans
(males being considered and treated as females if they prefer womanly
occupations) (Mead, 1928).
Other
anthropological evidence can illustrate the development of male and
female sexual patterns in spite of the lack of specificity in rearing.
Data are available for communities where there is no sex gender in the
language and the names of males and females are undifferentiated and
for communities where juveniles of both sexes dress alike (Mead, 1961).
Societies exist where boys are classified with women until initiation
(Iatmul) and where girls are classed with men until betrothal (Manus)
(Mead, 1961). Here it would seem that the critical period would be
passed without opportunity for gender role imprinting and learning! To
think or to expect that these individuals would exhibit no adult sexual
behavioral distinctions or that they would remain in a sort of sexual
limbo is not in keeping with the facts. It no doubt would aid in the
sexual orientation of individuals within these cultures if their
society had strict gender taboos and restrictions. But in their
absence, constitutional factors as well as obvious physical
characteristics are sustaining.
Notably, what
evolves from anthropological studies is scattered but abundant evidence
that there occur individuals with the behavior patterns of the opposite
sex, in the absence of any patterned cultural recognition of such a
possibility. This conclusion strongly suggests the presence of some
rare but recurring constitutional factor which is less overt than
congenital genital anomalies. It seems safe to assume that any
behavior, sexual or not, which can be institutionalized in a culture
and regarded as a recurrent possible human choice has some hereditary,
i.e., genetic, basis (Fletcher, 1957: Mead. 1961).
Fletcher
(1957), in defending the role of sexual instincts in man, also calls
upon cross-cultural data. In concluding this portion of his discussion
he criticizes the attempt to explain all human behavior in terms of
learning cultural direction and values. His argument is noteworthy:
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Two
points which have a bearing on the present question might be mentioned.
Firstly, it seems probable that the tendency to describe individual
personalities in terms of broad cultural uniformities, has gone too
far, and it may be that the whole question of the degree to which
individual persons are 'conditioned' by their 'culture' has been too
readily assumed, rather than demonstrated. The second point is that the
emphasis on the varieties of behaviour in different human societies may
well have tended to obscure the similarities; similarities not only of
'instinct-experience' (congenital impulses), but even of elements of
behaviour. Thus, let us consider behaviour involved in walking, eating,
drinking, defecation, sleeping and waking, sexual intercourse, the care
of young infants, fear and the avoidance of danger. It would seem that,
no matter how varied are the more complicated methods of food-seeking,
sanitation, provision for rest and sleeping, the regulation of the
relations between the sexes, the bringing up of children, the social
methods for avoiding danger, and so on, it remains true nonetheless,
that there are certain basic features of behaviour which are congenital
in man and which are necessarily involved in the satisfaction of the
congenital cravings, some of which persist throughout his life.
Margaret Mead describes for us three varieties of sexual behaviour in
three societies, but, we suggest, this merely indicates that the
cultural setting exercises its influence upon the behaviour adopted in
order to satisfy the instinctual demand which is inherited: and the
contributors to the theory of instincts would have no quarrel with
this. But if the persisting sexual impulse was not inherited, and if
this impulse did not drive men and women to definite fundamental forms
of behaviour for its gratification, no 'social conditioning' would ever
take place. There would be nothing to 'condition.' No rules regulating
sexual relations would be necessary. There would be nothing to
regulate. If the Cultural Anthropologists [or any other group] are
going to make us doubt the existence of the sexual instinct in man (and
the same applies to the other instincts) they must show us not how
variously men and women satisfy this instinct in different societies,
but a society in which-as an outcome of the determining influence of
the social environment - there is no evidence of the sexual impulse, or
of the basic forms of sexual behaviour, at all. We can predict that
such a society is going to be very hard to find.
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Predisposition of Gender Orientation
Genetic Considerations.
Primary in any discussion of predisposition towards or away from a
particular pattern of sexual behavior would be consideration of the
possible genetics involved. That animals are subject to inherited
tendencies in relation to their sex roles cannot be disputed. Young
(1957) has reviewed many of the nonclinical studies and presents
evidence not only showing innate manifestations of sexual behavior
patterns but describing how different animal strains can react
differently to the environment. Many recent studies corroborate these
findings (Goy and Jakway, 1959; Jakway, 1959: McGill, 1962a, b; McGill
and Blight, 1963a, b). In regard to man, however, our knowledge is a
little more obscure. Kinsey, Pomeroy, and Martin (1948) state this
theme thus: "The most important biologic factors affecting the nature
and frequency of sexual response in the human animal are the hereditary
forces which account for the differences between male and female.
Within either of these sexes, heredity must also account for some of
the variation in sensory structures and in the mechanisms which are
concerned with emotional response." However, no other area in the study
of human sexuality seems beset with as many difficulties as a study of
inherited sexuality. Not only would a proper investigation involve a
broad longitudinal survey over many years but it would have to cover
succeeding generations. Nevertheless some data are available.
Kallmann's
work (1952a. b) and that of Schlegel (1962) are probably the most
conclusive. Kallmann studied 40 monozygotic and 45 dizygotic twin pairs
in which one of the cotwins was a known overt homosexual. He found 100
per cent of the monozygotic twins concordant for homosexuality; whereas
the dizygotic cotwins were essentially similar to the general male
population. Strikingly, the monozygotic twins were even comparable in
the mode and extent of their deviance and type of displayed behavior,
and although they had developed their gender roles independently when
separated from each other. Kallmann considers this evidence, and I
would agree, to throw "considerable doubt upon the validity of purely
psychodynamic theories of predominantly or exclusively homosexual
behavior patterns in adulthood and correspondingly strengthens the
hypothesis of a genically determined disarrangement in the balance
between male and female maturational (hormonal) tendencies" (Kallmann,
1952a).
Schlegel (1962) reviewed reports on
113 twin couples and found 95 per cent concordant homosexuality in the
monozygotic twins and only 5 per cent concordance among the dizygotic
twins. His evidence is in excellent agreement with Kallmann's data.
Hutchinson
(1959), in a broad theoretical discussion on the origins of paraphilia,
has reemphasized Kallmann's work and viewed it, along with animal and
other human studies, as leaving little theoretical doubt as to the
existence of a genetic influence on sexual orientations. He suggests
that gene-specific components may affect ". . . the rates of
development of neuropsychological mechanisms involved in identification
processes . . . ." Recently Melicow and Uson (1964), in an excellent
review of human sex anomalies, have postulated that there may exist
gene(s) in the sex chromosomes responsible for "identification and feel
of maleness or femaleness." If the normal attachment of this gene is
broken from the Y chromosome in males or the Y chromosome(s) in
females, it may become transposed to another chromosome predisposing to
abnormal sex role orientation.
In a most
recent work Kallmann (1963) reviews much of the more recent genetic
data and still maintains that genetics are crucially involved in
psychosexual development, the mechanism, however, still to be
determined.
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Gedda
(1963) has reevaluated Kallman's data statistically and claims to have
computed that they show a minimum genetic contribution of 30 per cent
in the etiology of homosexuality.
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Hampson
and Hampson (1961) and J. L. Hampson (1964) have considered Kallmann's
work, but regard his evidence as being outweighed by two types of
studies. The first of these is exemplified by the work of Pare (1956).
who, using the Barr technique for sex chromatin analysis, investigated
male homosexuals for presence of the female chromatin body in the cell
nucleus. Pare found no difference between the sex chromatin of the
homosexuals and control males. This is a weak counter argument to the
genetic one, since a negative finding of this sort is not necessarily
evidence against the importance of genetic differences. With present
techniques, chromosomal studies can do little more than indicate the
presence of an extra sex chromosome or deficiency of an entire sex
chromosome, or a gross translocation. They cannot reveal a single
deviant gene or even several. The second type of study is more weighty,
and consists of psychiatric and psychological reports which claim
psychosexual disorders to be the result of social learning. These are
exemplified by the reports of a multitude of workers who describe
family situations and experiences which supposedly provide a basis for
homosexuality. Green and Money (1961a, b) also attribute sexual
deviation to certain kinds of experiences. In discussing the possible
etiology of effeminacy in 5 prepubertal boys they cursorily review and
dismiss the possible influence of a genetic involvement and prefer
instead to consider only improper imprint experiences at an early age,
despite the fact that common imprint experiences could not be proved.
Gildea and Robins (1963) commented on the comparative findings of
Kallmann and of Money in the following terms:
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His
[Kallmann's] findings of perfect concordance for homosexuality in
identical twins would indicate that homosexuality is in some way
genetically determined and that the process of rearing cannot override
the genetic constitution. Kallmann's findings do not fit very well with
Money's emphasis on the crucial importance of rearing in determining
sexual direction.
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Dobzhansky
(1962) too comments on social experience, genetics, and human
sexuality, thus: "Let us suppose that all persons who exhibit deviant
sexual behavior as adults are found to have had certain kinds of
experience in their childhood, particularly in their relation to their
parents. But does it follow that such experiences induce sexual
deviations in everybody who had them in his biography? Or does this
happen only to the carriers of certain genetic endowments, which are
apparently not rare in human populations?" Undoubtedly we are dealing
with an interaction of genetics and experience; the relative
contribution of each, however, may vary with the particular behavior
pattern and individual concerned. Effeminacy and other sexual
deviations are not altogether rare in our society. Without contending
that inheritance is the whole cause, we may well consider it
influential and predisposing. A quotation from Mead is again
applicable: "It seems safe to assume that any behavior which can be
institutionalized in a culture and regarded as a recurrent possible
human choice has some hereditary base" (Mead, 1961). This hereditary
base is what, especially for other animals, is usually termed an innate
and instinctual framework within which the individual develops, meets,
and contends with his environment.
Most
individuals, falling within the range of normal sexual behavior for our
society, may be considered as following a path of genetic least
resistance - that of their "innate instincts." In analyzing human
behavior, trying to separate genetics and experience may be like trying
to separate hydrogen and oxygen in their importance with respect to the
properties of water. Those misassigned individuals who go against the
predisposition inherent in their genetic make-up overcome it only to
the extent their genetic flexibility will allow.
Schultz
(1963), in reviewing psychosexual problems associated with
intersexuality and transvestism, stated in regard to the origin of
psychosexual orientation that:
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The
ultimate basis of hereditary endowment is influenced peristatically
from the earliest time onward by the action of hormones which again are
perhaps accessible not only to broadly somatic but even
neuropsychiatric influences. Thus the love-life is fitted biologically
to the dynamic totality of the constitutional make-up, and this
unitaryformation corresponds in psychic range to the not less dynamic
personality development. Even this rests on primary assumptions of a
genotypic and certainly mainly primitive kind, of which the
development, now thoroughly analogous to the development of
constitution, is determined by an immense number of conditions.
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In
the development of any behavior pattern we must consider not only the
stimuli serving to mold the pattern but the nature of the receptive
medium which is to be molded. Many humans, sibs in particular, can be
subjected to extremely diverse experiences and still develop similar
personalities; conversely, humans may be subjected to like experiences
and develop quite differently. The individual's constitutional capacity
to respond to these environmental stimuli exerts its influence, too. It
is the genetic heritage of an individual which predisposes him to react
in a particular manner so that the learning of a gender role can occur.
Even if one thinks in terms of imprinting and innate releasing
mechanisms (IRM) (Money, Hampson, and Hampson, 1957; Money, 1960a),
these concepts must be recognized as implying that the individual
possesses a genetic heritage. The IRM does not appear de novo but is
species-specific and, as its name says, innate.
Hormonal Organization of Sexual Behavior.
To support the theory of psychosexual neutrality at birth we have been
presented with no instance of a normal individual appearing as an
unequivocal male and being reared successfully as a .female, or vice
versa. Wherever the etiology of the hermaphroditism was determined the
particular patients had been subjected, during their prenatal or
neonatal existence, to a genetic or hormonal imbalance, or both
(Hampson and Hampson, 1961). This imbalance may provide the requisite
basis for what seems to be psychosexual neutrality. Schultz considers
that in normal individuals there are in the two sexes differential
psychosexual tendencies which determine the degree of male or female
characteristics each individual will manifest. Hermaphrodites, however,
he considers to possess an "undifferentiated constitution;" since they
display a sexual erotic state low in vigor, and occasionally bordering
on the eunuchoid, yet with nothing specific in incidence or character
(Schultz, 1963). Benjamin (1964) reports that for transsexual
individuals, "A certain significance endocrinologically may be attached
to the fact that in 28 out of these 91 patients, a more or less
distinct immaturity and hypogonadism to the point of eunuchoidism was
found."
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["Transsexualism
-a striking disturbance of gender role and gender orientation. It is a
disorder of the harmony and uniformity of the psychosexual personality"
(Benjamin, 1964).]
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It
has long been recognized that various hormones are potent regulators of
human behavior. Earlier cultures had a knowledge of the effects of
castration, and much recent evidence is available to confirm the role
that androgens serve in sexual drive and activity in men.
Occasional
studies to the contrary, the bulk of evidence indicates that testicular
androgens activate libido, and that castration or other androgen loss
due to some pathological condition reduces libido. Reviews (Lipschütz,
1924; Tauber, 1940; Beach, 1948a, b; Kinsey, Pomeroy, and Martin, 1948)
and more recent case studies (Brewer, 1959) can readily document this
conclusion. Brewer (1959), in evaluating the effect of castration in
157 cases, says:
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. . . in all cases without exception the amount of sexual activity has been altered.
It has been reduced or abolished, irrespective of the direction or the
form of sexual urge-heterosexuality, homosexuality, fetichism,
zoophilic actions, masturbation, exhibitionism, or fetichistic actions
. . . [emphasis original.
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Females
too are influenced by their endocrines. The early work of Foss (1937),
Shore, Papanicolaou, and Stimmel (1938), Loeser (1940), Geist (1941),
Salmon and Grist (1943), Kupperman and Studdiford (1953), and the
recent work from the Sloan-Kettering Institute is probably quite
definitive in this respect (Waxenberg, Drellich, and Sutherland, 1959;
Schon and Sutherland, 1960; Sopchak and Sutherland, 1960; Waxenberg,
Finkbeiner, Drellich, and Sutherland, 1960: Waxenberg, 1963). These
studies show the significant role androgens usually play in contrast to
the "female" hormones, the estrogens and progesterone, in maintaining
and stimulating erotic inclination, sexual desire, and behavior in
females. In males the origin of the androgen is primarily from the
testes, in the female from the adrenal and the ovary itself.
The
androgenic influences are acknowledged by Money (1961a). However, he
sees them as supporting the neutrality theory, essentially on the
following line of reasoning. Sexual desire and erotic functioning of
both men and women are dependent upon a similar group of substances
-androgens. Since men react to androgens with male sexual behavior and
females react to androgens with female sexual behavior, the hormones
are nondirectional, only activational, and the direction comes from
another source. "The direction or content of erotic inclination in the
human species is not controlled by the sex hormones. Hormonally
speaking, the sex drive is neither male nor female but undifferentiated
- an urge for the warmth and sensation of close body contact and
genital proximity" (Money, 1961a). The direction taken by the drive is
assumed to be learned or imprinted purely from the sex of rearing.
Hampson and Hampson (1961) have stated that among patients whose sex
hormones and secondary sexual body development contradicted the sex of
rearing only 16 per cent were unable to adjust unambivalently
to the assigned sexual role. Thus they reason that sex hormones do not
act as causal agents in the establishment of an individual's gender
role and psychosexual orientation.
Perloff
(1949, 1963), Kinsey and his associates (1948, 1953), and others also
suggest that in the adult human individual endocrines are not the sole instigator or sole
director (or both) of sexual behavior. Indeed, this position is not
under contention. But to say that something is not the cause or sole
director of a particular effect does not mean that it has little or no
influence. Admittedly, hormones are probably not the single causal
agent that induces gender role orientation, but their influence is
undeniable and strong. Money (1961e) has said, "The sex hormones, it
appears, have no direct effect on the direction or content of erotic
inclination in the human species. These are assumed to be
experientially determined." But the importance of the hormones in this
regard was implicitly admitted, since hormonal therapy was recommended
for correction of psychosexual and physical doubt (Hampson and Hampson,
1961). George W. Corner in his classic book The Hormones in Human Reproduction (1942) has said:
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Human
[sexual] behavior involves all sorts of mental processes not subject to
experimental control. We may be sure, however, that the hormones have
an important part in the matter, directly or indirectly, and that
without them there could be no human mating.
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These
hormones, however, can affect behavior only to an extent that is
inherent and previously organized within the soma. Boss (1943), in
considering the activating properties of hormones in regard to a
somatic base of sexual behavior, stressed that genetic factors are
strongly involved, not only in determining the specific pattern of the
taxonomic unit, but also of the sex. She considered this to be
demonstrated by the widely if not generally valid rule that the same
amounts of hormone do not produce identical reactions in the two sexes
of a given species. Young (1961) has expressed a similar idea as
follows: "We feel that the responses that the members of different
sexes give to hormonal stimulation are predetermined; in this sense a
specific rather than a non-specific relationship exists." Harris (1964)
most recently presented the idea in this manner: "This (sex specific
differential behavior response to hormones) reflects, in all
probability, some anatomical or biochemical difference in the central
nervous system of the two sexes."
A most
critical point to be elaborated here is that although endocrines may be
primarily activational in the adult, in the fetus or neonate they must
be considered directional. Phoenix, Goy, Gerall, and Young (1959) have
clearly demonstrated that female guinea pigs are behaviorally as well
as somatically masculinized by an androgen, testosterone propionate,
prenatally injected into the mother. Postnatal behavior, more than the
genitalia, was shown to be liable to alteration by the androgen, as
even somatically unaffected females were behaviorally masculinized.
Genetic females, if potentiated by androgens, manifested a suppression
of the capacity to display lordosis following estrogen and progesterone
treatment, and male-like mounting behavior was displayed by many of
these animals even when lordosis could not be elicited (Phoenix, Goy,
Gerall, and Young, 1959). Similar studies with the rhesus monkey
afforded comparable results. that is, prenatally administered androgens
will alter the normal female behavior patterns and genital structures
to those of the male (Young, Goy, and Phoenix, 1964). These data may be
taken as evidence of the organizing ability of prenatally acting
androgens on the neural tissues mediating sexual behavior. Human
females, in utero, also have been shown to be structurally modified by
androgens (Wilkins, Jones, Holman, and Stempfel, 1958; Grumbach,
Ducharme, and Moloshok, 1959; Grumbach and Ducharme, 1960; Diamond and
Young, 1963). Although it has yet to be adequately demonstrated that
these embryonic individuals were behaviorally affected, the possibility
is within reason and not without zoological precedent. A possible
mechanism for genes and hormones to interact and provide direction has
recently been suggested. In contrast to the well-known evidences that
genes can control hormonal activities, Karlson (1963) proposes and
cites experimental evidence to show that steroid hormones are capable
of altering and controlling gene activity. If such an alteration were
to occur in cells within the (behavior mediating) nervous system we
might expect an influence on subsequent behavior, certainly if the
change were to occur during a critical prenatal period. Just as the
presence of androgen has been demonstrated to be crucial, the prenatal
absence of androgens is also crucial for the organization of mammalian
tissues.
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Although
it has not yet been definitely shown that the morphogenic substance
elaborated from the fetal testis is an androgen similar in character to
adult testoids, most inferential evidence points in this direction
(Bums, 1961).
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Jost
(1958) and Burns (1961), in excellent reviews, have cited the
experimental evidence indicating that sexual differentiation of the
normal male and female is dependent upon the presence of testicular
substances. If testicular substances are present the differentiation is
masculine; if absent, the differentiation is feminine. Males castrated
prior to sexual differentiation develop structurally as females; in
them there is an absence of external male genitalia and maintenance of
derivatives of the Müllerian duct, e.g., the fallopian tubes, uterus,
etc. Comparable human evidence is available from different types of
hermaphroditic individuals; those with gonadal (testicular) aplasia
(Grumbach, Van Wyk, and Wilkins, 1955; Grumbach and Barr, 1958; Jones
and Scott, 1958: Wilkins, 1960; Overzier, 1963; Armstrong, 1964) and
testicular feminization (Morris, 1953; Grumbach and Barr, 1958; Jones
and Scott. 1958; Marshall and Harder, 1958: Barrio, 1962: Kendall and
Loewenberg, 1962; Morris and Mahesh, 1963: Overzier, 1963; Armstrong,
1964) in particular. These genetic males are phenotypically female.
Hampson. Hampson, and Money (1955) have claimed that since these
individuals who possess a male chromatin pattern, can assume a gender
role as normal females it means that the gender role is assumed
independently of the genetic sex. It must be recognized that these
genetic anomalies deprive the developing fetus of proper gonadal
substances which in the human species, as demonstrably in other
animals, may potentiate and organize the nervous system for masculine
behavior. The deprivation of typical hormones or the presence of
heterotypical ones may simultaneously potentiate and organize the
nervous system for female behavior.
Most
significant are the findings which bridge the hormonal induction
phenomenon discussed above and the resulting demonstrable sex-specific
differences in the nervous system, in the hypothalamus in particular.
Harris and Jacobsohn (1950, 1951), Martinez and Bittner (1956), Harris
(1964), and Gorski and Wagner (1965) have shown that early in
development the hypothalamus is differentiated into a male or female
type. Their studies emphasize this in regard to the
hypothalamo-hypophyseal axis in particular. Pituitaries transplanted
beneath the hypothalamus from males or females into hypophysectomized
castrated males will not cycle, whereas hypophysectomized females
bearing either male or female pituitary grafts show complete and normal
estrus cycles.
Later Barraclough (1961),
Barraclough and Gorski (1961, 1962), Harris and Levine (1962), Whalen
and Nadler (1963), and Gorski and Barraclough (1963) demonstrated how
this sexual differentiation of the hypothalamus may be achieved
relatively simply with a single injection of steroid in a neonatal
animal whose nervous system is still undifferentiated sexually. These
experiments reflect on the organization of neural tissues implied in
the work of Phoenix, Goy, Gerall, and Young (1959) and most probably
occur in nature by means of the induction of gonadal substances.
The
implications are clear. The well-known and documented instances of
hormonal regulation of sexual behavior below the human level are seen
to be brought under neural mediation. With a broader outlook we see
that genetic forces induce gonadal development, and gonadal development
is normally followed by the elaboration of fetal or neonate gonadal
substances responsible for the sexual differentiation of the nervous
system. The neuroendocrine relations of the hypothalamus are the most
obvious entities affected but it may be surmised that other, purely
neural, aspects are also differentiated or potentiated at this time.
Since
most sexual anomalies are under genic control (Grumbach and Barr, 1958;
Jones and Scott, 1958; Overzier, 1963; Armstrong, 1964; Beatty, 1964;
Brunner-Lorand, 1964) it may be inferred that it is via such indirect
and subtle means, as through hormonal action, that genes may be
expected to influence organization of the nervous system and to mold
sexual behavior. Thus rearing and assignment based on phenotype are not
all that is involved in analyzing the etiology of sexual behavior in
hermaphrodites. Those individuals with a male chromatin pattern who
successfully assume a female gender role do so with the absence of
crucial (hormonal) potentiating factors that may, in a normal male,
establish a male constitution and a predisposition for the assumption
of a male gender role.
In the only behavioral
studies of their kind to date, Grady and Phoenix (1963), and Feder and
Whalen (1965), working with William C. Young, have completed studies
which show that male sexual behavior is influenced by the loss of the
neonatal gonad. They castrated male rats prior to sexual
differentiation and observed that when reaching the normal age of
maturity these rats fail to show masculine behavior and can readily be
induced to show female behavior. Phoenix, Goy, Gerall, and Young (1959)
aptly summarize these sorts of data:
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For
the neural tissues mediating behavior, corresponding relationships [to
the development of the genital tracts] seem to exist. The embryonic and
fetal periods are periods of organization or "differentiation" in the
direction of masculinization or feminization. Adulthood, when gonadal
hormones are being secreted, is a period of activation; neural tissues
are the target organs and mating behavior is brought to expression.
Like the genital tracts, the neural tissues mediating mating behavior
respond to androgens or to estrogens depending on the sex of the
individual, but again the specificity is not complete (Antliff and
Young, 1956; Young, 1961).
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They go on to discuss the question of inherent neural bisexuality as follows:
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Like
Dantchakoff (1938a, b, c), Raynaud (1938), and many others (Beach,
1945a; Steinach, 1913, 1916; Lipschütz, 1924; Beach, 1942, 1945b), the
existence of a bisexuality is assumed. We suggest, however, that in the
adult this bisexuality is unequal in the neural tissues as it is in the
case of the genital tissues. The capacity exists for giving behavioral
responses of the opposite sex, but it is variable and, to most mammals
that have been studied and in many lower vertebrates as well, it is
elicited only with difficulty (Young, 1961).
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Therefore,
when we consider prenatal as well as postnatal existence, hormones may
be regarded as directional as well as activational; and at birth the
individual may be considered to have been neurally predisposed by
genetic and hormonal means toward one sex. Since this predisposition is
demonstrated so vividly in animals, including anthropoids, we may
logically assume that it persists in the human after birth, although
manifestations of it may be suppressed or modified. In a recent review
article Young, Goy, and Phoenix (1964) expressed such confidence about
this point that in relation to the theory of Hampson and Money they
stated: "In view of what we have learned an endocrinological basis
which is consistent with the concept of psychologic bisexuality exists
for the interpretation of most if not all of the cases they report."
The Nervous System.
In discussing behavior, we find it inevitable to consider in some
detail its medium - the nervous system. The point at issue here is
whether the nervous system is just a neutral responsive system
intermediate between stimulus and response, or is a system with a
built-in diasthetic bias. This consideration is crucial, since it is on
the nervous system that potentiation and organization must exert their
influence and it is on the nervous system that learning (to be
discussed below) exerts its effect.
Previously,
genetic and hormonal factors were seen to be capable of organizing the
nervous system to direct future sexual behavior. More direct,
immediate, and independent influences of the nervous system may be
understood from clinical studies and from experiments investigating
behavior by means of ablation, lesion placement, direct stimulation,
direct application of hormones, electrical self-stimulation, or
electrical recording. These various methods reveal different functional
levels of activity and the sites of so-called "sex-centers" - loci for
the integration of the component activities of a particular sex
behavior pattern. Significantly, these studies often reveal inherent
differences of the nervous system dependent upon gender. Were a
"neutral" nervous system to exist, identical effects would be expected
from individuals of both sexes.
The majority
of direct studies do not set out primarily to investigate response
differences between the sexes. These differences are in fact taken for
granted, and sex-specific response patterns such as lordosis and estrus
behavior are used as dependent variables. The functional role of a
specific locus or structure is thus usually analyzed only in relation
to the anticipated patterns applicable to the sex of the animal
investigated. But although male-female comparisons are not usually
made, direct studies are of value in illustrating that loci within the
nervous system possess inherent properties related to sexual
disposition, behavior, and manifestations of gender role.
The
most significant differentiation of the hypothalamus has been mentioned
above in discussing the role of the endocrines in sexual
differentiation. The hypothalamus has for quite some time been
implicated both indirectly and directly in influencing sexual behavior
patterns. Its indirect functioning via the hypophysis has been
discussed by Harris (1955, 1956, 1960, 1964), Green (1956), Greer
(1957), Sawyer (1960, 1962), Szentágothai, Flerkó Mess, and Halász
(1962), Nalbandov (1963), Everett (1964), and others. The significance
of this functional pattern was discussed in an earlier section (p.
161). Direct functioning without hypophyseal involvement has been
suggested by the experiments of Brookhart and Dey (1941), Clegg,
Santolucito. Smith, and Ganong (1958), Sawyer and Robison (1956),
Robison and Sawyer (1957), Soulairac (1959), Soulairac and Soulairac
(1956), Phoenix (1961), and Goy and Phoenix (1963).
These
studies inferring direct hypothalamic involvement indicate a
sex-specific functioning of certain loci. Crucial for our argument are
instances where similar loci were investigated in both males and
females. For example, Goy and Phoenix (1963) have demonstrated that
midventral hypothalamic lesions in female guinea pigs result in an
alteration of the normal sexual behavior ranging from a complete loss
of the capacity to display estrus to permanent estrus, depending upon
the precise locus of the lesion. In male guinea pigs (Phoenix, 1961)
similar lesions also produced behavioral alterations. The type of
alteration is significant. Lordosis was lost in the female, and
mounting was lost in the male.
Many reviews
(Beach, 1951; Goldstein, 1957; Sawyer, 1960, 19112) detail the relative
dependence of the male and independence of the female on the cortical
mass in relation to the competent expression of sexual behavior.
Complete removal of the cortex will not prevent mating responses in the
female rat, cat, rabbit, or guinea pig, whereas destruction or removal
of 75 per cent of the male cortex completely abolishes the male mating
pattern. In female rats which spontaneously exhibit male-like mounting,
decortication stops this behavior whereas the usual female behavior
components are unimpaired (Beach, 1943). While it may be argued that
most of the data are from nonhumans, Ford and Beach (1951) have
suggested that the human male and female are also differentially
dependent upon cortical mass relative to their expression of sexuality.
These, then, are indices of sexually differentiated nervous tissues.
The
classical work of Klüver and Bucy in 1939 and by Klüver (1952)
afterwards showed that sexually mature male macaques respond to
bilateral removal of the temporal lobe by hypersexual activity:
heterosexual, homosexual, and autosexual in direction. The female does
not show this. Significantly, however, Klüver (1952) remarked, ". . .
an intensification of sexual responses may occur even in a
pseudohermaphrodite or in a female from which the uterus and both
ovaries have been removed prior to extirpating the temporal lobes."
Later in his review Klüver (1952) added, "There is no doubt that age,
sex, species and many other factors influence the picture of behavior
alterations produced by a bilateral temporal lobectomy." Schreiner and
Kling (1955, 1954, 1956) and Green, Clemente, and De Groot (1957) have
similarly demonstrated that lesions in the piriform cortex of the male
cat induced hypersexual changes, whereas hypersexuality was not usually
observed in female cats with similar lesions. Analogous functioning of
the human cerebrum may be inferred from clinical reports of the
Klüver-Bucy syndrome (Sawa, Ueki, Arita, and Harada, 1954; Terzian and
Dalle Ore, 1955) and other disorders of the temporal lobe (Epstein,
1960, 1961). Interestingly, these reports show sexual deviation
manifested only in men.
Lansdell has reported
a sex difference in verbal ability (1961) and in design preference
(1962), which reacts differentially to temporal lobe surgery. After
surgery to the dominant lobe, women maintain their previous "artistic
judgment" while men lose theirs- "The effects of the operations suggest
that some physiological mechanisms underlying artistic judgment and
verbal ability may overlap in the female brain, but are in opposite
hemispheres in the male" (Lansdell, 1962).
On
a more subtle level, perceptual differences between males and females
can be considered. In children, the work mentioned earlier with
Rorschach tests (Ames, Learned, Métraux, and Walker, 1952) and block
building (Ames and Learned, 1954) is suggestive of the presence within
the nervous system of perceptual and cognitive processes which are
early manifested sex differences. On a purely neurophysiological basis
Lipsitt and Levy (1959) have shown that as early as the first three
days of life females show a lower threshold to electric shock
stimulation than do males.
Adult women usually
have greater olfactory acuity than men (Schneider and Wolf. 1955) and
this has been seen to vary with hormone levels (Schneider, Costiloe,
Howard, and Wolf, 1958). Kinsey et al. (1953) reported that males, more
often than females, are erotically oriented to visual cues. Females may
be more susceptible to tactile stimuli. Sexual distinctions such as
these cannot help but influence various aspects of an individual's
life, including the way he or she views and reacts to the world, and
hence gender role.
It may be argued, as Money (1963x) does, thatdifferences such as perceptual responses are results
of learning rather than inherent in the nervous system and causal.
However, Money presents no model to explain how or why perceptual
thresholds to stimuli which are obscure and novel, such as those used
by Lansdell, may be differentially altered and learned, particularly
where the patient is unaware of a desirable direction for the change.
Because of the nature of the tests and the early ages at which they
were administered, it would also be difficult to explain how the
Rorschach and block-building tests were biased by learning.
It
may be concluded that the nervous systems of males and females are
differentially reactive to the environment. And there is good reason to
believe that these differences, so definite in humans as well as in
other animals, are present and influential at birth and afterwards.
Imprinting. Hampson and Hampson (1961) contend that:
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The
premise that behavior is based primarily on instincts is gradually
disappearing from scientific writing and the traditional concept of
instinct is undergoing revision and modification. In its place has
emerged the view that early experience importantly structures
subsequent behavior. This is not to say, lest misunderstanding arise,
that the animal organism - human or subhuman - is merely a blank slate
to be written upon by the capricious finger of life experiences. Quite
the contrary, for there are now many studies in the literature dealing
with genetic constitution and the inheritance of basic capacities
affecting later learning, temperament and personality.
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This
theme is developed so that the constitutional factors are considered
insignificant when compared with ontogenetic factors. Difficulty in
incongruous sex orientation or modification of sex is thought of in
ontogenetic terms of crucial timing and imprinting.
To
support their view, Beach and Jaynes (1954) were cited by Hampson and
Hampson (1961) to show how early experiences may modify behavior.
Emphasis was placed on the last of three possibilities given
by Beach and Jaynes, namely, that which postulated a "critical period"
in ontogeny during which certain types of behavior are irrevocably
structured for the remainder of the organism's life. However, once
stated, the possibility was accepted as an established fact. Hampson
and Hampson allow, it is true, for species variation, but now consider
this variation to be minor.
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Neither
the Hampsons nor Money give criteria to indicate when they think
species differences (between humans and other animals) are negligible.
They are grossly inconsistent in this respect. In relation to basic
sexual tendencies, the human is assumed to be quite distant even from
other mammals. But in relation to imprinting, seen definitely only in
birds, men and birds are assumed to be quite close.
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Hampson
and Hampson have not recognized that Beach and Jaynes mentioned, in the
same paragraph, when referring to critical periods and imprinting in
humans and birds: "It is tempting to suggest the existence of
similarities in underlying mechanisms, but this would be unwarranted on
the basis of present knowledge" (Beach and Jaynes, 1954). Schiller
(1957) in Instinctive Behavior, isolated imprinting as predominantly avian and contrary to mammalian behavior. Fletcher (1957), in his book Instinct In Man,
although discussing human sexuality at length, did not even consider
the possibility that imprinting might be involved in the behavior of
humans. Nevertheless, the "psychosexual neutrality-at-birth theory"
assumes the human species, in regard to the establishment of gender
role, to be analogously imprinted (Money, Hampson, and Hampson, 1957;
Money, 1960a, 1961b, d; Hampson and Hampson, 1961). Money has even gone
so far as to say, "It is quite likely that aberrations of sexual
inclination and behavior, the so-called perversions, are errors of
imprinting;" and that "the phenomenon of falling in love can be
analyzed as an imprinting phenomenon" (Money, 1960a).
Since
no experimental studies on the imprinting of human sexuality per se are
available, animal experiments may provide further insight into such a
possibility. Young (1961), in reviewing isolation experiments with the
guinea pig, stated, "The data as a whole indicate that the emergence of
sexual behavior patterns in the male guinea pig is not restricted to an
early critical period comparable with that described in the literature
dealing with imprinting (Lorenz, 1937)." Rats, too, have been shown to
be relatively free from the need of sexual imprinting (Beach, 1958),
and so have mice (King, 1957). Since lower mammalian species are free
of an imprinting requirement for competent sexual behavior, it seems
that it would be difficult to defend the proposition that humans, a
behaviorally more flexible species, are subject to such an imprinting
stereotype.
Admittedly, although many species
and individual variations exist (Scott, 1962), "critical periods" do
exist for mammals in regard to reproductive phenomena. But while
reproduction may be affected, assumption of a sexual role may not be. A
normal rhesus monkey raised in isolation may not react sexually
sufficiently to mate, but a male still follows male behavior patterns
(albeit deviantly); and a female, female patterns. Harlow (1961) has
mentioned that many types of sexually dimorphic behavior patterns such
as play, aggression, and receptivity, which are as much a part of the
proper gender role as coitus, arise spontaneously in isolated male and
female monkeys. He said, "It is unreasonable to account for these sex
differences as learned, culturally ordered patterns of behavior because
there is no opportunity for acquiring a cultural heritage, let alone a
sexually differentiated one, from an inanimate cloth surrogate"
(Harlow, 1961). This conclusion is in contradistinction to the response
of the female rhesus which, as mentioned earlier, when potentiated by
prenatal androgen injections, behaves not as a deviant female but as a
male. There seems to be little doubt that normal humans would manifest
sexually dimorphic behavior patterns even if raised in isolation.
It
is interesting here to consider the following point. If imprinting were
involved to any great extent and the gender role independent of a more
significant sexual instinct, then a neutrality theory would have to
contend with the fact that for the first three years of life babies are
almost exclusively with their mothers (or some other female), and yet
male children are usually not imprinted as females. This fact
must be considered in the light of the observations that imprinting, as
we see it in birds, occurs within the brief space of a few hours and
irrespective of sex. Nothing really comparable to imprinting has been
demonstrated to occur in human sexuality.
Learning and Reinforcement
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The
concept of reinforcement is important and basic to any learning theory.
A reinforcement is any change in the organism or in the environment
which has the ability to increase the probability of occurrence of some
particular behavior performed just prior to the presentation of the
reinforcement (Thorndike, 1913: Hull, 1952). Thus, orgasm may be
reinforcing to an animal and increase the probability of some action
required to obtain the orgasm.
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Much
of the psychosexual "neutrality at birth" theory depends upon the great
part that learning plays in the instillation of masculine and feminine
gender roles (Hampson and Hampson, 1961: Money, 1960x, 1961e). Sears,
Maccoby, and Levin (1957), Rabban (1950), and others are cited by
Hampson and Hampson (1961) as indicating that culture and learning
shape subsequent behavior. Ehrmann (1963) has recently provided an
excellent review of various studies investigating the social
determinants of human sexual behavior. These studies indeed indicate
that gender personality is influenced by society and thus, in part, is
learned. But Ehrmann wisely started his review by emphasizing that in
looking for the social determinants of sexual behavior one must take
into account biological considerations and not simply learning
processes. Benjamin (1964) in a very recent study of transsexual
individuals could find no evidence that childhood conditioning is
involved in the etiology of the transsexualism in 47 out of 87
patients. Of the remaining 40 patients conditioning was of "doubtful"
influence in 24 individuals and definitely influential in only 16 cases.
As
a function of learning, assumption of a gender role presumably should
follow the characteristics of a normal learning curve. But, when viewed
properly, modifiability of sex behavior by learning must be seen also
as a disproof of the imprinting theory, for the same modifications of
behavior cannot be caused both by learning and by imprinting in the
same species. The basic incompatibilities are that learning requires
reinforcement while imprinting does not, and that imprinting is fixed
and irreversible while learning is not. But even to grant that
assumption of a gender role by an individual in our society may be
molded by learning in no way proves that it is the sole or dominant
determiner of the gender role. Money, Hampson, and Hampson would have
us believe so. Hampson and Hampson (1961) contend:
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In
the human psychological sexuality is not differentiated when the child
is born. Rather, psychological sex becomes differentiated during the
course of the many experiences of growing up, including those
experiences dictated by his or her own bodily equipment. Thus, in the
place of the theory of an innate, constitutional psychological
bisexuality such as that proposed by Freud-a concept already questioned
on theoretical grounds by Rado (1940), among others - we must
substitute a concept of psychologic sexual neutrality in humans at
birth. Such psychosexual neutrality permits the development and
perpetuation of divers patterns of psychosexual orientation and
functioning in accordance with the life experiences each individual,
may encounter and transact.
Rado (1940) indeed
questions the concept of bisexuality, but nowhere does he assume
neutrality at birth. Instead, he claims that there is at birth a
differentiated unisexuality. He states, "Under normal developmental
conditions, as differentiation proceeds and one type of reproductive
action system grows to completion, the original bipotentiality ceases
to have any real significance .... The standard developmental pattern
of our species provides for each individual only one reproductive
action system. The two inherent potentialities of the zygote are
thereby mutually exclusive."
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It
is not obvious, when we examine the best possible evidence, how the
criteria of learning can be logically applied to the hermaphroditic
evidence. Yet to do just that is the core of their philosophy, which
asserts that if gender roles are modified by learning or are
established by imprinting, then sexual behavior patterns are not
prenatally mediated. Here is a subtle non sequitur. All evinced
learning, be it operant or classical, is by definition a modification
of behavior (Verplanck, 1957). The evidence presented in this paper
indicates that the learning of a gender role is a culturally fostered
ontogenetic phenomenon of development superimposed on a prenatally
determined pattern and mechanism of sexual behavior. As Tinbergen
(1951) has stated. "There is a close relationship between innate
equipment and learning processes, in that learning is often
predetermined by the innate constitution. Many animals inherit
predispositions to learn special things, and these dispositions to
learn therefore belong to the innate equipment." This predisposition
may be considered also in terms of differential endocrine sensitivity.
The nervous systems of males and females subjected to genetic and
hormonal factors may present an altered learning capability that sets
limits to or extends the range of sexual behavior possible to the
individual. Hutchinson (1959) has proposed that the individual's
genetic endowment operates to mold behavior by affecting "the rates and
extent of development of the neuropsychological mechanisms underlying
the identification process and other aspects of object relationships in
infancy." An extensive search of the literature reveals no case where a
male or female without some sort of biological abnormality, e.g.
chromosomal, hormonal, or gonadal, accepted an imposed gender role
opposite to that of his or her phenotype. If such an individual is
available he has not been referred to by proponents of a "neutrality at
birth" theory. It may be assumed that such an individual will be hard
to find, since this anomalous behavior would be outside normal limits.
Human
hermaphrodites, it would seem reasonable to assume, are somehow altered
in their neurophysiological capacity towards or away from certain
features of sexual behavior. But since their behavior still falls
within the broad scope of normal behavior their actions usually go
unchallenged. It might also be pertinent here to state that, in humans,
behavior can be affected and that for females passivity may serve as
"normal" sexual behavior and thus seriously hamper any rating system of
"femaleness." An individual's personal conviction as to his or her sex,
even if bolstered by suitable genitalia, may lack the essential
reinforcing properties of orgasm. For females this normally does not
seem to be crucial (Wallin and Clark, 1963), but for males orgasm may
be a necessary reinforcement of the sex role (Ford and Beach, 1951).
This greater dependence of males upon orgasm as reinforcement may be
significant in a more general way, in that males are more capable of
sexual learning and conditioning, whereas females seem to show a
relative absence of such processes (Ford and Beach, 1951).
Parenthetically, we may mention the existence, of differences in
genital response, only recently investigated. These could hardly have
been learned. Masters and Johnson (1968) have shown that practically
all stages of the orgasmic process differ between males and females.
Clitoral erection is comparatively slow during initial excitement; then
the clitoris retracts and essentially maintains a "buried" position
until the orgasmic phase has passed. Only after the cessation of
vaginal orgasmic contractions does the clitoris reappear (Masters and
Johnson, 1963). So although we may speak of the penis and clitoris as
homologous structures, their functioning is not parallel.
In
truth, instinct is modified by learning as much as learning is modified
by instinct (Tinbergen, 1951; Verplanck, 1955; Deese, 1958). The
evidence may well indicate that while among all species sex roles and
the learning of them are prenatally organized, such roles, particularly
among humans, may be greatly modified though never fully negated. It is
natural to conclude that both biological and cultural factors interact
and meld to determine masculine and feminine gender roles (Dengrove,
1961). To say that learning predominates in sex role assumption, when
based upon evidence from hermaphrodites, is unwarranted. All this
evidence may show is that hermaphrodites are quite flexible in their
assumption of a gender role. The surprise or abnormality would be if
humans, whom we consider to be among the highest evolved forms of life,
could not greatly modify instinctive behavior. To jump the gap by
extending the breadth of this modifiability and to say that because of
it man is completely divested of his evolutionary heritage to
instinctive mediation is specious.
Tinbergen
(1951), in discussing the instincts and causation underlying human
behavior, said, "Mating behavior in man, not in the form of the
accomplishment of the consummatory act, but in the preparatory,
appetitive stage of 'lovemaking' proves, when studied ethologically, to
be basically dependent on sex hormones and on external stimuli and it
is on these agents that our rational powers exact a regulating
influence." Beach (1949) has offered a basis from which human sexual
behavior may be studied when he said, "To interpret the sexual behavior
of men and women in any society it is necessary first to recognize the
nature of any fundamental mammalian pattern and then to
discover the ways in which some of its parts have been suppressed or
modified as a result of social pressures brought to bear upon the
individual" (emphasis added).
The proper
interpretation of human sexual behavior must not stumble on a debate of
nature versus nurture. Undoubtedly both are significantly involved!
SUMMARY
The
evidence and arguments presented show that, primarily owing to prenatal
genic and hormonal influences, human beings are definitely predisposed
at birth to a male or female gender orientation. Sexual behavior of an
individual, and thus gender role, are not neutral and without initial
direction at birth. Nevertheless sexual predisposition is only a
potentiality setting limits to a pattern that is greatly modifiable by
ontogenetic experiences. Life experiences most likely act to
differentiate and direct a flexible sexual disposition and to mold the
prenatal organization until an environmentally (socially and
culturally) acceptable gender role is formulated and established.
It
is also indicated, on the one hand, that the argument in favor of an
imprinting type of assumption of gender role is spurious for the human
being and that, on the other hand, learning theory cannot account for
all observed sexual behavior. That imprinting does not account for
assumption of the gender role is shown by the failure of the phenomena
to meet the criteria for imprinting and by the inability of an
imprinting theory to handle various facets of human behavior. That
learning cannot account for all sexual behavior was shown by reviewing
the original evidence, and by presenting clinical, comparative
cultural, and animal studies.
Instead, human sexual behavior is seen to be a composite result of
prenatal and postnatal factors. The evidence derived from human
hermaphroditism, instead of constituting a separate group of data from
which a state of psychosexual neutrality at birth is to be inferred,
can perfectly well fit into the classical and phylogenetically
consistent theory of sexual predisposition at birth. This conclusion is
best seen not when the evidence is atomized, and gender role is
compared with each atom of influence, but when all the evidence is
considered in toto. Considering normal psychosexual development, the
two theories may be represented as in Fig. 1. In Fig. 1, A. a
psychosexually neutral origin provides a narrow basis from which all
the manifestations of sexuality are supposedly developed. In
comparison, Fig. 1, B depicts the comparatively broad basis of a
sexually predisposed individual. The former theory postulates specific
imprints or learning experiences which would enlarge and direct sexual
development. The latter need only postulate cultural restrictions and
learning to narrow and concentrate sexual direction and orientation. As
the figure indicates, there are various "critical stages" which affect
the range of subsequent sexual capability. A theory of psychosexual
neutrality sees these stages as levels which remove the individual
further from the neutral midline. A theory of psychosexual
predisposition views these stages as imposing limits and restrictions
in the form of culturally and biologically acceptable sexual outlets
within the total capability. To cross from the male to the female
"path" in Fig. 1, A would mean to overcome a relatively broad gap
(indications of an irreversible change): for malassigned individuals to
cross over in Fig. 1, B would require only transcending a culturally
imposed barrier to arrive on a different biologically "predisposed"
path. All in all, the second model (B) seems best suited to the
available anthropological and clinical data, which predicate the
initial existence of a bisexuality that is subsequently narrowed.
[Chall (1963) presents a scheme of levels which is an attempt to depict
graphically the determinants of human sexual behavior.]
CONCLUSION
The
theory of inherent sexual predisposition and of a somatic basis for the
patterning of sexual behavior is not original with me. Aside from
mythological and religious beliefs of a similar nature, this hypothesis
was advanced scientifically almost fifty years ago by Goodale (1918).
It was scientifically revived by Ball (1937) and by Young, Dempsey,
Myers, and Hagquist (1938) over twenty-five years ago. Recently Young
(1961) has reviewed much of these data, but he did not consider the
human species. Essentially, I have added an accumulation of evidence
bringing the human species into line with others in respect to the
existence of a somatic basis for sexuality.
The
clinical aspects of the work on which their theory is based, and the
case management and therapy recommended by Hampson, Hampson, and Money,
as well as by Wilkins (1964) and others, may, in the main, be
applicable to our society and appropriate. This aspect of their work
was not under discussion. However, doubt as to the validity of their
theory may reasonably raise some question as to its proper extension to
practice. H. F. Bettinger considers that a hermaphrodite should be
given treatment, medical and sociological, in accordance with the sex
of personal preference, and irrespective of the sex of rearing. He
stated (Bettinger, 1950):
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In
practice this formula has been usually applied to those patients who
were brought up as girls but developed distinct male feelings during
adolescence. They have been advised to change their legal sex and to
undergo surgical operations aimed at approximating as closely as
possible their anatomical structures to the male pattern. On the whole,
their management has been quite successful, mainly for the reason that
it was held that their 'true sex' was male, and that therefore,
everything done for them to make them more like ordinary males was
right and proper and deserved every encouragement.
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Other
clinicians have expressed similar convictions (Armstrong, 1955: Norris
and Keetel, 1962; Dewhurst and Gordon, 1963: Berg, Nixon, and MacMahon,
1963). Benjamin (1964) advises similarly for the treatment of
transsexuals. Brown and Fryer (1957), clinicians at the Washington
University School of Medicine, claim never to have seen a single male
patient who did not eagerly anticipate and undergo the change from
sexual malassignment to the correct status regardless of the degree of
distress over the original error. Kraft and Bedford (1963) have even
set forth a methodology for facilitating sex reassignment when
describing the change of a five-year-old "boy" to a girl without
psychopathological sequelae. Thus, from a practical standpoint alone,
the theory and practice advocated by the Hampsons and by Money may be
questioned. In a most recent and excellent review on the psychiatric
aspects of intersexuality, Roth and Ball (1964) have stated:
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The
anatomic equipment will limit or dictate what [treatment] can be
undertaken but the patients social circumstances, sexual identification
and personal wishes have to be allowed to decide the issue in the
majority of cases as far as this is practicable.
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A competent and extensive clinical reappraisal is perhaps warranted.
It
is time, not as Hampson and Hampson (1961) have said, "to assume sexual
neutrality and [that] the theory of bisexuality must be laid to rest
when one considers the evidence;" but rather to admit that in
sexuality, as in so many other areas, the human being is extremely
flexible and his behavior is a composite of prenatal and postnatal
influences with the postnatal factors superimposed on a definite
inherent sexuality. With this approach we can advance toward an
analysis of the mechanism of this composite formation and begin to
analyze further the interplay of phylogeny and ontogeny in human sexual
behavior.
ACKNOWLEDGMENTS
I
am indebted to Dr. Robert W. Goy who originally suggested the writing
of this paper, and to Drs. William C. Young, Charles H. Phoenix, and
Arnold A. Gerall for enlightening discussion of the theories and
problems involved in a presentation of this type. Naturally, they are
in no way responsible for any shortcomings herein.
This
study was supported in part by the Committee for Research in Problems
of Sex, National Academy of Sciences-National Research Council. and in
part by Public Health Service Research Grant GM 10632 of the National
Institutes of Health, Public Health Service.
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