CHILD AND ADOLESCENT PSYCHIATRIC CLINICS
Child Adolesc Psychiatric Clin N Am OF NORTH AMERICA
13 (2004) xv—xvii
Preface
Sex and Gender
Milton
Diamond, Ph.D., and Alayne Yates, M.D.
Guest Editors
A decade is a
long time for any publication to remain current. It is not a long time,
however, for one to remain of value. The last issue of the Child and
Adolescent Psychiatric Clinics of North America devoted to sex and gender
is a long-lasting and valued monograph. The publisher, however, asked if we
would assemble an issue that was more current in the material covered and more
extensive in range. We warmed to the task when almost everyone we asked to
participate in this project immediately agreed, reinforcing the belief that it
would be a worthy effort.
The gist of some of the articles remains the same-other topics are newly
presented. In any case, the style of discourse is now somewhat different. This
follows from our belief that each contributor brings to his or her article not
only years of experience with the topic but some unique insights as well. As
Guest Editors, we saw our goal as threefold: (I) choose the best authorities
possible; (2) allow these experts freedom to select their material for
presentation and express their ideas as to how these findings might best be
used clinically; and (3) encourage independent views and perspectives with a
view of the future. This approach has both an up side and a down side. The
advantages are that the reader is offered the latest compilation of findings
and thinkings in different areas. In this regard, we are free of the usual
peer-review journal limitations that eschew speculation and opinion. The
disadvantages are that some of the thinking might be controversial or
premature. We leave judgment as to the merit of this decision to each reader
and the future.
Considering the vast breadth of sexology, while
reviewing many of the articles in draft form we as editors found ourselves
trying to clarify and unify some of the terminology used by the authors. The
common word sex, for instance, was particularly at issue. In some cases
it meant intercourse, in other cases it meant one’s biology and genetics, but
at other times it might mean anything and thus would be left to the reader’s
imagination. It was not only President Clinton who did not see oral—genital
relations as “sex.” A recent survey showed that approximately 50% of teenagers
also do not see it as “having sex.” (One teenage girl was quoted as saying that
it’s like kissing.) Some authors referred to “sexual experience.” It wasn’t
clear if that meant coitus, homosexual mutual masturbation, petting, all of the
above, and so on. Another area of confusion was with the term identity. Consider
these uses: sexual identity means how one sees oneself as male or female; how
one sees oneself as heterosexual, homosexual, or bisexual; how one sees oneself
as an erotically active human being; and soon. And gender is seen as a
word that can refer equally to sex, a social construction of value in
separating biology from sociology, or of use only in discussing language. We
have done our best to standardize terminology, but the reader should maintain a
watchful eye to potentially different interpretations and usage of common
words.
The issue begins with an article by historian Vern Bullough on how
children and adolescents have been seen as sexual over time. With all the
attention focused on children’s innocence in contemporary times, it is
difficult to imagine prepubertal individuals as just small adults with accompanying
responsibilities and license. In the article that follows, anthropologist Jose
Nieto discusses how differently children and sex were and are seen when looked
at from a cross- cultural perspective. Particularly of interest is the
perspective that the so-called “universal incest” taboo, is in actuality, a
limited finding.
The three articles that follow set a framework of more or less typical
development in American society. Alayne Yates concentrates on children and
tries to show how emerging biologic concepts can modify our views of erotic
development; Lynn Ponton and Samuel Judice focus on children’s overall
transition through the turbulent years of puberty and adolescence. They
distinguish risk from danger—a valuable concept for therapists to
keep in mind. Michael Potegal and John Archer offer a cogent perspective on how
anger and aggression—from toddler stage on up—are managed and seen as
harbingers of the future. They show that anger and aggression do not always go
together, destroying another popular myth.
The next three articles cover subjects that are commonly brought to
psychiatric attention. Ritch Savin-Williams and Kenneth Cohen cover homoerotic
development, Kenneth Zucker deals with gender identity disorders in children
(transsexual ideation), and Charles Moser, Peggy Kleinplatz, Dino Zuccarini,
and William Reiner discuss their ideas on unusual and controversial (paraphilic
and nonparaphilic) behaviors. Here again we are presented with variations on a
theme and are given new ways to think about and organize older ideas. It is
good to keep in mind that one of the features that both Darwin and Kinsey
emphasized is the great variation seen in life and that differences are normal
and to be expected.
Intersex and
related issues are covered in the next five articles. Although problems in
these areas are not discussed as often as those covered in the preceding seven
articles, these variations, when they do occur, pose extremely challenging
problems. Up-to-date information on the management of these conditions is
offered here. This section begins with a discussion of how the topics and
terminology surrounding sex and gender have changed over the years and how the
intersex phenomenon has supercharged thinking in medicine, psychology,
sociology, and even politics. If marriage is only to be for a man and a woman,
what of those who, from birth and not by choice, are both or not clearly one or
the other?
Vivian Sobel and Julianne Imperato-McGinley discuss the intersexual
phenomenon of gender identity in those with XY cell lines. An article by Milton
Diamond continues the theme and adds a discussion of Klinefelter’s syndrome.
Melissa Hines broadens the scope by presenting female pseudohermaphroditism
among children and adolescents. William Reiner brings us up-to-date on the area
of cloacal exstrophy. Although not an actual intersex condition nor a common
problem for psychiatrists, understanding this condition and how children and
adolescents negotiate it is, indeed, significant in enlightening our
understanding of many issues surrounding sex and gender.
Last, and certainly not least, we have two articles that are crucial in
dealing with health care decisions related to children and adolescents. Hazel
Beh and James Pietsch discuss relevant legal matters, and Kenneth Kipnis
addresses ethical issues confronting psychiatrists in dealing with minors.
These articles bring to the fore contemporary matters with perennial problems
and offer guidelines with how to deal with them. They retum us continually to
focus on what is best for the child or adolescent.
All in all, we hope we have provided an issue that will endure in
influence and value as its predecessor has.
Milton Diamond,
PhD
Alayne Yates, MD
John A. Burns School of Medicine
Department of Anatomy and Reproductive Biology
University of Hawaii at Manoa
1960 East-West Road
Honolulu, HI 96822, USA
E-mail addresses:
diamond@hawaii.edu
(M. Diamond)
yates@dop.hawaii.edu (A. Yates)