THE CASE OF JOHN/JOAN
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Chase says she understands why the medical establishment has resisted listening to ISNA. As she once wrote: “Our position implies that they have unwittingly at best and through willful denial at worst – spent their careers inflicting a profound harm from which their patients will never fully recover.” So she does not expect doctors like Gearhart to change their views unless forced. “I think a context will open up for surgeons who keep doing this to be vulnerable to lawsuits,” Chase says. “But it’s going to take a while to create that context. Right now, we can’t sue, because it’s standard practice and parents give permission. The first thing that we want to have happen is that when they recommend this to parents, they tell them it’s experimental and there’s no evidence that it works and that there’s plenty of people who’ve had it done to them who are mad as hell.”

Other large changes will have to take place. Anne Fausto-Sterling, an embryologist at Brown University, endorses Diamond and Sigmundson’s recommendation for delaying surgery but says that the medical establishment will have to provide education and emotional support to help parents with the difficult task of raising an infant whose genitals are atypical.

“A different kind of support system has to start getting built,” Fausto-Sterling says. “At the moment there is no ongoing counseling done by people skilled in psychosexual development.” Currently, she points out, counseling is done neither by experts trained in gender issues or psychology nor by intersexual peer-support counselors – it’s handled by surgeons or endocrinologists, who conduct only cursory follow-up exams once a year. “If there was really a wholesale change in this,” she continues, “the medical profession would have to do something like what they’ve done with genetic counseling – which is to develop a specialty of people who would work with these families long-term and help them resolve both emotional and practical questions. The practical questions are very real: ‘What do I do when it comes to undressing in gym? How do I intervene with the school system?’ There are a lot of things that have to happen to make what I’m arguing or Cheryl’s arguing or Mickey’s arguing work. There’s a different infrastructure that has to get built and put into place. I think it’s the responsibility of the medical profession to do it.”

Now 76 years old and in semi-retirement, John Money has nevertheless remained a prolific and opinionated writer on the subject of sex and sexuality. His latest book, called Principles of Developmental Sexology, came out this year. Through the 1980s, his books and articles continued to appear with regularity – although his later work showed a shift from his earlier extreme position on the primacy of rearing over biology in the making of boys and girls. Indeed, in a May 1988 Psychology Today profile publicizing the publication of his book Gay, Straight and In-Between, Money characterized himself as a longtime champion of the role of biology in psychological sex differentiation. Money is quoted saying that in the 1950s, when he was publishing papers on the behavioral influence of prenatal sex hormones, “many people in various branches of the social sciences were just enraged at the idea that hormones in the bloodstream before you were born could have a sex-differentiating influence on you.” In the same article, Money reiterated his claim that male babies with undeveloped penises and fully formed testicles can, with surgery and hormone treatment, be turned into heterosexual women.

To the many news organizations that requested comment from Money about the now-infamous John/Joan case, the psychologist refused to speak, citing confidentiality laws.

But he did speak with me briefly on the phone in early November, after six months of appeals. Though he refused to discuss John Thiessen directly, Money claimed that the media’s reporting of the case has reflected a conservative bias. “It’s part of the antifeminist movement,” he said. “They say masculinity and femininity are built into the genes, so women should get back to the mattress and the kitchen.” As to his failure to report the case’s outcome, Money was unapologetic, saying that he had lost contact with the Thiessens when they did not return to Johns Hopkins and that the opportunity to conduct a follow-up had been denied to him. He stood by his original reporting of the case and dismissed my suggestion that he “misperceived” what was going on with the child. Furthermore, he implied that John’s sex change to male at age 15 may not have been entirely his own decision. “I have no idea,” Money said, “how much he was coached in what he wanted, since I haven’t seen the person.” He also hinted that the Diamond-Sigmundson paper had a hidden agenda. “There is no reason I should have been excluded from the follow-up, was there?” he asked. “Someone had a knife in my back. But it’s not uncommon in science. The minute you stick your head up above the grass, there’s a gunman ready to shoot you.” (Diamond insists that there was “nothing personal” in his decision to publish the outcome of John’s case.)

When I asked Money about Diamond’s appeal to delay surgery on intersexual babies until they are old enough to speak for themselves, Money emphatically rejected the idea. “You cannot be an it,” he declared, adding that Diamond’s recommendations would lead intersexes back to the days when they locked themselves away in shame or worked as circus freaks.

I reminded Money that his book Man Woman, Boy Girl is still in print and that it reports the John/Joan case as a success. Asked if it would not be worthwhile for him to make changes in the text for a future edition, Money said flatly, “I’ll be dead by then.”

John Thiessen’s final contact with Dr. Money was almost 20 years ago, when the famous sexologist slipped him $15 in his parents’ living room. In the intervening years, John has often imagined what he might say, or do, to the psychologist if they were ever to meet face to face. As a younger man, his fantasies, he admits, ran to violence. But no more. “What’s done,” John says, “is done.” He refuses to dwell on a past that he cannot change. In their paper, Diamond and Sigmundson describe John as a “forward-looking person.” In conversation, Diamond calls him a “true hero.” John’s life today defies the dire prognosis of the local psychiatrist who, 31 years ago, declared that John would never marry and “must live apart.” John’s second phalloplasty allows him to have intercourse with his wife, and he is a strict but loving father to their three children, ages 15, 12 and 9. He has even mustered the emotional maturity to tell his eldest child about his painful history. And he prefers to focus on the positive changes that have resulted from his speaking out in public. For despite the brave four-year efforts of Cheryl Chase, despite the 30 years that Mickey Diamond spent trying to warn the medical establishment about the dangers of the current protocols for treatment of ambiguous or injured genitals, and despite the long-term follow-up of sex-reassigned youngsters in Bill Reiner’s study, the medical establishment remained unwilling to address the issue until John went public.

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