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Journal of Sex & Marital Therapy

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Gender: History, Theory and Usage of the Term in Sexology and Its Relationship to Nature/Nurture
John Money PhD
a a

Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, The Johns Hopkins University and Hospital, Baltimore, MD, 21205 Version of record first published: 14 Jan 2008.

To cite this article: John Money PhD (1985): Gender: History, Theory and Usage of the Term in Sexology and Its Relationship to Nature/Nurture, Journal of Sex & Marital Therapy, 11:2, 71-79 To link to this article: http://dx.doi.org/10.1080/00926238508406072

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Gender: History, Theory and Usage of the Term in Sexology and Its Relationship to Nature/Nurture
John Money, PhD
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A persons sexual status is conventionally defined on the criterion ofthe external sex organs, and this criterion is presumed to be concordant with the other criteria of sex. When the sex organs are deformed, as in hermaphroditism, or mutilated, their sex role is to some extent a f f t e d , whereas all the other manifestations of the persons masculinity or femininity may be intact. G e n d e r , not sex, is the umbrella term which refers to the totality of masculinity/femininity, genital sex included. Gender role and gender identity are two sides of the same coin, genderidentity/role (G-UR), G-I/R may differentiate to be discordant with one OT more of the basic sex variables which are now listed in the defnition of sex in Dorlands Medical Dictionary. G-I/R is the product not of either nature OT nurture acting alone, but of both in interaction at crucial periods of developmental differentiation. The new paradigm is nature/crucial-period/nurture, not nature/nurture. Social scientists and sexologists are among those who, for the most part, have not made the Paradigm shift. It is not surprising that the recently idiomatic English t e r m , gender role (first used in M o n e y , 1955), has proved difficult to translate into other languages. So also have the terms, g e n h identity andgender-identity/ole. In 1955, it had proved similarly difficult for me to transplant t h e t e r m , gender, f r o m language science to sexual science and have its new usage accepted. At first it sounded f u n n y and idiomaticall y unfamiliar. V e r y rapidly, however, it became assimilated into b o t h scientific and literary usage as a necessary supplement t o the t e r m , sex.

John Money, PhD, Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, The Johns Hopkins University and Hospital, Baltimore, MD 21205. Supported by USPHS Grant #HD00325 and Grant #830-86900, William T. Grant Foundation. Copyright, John Money, 2/15/85 Journal of Sex & Marital Therapy, Vol. 11, No. 2, Summer 1985

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SEX, SEX ORGANS, A N D GENDER

I first became aware of the terminological overload imposed on the word, sex, in my early studies of individuals born with a birth defect of the sex organs. Take, for example, the case of a child growing up as a boy with a miniscule penis, too small to urinate from while standing. H e is in a position similar to that of a boy or man whose penis has been accidentally ablated. H e may grow up to be masculine in all respects except that he cannot urinate or perform sexually as a male with his penis. Terminologically, one cannot say that his sex role is masculine because, insofar as his sex role with his sex organs is lacking or incomplete, it is not. The way out of this terminological impasse is to say that his gender role is masculine in all of its extragenital manifestations, whereas in its specifically sexual, or genital and erotic manifestations, it is imperfect. The gender role (a definition is appended) is all-encompassing, like a big umbrella that houses all its heterogeneous components, of which the genital-sexual role is only one. Other components, according to traditional conceptions, are legal, educational, vocational, recreational, sartorial and cosmetic roles, and so on, that are male/ female stereotyped.

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M AL E-FEMAL E POLARITY: HERMAPHRODITISM

Univariate, not multivariate determination of sex as either male or female has the status of an eternal verity. Man and woman created H e them, declares the book of Genesis, having first declared that God created man in His own image. Taken literally, that implies that God is a manwoman God. This ambiguity has its counterpart in pre-Biblical creation myths of an original unisex that divided into male and female. Plato tells how the two halves ever since have sought reunion. It is not so much the reunion, however, that has permeated the scientific thinking of humankind (not mankind or wom(b)ankind, but humankind!) as the absolute polarity of the division between male and female. The phenomena of manwomanism, that is, hermaphroditism, belie the univariateness of the polarity of male and female, insofar as there exists in the hermaphroditic individual an incongruent combination of both male and female variables. Lord Coke, the great British jurist of the 16th century, attempted to deal with this incongruency by decreeing that a hermaphrodite may, by the common law of England, be either male or female, and it shall succeed [i.e., inherit] according to the kind of sex which doth prevail.2 Despite its commonsense wisdom, this decree did not specify the criterion by which to judge the sex that doth prevail. Medicine and science of the time had no fixed criterion of sex. T h e association of testes with the male, and ovaries with the female had an ancient history; but there was no technique of surgical exploration for internal gonads, and no surgical anesthesia. Pregnancy was abstrusely attributed to the semen (the seed) of the male, in combination with the females menstrual blood. Spermatozoa were unknown until 1677 when Antoni van Leeuwphoek, addressing the Royal Society of London, reported having seen them under the newly invented microscope. T h e existence of the human egg was first authenticated by Carl Ernst Von Baer in 1827. By 1867, Klebs in Germany decreed the diagnostic criterion of sex in hermaphroditism, namely the histology of the gonads, that has remained in use for

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more than a ~ e n t u r y True . ~ hermaphrodites were decreed as those with ovotestes. Those with two testes, or two ovaries were decreed to be not true hermaphrodites at all, but pseudohermaphrodites, that is, primarily males or females with secondary hermaphroditic ambiguity. Thus, except for rare cases of true hermaphroditism, the criterion of the difference between male and female was reaffirmed as univariate and absolute. ClinicaIly, the spinoff from this dogma is that urologists claim male pseudohermaphrodites for enforced masculinizing surgery, and gynecologists, female hermaphrodites for feminizing surgery. In addition, psychiatrists, or at least some of them, claim homosexuals for enforced change of orientation and behavior.

MULTIVARIATE DISCORDANCE
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The Klebs nomenclature, variously qualified but still in use, is totally without prognostic value. It makes no provision for the fact that testes do not automatically predicate pubertal masculinization, and, vice versa, that ovaries do not automatically predicate pubertal feminization. Each syndrome of hermaphroditism, regardless of gonadal status, has its own developmental prognosis with respect to the variables of being male or female, masculine or feminine. The different variables may be discordant with one another, instead of concordant as they are usually expected to be in nonhermaphroditic people. In my earliest studies of hermaphroditism,* I came to the realization that there is no absolute dichotomy of male and female. A persons sex must be specified not on the basis of a single criterion, but of multiple criteria. For example, it is possible to have the genetical sex of a male (chromosome counting had not been discovered in those days, before 1959), the gonadal sex of a male; the internal morphologic sex of a male; the external genital morphologic sex of a female; the hormonal pubertal sex of a female; the assigned sex of a female; and the gender-role and identity of a female, This is what typically happens in the androgen-insensitivity syndrome - and there are many other syndromes, each with its own story. The only irreducible difference between male and female, in higher primates, is that males impregnate, whereas females menstruate, gestate and lactate - in other words, they have the babies. In some fish, even this reproductive difference is reducible, for they are able to change sex and breed as both male and female in one lifetime. I first published a tabulation of the multivariate determinants of sex in 1955.4 Very rapidly, they became idiomatic, and the conception of sex as multivariate and multivariately determined became assimilated into general medical and scientific thinking. By 1965, in the twenty-fourth edition, Dorlands Illustrated Medical Dictionary changed its definition of sex, listing and defining the multiple variables. Eventually, I devised a diagram showing not only the variables of sex, but also the chronological sequence in which they exert their influence. This diagram, updated to include H-Y antigen, appears as Figure 3-1 in Money.5 In writing about ordinary people born without a hermaphroditic or other sexual birth defect, it is feasible to assume that sex is a univariate characteristic, simply because all of the multiple variables are concordant with one another. When, however, one or more of the variables is discordant with the others, there arises

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the issue of which variables to use, and which to disregard in defining the sex of the person.

GENDER-IDENTITY/ROLE [G-I/RJ
In the theater, an actor plays a role. A good actor may even continue to play the role extramurally, while the production lasts. A gender role is not so ephemeral. It belongs to the person who inhabits it and lives in it every day, indefinitely. Thus a gender role is experienced not as a social script, dictated like the script of a play. Rather, it is experienced at first hand as ones own gender identity, and it is manifested to others in what one says and does. Ideally, it should have been possible to have the unity of the private experience and the public manifestation of ones gender role guaranteed within the single term, gender role. In the 1950s, the social and behavioral sciences were not geared toward such a principle of unity, and so the two terms, gender role, and gendm identity became part of common usage.j Inevitably, the existence of the two terms led to their false reification as independent entities. To reunify them, I have now adopted the practice of using the acronym G-I/R as a single term for gender-identity/role.

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G-I/R: DIMENSIONS
Hypothetically, G-I/R may be subdivided into dimensions which either are or are not irreducibly male or female. In mammals, though not in sex-changing fish, breeding roles are irreducibly male or female. In human beings, there are three categories of reducible roles: 1) sex-derivative, as in urinary posture, or hormone-governed muscular build; 2) sex-adjunctive, as in the extension of womens breast-feeding to overall food preparation, or mens territorial roaming to truck-driving; and 3) sex-arbitrary, as in cosmetic and grooming styles. Most people experience and manifest their G-I/R as cohesive and unitary in dimension, whether as stereotypically masculine or feminine, or as an androgynous mixture of the two stereotypes. Others may have a greater or lesser degree of dualism, the extreme being the dualism of two names, two wardrobes, two personalities, and two occupations, one male and one female, respectively. In its genital-erotic dimension, a G-I/R may be heterosexual, bisexual, or homosexual in variable degree. Whatever its status in this dimension, the G-I/R may or may not incorporate some degree or type of paraphilic, hypophilic, or hyperphilic phenomenon. To illustrate: a man may have heterosexual G-I/R, but be inert or apathetic with respect to penovaginal coitus, his turn-on being klismaphilic, that is being given an enema by his woman partner, without the imagery of which he would remain impotent and anorgasmically hypophilic.

A PARADIGM SHIFT NEEDED

A persons G-I/R is the product of neither nature nor nurture, heredity nor environment, acting alone, as is spelled out in Money and Ehrhardt.8 To replace such simple polarization, what is needed is a theoretical earthquake that will bring into being a paradigm shift away from the two-term nature/nurture formulation, to the three-term, nature/crucial-period/nurture formulation. Nature and

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nurture interact during a crucial period of development. What they effectuate is serially added to by subsequent interactions, until the final product is permanently in place. This three-term formulation has long been accepted in embryology. For nearly half a century, it has been also accepted as the basis of imprinting theory in animal ethology. But the paradigm shift that it represents still has not been generally accepted in the social and behavioral sciences - psychology included - though not through lack of a convincing model. This is the model of native language in human beings. Native language inhabits a brain that must be human, and must have had a healthy and normal prenatal life. Only in postnatal life, however, does language actually get into the brain - extraceptively, of course, and typically from sound waves that enter the brain through the ears at a crucial period of development. Once language gets implanted into the brain, it stays there, as permanently ineradicable as if it had been programed there prenatally by genes, hormones, or other brain neurochemistries. Despite its postnatal origins in learning, native language can be eradicated only by a neurosurgeon's knife or, perhaps, by stroke or trauma. This example of native language shows that permanence in the brain is not synonymous with innateness. That which becomes permanent may also be postnatal, and acquired by social learning. Thus, the much-vexed issue of whether G-I/R in human beings is innate or acquired, biological or learned, prenatal or postnatal, does not either quarrel or correlate with the issue of whether G-I/R is immutable or changeable.

G-I/R: PRENATAL AND POSTNATAL

In experimental studies of subprimates, it has been amply documented that reciprocal mating behavior of male and female is preprogramed, robot-like, into the fetal or neonatal brain by steroidal sex h o r m ~ n e .Then ~ * ~ at the first breeding season, the behavior of male and female emerges, robot-like, as is remarkably demonstrated in a film by R. V. Short and I. J. Clarke on prenatally masculinized ewes that mate as rams.lOJ1 In primates, and in particular human primates, there is no such robot-like program. Except for the irreducibles (see above) of procreation, the influence of sex steroidal hormone prenatally is to set differential thresholds for behavior that is sex-shared, but threshold dimorphic. That is to say, in adulthood, either sex can manifest exactly the same behavior, but the threshold for its release is male/female divergent. Parenting behavior in rhesus monkeys is an example. It is the same in males and females; but in the father it is released only after prolonged cajoling and entreaty by the infant, whereas in the mother, the response is released momentarily. T h e list of sex-shared/threshold-dimorphic behavior5 includes: General kinesis- activity and the expenditure of energy, especially in outdoor, athletic, and team-sport activities Competitive rivalry and assertiveness for higher rank in the dominance hierarchy of childhood Roaming and territory or boundary mapping or marking

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Defense against intruders and predators Guarding and defense of the young Nesting or homemaking Parental care of the young, including doll play Sexual mounting and thrusting versus spreading and containing Erotic dependence on visual stimulus versus tactual stimulus and arousal In postnatal life the continued differentiation of G-I/R is, like native language, contingent upon input through the special senses into the brain. Smell, taste, skin senses, eyes and ears participate with different degrees of prominence at different crucial periods, progressively, in development. Ultimately, it is the eyes and ears that carry the major responsibility for continuing the differentiation of G-IIR as shaped by other people, in accordance with the traditions they transmit.

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IDENTIFICATION AND COMPLEMENTATION

Identification is one of the principles according to which G-I/R differentiation takes place in postnatal life. The term, identificution, has long been in use to signify learning by copying, imitating, or modeling. In psychoanalytic theory, particular emphasis is given to the parent of the same sex as the model. In the differentiation of G-I/R, the model is not restricted to the parent. In childhood, age mates and leaders of the peer group may supersede members of the household as identification models. Popular heroes of sports and entertainment also serve the same function. Complementation, or reciprocation, is the other principle according to which G-I/R differentiation takes place in postnatal life. This concept had its origin in hermaphroditic s t u d i e ~ , ~ and **~ in~ particular in the case of a child with a birth defect of the genitalia whose sex was reannounced from son to daughter at age 16 months. In the next couple of years, complementarity of this childs behavior as a girl in relation to that of her father and brother (and of theirs to hers) was clearly equal in importance to her identification with her mother as a model for behavior as a girl. Like identification, complementation takes place among friends within the peer group, and not only within the family.

BRAIN SCHEMAS
The schemas of identification and complementation become locked into the brain where they function as templates in the governance of sex-dimorphic behavior. Identification is for the self and others identified as of ones own morphologic sex (or successful impersonators thereof); and complementation, vice versa. The more overlap or interchangeability between the two, the greater the degree of androgyny. The more rigid and extreme the male/female stereotyping of behavior, the less the overlap and interchangeability. There may be some change in the degree of overlap and interchangeability during the course of a persons lifetime, but for the most part a persons identification/complementation quotient remains remarkably fixed in hidher GI/R.

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Fixity of G-I/R applies even in cases of male/female transposition, of which transexualism with hormonal and surgical sex reassignment, is an extreme example. Gynemimesis, known in street language as being a drag queen, applies to a person who lives full time as a lady with a penis and, if taking female hormone, breasts. Andromimesis is the converse. Transvestism (the syndrome, and not the act of cross-dressing) is episodic malelfemale transposition of G-I/R. Each episode represents a very convincing male or female G-I/R with, respectively, its own name, wardrobe, and occupation. In homosexualism, there are varying degrees of transposition. If manifested in gesture and mannerism it is referred to as effeminacy in males, and as mannishness or lesbianism in females. In many instances there is no such manifestation, in which case the person is homosexual only in the sense of having a person of the same genital morphology as an erotic partner or lover. In bisexualism, the erotic partner or lover may be of either sex. The bisexual ratio may symmetrically be 50:50 or, as is more likely, asymmetrical. Male/female transpositions of G-I/R exclusive of procreative sex, genital sex, eroticism, and limerence (being love-smitten) apply to legal status, work, schooling, play, customs, and manners. These are the transpositions that generate the sometimes intense and partisan passions of sexual politics.

SEXUAL POL I TICS

Partisanship in sexual politics polarizes on the body/mind split, for the body is readily ceded to nature and biology, and the mind to nurture and social science. Except for the growing influence of neuroscience, theories of mind and motivation hold sway in todays sociology, social and clinical psychology, psychiatry, and psychoanalysis. The proponents of these disciplines have assimilated the concept of gender into their teleological theory of mind and motivation by isolating it from sex and the body. Sex they classify as biological or constitutional, and gender as acquired or learned. This same polarization has been espoused also by some biologists and sociobiologists, intent on preserving their own definition of biological determinism in the genesis of sex differences in society. Sexual politics, it transpires, is in many instances their hidden agenda. They misuse biology to justify the dominance of the male, and to attack the contrary arguments of militant feminists. The latter, by contrast misuse biology by explaining it away. They substitute instead a mystique of social stereotyping and historical determinism that, by fiat, has a nonbiological existence. Each side quotes research material to bolsters its own doctrines, and excludes that which does not. My own research has been assaulted from each side, since its theoretical position is biosocial, integrating nature and nurture, not polarizing them. Neither side is yet intellectually ready to put into practice the unity of biological and social determinism in the brain, which is where the unification takes place. Social learning and memory are, let it never be forgotten, just as much biology in the brain as are genes, hormones, and neurotransmitters. All share in both

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long-term and short-term programming of the brain and mind. That is the basic principle of the unity of bodymind.

DEFINITIONS andromimesis: the condition in which a girl or woman manifests the features or qualities of a male in body language, bodily appearance, dress and behavior. There is no fixed vernacular synonym except, maybe, being a bull dyke, that is, a female homosexual who lives the role of a man, who may request breast removal but not genital surgery, and who may or may not request hormones to masculinize the voice, beard and body hair. See also gynemimesis.
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gender: ones personal, social and legal status as male or female, or mixed, on the basis of somatic and behavioral criteria more inclusive than the genital criterion alone. gender identity: the sameness, unity, and persistence of ones individuality as male, female, or ambivalent, in greater or lesser degree, especially as it is experienced in self-awareness and behavior. gender identityhole (G-YR): gender identity is the private experience of gender role, and gender role is public manifestation of gender identity. Both together are G-I/R. gender role: everything that a person says and does to indicate to others or to the self the degree that one is either male or female, or androgynous; it includes but is not restricted to sexual arousal and response. gnemimesis: the condition in which a boy or man manifests the features or qualities of a female in body language, bodily appearance, dress, and behavior. The vernacular synonym is being a drag queen, or a lady with a penis, that is, a male homosexual who, living the role of a woman, retains his male genitalia, even though he may take hormones to grow breasts. See also andromimesis. sex: [as defined in the 26th (1981) edition of Dorlunds Illustrated Medical Dictionary] (L. sexus) 1. the fundamental distinction, found in most species of animals and plants, based on the type of gametes produced by the individual or the category into which the individual fits on the basis of that criterion; ova, or macrogametes, are produced by the female, and spermatozoa, or microgametes, are produced by the male, the union of these distinctive germ cells being the natural prerequisite for the production of a new individual in sexual reproduction. 2 . to determine the sex of an organism. chromosomal s. , sex as determined by the presence of the XX (female) or the XY (male) genotype in somatic cells and without regard to phenotypic manifestation; called also genetic s. endocrinologic s., the phenotypic manifestations of sex determined by endocrine influences, such as breast development, etc. genetic s., chromosomal s . gonadal s., the sex as determined on the basis of the gonadal tissue present, whether ovarian or testicular. morphological s., sex determined on the basis of the morphology of the external genitals. nuclear s., the sex as determined on the basis

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of the presence or absence of sex chromatin in somatic cells, its presence normally indicating the XX (female) genotype, and its absence the XY (male) genotype. psychological s . , the self-image of the gender role of an individual. social s., the complex of attitudes, expectations, etc., that a society attaches to the male and female roles

REFERENCES
1. Money J: Hermaphroditism, gender and precocity in hyperadrenocorticism: Psychologic findings. Bull Johns Hopkins Hasp 96:253-264, 1955. 2. Money J: Hermaphroditism: An inquiry into the nature of a human paradox. Doctoral Dissertation, Harvard University Library, 1952. University Microfilms Library Services, Xerox Corporation, Ann Arbor, M I 48106, 1967. 3. Klebs E: Handbuch der pathologischen Anatomie. Berlin, August Hirschwald, 1876; 1 .Band, Zweite Abtheilung, 718. 4 . Money J , Hampson J G , Harnpson JL: An examination of some basic sexual concepts: The evidence of human hermaphroditism. Bull Johns Hopkins Hosp 97301-319, 1955. 5 . Money J: Loue and love sickness: The science of sex, gender difference, and pair-bonding. Baltimore, Johns Hopkins University Press, 1980. 6. Money J : Gender role, gender identity, core gender identity: Usage and definition of terms. J Amer Acad Psychoanal 1~397-403,1973. 7. Money J : Two names, two wardrobes, two personalities. J Homosexuality 1:65-70, 1974. 8. Money J , Ehrhardt AA: M a n and woman, boy and girl: The differentiation and dimorphism ofgender identity from conception to maturity. Baltimore, Johns Hopkins Press, 1972. 9 . McEwen BS: Neural gonadal steroid actions. Science 211:1303-1311, 1981. 10. Clarke IJ: The sexual behaviour of prenatally androgenized ewes observed in the field. J Reproduction Fertility 49:311-315, 1977. 1 1 . Short R V , Clarke IJ: Masculinization ofthe female sheep (film). Distributed by, M R C Reproductive Biology Unit, 2 Forrest Road, Edinburgh E H l 2QW, Scotland, U . K . 12. Money J: Differentiation of gender identity and gender role. Psychiat Ann 1:33-43, 1971. 13. Money J : Identification and complementation in the differentiation of gender identity. Danish Med Bull 19:265-268, 1972.

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