Armed with her own story and those of her fellow intersexes, Chase began trying to alert the medical establishment to the dangers of the protocols for intersex management initiated by Johns Hopkins. ISNA’s stated aim was to abolish all cosmetic genital surgery on infants—not simply the castration and sex reversal of micropenis boys. While Chase did not oppose life-saving corrective surgery on genitals, she denounced as “barbaric” all medically unnecessary cosmetic treatments on newborns that could have an irreversible effect on their erotic or reproductive functioning. And ultimately, she said, she wanted to “end the idea that it’s monstrous to be different.”
Chase found it more difficult than she had anticipated to gain an audience with influential people in the field—including John Money. “I’ve written him several times, politely, asking if he would clarify his position for us,” Chase told me. “Each time he would return my letters with a note scribbled on the corner saying he doesn’t have enough time to talk to me.”
Chase also wrote to the American Academy of Pediatrics—an association with a membership of over fifty-five thousand doctors in the United States, Canada, and Latin America. The AAP has long endorsed Money’s protocols for intersex treatment. “I write to inform you that many who have been treated according to the model you outline have found that the treatment itself has rendered our lives an ordeal,” Chase wrote to the AAP in 1995. “We who are intersexual have been discussing our experiences through the Intersex Society of North America . . . and we find that the current model of treatment does nothing to discourage the shame and secrecy surrounding intersexuality. . . . We would love to open a dialog with you, and we encourage you to mention, when you teach about treatment of intersex, the existence of a vocal, organized population of intersexual former patients who oppose the current model.”
The AAP did not respond to this letter. Chase wrote to them again in 1996 and again received no response. That October, Chase and other ISNA members held a demonstration at the AAP’s national conference in Boston. Academy officials refused to meet with the protesters, but they did distribute a press release among the journalists and protestors at the demonstration. “The American Academy of Pediatrics, a voice for children for over 60 years, is aware of the concerns and sensitive to the needs of intersexuals,” the statement read. It went on to say that the AAP would not change its stance on intersex treatment and cited Money’s work from the 1950s to defend its position.
Chase also appealed to former Surgeon General Joycelyn Elders, who prior to her appointment to Clinton’s administration had practiced for over twenty years as a pediatric endocrinologist in Arkansas, where she regularly applied Money’s protocols for intersex management to ambiguously sexed newborns. Elders never acknowledged Chase’s letters.
In 1996, Chase did succeed in persuading the New York Times to write a feature article about the burgeoning intersex activist movement, but in the story members of the medical establishment refused to discuss ISNA’s complaints. Dr. John Gearhart, head of pediatric urology at Johns Hopkins, dismissed the group as “zealots.” In a conversation with me in the summer of 1997, amid the media storm generated by Diamond and Sigmundson’s article on the failed twins case, Gearhart was more politic when addressing the issues raised by ISNA and David’s case. While he insisted that sex reassignment remains a viable option for boys born with micropenis or who lose their penises to injury, he noted that advances in penile reconstruction made him more hesitant to recommend the procedure today. “If John/Joan happened today,” he told me, “I would sit down with those parents and say, ‘The child has testicles; it’s a normal male child.’ I would suggest that you could change the child’s gender, but I would not recommend that, because reconstructive genital surgery has come light-years since John/Joan’s accident.”
Gearhart also said that advances in medicine render ISNA’s concerns obsolete. “When these people in ISNA were operated on, twenty-five and thirty years ago, there weren’t really children’s reconstructive surgeons around,” he said. “So most of [these babies] had their clitoris or their penis amputated. That was wrong, OK? That was wrong. But the surgeons didn’t know any better. Nowadays, people in modern reconstructive surgery are not cutting off little babies’ clitorises or penises, or anything along those lines.” Gearhart said that modern microsurgery retains sensation.
To hear the back-and-forth exchanges of doctors like Gearhart and activists like Cheryl Chase is to be convinced that the issues involved will not be settled anytime soon. For instance, Chase flatly rejects Gearhart’s claim that surgeons maintain clitoral sensation after reducing the organ’s size. Gearhart meanwhile continues to reject ISNA’s call for change in the current treatment protocols, insisting that scores of intersexes live happily in the sex assigned to them in infancy and that Chase and the members of ISNA represent only the “disgruntled” few—a charge to which Chase and other ISNA members take particular exception. They insist that silence among intersexual adults does not reflect happiness with the decisions made for them as babies, but is instead a symptom of the shame and secrecy that are the legacy of the current treatment methods.
“It goes back to being completely isolated as children,” Heidi Walcutt told me. “Knowing that there’s this difference, but being silenced and being shamed about it. Some people never get to the point where they start looking for answers—let alone step out as an activist against what was done to them.” Chase adds that there is also a strong disincentive for intersexes to speak out, since doing so often means undergoing a traumatic confrontation with parents who authorized the surgeries in the first place. Chase points out that more than a few ISNA members find themselves estranged from their families.
It is obviously difficult for an independent investigator to verify either Gearhart’s or ISNA’s conflicting claims about the relative happiness of adult intersexes who decline to speak about their lives; they are by definition invisible. Asked to provide a satisfied patient, every pediatric specialist I contacted voiced the Catch–22 that they “lose track” of their patients after young adulthood. Gearhart added, “And the ones I do know just want to live their lives in privacy.”
I was able to locate and speak to one intersex who is not a member of ISNA or any other activist group. She is notable in her own right in that in the late 1970s she was repeatedly cited as a particularly successful example of an intersex who was sexually reassigned in infancy. Her case was featured not only on an Emmy-winning ABC-TV science series documentary, but also in the BBC’s investigative report on the twins case. She is Paula, the former John Money patient whom Peter Williams and Martin Smith included for balance in their twins case exposé. Living anonymously now in the Northeast, but located through an Internet search engine that lists census records, Paula agreed to speak with me on the condition that I not use her last name or otherwise reveal her identity.
In a series of phone conversations and a five-hour in-person interview with Paula and her mother, I learned the circumstances of Paula’s birth. They were in many respects strikingly similar to the stories I had already heard from Chase and her colleagues in ISNA. Born in September 1971, the second of three children, Paula presented ambiguous genitalia with a scrotum but no testicles inside and a small penis of mostly empty skin. The local doctors recommended assignment as a boy, saying that the penis would grow and that the testicles would descend over time. The baby was duly christened Michael Edward. But Michael’s mother remained upset by her baby’s appearance and continued to consult doctors over the first year and a half of her child’s life. When Michael was eighteen months old, a neighbor in whom Michael’s mother had confided the dilemma brought over the current issue of Time magazine, which carried a story about one of a pair of twin baby boys who had lost his penis to circumcision and was later turned into a girl on the advice of Johns Hopkins psychologist John Money. According to the Time article, the sex change had been a complete success. Michael’s mother immediately wrote to Dr. Money, who replied promptly a
nd advised that she bring Michael to Baltimore for immediate sex reassignment as a girl. “Within two days,” Paula’s mother says, “I was on my way down there with my husband and my child.”
On 23 February 1973, Michael was operated on at Johns Hopkins by Dr. Howard Jones, who established that the baby (like Cheryl Chase) had gonads containing both ovarian and testicular cells. Jones removed the undescended gonads (to prevent spontaneous masculinization at puberty) and reconstructed the external genitalia so that they would appear more feminine. Full .excavation of a vaginal canal was to wait until the baby was in her teens. In the meantime it was arranged that Paula would return periodically to Johns Hopkins for counseling with Dr. Money. And indeed, Paula’s mother brought her daughter back to see Dr. Money several times a year throughout her childhood. Since Dr. Money had often said that Paula was one of his best patients, it came as little surprise to Paula’s mother when, shortly after her daughter’s seventh birthday, Dr. Money asked if she would be willing to put Paula on television to discuss her successful sex reassignment. “I said, ‘If it would help one other person,’ ” Paula’s mother recalls, “ ‘then that’s all I want from it.’ ”
The program was part of the ABC-TV science series The Body Human. The episode, entitled “The Sexes,” featured a scene of Paula, a freckle-faced, short-haired girl, during one of her trips to the Psychohormonal Research Unit. With the camera keeping a studious distance from the fertility sculptures arrayed around Money’s plant-festooned office, the famous psychologist was shown sitting at his desk, in shirtsleeves and tie. He asked Paula questions as she faced him from a large, afghan-covered armchair. In a flowered dress with lace collar, her fingernails painted bright red, Paula smiled warily as she haltingly answered Money’s questions about marriage and career. Meanwhile the narrator explained in voice-over, “At the Johns Hopkins Hospital, under the enlightened care of specialist Dr. John Money, careful attention is paid to nurturing Paula’s image of herself as a girl, preparing her for all the complete experiences of womanhood.”
Shortly after this program aired in May 1979, Money again asked Paula’s mother to put her daughter in front of the cameras. This time the reporters were with the BBC. Again Paula’s mother agreed, and Dr. Money made the preliminary arrangements with Williams and Smith to interview Paula’s mother. The filming took place in early October 1979. According to Paula’s mother this interview proved less gratifying than her encounter with the ABC-TV producers. Within hours of doing the interview, she received an agitated call from Dr. Money, who told her he had learned that the BBC reporters had an “ulterior motive” in making their documentary. Money wanted Paula’s mother to pull out of the interview. When he learned that the reporters had already done the interview, he was irate. “He was absolutely furious with those reporters,” she recalls. “Furious.” The imbroglio did nothing to mar the relationship between Dr. Money and Paula’s mother. She continued to bring her daughter to see Money for regular follow-up visits until Paula was eighteen years old, at which point Paula underwent the final stage of vaginal surgery and stopped going to Johns Hopkins.
Today, at twenty-seven, Paula is a slim woman with blue eyes and tawny, straight, side-parted hair that falls to her waist. Dressed in jeans, a blue shirt, and platform open-toed sandals, she passes easily as a woman, albeit a boyishly figured one. Her small breasts and hip shape are maintained only through a regular lifelong regimen of estrogen ingestion. She takes care to pitch her raspy voice in the upper part of its register, but it does at times dip into lower notes than would ordinarily be expected in even a deep-voiced woman. Paula takes assiduous care of her grooming, lavishing great attention on her long mane of hair; she pays once-weekly visits to the pedicurist and manicurist for the maintenance of her nails; and in the course of our conversation, she frequently refreshed her makeup with the skill of a trained cosmetician.
Despite these obvious outward efforts to enhance her public femininity, Paula says that privately she has no choice but to think about her medical condition every day. Like the other intersexes I spoke with, Paula’s surgically created vagina is a daily reminder that she was not born a typical woman. “I don’t look like everyone else does,” she says. “Not at all. So of course you’re always going to have a constant reminder.” Asked if her vagina carries sensation, Paula drags on her cigarette. “There’s always lack of sensation where there’s scarring,” she says. Given these realities, it comes as little surprise to hear Paula say that despite the best efforts of medical science, she has a constant sense of living “with a secret.” Asked if there are any close friends to whom she has felt comfortable divulging her secret, Paula’s face hardens and she chuckles with brittle cynicism. “You have very few friends in this world—trust me.” She takes another drag on her cigarette. “Yeah,” she continues in the same tone. “That anyone can trust. There are very few people in this world.” She says that she had a boyfriend for six years in her late teens and early twenties in whom she confided her secret, and he was understanding. Since then, however, she has preferred to keep her condition, and the circumstances of her birth, to herself.
A virgin at age twenty-seven, Paula says that she has never felt any sexual attraction to women. When I asked about this, she cut me off before I had even finished the question. “Not at all,” she said. “Never. Never, at all. Not at all.” I asked if, while growing up, she had ever thought, “Maybe I’m a boy,” but again she spoke before I could get the question out. “Never,” she said. “Never at all.”
Paula is open about her desire not to upset her mother by voicing doubts about the decisions made on her behalf as a baby. She insists that she is happy with the choice made to reassign her as a girl—or rather, she expresses the view that no other decision could have been made at the time. “I can’t see things being any other way,” she tells me. “You know?” She pauses, then resumes. “As far as anybody was concerned at the time, this was, like, the only way.”
Like the other former research subjects of John Money to whom I spoke, Paula has vivid memories of her counseling sessions with him. She was shown pictures of men and women engaged in sexual intercourse and queried about the most private aspects of her inner self. “He asked questions that a six-, seven-, nine-, ten-year-old would not ever be asked,” Paula recalls: about masturbation, her private sex fantasies, how to deflect lesbian advances from other girls. “He would press you for answers,” Paula says. “He would sit there and press you and press you and press you. It was way too much for a child. I always said to my mother, ‘I don’t know why the hell I have to go to him.’ ”
Appearing on network television as the world’s first openly intersexual seven-year-old was also, Paula says, “traumatic.” When she discusses this aspect of her dealings with Dr. Money, Paula’s vocabulary and tone of voice lose their quality of studious feminine poise. Her voice drops several tones lower as she spits out a stream of angry expletives. “All that TV bullshit was garbage,” she snarled. “It was bullshit, it was traumatic. I mean you have to understand, at that time of my life I was in grade school. People in my class were asking me about it the next day. I was too young to make my own decisions, but if I had had the choice I never would have done it. But that’s my mama,” she adds with a forgiving but exasperated smile. “She loves John Money. She would do anything he said. She thought she was doing good. Helping other mothers. But I think it was bullshit.”
Paula’s mother has never questioned the decisions she made on Paula’s behalf, nor has she questioned John Money’s handling of the case. To this day she refers to Money as her “savior” and speaks in only the most glowing terms about him and about her former son’s conversion to girlhood. “Everything worked out fantastic with Paula,” she told me, speaking in ecstatically upbeat tones in a phone conversation before I met her daughter. “She is full of life and full of fun. She has never confided in me of any worries. She’s a character! A real party girl. Loves life, parties, going out, oodles and oodles of friends. Th
e phone never stops.” She described Paula as the very quintessence of femininity. “Loves being a girl. Loves to shop. Buys the most expensive clothes. And jewelry. Everything is top designer.” She said that Paula had never seemed even slightly tomboyish as a child (an observation in contrast to the recollections of one of the ABC-TV producers, whose impression of the seven-year-old Paula was “That little boy stayed a little boy, no matter what they did to him” ).
Paula’s mother does voice one small concern about Paula’s life today: her daughter’s single status. When Paula’s parents brought her to Johns Hopkins, Dr. Money had specifically explained that sex reassignment was being done to ensure that Paula could one day marry, have a normal heterosexual love life, and have children by adoption. “Dr. Money looked that far ahead,” Paula’s mother marvels. Marriage is the one area where Dr. Money’s prognostications have yet failed to materialize, but Paula’s mother has not given up hope. “For me,” she says, “closure will come when Paula gets married.” Paula, watching as her mother speaks, takes a hard drag on her cigarette, then looks away.
Paula is dubious that she will ever marry. For one thing there is the delicate circumstance of her unusual genitals—which Paula feels is a severe stumbling block to physical and emotional intimacy with a partner. There is also the fact that Paula views marriage as an outdated institution. So for now, she continues to live at home with her parents. Her father, who suffers from severe clinical depression, confines himself mostly to his room. Most of Paula’s dealings are with her mother. It is a close but emotionally complex relationship in which Paula is totally devoted to her mother, despite Paula’s spates of brittle snappishness. Having heard many times during the course of her growing up about the severe trauma her birth caused her mother, Paula lives a life dedicated to minimizing any further emotional upset or unease that her existence might cause. Paula has thus told her mother that she will live at home forever to look after her and will “never leave her.”
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