The Riddle of Gender

underwent genital surgery, Erickson had a mastectomy in Mexico in the early sixties, and had some “touch-up work” on his chest in the United States, as well as a hysterectomy after becoming a patient of Harry Benjamin’s. “There were doctors who would do this if you had the money, and Erickson had the money,” Devor says. “Though it doesn’t seem that Erickson had much trouble himself, I think he was very aware of the troubles that others were having. One of the first projects of the EEF was drawing up a list of helpful and sympathetic doctors and surgeons by city and region. EEF was started in ’64 and this was one of their early projects. It was an ongoing project, and they were always adding new names to the list.”

Erickson enjoyed a warm relationship with Money, whom he was also funding by that time. “They were quite close for a long time, enjoying lots of social interaction,” says Devor. “They shared common interests. It was more than just a business relationship.… John Money was quite open and liberal and certainly not snobbish about socializing with transsexuals,” he says. “I know they were friends, and of course Erickson was putting money into what Money was doing.”

Erickson donated nearly $85,000 to the Johns Hopkins Gender Identity Clinic over ten years, says Devor. “It has become quite clear to me that the money from the EEF was essential to the start-up of the Johns Hopkins clinic. Media reports from the time said that the clinic was entirely funded by the EEF.” The importance of Erickson’s support, and Money’s gratitude toward his benefactor, can perhaps be judged by the fact that Erickson was invited to contribute the preface to Transsexualism and Sex Reassignment, edited by Richard Green and

John Money and published by the Johns Hopkins University Press in 1969. In the preface to that volume, Erickson testifies to the difficulty that transsexual people had in finding physicians who understood their condition and surgeons both competent and willing to carry out the surgery. “Although here and there an occasional doctor or clinic performed sex-change operations—sometimes successfully, sometimes not—it was only after The Johns Hopkins Hospital provided its facilities and publicized its work that sex-conversion operations began to be undertaken openly by hospitals of high reputation.”

By all accounts, the opening of the Gender Identity Clinic at Johns Hopkins Hospital in 1966, and the decision to begin performing sex-reassignment surgery there, was largely brought about by Money, who argued, cajoled, and arm-twisted reluctant colleagues into translating the expertise they had acquired treating intersexual people into treating transsexuals. In the introduction to Transsexualism and Sex Reassignment, Harry Benjamin writes, “Dr. John Money, psychologist at Johns Hopkins, widely-known and respected for his extensive studies on hermaphroditism and related endocrinopathies and sexual disorders, was probably more responsible than any other individual for the decision that such an august institution as The Johns Hopkins Hospital would take up this controversial subject and actually endorse sex-altering surgery in suitable subjects. This decision testifies to the high esteem in which Dr. Money is held by his medical co-workers.”

Even those who do not hold Money in high esteem—quite the opposite—acknowledge his role in bringing SRS to Johns Hopkins. John Colapinto, a journalist whose book As Nature Made Him portrays Money as a diabolical figure, twisted by arrogance and ambition, describes Money’s “campaign to establish Johns Hopkins as the first hospital in America to embrace transexual surgeries” in detail. Colapinto quotes Howard W. Jones, the gynecological surgeon who had developed the surgical techniques used in the neonatal intersex protocol, as saying that “for a number of months, maybe even years, John kept raising the question of whether we shouldn’t get into the transsexual situation.” Colapinto reports that Money brought in Harry Benjamin and some of his patients to help convince Jones and Milton Edgerton, the pediatric surgeon, “that this was something that maybe should be done.”

Paul McHugh, who was to close the Gender Identity Clinic at Hopkins shortly after he assumed the directorship of the department of psychiatry in 1975, confirmed in a 2002 interview that Money worked hard to persuade his colleagues to perform adult sex-reassignment surgery, in the face of considerable resistance. McHugh, who is adamantly opposed to sex-reassignment surgery, says that Money was “a powerful and never-ending advocate for transgendering as a real disorder, as a real thing.” His success in promoting SRS at Hopkins in the face of considerable institutional resistance was based on his scientific reputation and the institutional power it conferred. “Dr. Money is a very gifted scientist and psychologist who did superb work, pioneering work here before he became all taken up with sex,” says McHugh. “He did wonderful work on, for example, language disorders and reading disabilities and the psychological states of these individuals that had a variety of chromosomal abnormalities and the like. He did pioneering work in those areas.” As a result, says McHugh, his colleagues at Johns Hopkins “admired him” and were willing to follow him into the turbulent waters of adult sex reassignment.

McHugh, who is both scientifically and socially conservative, an avowed foe of psychiatric “fads” such as multiple personality disorder and repressed memory syndrome, calls Money “a victim of the sixties” whose views on the plasticity of gender were as much based in his politics as his science. “It was a very left-wing kind of view that we are fundamentally produced by our environment, almost Lysenkoist,” McHugh says. He characterizes Money’s decision to extrapolate the data and theories on gender fluidity that he had formulated working with intersexual people to all people as “a big mistake. It was a mistake driven in part, as I said before, by politics and being avant- garde at the time.” Money’s ideas were readily accepted by the public and fellow researchers for the same reasons, McHugh believes, because they meshed with the gestalt of the times, which encouraged a questioning of orthodoxies. “His science brought him so far, was bringing him so far, and then, like so many other people, the theme of Overthrow the patriarchy, make change, it’s the authority structures that are standing in our way’—I think that John bought that, hook, line, and sinker, and as a result, like so many others, came to suffer from it.”

The press release announcing the opening of the Johns Hopkins Gender Identity Clinic came a year after the actual inauguration of the clinic, when news about the clinic’s work had begun to leak out. Money says in Gendermaps that though the clinic had been “informally known as the sex change clinic,” at “my instigation it had been formally named the Gender Identity Clinic, a name that should have broadened its scope beyond transexualism [sic] to the manifold issues of gender identity. The narrower meaning, however, would win the day. Gender identity disorder became inseparably linked with transexualism [sic].” The clinic was conceived as a research project, “a definitive study” of transsexualism. The press release quotes Dr. John Hoopes, chairman of the clinic’s staff, saying, “This program, including the surgery, is investigational. The transexual [sie] has never previously been given adequate medical attention. The most important result of our efforts will be to determine precisely what constitutes a transexual [sie] and what makes him that way. Medicine needs a sound means of alleviating the problems of gender identification and of fostering public understanding of these unfortunate individuals. It is too early in the program to be either optimistic or pessimistic. We are still in the process of collecting accurate observations on the results of treatment.” Hoopes also stated that the Erickson Educational Foundation “is the sole source of research support” for the clinic.

Conceived as a research project (and limited to interviewing two new patients a month), the clinic was viewed quite differently within the community of people seeking sex-reassignment surgery, and among physicians. The former viewed the clinic as a service provider and resented its parsimonious approach to patient care. Even before the opening of the clinic was formally announced, the staff had received more than a hundred letters requesting treatment. Many physicians, on the other hand, found even two “sex-change” patients a month too many. Paul McHugh, a young faculty member at New York Hospital at the time, says, “It looked like a fad to us, like following along with Jorgensen and all that.” Nonetheless, the opening of the Gender Identity

Clinic at Johns Hopkins was soon followed by the opening of similar research projects at other university hospitals, including Stanford and the University of Minnesota. Despite the generally positive media response to the hospital’s decision to begin performing sex-reassignment surgery, many doctors and researchers continued to object to the practice—much to the sorrow of Harry Benjamin and the disdain of John Money. “The Johns Hopkins transsexual program was a source of immense satisfaction to Harry Benjamin, for it vindicated and authenticated his otherwise lonely advocacy of a group of patients generally despised and ridiculed by the medical establishment,” Money said at Benjamin’s memorial service in 1987. “Conversely the public repudiation of this program by medical moralists who were not members of the gender-identity team was to him a source of immense sorrow. I knew about that sorrow from my periodic phone calls and occasional visits with Harry Benjamin.”

Paul McHugh, who has himself been attacked by Money for “medical moralism,” maintains that resistance to the practice never really died down at Johns Hopkins. Soon after he became chair of the department of psychiatry there in 1975, he told me in 2003, he became aware of the discontent of the surgeons who performed the surgeries,