Mystery of our sexuality

A former colleague and ardent reader of the London Times brought my attention to an article in the 2 December 2017 issue: “Gay twin may offer an answer to mystery of our sexuality.” The mystery is how we become and act as boys and girls and men and women. More specifically, Is it the work of nature, nurture, or both in some combination that shapes and moulds us? 

These age-old mysteries have been unsuccessfully probed by such luminaries as Sigmund Freud, Richard von Krafft-Ebing, Havelock Ellis, Carl Jung, and others. Some of the more-recent studies have involved identical twins because they share common genes, thus genes might be less likely to be of significance in the development of their sexual identity or orientation. 

The research project featured in the newspaper involved 32 female and 24 male identical twins, each pair of the same sexual identity, but with one member of each pair declaring heterosexual interest, and the other member professing “discordant sexual orientation,” that is, homosexual (gay or lesbian) or bisexual orientation. The unique feature of the study by Watts and colleagues[1] was that they collected childhood and adolescent photographs of discordant twins growing up in the same home environment. Independent reviewers of the photographs were unaware of the purpose of the study; they were asked to spot at what age and in what manner did images of stereotypically gender-related clothing and play became different. The results of the study are inconclusive but suggest that the images interpreted as “discordant” occurred well before puberty. The researchers theorize that given the same genes and growing up in the same household, explanations for the discordance may lie in early intra-uterine events—perhaps unequal nutritional or hormone absorption levels in the embryonic or later stages of development. 

In contrast to this study, a study that was conducted in the mid 1900s, focusing on a single individual, aimed to prove that nurturing was the key element in the development of sexual identity and sexual orientation. That study had a Canadian connection, involved a medical catastrophe, and had a sinister and tragic ending. 

David Reimer (born Bruce Peter Reiner [his identity is in the public domain]) and his identical twin brother were born in 1965. At 7 months old both boys were referred for circumcision because of phimosis. An unusual cauterization technique was used on Bruce and his penis was burned beyond surgical repair. The twin brother was not operated on, and his condition cleared up without surgical intervention. The parents, concerned about the future of their son, were referred to psychologist John Money, PhD, (1921–2006) at Johns Hopkins Hospital in Baltimore. Dr Money was a prominent proponent of the theory of gender neutrality—that sexual identity was developed by learning from early childhood and could be changed by appropriate intervention. A simplistic example: upon being born with a penis, a child is identified as a boy and the parents and relatives provide toy firetrucks and cars to the growing child, while those born without a penis are identified as girls, and receive dolls and ballet slippers as presents, thus reinforcing certain gender-role stereotypes. Dr Money formulated a combined treatment and research study: he recommended that Bruce be raised as a girl and his identical twin brother be the control in the study—same genes, same home, presumably same uterine environment. The key was systematic nurturing the boy as a girl. Success would serve Bruce and the follow-up study by Dr Money would prove the nurturing theory. At 22 months old Bruce was renamed Brenda, and to prepare her for the female role she underwent orchiectomy and had a rudimentary vulva fashioned with a urinary outlet. Later, Brenda received hormone treatment to enhance breast development. The family received instructions on how to treat a daughter. For several years Dr Money reported on Brenda’s progress, describing successful female development and emphasizing her difference from her identical twin brother. 

In 1977 I met John Money briefly and heard his convincing presentation about the success of his “gender reassignment” experiment at a medical meeting. I was impressed, and even included some of his descriptions in a minor booklet that had a page on sexual identity issues. As it was, my clinical and research interests were focused on other sex-related areas, so it was not until 20 years later, in 1997, that I heard Milton Diamond, a psychologist, report the outcome of John Money’s experiment. Mr Diamond became disturbed by the unexplained lack of Dr Money’s yearly reports, and, like a detective, discovered who Brenda was, then persuaded Brenda, who by then called himself David, to go public with his story. Mr Diamond was determined to expose John Money and dissuade physicians from treating other infants similarly. 

Dr Money had hidden that Bruce, as Brenda, never identified with being a girl; he was bullied by his peers; neither frilly clothing nor female hormones made him feel female. He was depressed. At age 14 he threatened suicide unless helped to reassume his male sexual identity. He received testosterone replacement therapy, and later underwent a double mastectomy and phalloplasty surgery. In 1990, at age 25, he married. In the next few years he had to deal with his lifelong resentment of his parents, unemployment, the death of his twin brother from an overdose of antidepressants, and a strained marital relationship. In May of 2004, at age 38, in his home town of Winnipeg, he took his own life. 

In 2018 we are still in the dark about the way our sexual identity develops and the way in which we chose our sexual orientation. Further in-depth research is essential for us to understand ourselves and our unique human nature. 

However, in our contemporary cultural thinking we have now come to recognize that acceptance of various manifestations of sexual identity and sexual orientation is far more urgent than reaching a full understanding of this aspect of our humanity. 

Recently, when speaking in the House of Commons, Prime Minister Trudeau delivered an apology for the tragic acts of discrimination faced by those who suffered because of their sexual identity or orientation by a prejudiced system. Mr Trudeau said, “We were wrong. We apologize.” He received a standing ovation.
—George Szasz, CM, MD

1. Watts TM, Holmes L, Raines, J, et al. Gender noncomformity of identical twins with discordant sexual orientations: Evidence from childhood photographs. Dev Psychol. Advance online publication.

This posting has not been peer reviewed by the BCMJ Editorial Board.

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