Book Review

The Riddle of Gender: Science, Activism, and Transgender Rights

N Engl J Med 2005; 353:1751-1752October 20, 2005

Article

The Riddle of Gender: Science, Activism, and Transgender Rights
By Deborah Rudacille. 355 pp. New York, Pantheon, 2005. $26. ISBN: 0-375-42162-9

How do nature and nurture interact to produce a persistent awareness of one's identity as male or as female — that is, one's “gender identity,” as this term is now used in the official diagnostic manual of the American Psychiatric Association? How does understanding the psychology of transgendered people — those who fall between the polarities of being male and being female — illuminate gender psychology? Organized as verbatim interviews with commentary, The Riddle of Gender grapples with these questions in a stimulating way.

The book starts with a personal narrative by the author and goes on to include the narratives of insightful, articulate transgender or transsexual people. The narrators include Ben Barres, a professor of neurobiology at Stanford University and a female-to-male transsexual, or “transman”; Dr. Susan Stryker, cofounder of Transgender Nation, an activist group, and a male-to-female transsexual; Aleshia Brevard, an actress and writer who performed at a drag club before sex-reassignment surgery in 1962 — and subsequently worked as a Playboy Bunny; Chelsea Goodwin, a founding member of Queer Nation, who has been a commercial sex worker, and her partner, Rusty Mae Moore, a college professor; Tom Kennard, who spent many years as a lesbian before transitioning to being a male person; Dana Beyer, a male-to-female transsexual and ophthalmologic surgeon who is comoderator of the DES [diethylstilbestrol] Sons Network; and Joanna Clark, who as a man served in the U.S. Navy for 17 years before sex reassignment, and then as a woman served in the Army. Their reflections on personal, political, social, ethical, and psychological issues are informative and moving. A common thread of determination to persevere in the search for self-authenticity, despite being different from the mainstream, runs through all the narratives.

The lives of some important figures in the history of thought about sex and gender are also discussed — in particular, Magnus Hirschfeld (1868–1935) and Harry Benjamin (1885–1986). Benjamin's book Transsexual Phenomenon (New York: Julian Press), published in 1966, characterized transsexualism, distinguished it from transvestism, and changed the way science and medicine conceptualize transgender psychology. The life of Christine Jorgensen is also discussed, along with the often turbulent history of sex-change surgery.

(Figure)Christine Jorgensen, Who Underwent Surgery to Become a Woman in 1952, Sailing on the U.S.S. United States, August 6, 1954.

Where the book shifts from narratives to discussions of scientific and clinical topics, it would have been enriched by the inclusion of contributions from important scholars whose work is not mentioned in the highly selected reference list, such as Robert Stoller, Eleanor Maccoby, Kenneth Zucker, and H.F.L. Meyer-Bahlburg. There is some attempt to overcome this lack through interviews with Drs. Paul McHugh and Milton Diamond, whose views are presented as beliefs and opinions, but usually not with references to the literature.

The jacket copy states that “gender identity, like sexual orientation, appears to be inborn, not learned.” This may be true for some people, but it is certainly not true for everyone. Actually, there is no evidence that either gender identity or sexual orientation — as a general rule — is inborn in the population at large. The complex nature–nurture interactions that influence gender identity, sex-role behavior, sex differences in behavior, and sexual orientation among different groups of people are the subject of ongoing scholarly scrutiny and analysis.

The book assumes that the psychopathology in gender-variant patients results entirely from social discrimination. Malevolent prejudice is certainly a major problem, but gender variance, too, can be part of complex psychopathologic disorders. People with gender variance should not be thought of as inherently ill; nor should it be assumed that the mental disorders of such people are due simply to intolerance. Moreover, gender variance may, at times, result from primary psychopathologic factors.

The discussion of the political and social dimensions of the lives of patients with intersex disorders is interesting. Consideration of major contributors to the field would have added weight to the author's speculations about the scientific and clinical issues raised by such patients.

The Riddle of Gender is a useful introduction to political, social, and psychological issues in the field. Once readers become acquainted with the terrain, those who seek a more substantial knowledge of scientific and clinical questions about the field now known as gender psychology may choose to read the scholarly literature in their areas of interest.

Richard C. Friedman, M.D.
Weill–Cornell Medical School, New York, NY 10021