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Colapinto's portrait of the medical establishment's part in this case is compelling, although framed in such stark contrasts that he seems to caricature the two main players. They are Milton Diamond, a reproductive biologist, painted as the very model of the earnest, calm, rational scientist whose observations are unfettered by personal agendas, ambitions, or biases; and John Money, a psychologist at the prestigious Johns Hopkins University and one of most influential North American theorists on the origins and development of gender and sexuality, who is painted as the very model of scientific hubris: arrogant, dogmatic, sexually deviant, abusive, hostile—and unwilling to let the facts get in the way of his theories.
On first impression the book sends a strong biologically deterministic message about masculinity and femininity. David's brother Brian says: "She walked like a guy. Sat with her legs apart. She talked about guy things, didn't give a crap about cleaning house, getting married, wearing makeup. We both wanted to play with guys, build forts and have snowball fights and play army." She was the dominant twin, who fought with her fists, and usually won. She disliked wearing dresses and stood up to urinate. Readers get the impression that such things as posture, preferred activities, and dress are prenatally determined as either male or female.
But Colapinto is far too good an investigative reporter to leave things there. A careful reading of the subtext of the book yields quite a different message. For example, we will never know the extent to which David's rearing as male for nearly two years (his transformation didn't occur until age 22 months), and the experience of being forced into stereotypically female behavior, influenced his sexual identity.
Colapinto also tells the story, albeit too briefly, of the intersexed—that is, people with biological characteristics of both sexes. Once surgeons have determined whether they can more successfully create "normal" male or female genitals, intersexed infants are forced into the corresponding gender identity and role, and are not usually told the reason for their treatments until adolescence. This strategy is based on the assumption that ambiguous genitals always lead to unhealthy psychosexual development (e.g., David could not be a boy without a penis), and that gender identity is fully modifiable during early childhood. Colapinto points out correctly that there is virtually no re search to support these assumptions. What little is available suggests the opposite: that while living with ambiguous genitalia is challenging, intersexed persons can and do develop into well-adjusted adults capable of having intimate, committed sexual relationships without treatment, and further, that the state of the genitals does not accurately predict a person's gender identity and sexuality.
Indeed, the most important implication of David's story, which does not emerge as clearly as it might, is that we simply don't know very much about the origins of gender identity. Social scientists like myself are reminded that the complexities of gender and sexuality cannot be untangled in any particular direction through a single case. The medical professionals who have the authority to pronounce on gender and sexuality should learn from this tale that it is best to refrain from irreversible surgical interventions until the affected children are old enough to make in formed decisions. And all of us need to overcome our discomfort with "ambiguous" genitals and become willing to talk openly about intersexuality so that those who experience these conditions are not isolated or shamed, and will not have to go through David Reimer's hell. As Nature Made Him is a challenge for all, and a gift for many whose journey will be eased because David was willing to let his story be told.
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