ONTOGENESIS OF SEXUAL BEHAVIOR 



1429 



tients tended to lag in psychologic growth 

 and personality development relative to 

 their contemporaries of comparable IQ. 

 Spells of depressed moodiness, sullen and 

 anxious bash fulness and shyness, and ex- 

 treme diffidence and guardedness in matters 

 pertaining to sexual and romantic situations 

 were noted. With respect to the gender role 

 these individuals had established, in 95 per 

 cent there was an equivocal correspondence 

 between gender role and of the sex of assign- 

 ment and rearing whether or not a contra- 

 diction existed between this pair of variables 

 and 1 or more of the other 5 sexual variables. 

 Only 5 of the 94 gave any evidence of psy- 

 chologic nonhealthiness on grounds of a de- 

 monstrably ambiguous gender role and ori- 

 entation. None of the patients studied was 

 psychotic and none required psychiatric hos- 

 pitalization. This low incidence of seriously 

 incapacitating mental disorder is corrobo- 

 rated by Money's unpublished survey of the 

 literature on hermaphroditism in which he 

 found a 2 per cent incidence of psychosis 

 among 248 postadolescent hermaphrodites. 



In the 94 hermaphroditic patients referred 

 to above, several factors stood out as hav- 

 ing important bearing on psychologic 

 healthiness, including psychosexual orienta- 

 tion. The first important factor was the na- 

 ture and degree of the person's visible 

 genital or secondary sexual ambiguity; the 

 more publicly conspicuous the individual's 

 ambiguous appearance, the more difficult it 

 proved for him to transcend his handicap 

 and come to terms with it psychologically. 

 In view of the importance of body appear- 

 ance, as discussed earlier, this finding is not 

 surprising. The surprise is that so many 

 ambiguous-looking patients were able, ap- 

 pearance notwithstanding, to grow up and 

 achieve a rating of psychologically healthy, 

 or perhaps only mildly nonhealthy. The 

 healthy rating was certainly more common 

 in the patients whose body morphology, ir- 

 respective of gonads and sex chromatin pat- 

 tern, was unambiguous looking than it was 

 in the l)atients whose sexual appearance was 

 equivocal. Thus, patients whose sex of rear- 

 ing was contradicted by their gonadal and 

 chromosomal sex were not necessarily des- 

 tined to be rated nonhealthy. 



A second factor of importance in later 

 psychologic adjustment was the consistence 



of gender role training and experience which 

 the individual had received during the grow- 

 ing-up years. After the early months of life, 

 reassignment of sex, as commented on in an 

 earlier section, turns out to be extremely 

 conducive to later psychologic nonhealthi- 

 ness. Corrective surgical, hormonal, or psy- 

 chologic procedures were of greater benefit 

 if they were instituted during infancy or 

 childhood rather than at a later age. This 

 point is well illustrated by the psycho- 

 logic difficulties which hyperadrenocortical 

 women in their thirties or forties have ex- 

 perienced when treatment with cortisone 

 permitted, for the first time, some degree of 

 iDelated body feminization. Having already 

 attained some measure of acceptance of 

 their lot as virilized women physically un- 

 attractive to men, these women have found 

 themselves gauche, inexpert, and lacking in 

 the self-assurance required for success in 

 the role of girl-friend or wife. As a result 

 episodes of anxiety and depression were 

 common in such patients. By contrast the 

 girls treated in their pre-teen years to per- 

 mit feminizing body changes, found it 

 considerably easier, psychologically, to ne- 

 gotiate the transition to adolescence and 

 adulthood. 



The observation that a multiplicity of 

 factors is involved in the etiology of psy- 

 chopathology, where it occurs, in hermaph- 

 roditic individuals makes clear the danger 

 of embracing pat explanatory concepts, such 

 as those based on libido theory, for the neu- 

 roses or any other psychopathy. 



VII. Concluding Remarks 



On the foregoing pages the authors have 

 considered only a handful of the issues and 

 problems germane to human sexual behav- 

 ior. Without doubt many other considera- 

 tions, and many other research contributions 

 could and perhaps should have been in- 

 cluded. The reader who is aware of the vast 

 psychiatric and psychologic literature per- 

 taining to sexual functioning in humans will 

 understand the difficulties of a thoroughly 

 comprehensive discussion of the topic in a 

 limited allotment of pages. On the other 

 hand, it is hoped that a central theme will, 

 nonetheless, have been spelled out, a theme 

 first envisioned in the first edition of this 

 book bv Frank Lillie who wrote: 



