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The Nature and Nurture of

Gender
a b
Martha Kirkpatrick M.D.
a
University of California , Los Angeles
b
Los Angeles Psychoanalytic Society and Institute
Published online: 01 Jul 2008.

To cite this article: Martha Kirkpatrick M.D. (2003) The Nature and Nurture of Gender,
Psychoanalytic Inquiry: A Topical Journal for Mental Health Professionals, 23:4,
558-571, DOI: 10.1080/07351692309349051

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 The Nature and Nurture of Gender
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M A R T H A K I R K P A T R I C K , M.D.

This article attempts to find useful correspondence between psychoana-

lytic, psychological, and social observations of sex and gender and the
current discoveries in neuroscience related to sex and gender. The author
hopes to emphasize that sex and gender are not the same. The current habit
of replacing sex with gender adds to the confusion. While sex is very occa-
sionally ambiguous, gender in our current society is inevitably ambigu-
ous. The social descriptors which define gender change almost moment to
moment and vary greatly across socioeconomic status. The author hopes
to acquaint psychoanalytic readers with some of the relevant information
from the neurosciences. It is essential that we as psychoanalysts attend to
and use this information in evolving our understanding of the inner psy-
chic world.

P SYCHOANALYSIS INTRODUCED THE STUDY OF SEXUALITY IN ITS MOST

complex state, that of individuals in their social context. Neurosci-
ence, until recently, has pursued a narrower field of action, looking for a
location or group of neurons whose function would explain sexual be-
havior. New technologies are leading neuroscientists to devise complex-
ity theories of their own. Is the integration that Freud imagined in “The
Project” near at hand or are we simply beginning to signal across the
gap?

Martha Kirkpatrick, M.D. is Clinical Professor of Psychiatry, University of Califor-

nia, Los Angeles; Senior Faculty, Los Angeles Psychoanalytic Society and Institute.

558
 NATURE AND NURTURE OF GENDER 559

In this article, I search for bridges over the gap between psychoana-
lytic discussions of sex and gender and the findings of neuroscience. The
beginnings of psychoanalysis identified the roots of sexuality in child-
hood and the salience of repressed sexuality for symptom formation.
Psychoanalysis did not fulfill its promise of unraveling the mysteries of
sexuality. Freud’s contribution did, however, bring sexuality under sci-
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entific scrutiny. Freud’s discoveries have led to three specific emphases.

First, his instinct theory, “the body’s effect on the mind,” led him to hy-
pothesize the function of testosterone as the source of libido. Second, the
discovery of the Oedipus complex began the examination of the power of
fantasies. Third, the discovery of the profound effect of parental behav-
ior foreshadowed the development of object relations theory.

Gender

In the last few decades, the relational point of view has been informed by
the concept of “gender.” The word “gender” had a long and respectable
use in linguistics indicating the feminine, masculine, or neuter ending for
nouns and adjectives in languages other than our own nondiscriminating
English. Then, in 1955, John Money, that renaissance man who founded
the Johns Hopkins Department of Neuropsychoendocrinology, jarred
“gender” out of this conventional usage. He was searching for a single
word to refer to the overall sense of femaleness or maleness that was, in
his words, “privately experienced” and “publicly manifest,” irrespective
of genital anatomy. In his 1955 paper, gender was the word he chose to
describe the libidinal inclination, sexual outlook, and social behavior of
a number of adults who had been born with ambiguous genitalia. Money
and his colleagues were studying the rare intersexed patient, hermaphro-
dite or pseudohermaphrodite, who was very unlikely to ever be seen on
an analyst’s couch.
It was exactly this rare opportunity to see such a person in the clinical
setting that began Robert Stoller’s investigation of gender formation in
the late 1950s. His paper on gender dysphoria, that agonizing conviction
of belonging to the category opposite to that defined by one’s genitals,
appeared in 1964. I believe this was the first appearance of “gender” in a
psychoanalytic presentation. Stoller’s 1968 book, Sex and Gender, doc-
umented his interviews with 85 persons with gender dysphoria, and 63 of
their family members. Stoller brought Money’s work to the attention of
 560 MARTHA KIRKPATRICK

psychoanalysis. However, Money was interested in the forces which

play a part in gender formation when clearly delineated genital structures
were not present—that is, the intersexed person. Stoller was learning
from those who were born with normal genitals and nevertheless had a
profound and very early conviction of being of the opposite sex—that is,
the transgendered person. As Stoller saw it, sex is a biological state, con-
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sequent to prenatal biological forces, which almost always results in a

newborn with unambiguous female or male genitals. Gender is a psycho-
logical state, a complex evolving intrapersonal and interpersonal experi-
ence. The term gender caught the attention of social scientists, literary
and philosophical scholars, psychoanalysts, and feminists and combina-
tions thereof. Today, “gender” has flourished in every nook and cranny
of academic, political, and personal life. In 1998, there were 31 profes-
sional journals with “gender” in the title. One’s gender is requested in ap-
plications for credit cards and for training in psychoanalytic institutes.
This is unfortunate because when used to replace “sex,” “gender” loses
its meaning and its value as a different concept. Gender cannot be de-
scribed by a check mark on a questionnaire! Some aspects of gender are
always in process.

Gender Identity

Stoller observed that gender was comprised of several experiential do-

mains: gender identity (the conviction of belonging to a particular sexual
category female, male, or ambiguous), gender role (a complex mix of in-
terests, attitudes and behaviors assumed and promoted by one’s parents
and society as feminine or masculine), and sexual orientation (another of
Money’s terms to replace the implication of willfulness in the term ob-
ject choice). Stoller confirmed Money’s discovery that in an individual
the three aspects of gender were not necessarily concordant with sex or
with each other. In Stoller’s clinic we saw men and occasionally a
woman who despite normal genitalia were reported by family and per-
sonal account to have exhibited interests, behaviors, desires, and atti-
tudes of the opposite sex since very early childhood. The men described
no experience of pleasure in their penises. These were the men that
Stoller considered to be true transsexuals whose female identification
was “conflict free”; that is, there had never been a sense of maleness
which was being repudiated. In Stoller’s clinic, we met other men who
 NATURE AND NURTURE OF GENDER 561

had lived as fully functioning males well into adult life, yet harbored an
insistent demand to change their fraudulent maleness for femaleness. My
own experience as a member of Stoller’s clinical group and in my own
practice persuaded me of the dichotomy between sex and gender and that
gender identity, gender role, and sexual orientation were not necessarily
compatible nor did they progress from one to the other as if moving to-
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ward a specific goal. For example, I worked with a masculine-appearing

successful professional man, married to a woman he loved and devoted
to his two children, who was nevertheless agonized by the feeling he was
a woman inside. He demanded and eventually received sex-reassign-
ment surgery with great relief. Another anatomically normal male had
never experienced pleasure in his penis or any sense of maleness. He had
lived comfortably as a woman since early adolescence and, following
sex-reassignment surgery, he/she married and adopted two children. I
learned a great deal from another patient, a macho, snaggletoothed
fighter pilot, divorced and alcoholic, who hated his masculinity and
longed to bring to light the woman he felt was the best of him inside. He
had no sexual interest in men, but felt that only as a woman could he have
the intimacy with another woman that he desired. Although he was not an
acceptable candidate for sex-reassignment surgery, he lived the last 15
years of his life as a woman. This did not bring him the partner he had
hoped for but changed a chaotic and miserable life into one of stability,
generosity, and pleasure. Equally surprising were two men who had
lived together as lovers, both of whom had sex-reassignment surgery,
and continued life together as a lesbian couple. Women with these dis-
continuities are seen, but less frequently than men. When these dishar-
monies are extreme, the separate nature of sex, gender identity, gender
role, and orientation is dramatically emphasized.
Although the histories of many of the men we saw suggested deeply
conflicted identifications with hated or traumatizing male figures, such
patients were difficult to involve in long-term psychotherapy. In addi-
tion to recognizing that the three aspects of gender are not interlocked,
examples such as these make clear that genital anatomy (i.e., one’s sex)
is not sufficient to confirm gender identity.
It is noteworthy that the examples of repudiation of genital anatomy
given above are all male. A great preponderance of men over women is
reported in most clinics serving those requesting help with sex reas-
signment. Also, in my experience, transgendered males are more in-
tensely obsessed with body parts, while transgendered women are more
 562 MARTHA KIRKPATRICK

concerned with social relations. I have wondered if this difference in pre-

occupation with body parts is a major consequence of the testosterone
surge in the first six months of male life. Could it be that the testosterone
surge’s effect on the brain does not enhance male identity directly, but
promotes body and genital attentiveness resulting in rough-and-tumble
play, masturbation, and preoccupation with body parts in later life?
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While this usually promotes male identity, other factors may divert it’s
effect to energize female identity.
Money’s work further confirms that competent genital anatomy is
neither sufficient nor necessary for gender identity. This seems espe-
cially true for girls. For example, girls with vaginal atresia, absent uterus,
or internal testes and no internal female structures at all (XY-androgen
insensitivity syndrome) develop feminine gender identity. Girls with
Turner’s syndrome (only one X chromosome) do not have adequate in-
ternal organs for reproduction and yet they test very high on maternal in-
terest. Boys with microphallus or hypospadius or other genital
anomalies may also develop masculine identification, with parental sup-
port. While Freud thought genital anatomy was the root of gender iden-
tity, Stoller and Money concluded that it was the parents’ observations of
the child’s genitals and their assigning the child’s gender at birth which
begins the process. While many forces contribute to gender identity, the
most powerful of all is the parents’ belief that this infant is a boy or a girl.
Money and Stoller argue that it is the power of nurture, pink or blue, not
the genitals, that most informs the mind about gender identity. In
Money’s view, this inexplicable force begins operating at birth to im-
print gender identity like native language. Perhaps this presymbolic im-
print is organized within the procedural/nondeclarative memory system.
This memory system is a preverbal memorialization of the infant’s body
experiences which are mentalized to form a body self. This body image is
formed from the infant’s repeated sensory experiences of its body’s
boundaries and limits and its relations in space, against gravity, with
nonselfobjects, and the discovery of body parts. This, of course, includes
sensations from the genitals and a sense of their morphology. How care-
takers respond to these discoveries colors this aspect of body image. The
experience of genital sensations may be colored good or bad, damaged or
damaging, but may or may not be integrated with evolving gender iden-
tity. Such a primitive mental record can neither be retrieved nor accessed
by conscious processes. Money and Stoller agree that by 18 months of
age nurture has done its work and the process of gender identity is well
 NATURE AND NURTURE OF GENDER 563

under way, and by three years of age is indelible, since efforts to correct
errors in sexual assignment are usually unsuccessful after this age. By 18
months children are interested in and able to identify genital differences
and begin to incorporate this body formation as part of their gender iden-
tity (Galenson and Roiphe, 1981). The parental assignment of sex, be-
ginning at birth, lays a groundwork for the incorporation of the discovery
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of genital differences. According to Galenson and Roiphe, intentional

manipulation of the genitals for pleasure begins in the first half of the
second year in boys and around 17 months in girls. By this time, curios-
ity, moving from the anal area to the urethral to the genital, has allowed
for the discovery of genital differences. While boys retreat from this dis-
covery by increased rough-and-tumble play, girls become inward and
experience a spurt in symbolic thinking. Manifestations of castration
anxiety occur in those children who have experienced disruptions due to
illness or losses prior to the discovery of genital differences. The gender
identity formed during this period may be concordant with sexual
anatomy, ambiguous or opposite to it in the case of the true transsexual.
We cannot claim to understand the specific source of transgender
development.

Gender Role

There has been a great interest in gender role, unfortunately often con-
flated with gender identity. The differences in gender role—that is, the
behaviors, interests, attitudes, and values labeled feminine or masculine
in our society—are observable in children in early childhood. Boys ex-
hibit more energy expenditure, rough-and-tumble play, and exploration
than girls. Girls are more attentive to social cues and verbalize earlier.
Toy preferences and fantasy play often follow social stereotypes, even
when parents are determined to avoid them. However, the many features
of gender role are not fixed, as is gender identity, at this early age but con-
tinue to evolve under the impact of maturation and preoedipal and oedi-
pal transactions. Every individual contains a mixture of “masculine” and
“feminine” features which makes for individuality and the enjoyment of
a variety of social roles. These play an important part in sexual fantasy
and the way in which sexual desire is enacted. As analysts, we know the
many overlapping layers of unconscious identifications, contradic-
tions, ambiguities, desires, and defenses associated with gender role in
 564 MARTHA KIRKPATRICK

any individual personality. Fortunately, modifications go on throughout

life and consequent to psychoanalysis. Some identifications are ego-syn-
tonic, while others may be deeply dystonic as shown in my previous clin-
ical vignettes. Patients with severe gender dysphoria are rarely interested
in psychoanalytic exploration. They tend to seek therapy as a means of
helping adaptation to their preferred gender role.
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Sexual Orientation

Sexual orientation or the object of desire is perhaps the most complex

and least understood of the aspects of sexuality. A myriad of theories
abound demonstrating that there are many paths by which an individual
may arrive at heterosexuality, homosexuality, or some mixture thereof.
The conflicts and resolutions of the oedipal situation are particularly evi-
dent in the construction of sexual orientation. The establishment of sex-
ual orientation is not fixed as early or as immutable as gender identity,
but is not as flexible as gender role. Sexual orientation is seemingly well
established by five or six years of age. I believe, however, that it remains
more flexible in women. For example, in our study of the children of les-
bian mothers (Kirkpatrick, Smith, and Roy, 1981), 90 percent of the
mothers had been married, most of them for over five years, one third had
a lesbian relationship prior to marriage but all married for love of their
husband and desire for a family. All these lesbian mothers had clear gen-
der identity as female and were devoted to the quintessential feminine
gender role of mother. Such shifts in the object of desire may occur in
men as well but is less frequent.
My clinical experiences of discontinuity and variable assembly, cited
above, convinced me that gender does not follow a developmental line.
However useful this concept was when proposed by Anna Freud in 1965,
it makes the misleading assumption that evolution has the same goal for
each human development—namely, heterosexual reproduction. Devel-
opmental line suggests interlocking building blocks which when fitted
together properly result in the same structure. Gender looks to me more
like a kaleidoscope in which various different fragments overlap, rein-
forcing, neutralizing, or modifying the color, creating a unique pattern.
This complexity of gender may be less satisfying conceptually but is, I
think, closer to the human condition. Giving up our adherence to the con-
cept of developmental line does not mean that development is chaotic,
 NATURE AND NURTURE OF GENDER 565

simply that the goal is not predestined. Developmental sequence is easy

to demonstrate. For example, babbling precedes speech. In addition,
speech represents a more complex psychological organization demon-
strating developmental hierarchy, but these observations of sequence
and hierarchy in speech development do not predict what language the
child will speak. Recognizing developmental sequence and develop-
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mental hierarchy does not imply a line of development leading to a spe-

cific goal (Coates, 1997). Each level of organization is the consequence
of complex interactions between many formative forces and one cannot
predict the character of the next organizational level. Similar complexity
and unpredictability has been noted in other areas of development, such
as in affect and self development, by Stern (1985), Beebe and Lachman
(1992), Emde (1994), and Fonagy et al. (1995). The individual outcome
in any psychological domain is dependent on the interaction with other
domains. Money described this process for gender as multivariant se-
quential determinism. The powerful forces of parental assignment and
socialization proceed sequentially. Later identifications, conflict
resolutions, and the fantasies associated with the genitals take place in
those levels of psychic organization more accessible and familiar to
psychoanalysts.
Do these psychological events fall on different soil in boys and girls?
Are their brains different from birth? Is there evidence that early brain
structure is associated with the formation of gender identity and the early
roots of gender role and sexual orientation? These questions are postu-
lated by postmodern/poststructuralist feminist scholars as a debate be-
tween Essentialists and Social Constructionists (Lesser, 1997).
Essentialists are defined as those who believe that there is a fundamental
psychological difference between men and women irrespective of the
historic time, culture, and social forces. Constructionist scholars believe
any gender difference is the result of the social construction of gender.
They fear Essentialists will reduce gender to the expression of a gene or
location in the brain that explains all and rigidifies male/female roles, op-
portunities, and social power. I agree that we must be attentive to the ef-
fects of historical time, social and cultural forces, ethnicity and class on
anyone’s gender development, and that we should not pathologize indi-
vidual variability, but we need not turn away from the findings of
neuroscience. It is just too interesting.
Psychoanalysis needs to be a part of the process when mind and brain
meet. In this Decade of the Brain, sex researchers in the neurosciences
 566 MARTHA KIRKPATRICK

have searched for differences between the brains of men and women and
the sources of sexual orientation, particularly homosexuality. Some sex-
ual differences in the brain correlate with observed differences in gender.
Fetal morphology begins as neutral and multipotential. If it remains in
this uninduced form a baby will be born with female genital morphology,
and parental assignment as such will impinge on her gender develop-
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ment. If, however, a Y chromosome is present, the sex-determining fac-

tor will modify the fetal gonad to produce androgens. Testosterone, then,
will induce modifications in the body. The genitals will assume the male
form. This can only occur if the cells can receive and use testosterone. If
not, the female morphology will dominate (androgen insensitivity syn-
drome). This XY infant will be identified as a girl and grow to be a femi-
nine women although she will be sterile and probably will have had
surgical removal of inguenal testes in childhood. The brain also responds
to testosterone although no structural differences have been identified
before the age of five. The central nervous system (CNS) of the female
infant develops faster than the male, possibly due to testosterone inhibit-
ing apoptosis, the preprogrammed neuronal death that prunes the neural
system and allows for the formation of neural circuitry. This faster devel-
opment in girls allows for the greater neural stability at birth and may en-
hance mother/daughter bonding. There is also a postnatal testosterone
surge in boys which may induce the toddler’s higher energy expenditure,
exploratory behavior, and rough-and-tumble play. The testosterone
level during this three- to six- month postnatal period reaches pubertal
levels and then falls to that of girls. After six months, testosterone levels
are not significantly different between the sexes until puberty. Girls ex-
posed to androgens in fetal life also demonstrate these traits as tomboys
and are slower to develop romantic interests in adolescence although
they usually identify as female if so assigned by parents. Prenatally and
in the early postnatal period testosterone acts to modify brain structure as
well as the genitals. After puberty testosterone acts to stimulate the de-
velopment of secondary sex characteristics in boys and to stimulate sex-
ual desire in both sexes. As mentioned earlier, boys begin intentional
genital manipulation between 12 to 14 months, about five to three
months earlier than girls. I wonder if this enhanced genital awareness
promotes a body image more organized around the genitals in boys
than in girls, and gives rise to the preoccupation with body parts charac-
teristic of males. The role of estrogen in fetal development is still uncer-
tain. There is evidence to support the view of the brain as fundamentally
 NATURE AND NURTURE OF GENDER 567

female—that is, requiring no sex hormonal influence to develop

normally as female. However, there is also evidence to support the
view of the brain as neutral and requiring the influence of estrogen to
develop in the normal female form. It is certain that both testosterone
and estrogen are both necessary to maintain optimal brain function in
adult life.
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Brain Differences

Neuroimaging shows greater vascularity and communication between

the hemispheres in the female brain. This communication between the
hemispheres is structurally demonstrated by larger anterior commisure
and massa intermedia in the female. Women with a stroke in the left
hemisphere have a greater chance of developing speech using the right
hemisphere because of this communication. In the adult the male brain is
larger in proportion to body size than the female brain. The male brain is
more laterally compartmentalized. Is this a testosterone modification on
an originally more flexibly organized female brain? The greater CNS
stability may account for girl toddlers’ greater responsiveness to social
cues and early speech development. Female speech development and
perhaps the importance of social communication in women is correlated
with the longer sylvian fissure, temporal plane, and frontal operculum.
The brains of boys and girls may be different in their readiness to re-
ceive the messages from the social surround about gender. We are still
a long way from integrating the many elements of gender with brain
organization.
However, the most exciting and the most robust sexual dimorphic
structures in the human brain were identified by Gorski and Allen at
UCLA (Allen et al., 1989). These are the four interstitial nuclei of the an-
terior hypothalamus (INAH). These four little clumps are in a similar lo-
cation as the sexually dimorphic nucleus in the rat which does change in
size under the influence of testosterone and which regulates sexual and
maternal behavior. Gorski and Allen found INAH 2 and 3 to be sexually
dimorphic in humans. Both were larger in men, although during preg-
nancy women’s INAH 2 equaled that of men. It is not yet known whether
these little clumps have anything to do with sexual response or orienta-
tion in humans. The INAH are robust for sexual difference but not for
sexual orientation, despite the media’s enthusiastic report of LeVay’s
 568 MARTHA KIRKPATRICK

study (1991). LeVay at Scripps found only INAH 3 to be dimorphic, but

the big news was his finding that INAH 3 was smaller in homosexual
men who died of AIDS than in heterosexual men who died of AIDS. Not
only is there no replication at this time, but the separation into homosex-
ual and heterosexual was made by post mortem chart review. If no men-
tion was made of homosexuality it was assumed the man was
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heterosexual, a risky assumption. Two other curious findings are that

both the suprachiasmatic nuclei and the anterior commissure are found to
be larger in homosexual men than in either heterosexual males or
females (Allen and Gorski, 1992). A center for sexual orientation,
heterosexual or homosexual, has not been identified.
Are there heritable factors influencing sexual orientation? A media
favorite,this question has been raised by twin studies that show more
concordance for male homosexuality in monozygotic as compared to
dizygotic twins. These studies vary in the concordance shown (60–100
percent) and suggest some heritable vulnerability for male homosexual-
ity. In addition, Hamer and colleagues (1993) reported a pedigree study
identifying a region of the X chromosome (Xq28 on its short arm) in
which some variation was more often shared by homosexual brothers (80
percent) than by a homosexual brother and his heterosexual brother (25
percent). They also found more homosexual male relatives on the mater-
nal side of homosexual men’s families than on the father’s, supporting
the notion of a heritable factor passed on by the mother (LeVay and
Hamer, 1994). No specific gene for male homosexuality has been dis-
covered, simply character traits that enhance that possibility. There are
four million base pairs of DNA in this region (Xq28). Furthermore, the
only replication so far is from Hamer’s own group, while a similar study
arrived at the opposite conclusion (Ebers, 1995). Female sexuality, like
female homosexuality, does not appear to be influenced by biological
factors. New information arrives from the Human Genome Project al-
most daily and is often given a headline by the media which is quite mis-
leading. Even a genetically determined condition such as cystic fibrosis
can be caused by several hundred different mutations. Other factors are
necessary to turn a gene on; it’s a matter of interaction. It remains unclear
if other sexual orientations (heterosexuality, bisexuality, fetishes,
perversions) are influenced by genetic factors.
Gorski calls the brain a sexual organ. He contends that perhaps 60 to
80 percent of gender differences originate in brain structure but like other
neuroscientists he does not expect to find a locus for gender difference.
 NATURE AND NURTURE OF GENDER 569

Rather he believes there is an interacting network of neural circuitry

connecting many different areas of the brain that result in gender differ-
ences, including orientation. It is this emphasis on complexity that be-
gins to unite neuroscience and psychoanalysis. The most important
interaction between nature and nurture takes place in that early postnatal
period when the immature infant’s neural system is growing and orga-
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nizing under the impact of the affective milieu (Schore, 1994). In this
memorialized but not remembered period the circuitry for gender iden-
tity is regularly closed. The circuitry for gender role remains open and
multilayered.
External genitals by themselves do not create gender. Fantasies orga-
nize around the genitals and reorganize as their significance is under-
stood in new ways and they become part of a symbolic system. The
cognitive connection between genitals and gender is not easily made in
our cover-up world. De Marneffe (1997) reported on a series of inter-
views with 46 children between 15 and 36 months as they played with
naked dolls that were dissimilar only by genitals. Children over 24
months had no difficulty identifying the doll that looked like them and
often chose that doll as their favorite. But when asked which doll was a
boy and which a girl they were at a loss! The relationship between geni-
tals and gender was not clear to them. Susan Coates reported a
two-and-a-half-year-old boy’s response to being asked to identify the
sex of naked children in a series of pictures: “I don’t know, they don’t
have their clothes on.” A conviction of one’s own gender identity and an
awareness of genitals are not enough to ensure gender constancy (clothes
don’t change your sex), gender stability (you’ll always be this sex), or
the limitations of each. As Irene Fast has concluded (1984), the greatest
difficulty in the development of gender role is accepting its limitations,
giving up the capacities of the other gender. My favorite example comes
from my firmly male-identified four-year-old grandson. With a sword in
his belt, he put a pillow under his pirate shirt and asked me to do the same.
I did so, and said, “Oh, we’re pregnant like your Mommy was when you
were growing in her tummy.” He agreed and added, “Then Mommy and
Daddy were in my tummy, and that’s how they got born.” I have met the
Creator! Seven months later, this pillow under the shirt became a preoc-
cupation with being Santa Claus which helped me understand the bisex-
ual imagery contained in the jolly old man and his birth from the
fireplace. Such ambitious fantasies do not arise from genitals or hor-
mones or brain loci but from the complex psychological matrix we
 570 MARTHA KIRKPATRICK

usually spend our time discussing. Gender role is constantly reorganiz-

ing throughout life as potentials come and go.

Summary
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Great diversity of sexual response is a characteristic of human life that

differentiates it from that of other primates. The neural circuitry that un-
derlies human sexuality is open to modification from influences outside
the nervous system, including those from other parts of the body and
from the environment. This adaptability allows for the variations, distor-
tions, and individual complexity of human sexual life.
I would like to conclude with two analogies about the individuality of
gender development. First, I want to remind you of Ethel Person’s
(1980) analogy of the unique sex print of each individual. Like the finger
print, it is neither the ridges nor the troughs that create the print, but the
pattern of their interaction. So with nature and nurture. Much as I love
that analogy, I prefer my own way of analogizing an individual’s gender
totality—namely, as a spring-fed lake which takes form as it grows de-
pending on the flow from the spring and the impediments and openings it
encounters. I prefer this analogy because unlike the sex print it is dy-
namic both in development and over time. Lakes may change their
shape, their surface may be smooth or choppy, and what’s under the sur-
face may interrupt or enhance their beauty or may never be known. Awe
and curiosity about this fascinating scene, whether observed from the
surface looking down or from the lake bed looking up, will bring
psychoanalysis and neuroscience into partnership at last.

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