The case of David (originally Bruce) Reimer (often known as "John/Joan") is a tragic but illuminating story in the history of medicine
, a controversial case study which reveals some crucial insights into psychiatry
In August 1965, twin brothers Bruce and Brian Reimer were born without complications in a city in the Midwest of America. At the age of seven months, the twins started to experience phimosis, a common condition in which the foreskin closes and makes urination difficult. The problem can be easily remedied by circumcision, and the operation was arranged for April 1966.
Unfortunately, a serious mistake occured during the procedure on Bruce, and a surge of intense heat from a cautery needle burnt his penis so badly that it simply crumbled to ash over the following days. Teams of specialists were called in to analyse Bruce's plight and suggest the best course of action, but the medical technology of the time allowed nothing more than a crude reconstruction of a rudimentary penis, useful for nothing more than urination. Bruce's parents were at a loss over what to do with their son.
The influence of Dr. Money
In December 1966 they watched a TV program featuring the psychologist John Money, who specialised in sexology. Money, who worked at Johns Hopkins hospital in Baltimore, had developed the theory that the gender identity of a child develops purely as a result of their upbringing, and of their sexual organs, which play a Freudian role in gender development. As he put it, ". . . it is no longer possible to attribute psychological maleness or femaleness to chromosonal, gonadal or hormonal origins. . . psychologically, sexuality is undifferentiated at birth and it becomes differentiated as masculine or feminine in the course of the various experiences of growing up."
Money had based this idea on the study of intersexual children, which had been the topic of his doctoral thesis, but believed that it extended to all children - and thus also to people like Bruce, who was not intersexual, but through accident no longer had a male sexual organ.
In 1965, this theoretical extension of Money's theory had been strongly criticised by the biologist Milton Diamond, who believed that gender identity had a strong biological basis, and had been carrying out animal research which demonstrated a link between adult sexual functioning and the hormones encountered by the fetus during prenatal development. Diamond believed that even if intersexual children had enough biological ambiguity in their early days to justify being streamed into either gender, the same did not apply to sexually normal children, such as Bruce.
It was not long after the publication of this paper - which contained the rebuke ". . . we have been presented with no instance of a normal individual appearing as an unequivocal male and being reared successfully as a female" - that the case of Bruce Reimer came to Money's attention. Bruce's mother had written to him explaining her son's drastic situation, and at a meeting in his Baltimore office, Money suggested that he should undergo surgery to give him female genitalia, and should be brought up as a girl. On his theory, these two conditions would be enough for him to grow up as a perfectly normal female in his thoughts and feelings, and this undoubtedly seemed better than growing up as a male with a penis destroyed in infanthood.
Bruce becomes Brenda
Money advised Bruce's parents that they should act quickly if they wanted the operation done, because he had established a maximum age of about 30 months at which a child was still ready to adopt either gender. Bruce - now set to become Brenda - was already 22 months old. His parents eventually agreed, and Money reminded them that from now on, Brenda was to be treated in every as a female. Money was aware that the process could not work if Brenda's parents showed any doubt or ambiguity as to the gender of their child.
Bruce became Brenda, and was brought up with her brother but in every way a girl. She wore dresses, was given dolls and sewing kits as toys, and was encouraged to play with the other girls and behave like them. Her mother exchanged letters with Dr. Money in which she made sure to optimistically mention every instance of "feminine" behaviour Brenda showed. Everyone was hoping, naturally, that her feminization would be a success, and that she would grow up a perfectly normal girl.
Money had stipulated that both Brenda and her brother Brian should visit him at his Baltimore office once a year, so that he could check on their progress. Both recall that he asked them intensely personal questions, attempted to arouse their interest in the opposite sex with the use of pornographic pictures, and even asked them to undress, sometimes in the presence of psychiatric colleagues.
In December 1972, Money made his first public announcement of the "twins case". A Time magazine article, and a mention in his latest book Man & Woman, Boy & Girl, proudly presented the case as proof of the theory that gender is determined by upbringing, not by biology. Brenda was, apparently, a perfectly normal, perfectly feminine seven-year-old girl. It was a triumph for environment over genes.
Over the following years, Money continued to follow-up on the twins and reported that everything was going smoothly. This was the gist of a 1975 article in the Archives of Sexual Behaviour, and a description of the case in his book Sexual Signatures. The lives of the twins - identical in genes, different in behaviour - would have been a perfect vindication of Money's theory if not for the simple fact that Brenda's behaviour had never been anything like that described by Money himself.
Brenda's failed feminine identity
In childhood, Brenda had tried to tear off her dresses and play with her brother's toys. When a young Brian wanted to pretend-shave to imitate his father, Brenda was determined to do so as well. In her speech, mannerisms and interests she resembled nothing so much as a typical boy of her age, and it was clear to outsiders that there was nothing much feminine about her.
Her experience at school, was accordingly, a nightmare. Rejected by both sexes, mocked by the children, and not even supported by the teachers, she found herself without friends. At high school, neither sex would allow her to use their bathrooms, and she was reduced to urinating outdoors.
Part of Money's plan for making her a normal female involved taking estrogen tablets from the age of 12, so that her body would develop female in tandem with her supposedly feminine identity. Brenda rebelled against this, but reluctantly started to take them after pressure from her parents and endocrinologists. She was also supposed to have vaginal surgery to make her sexual organs fully female (as per Freudian developmental theory), but adamantly refused. In any case, her male endocrine system (courtesy of "her" XY chromosomes) was starting to compete with the estrogen medication; Brenda was clearly not growing up to be a normal girl physically anymore than she was mentally.
Both the twins were increasingly objecting to their yearly meetings with Dr. Money, and the last time the family met him was in 1979. With her obviously masculine physique and behaviour, it was becoming obvious that the "sex change" had comprehensively failed. Brenda was supposed never to hear of what had been done to her, for fear that she would be struck by confusion as to her gender, but the idea was becoming a sham. She had in any case never experienced any form of confusion - she had claimed since early childhood that she knew she was a boy. In March 1980, her father tearfully explained to her what had happened when she was seven months old.
Genes win over environment
She quickly opted for a sex change. Her breasts were removed, a rudimentary penis was constructed, and Brenda became Bruce once more. After a reasonably happy start as a sixteen-year-old male, he encountered problems when it became clear that dating would be enormously difficult with a makeshift penis that was not capable of becoming erect. At one point he attempted suicide. But at the age of 21 he underwent an operation which significantly improved the function of his penis, and this helped him to become a more normal male. At the age of 25 he married the woman with who he still lives at a typical suburban address, working a well-paid factory job. He has since renamed himself David, a name he chose in childhood to represent his victory over the "Goliath" of Dr Money's failed scheme.
For many years all this went unreported, and most people assumed that "Brenda" had grown up to be the normal female that Money had claimed she was all along. But in 1997, Milton Diamond and the psychologist Keith Sigmundson, to whom Brenda's case had been referred twenty years earlier, published the results of a series of interviews with the now-married David Reimer in the Archives of Adolescent and Pediatric Medicine. Despite an uproar of objections, the case could lead to only one conclusion - the notion of a psychologically-pliable gender, determined purely by early experiences and independent of chromosomal biology, was a myth.
Similar studies of other cases, in which the gender of intrasexual or sexually-disfgured children has been arbitrarily decided and then implemented by psychological means, are only now being carried out. This case has been a victory for those opposed to the idea of indefinite environmental determinism, but at the cost of a wasted and traumatic childhood and a family tragedy.
Source: Rolling Stone article available at http://www.infocirc.org/rollston.htm.