★★★★

The Boy Who Was Raised As A Girl

Following on from Genie, this book explores another case which featured prominently in my A level Psychology textbook. It’s one of the most famous stories in the canon, a case which has been used on both sides of the nature-nurture debate, and one which does more than any other to prompt outrage at the medical establishment. It tells the tale of twin baby boys, born in Winnipeg in 1967 and admitted at eight months old for circumcision. When error, either mechanical or human, caused catastrophic burns to the penis of the elder twin, doctors advised that the only option was to castrate the child and raise him as a girl. His distraught parents followed this advice. This is the story of David Reimer: a story of dizzying medical hubris and humbling resilience, made deeply poignant by a tragic coda which postdated the publication of this study.

What do you do, as a young and inexperienced parent, when the unimaginable happens to your child? Janet and Ron Reimer did what any couple would have done in the 1960s: they trusted their doctors. But even here they had conflicting advice. There was no question that baby Bruce’s penis had to be removed; but local doctors recommended that the next stage should be to wait, and construct an artificial penis shortly before he was due to start school. But the Reimers were beside themselves with anxiety, until (when the twins were a year old) they saw a doctor being interviewed on television.

This man, John Money, had a successful clinic at Johns Hopkins Hospital which dealt in sex reassignment surgery, then still very much in its infancy. He was a charismatic and persuasive advocate for the treatment and the Reimers felt that he could give them some hope. When they contacted Money, begging for help, he invited them to visit him in Baltimore where he offered an alternative solution to their problem. Forget the idea of a clumsy phalloplasty. He could give them something even better. Studies had shown that, if Bruce was castrated and scheduled for a vaginoplasty just before adolescence, he could be reared as a completely normal, happy and well-adjusted little girl. The Reimers saw a light at the end of the tunnel. And so it was that Bruce Reimer became Brenda, shortly before her second birthday.

John Money is, very clearly, the villain of this book. Colapinto gives the impression of being a balanced writer, presenting the facts as they stand, but it’s tempting to think he has emphasised Money’s most objectionable qualities. How else can we accept that such a man was allowed such leeway for so long? I can only base my reaction on this one book, which is all I know about the details of the case, but what this gives us is chilling. Money comes across as arrogant, overbearing and aggressive, used to being hailed as the genius of his field and unable to deal with any challenges or criticisms of his work. Committed to the idea that gender identity was formed by nurture rather than nature, he cited a whole raft of successful case studies (few of which, notes Colapinto, can be tracked down and none of which are as clear-cut as Money claimed). The ethical alarm bells go into overdrive even before the most disturbing sections of the book. It’s clear that the Reimers were intimidated by Money’s status and education, and beguiled by his confidence. There seem to have been no committee meetings or board approvals of the very risky and comparatively untried experiment on which Money would embark with Brenda as his guinea pig. The overriding impression is of a man playing God, confident that he could brazen his way through it and gain acclaim with this little girl’s success.

More troubling, far more troubling, is the way that Money’s attitudes were influenced by his time. Moulded by the 1960s and 1970s, he argued that sexual identity could only be formed successfully in a climate that was entirely free and open about sex. He encouraged the Reimers to walk around the house naked so that the twins could understand that sexual difference was a natural, healthy and honest part of life. This, I can vaguely understand. But Colapinto delves into the darker aspects of Money’s work (not necessarily connected directly with the Reimer case). He notes Money’s condoning of ‘affective’ sexual relationships between pubescent children and much older adults; the doctor’s suggestion that parents should make love in front of their children to promote the formation of healthy sexual identity; and, most disturbing to me, his insistence on the healthy role of sexual play amongst children, to the point of forcing the Reimer twins to engage in sexual role-play in front of him. He also showed Brenda (and other patients) explicit pornography during their sessions. All this seems to have happened without the parents’ presence, awareness or consent. Nowadays the scandal would be unimaginable.

In such deeply uncomfortable circumstances, what comes through very strongly is the force of Brenda’s self-assertion. Despite what she was being told by the adults around her, and despite the annual visits to Money (where she was badgered to agree to a vaginoplasty from the age of seven, something she refused point-blank from the same age), she knew something wasn’t right. All the witnesses and case reports quoted by Colapinto show that she was extraordinarily masculine in her behaviour, her aggression and her interests. She was confused by the fact that everyone wanted her to behave in a way that felt so unnatural. Why did everyone want her to be interested in cooking and sewing and cleaning? (Gender roles, I might add, for which most genetic females would be hard-pressed to show enthusiasm.)

School and socialising, needless to say, were a torment, especially as Brenda grew older – remember, of course, that at this stage she was effectively a castrated boy, lacking testicles and penis but otherwise developmentally normal. At around ten or eleven, her body began to change: no amount of play-acting as a girl would hide the fact that her body was trying to develop as a boy. And she was beginning to find herself sexually attracted to girls. Besides, she knew, with unshakeable conviction, that she herself wasn’t a girl, even if she felt obliged to play-act the role sometimes to please her parents. After thirteen years of confusion, emotional problems and increasingly aggressive behaviour at school, her psychiatrist eventually said that enough was enough. Her parents had to tell her the truth. At the age of fourteen, Brenda and her twin Brian finally learned the truth of what had happened. And, at that point, Brenda immediately ceased the charade she’d been forced into. She stopped taking feminine hormones, began presenting as a boy, and chose to undergo the further surgery that would give him, as David, a functioning penis.

There are so, so many issues raised by this book that I just can’t process them all at the moment. It’s some comfort, perhaps, that such a thing would never happen nowadays – or at least, I assume it wouldn’t. Am I being naive? It seems to me that so much work has been done on gender identity in recent years that we’re increasingly choosing to give intersex children, or those with damaged genitals, the chance to grow up to find their own identities without imposing them through almost irreversible surgery. Colapinto’s argument makes a strong case for nature being a key component in the formation of such identities. Nurture still plays an important role, but is often undermined by contradictory messages sent from chromosomes, the exposure to testosterone in the womb, and other in utero developmental factors. The conclusion I drew, very tentatively, is that nature (biology, genetics, prenatal hormones) is largely responsible for our gender identity, but that nurture defines the kind of gender roles children think are appropriate (i.e. bringing up girls with a shallow vision of femininity which is all frills, pink and princesses). One thing’s for sure. If I were to have an intersex child, I wouldn’t let a doctor and scalpel anywhere near them until they were ready to make their own choice.

The book does very well in avoiding sensationalism. I think Colapinto is less neutral than he claims to be, because his heart is obviously very much with David (as is mine) and against Money’s egotistical attempts to play God. But he is nevertheless scrupulously clear and thorough. He has drawn on case notes from Money’s meetings with Brenda; transcripts of conversations; and recorded testimonies. He has tried to discuss the case with Money, and has succeeded in discussing it with Money’s academic rival and nemesis Milton Diamond. More importantly, Colapinto explains that he wrote the book with David’s full involvement, and David’s memories are frequently included verbatim.

Having said all of this, there are ethical problems: problems that Colapinto anticipated, as one can seen from his thorough afterword. For example, I was struck by his account, in his introduction, of the book’s genesis, particularly the fact that he agreed to write it on condition that David dropped the mask of anonymity that he’d maintained up until that point (1997). I have no doubt that this was done in the best of faith. I have no doubt that David agreed. But did he really think through what such publicity would do to him, and his family, in associating him openly and irrevocably with childhood memories he often said that he (and his parents and brother) wished to forget? But the book gives only an upbeat report of the consequences of David’s decision to go public. Colapinto finishes on a high as the world embraces David with compassion and acceptance, and he finally finds a way to speak out and save others from a similar fate.

It’s a Hollywood ending. We’re shown that, despite enormous suffering, David has rebuilt his life with the same remarkable resilience he showed as a child when, as seven-year-old Brenda, he resisted the doctors who wished to turn him into a girl forever. He’s now married and has (step)children; he has found a gender identity within which he feels comfortable, and he doesn’t blame his parents, saying they only tried to do the right thing. His brother Brian, who went through almost as much, has been through some dark times with drugs and crime, but is doing well. Their mother Janet is dealing with her depression, and she and Ron are now much closer than they have been for years. You close the book with relief, thinking, ‘Thank God that all turned out OK in the end’.

Only it didn’t, because life carries on after the last page of a book like this. As Nature Made Him was first published in 2000, accompanied by enormous press interest in David. My paperback edition came out in 2001. By that time, the slaughterhouse where David worked had already closed and he was unemployed. In 2002 his brother Brian, who had already attempted suicide twice, succeeded in killing himself with an overdose. In 2004, David’s wife – who, remember, must have been overwhelmed by the media circus surrounding her husband – asked for a separation. Two days later, at the age of 38, David shot himself in the head. And so the final message is actually grim: childhood trauma, of the kind these two poor boys were put through, affects you for life. What was an intellectual experiment for John Money – and to some extent for Milton Diamond too – was life for David. And, ultimately, he just didn’t feel it was worth it.

Harrowing and enraging, this is not an easy book to read. It feels voyeuristic, especially knowing what happened in the end. But it’s an important book if you have the slightest interest in childhood development, medical ethics, or gender issues.

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