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I picked up this book on David Reimer recently. Nonfiction, it devotes its attention to three different subjects. One of those is David, born Bruce and raised as Brenda. As an identical twin, David was born with normal cis hormones and genitals, but lost his penis in a botched circumcision around the age of 8 months. Afterward, he was surgically altered and raised as a girl on the advice of Subject #2, Dr. John Money.

Money made a name for himself as a sexologist and headed up the Johns Hopkins gender research lab. He guided and honed MTF transgender surgery in the United States. He also spearheaded the movement to surgically alter intersex children and raise them as whatever sex parents preferred, often citing David Reimer as proof that it could be done. Money believed gender was entirely sociological, not biological, and therefore, babies could be altered and raised as any gender without ill effects.

The third subject is Milton "Mickey" Diamond, a scientist who naively published a paper challenging Money's research when he was in grad school. Mickey became a lifelong target of Money's, and was in a sense ostracized by the scientific community, but he quietly continued his research. Unlike Money, Diamond believed there was a biological, genetic source of "gender" -- and that includes for trans and intersex folks, too. One's genetic gender, for a variety of reasons, might not match one's assigned gender at birth, and extensive bloodwork might show an invisible intersex condition in many trans folks.

Since this book was published in 2002, it's not clear if Diamond's research was ever continued ... I haven't looked into it yet.

Largely, the book follows Money's soaring career, his manipulation of patients and shady business practice, and the decidedly tragic trajectory of David's life. David, raised as Brenda, knew he was male from the moment they tried to put him in dresses, but couldn't articulate it. He consistently struck strangers (classmates, teachers, babysitters) as a little boy, in terms of demeanor and interests, posture, the way he walked, etc. Every year, David was taken to Money's research lab, where he and his twin brother were subjected to highly personal interviews from a very young age. Money quizzed them on their sexual preferences, habits, and fantasies as young as six, showed them pornography, and made them reenact sex with each other and unclothe to examine each other's genitals.

Money firmly believed all this was necessary for "Brenda" and her uncertain gender identity. In the press, Money made no mention of Brenda's insistence that she was a boy, her disgust for girly things, her peers' and teachers' POV, or her struggles in school. He trumpeted the case as a total triumph and described Brenda as a very girl young girl who loved dolls and dresses.

When she hit puberty, Brenda refused to go see Dr. Money for her yearly trips. She knew by now that there was something wrong with her genitals and that she was supposed to have reconstructive surgery on her vagina. The concept made her miserable. Eventually she rejected dresses and long hair and started going out in public as a boy. Her parents felt compelled to tell her the truth and help her transition with a local team. His therapists at first resisted, but over the course of several years, they broke away from Dr. Money and helped David start on testosterone and get a phalloplasty. He, his parents, and his twin brother remained traumatized by the whole ordeal.

Although the author of the book didn't know this at the time, David's twin brother would commit suicide shortly after it was published. David followed not long after.

Here are some quotes I highlighted:

"My parents feel very guilty, as if the whole thing was their fault," David explained to me during my first visit to Winnipeg. "But it wasn't like that. They did what they did out of kindness and love and desperation. When you're desperate, you don't necessarily do all the right things."

(Note: Why did David's parents agree to transition their son into a daughter? For David's mom, Money stressed that David would never get married to a woman as he was, never have kids, never be a dad. Phalloplasty was not advanced enough at the time to allow David to pass as a normal man. For David's dad, it was simple. He imagined his son playing with other toddlers. What do little boys do? They have pissing contests. Right away, before he even hit preschool, David would have social issues. When the other boys pissed against a fence, David would either have to say no and explain why, or show them what was wrong with him, maybe not willingly. If David was surgically altered, though, he could get married as a woman to a man, have sex normally, and adopt children as many women do. No little girls would find anything odd about his genitals. There would be no awkward moments, no bullying.)

*****

Addressing the theory about the psychosexual flexibility of intersexes, Diamond pointed out that such individuals had experienced "a genetic or hormonal imbalance" in the womb, and he argued that even if human hermaphrodites could be steered into one sex or the other as newborns (as Money claimed), this was not necessarily evidence of their gender neutrality at birth. It might simply suggest that the organization of their nervous systems and brains had undergone in utero a similar ambiguous organization as their genitals. In short, they had an inborn neurological capability to go both ways -- a capability, Diamond hastened to point out, that genetically normal children certainly would not share. As for transexuals, who showed no observable anatomic ambiguity of sex, Diamond postulated that they, too, might possess an as yet undiscovered biological condition that hardwired their brains to a program opposite to the evidence of their bodies -- a possibility that Diamond was able to back up with evidence from no less an authority than Dr. Harry Benjamin himself, who had recently reported that in forty-seven out of eighty-seven of his patients, he "could find no evidence that childhood conditioning" was involved in their conviction that they were living in the wrong sex.

*****

"To support (such a) theory," Diamond wrote, "we have been presented with no instance of a normal individual appearing as an unequivocal male and being reared successfully as a female." And Diamond had added: "If such an individual is available he has not been referred to by proponents of a 'neutrality-at-birth' theory. It may be assumed that such an individual will be hard to find." Hard -- but not, as events transpired, impossible. For it was just one year and eight months after Diamond threw down this gauntlet in the Quarterly Review of Biology that Dr. John Money received a letter from a young mother in Winnipeg, Canada, describing the terrible circumcision accident that had befallen one of her identical twin baby boys.

*****

What is not clear from Money's written accounts of this meeting is whether Janet and Ron (Reimer), whose education at the time did not go beyond ninth and seventh grades, respectively, understood that such a procedure was in fact purely experimental -- that while Money and his colleagues at Johns Hopkins had performed sex reassignments on hermaphrodite children, no such infant sex change had ever been attempted on a child born, like their Bruce, with normal genitals and nervous system. Today Ron and Janet say that this was a distinction they did not fully grasp until many years later.

*****

Finally Ron and Janet realized that only they could decide the fate of their child. They alone were the ones living with the reminder, at each diaper change, of his terrible injury. Janet saw the benefits of changing their son into a daughter. "I didn't know much back then," she says, "and I thought women were the gentler sex. Mistakenly. I have since learned that women are the hard-core knockabout tough guys. Men are the gentler sex, by far, from my experience. But I thought, with his injury, it would be easier for Bruce to be raised as a girl -- to be raised gently. He wouldn't have to prove anything like a man had to."

*****

Instead, Diamond met several patients who contradicted the claim that rearing in a particular sex will always make a child accept that designation. There was the female baby exposed to excessive testosterone in utero, who was reared from birth as a girl but at age six stated to her mother that she was "a boy." There was the genetic male born with a tiny penis and raised as a girl, who at age seventeen voluntarily came to Louisville Children's Hospital requesting a change of sex to male -- and was willing to endure more than twenty-five surgeries to construct an artificial penis, so vehemently was "she" determined to live in the sex of her genes and chromosomes.

*****

By exploring the family dynamics of his gay patients, Zuger discovered that in many cases the stereotypical pattern of an overbearing mother and a detached, hostile father did pertain; but by actually observing children in their family settings, Zuger came to believe that such a dynamic was not a cause of the child's homosexuality, but an effect.

******

That the academic community at large accepted Money's version of events was clear from yet another book published that year: John Money: A Tribute, a collection of essays written on the occasion of Money's seventieth birthday. Replete with paeans to Money's scholarship from longtime acolytes, including Anke Ehrhardt and June Reinisch, the volume also included a fulsome tribute from Dr. John Bancroft, a psychiatrist and clinical consultant at the Royal Edinburgh Hospital in Scotland, who is now director of the Kinsey Institute. A behaviorist who was a believer in the primacy of rearing over biology in sexual orientation, Bancroft had taken this nurturist view to its logical conclusion in his clinical work. As a sex therapist in Great Britain, he had experimented with trying (in vain) to convert adult homosexuals to heterosexuality through aversion therapy.

*****

Dr. Howard Devore, the psychologist who studied under John Money in the 1980s, was born in 1958 with acute hypospadius (a penis open from base to tip) and with undescended, underdeveloped testicles, but was raised as a boy. Beginning at age three months he endured some sixteen "normalizing" surgeries through childhood, aimed at giving him a cosmetically convincing penis. The experience, Devore says, was emotionally devastating -- and wholly unnecessary. His genitals still do not resemble those of a normal male and the sole result of his constant hospitalizations is a psychological scarring far worse than he would have experienced had he been raised with counseling to accept his atypical genitals. Devore refrained from making this argument to Money. "I learned very early that if you choose to do battle with John," he says, "you have to deal with a very, very angry man who's going to make you feel horrible for challenging him."

*****

I did desist for the next two months while I wrote my Rolling Stone story. In early November, with the article going to press, I phoned Money's office to check some facts with his assistant, William Wang. I was surprised when Money got on the line. Although he refused to discuss David Reimer's case directly, he claimed that the media's reporting of it reflected nothing more than a conservative political bias. He was particularly incensed by the New York Times front-page story. "It's part of the antifeminist movement," he said. "They say masculinity and femininity are built into the genes so women should get back to the mattress and the kitchen."

*****

"You cannot be an it," Money declared, adding that Diamond's recommendations would lead intersexes back to the days when they locked themselves away in shame and worked as "circus freaks."

*****

On of Money's more engaging and intelligent defenders is Dr. Kenneth Zucker, a psychologist at the Clarke Institute of Psychiatry in Toronto and a longtime adherent to Money's nurturist bias in gender identity formation. In his clinical work, Zucker has for years attempted to modify homosexuality and transexualism in boy and girl children.

*****

He also presented a long-term follow-up on a second case of a developmentally normal baby boy who had been raised as a girl. The investigator was John Money, who had authorized and overseen the patient's sex reassignment in infancy and who had, true to practice, conducted a number of annual follow-ups with the child until she (for reasons unspecified in Zucker's paper) stopped returning to Johns Hopkins.

*****

"You know, if I had lost my arms and legs and wound up in a wheelchair where you're moving everything with a little rod in your mouth -- would that make me less of a person? It just seems that they implied that you're nothing if your penis is gone. The second you lose that, you're nothing, and they've got to do surgery and hormones to turn you into something. Like you're a zero. It's like your whole personality, everything about you is all directed -- all pinpointed -- toward what's between the legs. And to me, that's ignorant. I don't have the kind of education that these scientists and doctors and psychologists have, but to me it's very ignorant. If a woman lost her breasts, would you turn her into a guy? To make her feel 'whole and complete'?" -- David Reimer

*****

"After I tried to kill myself, they put me in one of those psycho wards. Right away they want to put you in a group meeting. You can't even face this by yourself, and they're going to stick you in a room full of people so you can discuss this with strangers?" -- David Reimer

*****

"I'm happiest when I'm alone. Doesn't mean I'm not friendly. It's just I'm more comfortable when I'm by myself. It's not lonely. It's relaxing. It's soothing. It reminds me of my grandfather's farm. If I go for a walk there, I'm in total peace. I'm never alone there. You always feel like you're surrounded in a place like that. Surrounded by what, I don't know. But you're not alone." -- David Reimer

*****

Impressed with what I had been able to glean about Mary's special human touch with her patients -- and especially with Brenda -- I asked her about her general approach to psychiatry. In reply, she said "You have a parental attitude to your patients." Then she glanced in the direction of the hallway, where David's voice could be heard. "Just like a parent," she added, "you often admire them." I was moved by this word admire -- so different from what one ordinarily expects to hear a psychiatrist say about a patient, or to hear a highly educated doctor like McKenty say about a slaughterhouse sanitation worker like David Reimer. But it was clear that her admiration for David was total.

*****

"Is there anything you want to change?" she asked. David looked down at his hands. He breathed a tired sigh. Then he looked at her. He smiled. "Everything I've wanted to do," he said, "I've done."

*****

From the afterword:

None of this is to suggest that nurture plays no role in gender identity. Virtually every page of "As Nature Made Him" contains an environmental cue or clue that helped to reinforce what Brenda's prenatally virilized brain and nervous system were telling her. Among these environmental cues, I would include the presence of an identical twin brother who so closely resembled Brenda and yet was, mystifyingly, of the opposite sex; the scarred and unfinished state of her genitals which contributed to her conviction that something was unusual about her assigned gender; the teasing and ostracization of peers and classmates who jeered at her for her masculinity; the growing realization on the part of Ron and Janet, around the time of Brenda's seventh birthday, that the experiment was a failure; the trips to Johns Hopkins, where her genitals and sexual identity were of such obsessive interest to Money and his students; and indeed, the second-class status assigned to females in society -- a condition that leads many dispirited girls to wish (around the time of puberty) that they could be boys. All of these factors, I'm convinced, played a role in undermining the experiment.

*****

How many children, at the exquisitely awkward age of fourteen, will insist, upon threat of suicide, that they undergo full sex change, in plain view of neighbors, family, and friends? This almost incomprehensible act of courage on Brenda's part speaks more convincingly than any other piece of evidence to the emphatic demands of our biology, and to the necessity that we -- ALL OF US -- be allowed to live as we feel we must.

*****

"It's hard to talk about it all the time," David told me recently about the seemingly unending publicity blitz. "The memories flood back that much faster. And they're not good memories. But what choice do I have? No one else who's been through what I've been through seems to want to talk about it. I don't blame them. It's embarrassing. But if you're going to let people know the truth, you have no choice. It's the only way to change things."

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