Book Review

Reclaiming sexual Identity


THE REIMER TWINS AND MEDICAL EXPERIMENTATION

Reviewed By Babette Francis


BABETTE FRANCIS reviews a book about a boy who was raised as a girl and whose unfortunate medical history led to claims that proof existed that boys and girls are 'made' not `born'. Ensuring media hype about the alleged fact that the primary factors driving human psychosexual differentiation are learning and environment is evaluated.


As Nature Made Him;
The boy who was raised as a girl

by John Colapinto
Published by Harper Collins,
279 pp. $25.05.

IN 1977 as a member of the Victorian Committee on equal Opportunity in schools, I wrote a Minority Report because I disagreed with the other members that most, if not all, of the observable differences in the educational outcomes for girls and boys were due to 'discrimination' or 'social conditioning'. While culture and parental influence obviously played a part, it seemed that many of the subject choices and the future career paths of girls and boys were based on their innate preferences, and the aggressive social engineering recommended by the Committee was not justified.

Although not recorded in the Majority Report, a recurring name in our Committee discussions was that of New Zealand-born Dr. John Money, who received his Ph.D in psychology from Harvard and then worked as a researcher at the John Hopkins Hospital in Baltimore. Credited with coining the term 'gender identity' to describe a person's inner sense of himself or herself as male or female, Money established the world's first Gender Identity Clinic at John Hopkins, devoted solely to the practice of converting adults from one sex to the other. Money became known as the world's undisputed authority on the psychological ramifications of ambiguous genitalia, and adviser on the pioneering practice of transsexual surgeries.

Money's influence throughout the academic and scientific world would define the scientific landscape for decades to come. To the present day many of his students and proteges, trained in his theories of psychosexual differentiation, occupy top positions in some of the most respected universities, research institutions and scientific journals in the USA. His theories on the psychosexual flexibility at birth of humans forms the cornerstone of an entire medical speciality - pediatric endocrinology - and his influence even reached the Victorian Committee on Equal Opportunity in Schools.

Bruce and Brian Reimer, normal identical twin boys, were born in Winnipeg, Canada, in 1965. Due to a circumcision procedure which went terribly wrong, Bruce's penis was burnt and destroyed. Eventually doctors at the Mayo clinic in Minnesota emphasising the difficulties of reconstructing the organ, suggested to the parents, Ron and Janet, the possibility of raising Bruce as a girl. They were referred to Dr. John Money at John Hopkins. He gave the parents reassurance that Bruce's sex re-assignment as a girl had every chance of success. John Colapinto's book tells the story of what happened to the twin boys thereafter.

Ran and Janet Reimer did not realise that Money's previous infant cases of sex re-assignment had been hermaphrodites and that the procedure he recommended - castration and the construction of external female genitalia, followed by hormone treatment when the child was eleven - was experimental. It had never been attempted on a child born with normal genitals and nervous system. Fate had delivered into Money's hands the opportunity for the perfect experiment, complete with the perfect 'control', the identical twin, essential if results are to be validated.

The Reimer's pediatrician in Winnipeg advised against the procedure and recommended that they wait until the child was of pre-school age before starting the long process of phalloplasty, i.e. surgical reconstruction of the penis. However, Money wanted a quick decision - according to one of the finer points of his theory, the 'gender identity gate' - his term for that point after which a child has locked into an identity as a male or female - comes at two and a half to three years of age. Bruce was now nineteen months. Money wrote: 'The child was still young enough so that whichever assignment was made, erotic interest would almost certainly direct itself toward the opposite sex later on, but the time for reaching a final decision was already short'. In July 1967, aged 22 months, Bruce was surgically castrated at John Hopkins by surgeon Dr. Howard Jones, the co-founder of Money's Gender Identity Clinic. The main procedure was a bilateral orchidectomy, removal of both testicles. Dr. Jones fashioned a rudimentary vagina with the remains of the scrotal skin.

Reimer twins
A Moral Revival?

PERHAPS the most promising development in our time is the rise of an energetic, optimistic, and politically sophisticated religious conservatism. It may prove more powerful than merely political or economic conservatism because religious conservatism's objectives are cultural and moral as well. Thus, though these conservatives can help elect candidates to national and statewide offices, as they have repeatedly demonstrated, their more important influence may lie elsewhere. Because it is a grass roots movement, the new religious conservatism can alter the culture both by electing local officials and school boards (which have greater effects on culture than do national politicians), and by setting a moral tone in opposition to today's liberal relativism.

We may be witnessing a religious revival, another awakening. Not only are the evangelicals stronger than ever in their various denominations but other organizations are likely to bring fresh spiritual forces to our culture and, ultimately, to our politics. The Christian Coalition, the Catholic Campaign for America, and the resurgence of interest among the youth in Orthodox Judaism are all signs that religion is gaining strength. If so, religious precepts will eventually influence political action.

- Judge Robert H. Bork, Slouching Towards Gomorrah, Regan Books, 1996.

'Brenda'

The baby was renamed 'Brenda'. In making their drastic decision, Ron and Janet Reimer were no doubt influenced by the prospect of the teasing and humiliation their child would endure as a boy at school and elsewhere. As a baby they could not even leave him with a baby-sitter because any nappy change would reveal his terrible injury. At that time plastic surgery was in its infancy, and it was considered easier to construct a vagina than restore a penis.

His parents made every effort to follow Dr. Money's instructions scrupulously and raise Brenda as a girl. For the twins' second birthday, Janet made her a dress from the white satin of her own wedding gown. 'It was pretty and lacy', Janet recalls. 'She was ripping at it, trying to tear it off. I remember thinking Oh my God, she know's she's a boy and she doesn't want to be a girl. But then I thought, well maybe I can teach her to want to be a girl. Maybe I can train her so that she wants to be a girl'.

The experiment was a failure from the outset - Brenda showed no signs of femininity and every sign of masculine behaviour, including rough and tumble and fighting games, and standing up in the toilet to urinate. She failed to bond with her female school mates, and despite several changes of school, and referral to counselling and psychiatrists, had disciplinary and academic problems; she just did not fit in. She was kept back in first grade; her twin was promoted.

At the time of Brenda's castration, Dr. Money had stipulated that the parents with both Brenda and her twin, Brian, pay follow-up yearly visits to his Psychohormonal Research Unit at John Hopkins in Baltimore. These trips were an ordeal for the Reimer family and exacerbated the fear and confusion Brenda was experiencing. Without their parents being present, the twins were subjected to detailed questioning, some of it mundane, some of it designed to persuade Brenda to accept her 'femininity'; other questions were of a more explicit sexual nature. The twins were also coaxed into sex play, somewhat reminiscent of Kinsey's experiments on infants, which in our more enlightened era we now regard as child abuse.

Besides the yearly visits, the Reimer parents also corresponded with Dr. Money about the many difficulties they were having with Brenda, but were reassured by Money and his colleagues that Brenda was just going through a 'tomboyish' phase. Despite all the indications that the experiment was a massive failure and that Brenda was having major psychological and behavioural problems, in December 1972, four months after Brenda began her second attempt at first grade, Dr. Money unveiled his famous twins' case. In a two-day series devoted to 'Sex Role Learning in Childhood and Adolescence' at the annual meeting of the American Association for the Advancement of Science in Washington DC, Money's paper was delivered to a capacity crowd of over one thousand scientists, feminists, students and reporters. He mentioned that a fuller account of the twins case could be found in his book 'Man & Woman, Boy & Girl', which was promotionally marketed the same day. The theme was that the primary factors driving human psychosexual differentiation are learning and environment, not biology.

Money wrote that as experiments on humans are ethically unthinkable, one can only take advantage of unplanned opportunities such as when a normal boy baby loses his penis in an accident, and how he had taken advantage of just such an opportunity. From his inaccurate description the case was a great success - he contrasted Brian's interest in 'cars, gas pumps and tools' with Brenda's avid interest in 'dolls, a doll house and a doll carriage'. Brenda's cleanliness was described as different from Brian's. Brenda was interested in kitchen work, Brian disdained it. The twins seemed to embody an almost miraculous division of taste, temperament and behaviour along gender lines, and seemed the ultimate proof that boys and girls are made not born.

The 'perfect' experimental proof

The importance of the twins' case cannot be underestimated. It was seized on by the feminist movement which had been arguing for years against a biological basis for sex differences. Money's papers from the 1950s on the psychosexual neutrality of newborns had already been used as one of the main foundations of modem feminism. Kate Millet in her 1970 definitive feminist tome, 'Sexual Politics, had quoted Money's papers as scientific proof that the differences between men and women reflect not biological imperatives but societal expectations and prejudices. The twins' case offered apparently irrefutable proof.

Over the next few years Money continued to present Brenda's case as a success - even when on her yearly visits to him she was frowning, sullen and answered his questions in monosyllables, and was so reluctant to see him that her parents had to bribe her with promises of trips to Disneyland. At a time when the Reimer parents, because of the behavioural problems Brenda was exhibiting at school, had been forced to break confidentiality and inform counsellors and her psychiatrist of her medical history, Money wrote: 'Her behaviour is so normally that of an active little girl, and so clearly different by contrast from the boyish ways of her twin brother that it offers nothing to stimulate anyone's conjectures'. The reality was that Brenda at age eleven was developing certain physiological changes - her shoulders had started to widen and grow more muscular, her neck and biceps began to thicken, and sometimes her voice would crack. She was rebellious about taking the estrogen pills intended to make her develop breasts, and she was totally resistant to the planned second stage of her vaginal reconstruction surgery.

On her visit in 1978 to Dr. John Money when he arranged for a transsexual to talk to her, Brenda became so terrified she ran away from the Clinic, and on being re-united with her parents at their hotel she told them that if they ever again forced her to see Dr. Money she would kill herself. Her parents still hoped that her metamorphosis as 'Brenda' would occur, but in May of 1980 when Brenda insisted to her Winnipeg endocrinologist and psychiatrist that she did not want to be a girl, they advised her father to tell her the truth about what had happened to her as an infant. Brenda's feelings were of anger, amazement, but overwhelmingly of relief. She said 'Suddenly it all made sense why I felt the way I did. I wasn't some sort of weirdo. I wasn't crazy'.

Although Money's views on psychosexual neutrality or the malleability of gender identity was the established wisdom of the scientific community and particularly of the feminist movement, there was one researcher who had been questioning his conclusions. With a pioneering team of endocrinologists at Kansas University in the 1950s, working of guinea pigs, researcher Dr. Milton Diamond and colleagues established that prenatal sex hormones played a significant role not only on the development of the reproductive system and external genitalia of a fetus, but also on the masculinisation or femininisation of the brain.

The results were published in a 1959 issue of Endocrinology. In a follow-up paper entitled 'A Critical Evaluation of the Ontogeny of Human Sexual Behaviour' Diamond rejected outright the John Hopkins teams' theory. Reporting on the guinea pig findings, Diamond stated that prebirth factors set limits on how far culture, learning & environment can direct gender in humans. Citing evidence from biology, psychology, psychiatry, anthropology and endocrinology, he argued that gender identity is hard wired into the brain virtually from conception. Later confirmation of the guinea pig experiments was to come from effects observed in girls who had been exposed to testosterone in utero - accidentally or as medication given to their mothers.

Diamond's 1959 paper was a direct challenge to the scientific authority of John Money, who had become one of the gurus of the feminist movement. A long and acrimonious academic debate spanning decades ensured. It may explain why when fate delivered to Money the opportunity for the 'perfect' experiment on the identical twins, he seized it so eagerly and why he was so reluctant to acknowledge the signs of failure.

The media inevitably became interested in the famous twins' case which stood as the most compelling evidence to prove the primacy of rearing over biology. However, when a BBC reporter began investigating, he heard rumours that the case was not all it seemed to be. A BBC documentary was produced, entitled 'The First Question' a reference to the first query by parents: 'Is it a boy or a girl?'. There were other media articles as well as the on-going debate in the scientific literature. Psychiatrist Keith Sigmundson's 'John/Joan' article on Brenda's case appeared in the Archives of Pediatrics & Adolescent Medicine in March 1997 and John Colapinto's article in Rolling Stone in December 1997 forms the basis for 'As Nature Made Him'.

Reimer twins2
Differing perspectives

"I have never quite understood the phrase, "Comparisons are odious". But anyone can see that even the very best of comparisons is only comparatively complimentary. A literal interpretation could turn most compliments into insults. It would not do to turn the poet into a botanist when he says "My love is like the red, red rose." There are roses which would suggest rather too apoplectic a complexion and be rough on the lady. And there are ladies of whom it might be said that we are rough on the rose. But there is another sense of the word comparative in which it is liable to another somewhat parallel abuse or error. It is that grammatical classification of a thing in the three degrees of positive, comparative and superlative: as illustrated in the bright little boy who gave the extension of an adverb in the form: "Ill, worse, dead." It will be noted that this, though founded on highly practical experience is not exact as an example of grammatical logic.'

- G.K. Chesterton.33

The real hero of this story is not Milton Diamond or John Colapinto - it is Brenda, or as she was renamed 'David', who having learned the truth, wasted no time in reclaiming his sexual identity. By his fifteenth birthday he was living socially as a male. He began receiving injections of testosterone, and in 1980 underwent an intensely painful double mastectomy. In 1981 he had surgery to construct a rudimentary penis from muscle and skin from the inside of his thighs. Before his twenty-second birthday he had a second more successful phalloplasty in a 12-stage operation. In September 1990 David Reimer married Jane Fontane, a single mother of three children.

His new name was symbolic of his struggle against the Goliath represented by John Money and the medical establishment, and of his courage in giving permission for his personal identity and medical details to be revealed. Until David Reimer spoke publicly about his ordeal the medical establishment was reluctant to admit the dangers of current practice in treating intersex babies, their reluctance no doubt underpinned by their deference to the feminist movement, which, still stuck in a time warp, believes that one can produce an androgynous society by adopting 'counter-sexist' educational practices.

Thus in Australia, Accreditation Guidelines for Child Care Centres forbid carers from telling a girl her dress is pretty. 'Counter-sexist' educational practice is to encourage boys to play with dolls and the dolls' house, eerily reminiscent of Money's euphoric reports about 'Brenda'.

A dose of reality eventually pervaded the medical establishment in the USA. Psychiatrist Dr. Jon Meyer, former director of the Gender Identity Clinic at John Hopkins, produced a long-term follow-up of fifty post-operative and pre-operative adult transexuals treated at John Hopkins and reported that none showed any measurable improvement in their lives and concluded that 'sex re-assignment surgery confers no objective advantage in terms of social rehabilitation'. The Gender Identity clinic was closed. In a 1992 article in the American Scholar, Dr. Paul McHugh, Chairman of the Psychiatry Department at John Hopkins, criticised transsexual surgery as 'the most radical therapy ever encouraged by 20th century psychiatrists', and likened it to the once widespread practice of frontal lobotomy.

Such reality has not reached Australian shores - legislation on 'Gender Identity and Sexual Orientation' is pending in the Victorian Parliament and surgery on transexuals and the transgender continues. In the meantime normal boys are being seriously disadvantaged by the feminisation of education, a problem which is just beginning to attract the attention of Australian politicians.

Recently in the US urologist William Reiner reported that despite hormone treatment and surgery, 25 baby boys born with no penis but normal testicles, castrated and raised as girls, all retained 'strong male characteristics' and most switched back to male. He has laid down his scalpel and has retrained as a child psychiatrist specialising in intersexual conditions. He is convinced that surgery steering intersexual babies at birth into one sex or the other is wrong. My own view is that children should be reared, and adults should live in the sex that matches their chromosomes - XX or XY. The brain is the primary sex organ, and our brains are programmed before birth to be male or female Colapinto's book is one of the most significant since the rise of the feminist movement. It reads like a murder mystery that one cannot put down until the last page.

BABETTE FRANCIS is a mother of eight with a BSc (Hons) in microbiology and chemistry. She is the national and overseas coordinator of Endeavour Forum which is an ecumenical Pro-Life and Pro-Family lobby.



From "Annals Australasia" November/December 2002

Portal to all Annals Australasia and Dr Leslie Rumble files


"ANNALS AUSTRALASIA"


Sean Ó Lachtnáin's Home Page