As Nature Made Him (2001)

In the late 1960s, the Reimers give birth to identical twin boys. When one is mutilated in a botched circumcision, they follow the advice of psychologist John Money to have the boy surgically castrated and raised as a girl. Money believes that people are sexually neutral at birth, that gender identity is entirely the product of environment, not biology. Identical twin boys give him the perfect opportunity to prove this theory. The "girl" rebels from the start, knowing something is wrong, but still the experiment continues, growing more disturbing over time. The psychologist even has the twins engaging in pretend sex play, nude, while he takes pictures.

This is not a novel. This actually happened. The whole thing is both highly disturbing and undeniably compelling. I was absolutely appalled at much of what went on under the guise of medicine, and at what lengths Money went to in order to confirm his cherished theories. The good news is that much of this led to changes in the field of sexual psychology, but that doesn't make it less infuriating to read about. Definitely recommended if you're at all interested in gender identity, but it's a bit hard to take at times. ( )

This compelling, disturbing, humane book forms a segment within a larger history of medical sexology stemming from Richard von Krafft Ebing and Sigmund Freud to Alfred Kinsey and Masters and Johnson to John Money and Richard Diamond. In brief, a surgical mishap turns into a titanic disaster because of theories of human sexuality and gender identity that have no empirical or scientific basis, but, rather, reflect the ego, the ambitions, and the self-delusion of the physician involved.
Bruce Reimer has, as an infant, a condition that makes it painful to urinate and so the doctors decide to give him a circumcision, which is a perfectly reasonable decision and routine procedure. However, in a freak accident, the circumcision is botched, and Bruce's penis destroyed. The Reimers are told that their son "must live a life apart," never get married and never expect the ordinary social comforts and connections as other people. This reaction gives an absolute primacy to the possession of the penis and the remainder of the book goes on to explore how misguided such views are. The parents are desperate and enlist the assistance of Dr. John Money after they see him on television. His proferred solution? Turn the botched boy into a normal girl, and rename Bruce Brenda. The surgeries must be done as soon as possible, and the hormone therapies begun on schedule--for Dr. Money's theory is that gender identity becomes "imprinted" around the age of 2 1/2 and becomes increasingly difficult to alter after that window of time. Brenda undergoes a surgery to remove her testicles, which eliminates permanently the chance for reproduction. However, although the Reimers do their best to raise what had been their boy as a girl, the experiment fails miserably, and Brenda behaves like an aggressive, self-assertive boy who is nonetheless a ridiculed outsider who is held back in school. Despite these facts, Dr. Money reports in his research that the "twins experiment" (Brenda has a brother) has been a great success that shows that gender identity is not biologically determined but, rather, socially constructed and malleable. Indeed, Dr. Money writes several notorious books on the basis of what he and other regard as his great success in this famous case. Among other things, Dr. Money lauds consensual incest (whatever that could possibly mean), parents walking around naked in front of their children, children's sexual role play in preparation for adulthood, and so forth, including sympathetic treatments of rather repugnant perversions. Throughout, however, Dr. Money remains an adamant and unwavering homophobe, who sees homosexuality, as he sees gender identity, as socially acquired as opposed to biologically imprinted and, therefore, natural. David is rescued by a woman psychiatrist with whom he creates an anti-Dr. Money group and upon the insistence of this noble psychiatrist, under whom "patients actually got well," the parents tell Brenda of his actual past. At this point, Brenda changes his name to David, stops taking hormone therapy, and, eventually, gets married and becomes a father to the children of his wife. Sigmund Freud had been the first to posit the primacy of the penis in constructing sexual and gender identity, and one cannot imagine a more devastating rebuke of his theories than this book, which reduces the Oedipus Complex into an idle theory proferred by someone who did not have the means to know what he was talking about and therefore relied on prejudice and inspired best guesses. It is refreshing to hear that the field of pediatric medicine has advanced greatly since the time that the events in this book took place, but it is also sad that David, following his brother Brian, committed suicide. ( )

I first encountered David Reimer’s story as a kid: my mother was getting her special ed certification and brought home a textbook on Child Psychology. At the end of one of the chapters, there was a brief sidebar about the case, which detailed its success, save for an incident when the little boy-turned-girl in question threw her panties over a neighbor’s fence.But, as I learned through John Colapinto’s powerful As Nature Made Him: The Boy who was Raised a Girl, that rosy-if-mischievous picture couldn’t have been further from the truth. David, born Bruce Reimer, was indeed raised a girl, Brenda, when doctors gave his parents no other feasible options after a botched circumcision at eight months old. Though this case was often touted by his doctor, John Money, as immutable proof that gender was completely a social construction, the truth is that Brenda had an incredibly unhappy childhood, marked by social difficulties and competition with her twin brother, Brian, and marred further by disturbing therapeutic sessions (which included forced viewings of pornography and graphic sexual conversations) administered by Money.Colapinto’s account is vividly and soundly written. It’s an incredibly fast-read and has the juicy journalistic quality of a good episode of Dateline, not to mention a similarly horrific car-crash-on-the-highway feel. Colapinto’s strong descriptions of David and his family are incredibly sympathetic; when, after finishing the book, I learned that both David and his brother Brian died at their own hands in 2004 and 2002 respectively, I fully felt the loss of their lives that had, I suppose, begun nearly four decades earlier.Before the publication of As Nature Made Him, the then-anonymous case of the Reimers was often cited by feminists as proof that it was nurture, not nature—upbringing, and not sex—that determines gender. The sad truth is that, had doctors been more open-minded about what constitutes a “boy” or a “man”, David Reimer would have never been subjected to castration, would never have had to endure therapy sessions with Money where he was forced to pose naked with his brother in order to model “proper gender roles”, would never have had to struggle in school and at home with the conviction that he wasn’t really a girl. The motives of the doctors were reductionist, as David himself says: “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 his 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.” (262)I do think that there’s a feminist lesson to be found in Reimer’s story: namely, that prescriptivist attitudes toward gender and sex are problematic, and that forcing gender models (and certainly genital surgery) on young children who cannot express their feelings about their own gender or sex is a dangerous game. ( )

What an account! I am very thankful to say this is not the state of pediatric urology today. I am a member of the American Academy of Pediatrics, Urology SEction, and remember very clearly when Milton Diamond spoke in San Francisco at the AAP conference. Out in the streets, we were being picketed by a group called "HErmaphrodites with an Attitude". What the group failed to realize is that the majority of the pediatric urologists were genuinely trying to understand what was best for the patient.

In my own experience, I can say that gender reassignment is not the norm. When a child is born with ambiguos genitalia, there is a concerted effort to find out what nature actually intended- where the genes are and what "equipment" is there. "Reassignment" is not the norm, rather careful consideration of "assignment". What also has to be looked at is the natural cycles of hormone surges that occur as early as a few weeks or months, that could impact a child. There is an AAP group. or at least was, before I had to leave practice because of medical disability, looking at issues of intersex and helping to clarify the best possible standards of care. Fascinating subject.

As an aside, when I was about 17 or 18, there was this girl I knew who insisted something had been "done to her" to make her a woman. That she was really both male and female, despite the female genitalia she said she had. She was...interested...shall we say, in a relationship with me, but it was not my cup of tea. She kept insisting she was both male and female, so that I shouldn't be uptight, but I still declined. That was in the late 70's. At this AAP lecture by Diamond in the 90's he showed slides of patients. There she was, up on the screen. I blurted out "holy S***! That's ______!" Turns out, she was a true hermaphrodite, who had the external appearance of a female. So she was right- there was a guy inside the female's body! She'd had an operation as a kid to "normalize" her exterior parts. Not that I would know by personal experience, but how weird is it that I should find that out after all those years???? ( )

Imagine an eight-month old boy whose penis was destroyed in a botched circumcision, and whose parents were then urged by a world-renowned psychologist to raise him as a girl. Imagine that they did so, subjecting him to clinical castration followed by a dozen years of psychological and hormonal treatment designed to make him female.

Imagine further that the psychologist - whom the child detested but was forced to meet with regularly - was a sex pervert who defended pedophilia and incest and whose sexual theories were based, not on scientific evidence, but on his own arbitrary beliefs. Imagine that the many psychiatrists the child saw over the years sided almost unanimously with the psychologist. Imagine tha the child lived in utter misery for fifteen years, because on some level he sensed that he was actually a boy - even as he was being hailed in medical textbooks as an ideal example of successful "gender transformation."

This is not the plot of a Hollywood horror movie; it is a true story - powerfully conveyed in *As Nature Made Him*. As the author explains, the psychologist's theory was that sexual identity has nothing to do with one's biological nature, but is solely a matter of "social conditioning." This theory holds, in effect, that the metaphysically given can be readily replaced by any object of human preference. In philosophical terms, it is a tragic instance of the "primacy of consciousness" - the view that reality is whatever we wish it to be - in action. The psychologist in question had no interest in scientific evidence ("It is like playing a game of science fiction") or even in the child's welfare; he actually hated men ("I wondered if the world might really be a better place for women if not only farm animals but human males also were gelded at birth").

Unsurprisingly, there is an additionally tragic aspect to the story. Although the child outwardly conformed to the female role, and suffered terribly, he did not give in intellectually; he continued to insist to himself that he was in some sense a boy, and even went so far as to defy the psychologist (who wanted him to have a "female" operation) and his own parents. When psychiatrists finally convinced his parents to tell him, at age 15, the truth about what had happened, he immediately chose to reassert his masculinity, to have corrective "male" surgery and to live as a man. After additional terrible struggles, he suicided.

At once an indictment of psychological and medical malpractice and a tribute to the resilience of the human spirit, this is a book that will both horrify and inspire. ( )