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David Reimer

David Reimer (August 22, 1965 – May 5, 2004) was a Canadian man who was born as a cisgender boy, but was sexually reassigned and raised as a girl in an attempt to improve his life after his penis was inadvertently destroyed during circumcision. The reassignment was ultimately unsuccessful and as an adult he resumed a male gender role and went public with his story to discourage similar medical practices. He committed suicide at the age of 38.

Overview

David Reimer was born as a male identical twin, in Winnipeg, Manitoba. His birth name was Bruce; his twin brother was named Brian. At the age of 6 months, after concern was raised about how Bruce and Brian urinated, both boys were diagnosed with phimosis. They were referred for circumcision at the age of 8 months (it is not known whether alternative therapies were tried). On April 27, 1966, the surgeon, Jean-Marie Huot, and the anaesthesiologist Max Cham performed the circumcision with the aid of a Bovie cautery machine (which is not intended for use on the extremities or genitals). Bruce’s penis was destroyed. After this, Brian’s circumcision was cancelled, and he made a full recovery from his condition without further treatment.

Bruce’s parents, concerned about his prospects for future happiness and sexual function without a penis, took him to Johns Hopkins Medical Center in Baltimore to see John Money, a psychologist who was developing a reputation as a pioneer in the field of sexual development and gender identity, based on his work with intersex patients. Money was a prominent proponent of the theory that gender identity was relatively “plastic” in infancy and developed primarily as a result of social learning from early childhood; some academics in the late 1960s felt that all psychological and behavioral differences between males and females were learned. He and the physicians working with other young children born with abnormal genitalia felt that a penis could not be replaced but that a functional vagina could be constructed surgically and that he would be more likely to achieve successful, functional sexual maturation as a girl than as a boy.

They persuaded his parents that sex reassignment would be in Bruce’s best interest, and at the age of 22 months, surgery was performed to remove his testes and construct a vagina. He was “reassigned” to be raised as a female and given the name ‘Brenda’. Psychological support for the reassignment and surgery was provided by John Money, who continued to see Brenda for years, both for treatment and to assess the outcome. This reassignment was considered an especially valid “test case” of the social learning concept of gender identity for two reasons. First, Bruce/Brenda had a twin brother, Brian, who made an ideal “control” since he had shared not only the genes, but also the intrauterine and family environments. Second, this was reputed to be the first reassignment and reconstruction performed on a male infant who had no abnormality of prenatal or early postnatal sexual differentiation.

For several years, Money reported on Brenda’s progress as the “John/Joan case”, describing apparently successful female gender development, and using this case to support the feasibility of sex reassignment and surgical reconstruction even in non-intersex cases. Oestrogen was given to Brenda when she reached adolescence to induce breast development. However, Brenda had experienced the visits to Baltimore as traumatic rather than therapeutic and her family discontinued the follow-up visits. John Money published nothing further about the case to suggest the reassignment had not been successful.

Reimer’s later account, written with John Colapinto, described how, contrary to Money’s reports, Brenda did not feel like a girl. She was ostracized and bullied by peers, and neither frilly dresses nor female hormones made her feel female. By the age of 13, Brenda was experiencing suicidal depression, and told her parents she would commit suicide if they made her see John Money again. In 1980, Brenda’s parents told her the truth about her gender reassignment, following advice from Brenda’s endocrinologist and psychiatrist. Now 15, Brenda decided to assume a male gender identity, calling himself David. After learning of the new relationship with his ex-sister, Brian began to experience a pattern of mental disturbance that would develop into schizophrenia. By 1997, David had undergone treatment to reverse the reassignment, including testosterone injections, a double mastectomy, and two phalloplasty operations. He had married a woman and become a stepfather to her children.

His case came to international attention in 1997 when he told his story to Milton Diamond, an academic sexologist who persuaded David to allow him to report the outcome to dissuade physicians from treating other infants similarly. Soon after, David went public with his story and John Colapinto published a widely disseminated and influential account in Rolling Stone magazine in December, 1997. They went on to elaborate the story in a book.

Although the book gave David Reimer more financial comfort, he had many other problems in his life, including a separation from his wife, severe problems for his parents, and the death of his twin brother Brian, in 2002, from an overdose of schizophrenia medication. David Reimer took his own life with a sawed-off shotgun in 2004.

The “Identity” episode of Law & Order: Special Victims Unit that aired on January 18th, 2005, was based on Reimer’s life.

Social impact of David Reimer’s story

The report and subsequent book about Reimer influenced several medical practices and reputations, and even current understanding of the determinants of gender identity. The case accelerated the decline of sex reassignment and surgery for unambiguous XY male infants with micropenis, various other rare congenital malformations, and penile loss in infancy (described in more detail in intersex.)

It supported the arguments of those who feel that prenatal and early-infantile hormones have a strong influence on brain differentiation, gender identity and perhaps other sex-dimorphic behavior. The applicability of this case to appropriate sex assignment in cases of intersex conditions involving severe deficiency of testosterone or its effects is more uncertain. For some people, the inability to predict gender identity or preference in this case confirmed skepticism about doctors’ abilities to do so in general, or about the wisdom of using genital reconstructive surgery to commit an infant with an intersex condition or genital defect to a specific gender role before the child is old enough to claim a gender identity.

Intactivists often cite David Reimer’s case because he underwent circumcision as well as sex-reassignment, both of which Intactivists oppose. They argue that, in Reimer’s case, both were involuntary and medically unnecessary. Intactivists actively try to prevent children from undergoing such procedures. They treat Reimer’s story as a cautionary tale about why one should not needlessly modify the genitals of unconsenting minors. They also mourn Reimer’s death, believing it to be a senseless tragedy that ultimately resulted from his surgeries.

Among the repercussions was damage to John Money’s reputation. Not only had his theory of gender plasticity been dealt a severe blow, but Reimer’s book described bizarrely unpleasant childhood therapy sessions, and implied that Money had ignored or concealed the developing evidence that Brenda’s reassignment was not going well. Money’s defenders have suggested that some of the allegations about the therapy sessions may have been the result of false memory syndrome.

The reputation of Johns Hopkins Medical Center as an institution at the forefront of progressive care for people with intersex and transgender conditions was hurt as well. Finally, theories of the malleability and cultural construction of gender identity, already falling out of academic fashion in the 1990s, became harder to defend, as the case was used by many to argue that “nature” trumped “nurture”.

Professor Milton Diamond contributed his feelings about David Reimer’s life and death:

“I hope David Reimer’s life lives on in documenting the ill in scientific hubris and mendacity and celebrating his courage to expose the harm that was done to him in order to save others from a similar fate. The John/Joan story will be recalled by all those who think that sexual development is simply a matter of upbringing. Rearing is important but must take into account any inherent predisposition with which an individual is born.”

(e-mail correspondence, May 20, 2004)

References

  • Colapinto, John (2000). As nature made him: The boy who was raised as a girl. New York: HarperCollins. ISBN 0060929596.
  • Colapinto, John. “The True Story of John/Joan.” Rolling Stone, December 11, 1997: 54–97.

External links