David Reimer

David Reimer (born August 22, 1965 as Bruce Reimer, died May 4, 2004) was a Canadian man who was born as a healthy boy, but was sexually reassigned and raised as female after his penis was inadvertently destroyed during circumcision. Psychologist John Money oversaw the case and reported the reassignment as successful, as evidence that gender identity is primarily learned. Milton Diamond later reported that Reimer never identified as female, and that he began living as male at age 14. Reimer later went public with his story to discourage similar medical practices. He committed suicide at the age of 38.

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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. On April 27, 1966, the surgeon, Dr. 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 the machine malfunctioned. After this, Brian's circumcision was canceled, and he made a full recovery from his condition without further treatment.^[1]

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 Dr. 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 believed that all psychological and behavioral differences between males and females were learned. He, and other physicians working with young children born with abnormal genitalia, believed that a penis could not be replaced but that a functional vagina could be constructed surgically, and that Bruce would be more likely to achieve successful, functional sexual maturation as a girl than as a boy.^{[citation needed]}

They persuaded his parents that sex reassignment would be in Bruce's best interest, and, at the age of 17 months, surgery was performed to remove his testes. 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 the two not only shared genes and family environments, but they had shared the intrauterine environment as well. Money often took pictures of them both in the nude. 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. Money wrote: "The child's behaviour is so clearly that of an active little girl and so different from the boyish ways of her twin brother." Estrogen 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 when Dr. Money started pressuring the family to bring their "her" in for surgery, in which a vagina would be created, the family discontinued the follow-up visits. John Money published nothing further about the case to suggest that the reassignment had not been successful.

Reimer's later account, written two decades later with John Colapinto, described how, contrary to Money's reports, Brenda did not identify as 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. At 13, 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 and later developed schizophrenia. By 1997, David had undergone treatment to reverse the reassignment, including testosterone injections, a double mastectomy, and two phalloplasty operations. He also married a woman and became a stepfather to her 3 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 in order 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.^[2] They went on to elaborate the story in a book, As Nature Made Him: The Boy Who Was Raised as a Girl.^[3]

Death

Although the book gave David Reimer more financial security, he had many other problems in his life, including a separation from his wife, severe problems with his parents, and the death of his twin brother Brian in 2002, from a toxic combination of alcohol and antidepressants.

After being told by his wife on the weekend of May 2, 2004 of her wish to separate, Reimer stormed out of the house without revealing where he was going. After he failed to return, his wife called the police to report him missing. The local authorities eventually located him, but told his wife that he did not want her to know where he was. Two hours later, they called again, informing her of his suicide. Reimer had returned home while she was out and retrieved a shotgun, sawing off its barrel before leaving. On the morning of May 5, he drove to the nearby parking lot of a grocery store, parked his car and fatally shot himself in the head.^[4]

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 biology of gender. 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 (see intersexuality.)

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 insensitivity to 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, who oppose circumcision and involuntary sex-reassignment, treat the story of David Peter Reimer as a cautionary tale about why one should not needlessly modify the genitals of unconsenting minors.^{[citation needed]}

Among the repercussions was damage to John Money's reputation. Not only had his theory of gender plasticity been dealt a severe blow, but Colapinto'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.^[5], but David's brother and mother are both agreed that the therapy was simply and obviously not "working" in the sense that "Brenda" was in any way developing a female self-image^[1].

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".^{[citation needed]}

In popular culture

The "Boys will Be Girls" episode of Chicago Hope that aired on February 3, 2000 was based on Reimer's life^{[citation needed]}. Additionally, the "Identity" episode of Law & Order: Special Victims Unit that aired on January 18, 2005 featured a male twin who had undergone sex reassignment therapy after an accident similar to David Reimer's and subsequent therapy by a psychiatrist reminiscent of Dr. Money (however, that episode ended with the murder of the doctor by one or both of the twins, who successfully tricked the police into being unable to tell which twin had committed the crime—effectively insulating both from prosecution). On the album Reunion Tour by the band The Weakerthans a song entitled "Hymn of the Medical Oddity" was inspired by the story of David Reimer. "Born a Boy, Brought up a Girl" is also another television special based on his life as well.

See also

• Penectomy
• History of intersex surgery

References

• "Sex: Unknown (transcript)", NOVA (TV series), October 30, 2001.