The Icepick Surgeon

by Sam Kean

  Although he never recanted—not his style—John Money dropped all references to the twins case in his talks and papers in the 1980s. This silence baffled his colleagues, who didn’t know the real story and couldn’t fathom why he’d abandoned the case of a lifetime. Whenever someone asked about the twins, Money got pissy and claimed they’d been “lost to follow-up.” Meanwhile, thousands of infants around the world continued to undergo genital surgery based on his “science-fiction games”—as clear a case of scientific malpractice8 as you’ll ever see.

  Money’s downfall came about only because of Milton Diamond, the former graduate student in Kansas who’d helped expose guinea pigs to hormones in the womb. Now a professional psychologist, Diamond had long been suspicious of Money’s claims, and had reportedly been placing ads in psychology journals begging anyone who knew the twins to help him get in touch. Diamond finally tracked them down in the mid-1990s, and everything David told him reinforced his doubts about Money. To be sure, Diamond was no biological determinist. He believed that environment and culture shaped human sexuality in all sorts of ways, and that all of us have masculine and feminine traits. Sex and gender aren’t binary. But he insisted that biology did play a role in human sexuality, and that ideologues like Money were not only wrong, but doing real harm to patients.

  (Today, many psychologists believe that sex and gender interact in the following way: On a base level, genes and other biological factors determine our ranges. That is, if you plot a trait like masculinity or femininity on a ten-point scale, then your biology and genes might position you between, say, four and six. Environment and experience will then determine which exact number you land on, or perhaps shift you over time. Other people with different genes might range between one and two, or six and ten, and of course their unique experiences will influence where they land. But both aspects, biology and culture, play a role.)

  In the spring of 1997, Diamond and one of Brenda’s former psychiatrists from Winnipeg co-authored an atomic bomb of a paper on David’s tumultuous life. David had been reluctant to participate at first, but he was stunned to hear that thousands of other children with ambiguous genitalia had already undergone surgery based on his “successful” conversion into a female, and he felt duty-bound to get the truth into the scientific record.

  Aside from some citations, Diamond didn’t mention Money by name in the paper and certainly didn’t attack him. Money didn’t care. A quarter-century after he’d socked him in the jaw, Money still hated Mickey Diamond’s guts, and when the paper began to attract media attention, Money went on the attack again. All his opponents, he claimed, were bigoted crypto-conservatives out to smear him, along with the entire field of sexology. Indeed, he was the real victim here—“sprayed by the blinding venom of a spitting cobra.” He also employed a classic defense of unethical behavior by pushing responsibility onto others. First, he pointed out that it was the surgeons who’d sliced up David’s genitals, not him, as if his theories and management of the case were incidental. He furthermore began spreading rumors that Ron and Janet were religious nuts (they’d grown up Mennonite) who couldn’t see past traditional gender roles and had thereby sabotaged David’s chance to live happily as a female. If only they’d been sufficiently committed, sufficiently progressive, David would have turned out fine. Given the Reimers’ devotion to Money, this was particularly cruel.

  Money’s allies in academia continued to defend him after the Reimer scandal broke, and even today some social scientists maintain that sex—not gender, but biological sex—has zero basis in nature and is more or less a political conspiracy. Other allies, however, abandoned Money in the early 2000s, especially in the intersex and transsexual/transgender communities. This exasperates some of Money’s admirers, considering that Money probably did more than any other person to win mainstream acceptance for those groups in the mid-twentieth century. That said, Money did push thousands of intersex children into what Milton Diamond called a “needless, unproven, and life-altering surgery,” surgery that eradicated most sexual sensation and reinforced the notion that they were deviants who needed “fixing.” In addition, even though Money didn’t intend this, his emphasis on culture over nature had the baleful effect of making transgenderism and even homosexuality seem less like innate, inborn traits and more like mere lifestyle choices. Because if environment alone produces sexual identity and orientation, then changing the environment should change those aspects of sexuality. Real bigots have in turn exploited this notion of choice in promoting “conversion therapy” and other programs that aim to turn homosexuals straight.

  But of all the unethical things Money did—concealing the experimental nature of the treatment; exploiting a family tragedy to win fame; refusing to recant his theories when they were proven bankrupt—the most damning thing was denying David’s autonomy as a human being. As Brenda, David had given Money every indication that he wasn’t happy as a girl. Money refused to listen, insisting that he was the authority and knew better. Intersex and transgender people were all too familiar with psychologists doing the same to them: dismissing their claims and bullying them into treatments. Not to go all Jeff Goldblum, but Money was so consumed with the scientific question of whether he could convert a boy like David into a female that he never paused to consider whether he should. For that, some people will never forgive him.

  Most psychologists have come to accept that our sexual identities emerge from a complicated interplay of anatomy, brain wiring, hormones, home environment, and cultural influences.9 Moreover, while gender isn’t quite fixed at birth, it’s not infinitely flexible, and doctors and other outsiders can’t change it by fiat. For these reasons, the United Nations declared in 2015 that the kinds of surgeries Money advocated—on mutilated infants and infants with ambiguous genitalia—were a human rights violation. Unfortunately, such realizations came too late for David Reimer.

  David Reimer’s biographer once noticed that, whenever he shifted from talking about his present life as David to his past life as Brenda, he also shifted from “I” to “you,” as if distancing himself. (“I’d give just about anything to go to a hypnotist to black out my whole past. Because it’s torture. What they did to you in the body is sometimes not near as bad as what they did to you in the mind—with the psychological warfare in your head.”) Sadly, David’s past refused to stay in the past.

  The slaughterhouse he worked at closed in the late 1990s, and David struggled to find work after that. He’d always been insecure about his manhood and, unfairly or not, being unemployed and unable to earn a paycheck reinforced those issues. His insecurities also undermined his marriage, as did his explosive temper and constant fear of abandonment. Not surprisingly, he refused to see a psychologist to get help.

  Life really unraveled for David when his twin brother Brian killed himself. Brian had never quite gotten over the way that Brenda-David’s needs had monopolized the family’s attention. After a delinquent youth, Brian began stealing cars as an adult and got hauled into court for assault. He’d also had children at a young age and went through a nasty divorce. Admirably, he tried raising his kids alone, but he also began drinking too much and slipped into crevices of depression. In the spring of 2002, he swallowed yet another bottle of antidepressants and ended his life.

  The two brothers had been estranged at the time, but the death devastated David and contributed to his downward spiral. At night, David would sometimes have intense flashbacks to life as Brenda, and would race to the bathroom to vomit. His finances were also a worry. David did earn some proceeds from the biography about him, and eventually got some handyman work at a golf course, changing lightbulbs and washing windows and cleaning bathrooms; the cooks in the clubhouse gave him leftover soup for dinner sometimes. But he ended up investing $65,000 in a shady golf shop run by the pro at the course and had his entire life’s savings wiped out.

  The final blow came when his wife Jane, unable to stand his mood swings any longer, suggested they separate. David went
berserk and fled the house. She called the police to report him missing, and the cops finally tracked him down two days later. He was unharmed, but didn’t want Jane to know his whereabouts. She sighed and went to work. At least he was alive.

  Two hours later, she got a second call. David had killed himself. If you look at the numbers, women attempt suicide more often than men, but men more often succeed at it, mostly because they use more violent methods. Although he’d tried pills before, David chose the most violent method possible for his final attempt. As soon as Janet had left for work, he returned home, grabbed a shotgun, and (rather symbolically) sawed off the barrel in the garage. Then, as his biographer later wrote, in a sad postscript, “He drove to the nearby parking lot of a grocery store, parked, raised the gun, and, I hope, ended his sufferings forever.”

  Since David Reimer’s death, other people with similar stories have come forward to say that their gender conversions failed as well. However deeply culture shapes us, human beings are not blank slates, and culture cannot magically override 160 million years of mammalian evolution. Not all women and men conform to gender stereotypes, of course, and the reality of biology doesn’t mean that sex discrimination doesn’t exist. But in the words of Milton Diamond, sexual biology is inescapably real: “We don’t come into this world neutral… we come to this world with some degree of maleness and femaleness which will transcend whatever the society wants to put into it.” In every known culture in every known age, men and women behaved differently, and that’s very unlikely to change anytime soon.

  That’s as true of crime as anything. Statistically speaking, men commit far more crimes than women, and for that reason, men have comprised most of the bad guys in this book. But we’re about to meet our first female villain—the perpetrator of one of the most extensive frauds in the history of science.

  Footnotes

  1 John Money wasn’t exactly known for his scrupulous scholarship, either. One example involved a tribe in Australia called the Yolngu, whom he visited in 1969. Despite spending just two weeks among them, he emerged with several sweeping pronouncements about their sexual lives. Most notably, he claimed that these adorable little primitives just loved getting nekkid and getting it on; as a result, he said, Yolngu adults had zero sexual hang-ups or neuroses, including a complete lack of pedophilia and homosexuality—both of which, he maintained, were entirely the product of Western sexual repression. Even apart from the implication that homosexuality is a neurosis, this is complete bunk. Anthropologists who actually lived and worked with the Yolngu said that of course there’s homosexuality and sexual hang-ups among them. Every tribe on every continent in the history of humanity has had those features. Money, however, continued to preach about the sexual bliss of the Yolngu for years, ignoring all criticisms that contradicted his theories.

  2 Nowadays, psychologists use the word “transgender” to describe people whose sex and gender don’t align. “Transsexual” is more of a historical term, especially for people who underwent medical treatment (including surgery) to alter their anatomies or hormones. Although “transsexual” now sounds dated, it was the most common term used in the 1960s and 1970s. For historical accuracy, then—and because John Money was indeed pushing people to undergo surgeries, which is part of the definition of “transsexual”—I’m using that term here. For more discussion on this, see www.healthline.com/health/transgender/difference-between-transgender-and-transsexual.

  3 For the etymologically inclined, Money loved odd words and coined dozens of them, including ycleptance, the act of naming something; foredoomance, mortality; eonist, a transsexual; and apotemnophilia, an amputation fetish. He also popularized many other obscurities: limerent, the state of being love-struck; paraphilia, a sexual perversion; ephebic, an adolescent; pedeiktophilia, penile exhibitionism; paleodigm, an ancient, barbaric custom preserved past the point of usefulness; quim and swive, terms for what a woman does to a man during heterosexual intercourse, as opposed to what a man does to a woman; autoagonistophilia, sexual pleasure from being watched or viewed, and of course phucktology, the study of sex.

  4 Unlike some of his later followers, Money didn’t believe gender was infinitely flexible. Rather, he argued for a critical period—a “gender identity gate”—in a child’s first few years of life. He compared this period to learning a language. Children’s brains are primed to acquire language, but whether it’s Tagalog or Japanese or French obviously depends on the environment they grow up in. Similarly, he claimed, children’s brains are wired to adopt a gender. And, contrary to the modern consensus, Money believed that by raising children in different environments, you could more or less pick their genders at will.

  5 It’s hard to know what exactly Money’s views were sometimes—he was a poor writer, almost deliberately obscure. At points, he shows a sophisticated understanding of the interplay of genetics and environment in making us who we are. And unlike his most radical disciples, he never rejected biology entirely, saying it shaped us. Yet at other times he seemed to dismiss biology and treat social factors as all-important. I was filled with the sneaking suspicion (perhaps unfairly), that his acknowledgment of genetics and other biological factors was mere lip service, and that deep down he was a hardcore social constructivist.

  6 It’s not clear how Money and Brenda’s parents justified the need to keep visiting him, given that they continued to conceal the truth from her. At one point they did explain that a doctor had made a mistake “down there” long ago and that she needed medical attention as a result; perhaps that was enough to satisfy a little kid.

  7 Given that doctors had removed Brenda’s testicles, she didn’t experience true male puberty, but her body did go through some of the same changes. We can see an analogy here in the castrati, the Italian choir singers from the sixteenth to the nineteenth centuries who were castrated as boys to preserve their singing voices. Counterintuitively, castrati were often taller than average, despite the lack of testosterone and related hormones. Testosterone can spur growth in the short term, but it also kicks off several physiological changes that end up sealing off the so-called growth plates at the ends of our long bones, where we gain much of our height. Because castrati lacked testosterone, their growth plates stayed open longer and they grew taller overall.

  Castrati experienced other anatomical changes as well. Similar to their limbs, their chests were often larger than normal. The lack of testosterone meant that their vocal cords never lengthened and thickened, either, as they do in most men. And the thyroid glands in their throats never swelled with cartilage, which meant they lacked an Adam’s apple in their necks. In sum, these changes left castrati with pure, high-pitched voices that could climb well into the soprano range, and their expanded chest size meant they could sing with unusual power.

  8 Indeed, in a review of a book about David Reimer, the Washington Post said that Money’s “handling of the twins case arguably amounts to malpractice.”

  To be fair, some of his patients defended John Money out of gratitude for the way he’d supported transsexuals and other marginalized groups in the 1960s and 1970s, a time when these groups were dismissed as freaks by mainstream society. Still, despite these defenders, far more cases like David Reimer have come forward in the past two decades—people with painful memories of the psychological and physical trauma they endured after Money and others forced them into sex-reassignment surgery.

  9 Psychologists now believe that the brain, not the genitals or other anatomical factors, is the primary determinant of our sexual identity and proclivities. In the immortal words of Jackie Treehorn, “People forget that the brain is the biggest erogenous zone we have, Dude.”

  12

  FRAUD: SUPERWOMAN

  Everyone was so thrilled for Annie Dookhan. She did quality control for a vaccine lab near Boston, and no one there worked harder. She arrived near dawn most mornings, and often had to shut the lab’s lights off at night. She never took lunch breaks, either, and often brought paperwork wi
th her on vacations. On top of all that, she’d been getting a graduate degree in chemistry on the side, through a part-time program at Harvard. As she confessed to colleagues, she’d been forced to drop out of Harvard as an undergraduate a few years prior, due to lack of money, and she’d had to finish her degree at a state school. Earning a graduate degree from Harvard therefore felt particularly sweet—especially considering that she’d finished in record time, just a year. To celebrate, the lab threw her a party, and hung a banner that read “Congratulations, Annie!”

  The only thing was, it was all a lie. Dookhan had never taken a class at Harvard, graduate or otherwise. Harvard didn’t even offer a part-time program in chemistry. Dookhan had made the whole thing up, as a ploy to advance more quickly at her company.

  Unfortunately for her, the gambit failed, and the company declined to promote her. Furious, she doctored her resume (omitting Harvard but adding, falsely, that she was halfway through a master’s degree at another school) and started looking for a new job in 2003. Before long, she secured an offer from a nearby government lab that tested drugs for court cases.

  Up until that point, the twenty-five-year-old Dookhan had already told plenty of lies. But she’d always had integrity at the lab bench: there’s no evidence she committed any fraud at the vaccine company. That was about to change.

  Most people who cut corners are lazy, but Annie Dookhan always worked hard.

  She grew up in Trinidad, immigrating to Boston with her parents in the late 1980s, when she was around eleven. She later attended the prestigious Boston Latin School and ran track there; she even tried hurdling, despite standing just four-foot-eleven. She was terrible at it, but her coach marveled at her hustle.