“I got the chart and looked at all the background information that was available,” says Winter. “I read Man & Woman, Boy & Girl, and I believed it. I said, ‘That makes sense, and everything fits, and I’m going to see this kid, and this is what we’re going to do’ ”—namely, put the child on a course of estrogens and commence vaginal surgery immediately. But things did not work out that way.
“It was easily the most frustrating case we had in the clinic,” Winter says. “We prided ourselves on excellent rapport with patients, being able to sit down with kids and talk and listen in a warm atmosphere. And here was this absolutely silent, angry child who didn’t want to be there. I’d ask, ‘Will you allow a blood test?’ ‘No.’ ‘Will you allow me to examine you?’ ‘No.’ So I would have these monologues about the importance of taking the estrogen and having the vaginal surgery and how successful and wonderful this was going to be.”
According to Winter, Brenda was especially adamant about never returning to Johns Hopkins. “I’d never seen a patient in my life who behaved that way about going to another doctor—who showed that depth of emotion,” Winter recalls. Meanwhile, Winter had no choice but to try to get her to take the estrogen pills—an increasingly urgent need, since her twelfth birthday was approaching in late August.
Brenda continued trying to resist, but after continued entreaties from Winter, her parents, and Dr. Ingimundson (not to mention the threat that Dr. Money had once introduced into Brenda’s head, that she would grow disproportionate limbs if she failed to take the drugs), she finally—on the eve of her twelfth birthday—began to take the pills. Or rather, she pretended to. When her parents were not looking, she would throw the small tablets into the toilet. “I remember the pink dye running out of them,” David says. “I had to flush fast before my parents saw.” Ron and Janet soon caught on, however, and took to standing over Brenda while she swallowed the daily medication—0.02 milligrams of ethinyl estradiol, later increased to 0.75 milligrams.
Soon enough, a pair of breasts sprouted on Brenda’s chest along with a padding of fat around her waist and hips. The changes caused her deep mortification. In a bid to disguise the increasing feminization of her figure, she began prodigious bouts of eating. With several ice cream cones every day, her waistline swelled to forty inches. The added fat helped to camouflage her breasts and hips, but no amount of binge eating could hide certain other physiological changes that began to accelerate within her that fall. “Spontaneously expressed anxiety about her voice,” Ingimundson wrote in her September session notes. “Starting to crack.”
The dramatic deepening of Brenda’s voice was a phenomenon endocrinologist Winter was at a loss to explain. Given her absence of testicles (the prirliary male hormone-secreting endocrine gland) and her estrogen therapy, her voice, by all known medical criteria, should not have undergone a virilizing change at puberty. Today Winter suggests that Brenda’s vocal cords and larynx were perhaps thickening because of increased androgen secretion from her adrenal glands. Whatever the cause, one thing was not in doubt. Brenda’s voice now began to change in a manner identical to her brother Brian’s. She asked her mother why.
Thinking fast, Janet mentioned the deep-voiced actress Mario Thomas from the TV situation comedy That Girl. “She has a raspy voice,” Janet told her daughter. “It’s normal for some girls to have voices like that.”
Armed with this explanation, Brenda started seventh grade that fall at her new school: Glenwood Junior High, a large public school some five minutes’ walk from her house. She was instantly exiled to the farthest periphery of Glenwood’s social life, where she took her place among a haphazard collection of the school’s misfits. One girl was an intersex. Another wore a complicated metal leg brace and built-up shoe to accommodate a right leg some three inches shorter than the left. Another, Esther Haselhauer, suffered from Poland’s syndrome, a congenital birth anomaly that had stunted her growth, partially withered one hand, and completely retarded the growth of her right breast. Esther remembers that she sensed an immediate kinship with Brenda.
“She was hard to connect with,” Esther says. “But there was something that I just responded to. It was . . . I don’t know, a sadness. She reminded me of me.” At the same time, Esther was aware that there was a big difference between the two of them, and indeed, between Brenda and any other girl she’d ever met. “Brenda wasn’t a girl girl,” Esther says. Furthermore, being with Brenda evoked a feeling in her that was curiously like that of being with a member of the opposite sex. “It was a feeling of security,” Esther says. “When I was with Brenda, I felt so safe. Kids would beat me up because I was so small. But when I was with Brenda, if anyone tried picking on me, she let them have it.”
David says that he was grateful for Esther’s friendship, but that their differences made it impossible for them to get close. “She was always talking about guys,”, David says. Asked if Brenda ever expressed interest in romance with boys, Esther laughs. “Oh no!” she says. “That would be unthinkable; as unthinkable as me, at four feet tall, going out for the basketball team.”
* * *
Six months after Brenda began seventh grade, Dr. Ingimundson received a letter from John Money requesting a progress report. Money’s letter arrived at a particularly inopportune moment—just two days after a disastrous family session Ingimundson had held with the Reimers. Her notes on the 20 February 1978 session make it clear that Brenda’s resistance to the surgery had abated not at all in the fourteen months since she had begun psychiatric treatment in Winnipeg. Refusing to utter a word, Brenda had pulled up the hood of her winter coat and folded her arms across her chest. Pressed to say something about the surgery, she finally burst into tears, while the adults looked on helplessly. “Parents & I at a loss for words,” Ingimundson wrote in her session notes. The session ended soon after that.
With this fraught scene still fresh in her mind, Ingimundson wrote back to Money. She explained that despite their success in getting Brenda to take hormones, the local team had made no further progress in the case. “[N]o plans for surgery have been formalized,” she wrote, “nor, for that matter, have they been discussed in a tentative fashion.” She added that Brenda remained “resistant to medical attention” and was “still refusing examination of her genitals.”
How Money greeted this letter is difficult to tell. His reply was written by his secretary—and it was brief. “Dr. Money has asked me to write you thanking you for your letter of March 8, 1978 giving a progress report on Brenda Reimer. We are very pleased to have it,” the note read in its entirety.
A more expansive articulation of Money’s opinion on the case soon appeared in a chapter of the book Biological Determinants of Sexual Behavior, an anthology of writings on gender identity published later that year in Britain. Once again the outlook was sunny. A full-page photograph of Brenda and Brian (taken at their last visit to the Psychohormonal Research Unit) showed them standing side by side against a white background. Brenda wears a short patterned dress with cap sleeves, her long, well-brushed hair falling to her shoulders; Brian is dressed in a boy’s short-sleeved shirt and dark jeans, his close-cut hair exposing his ears. A pair of large black dots cover their faces, obscuring all but their identical jaws, chins, and eyebrows. Nothing in the accompanying text suggested that, beneath the black dots, either child was anything but smiling and happy. “Now prepubertal in age,” Money wrote, “the girl has . . . a feminine gender identity and role, distinctly different from that of her brother.”
An attentive reader might have noticed in this update certain evidence to suggest a less sanguine prognosis for the sex-changed twin. Elsewhere in the chapter, Money wrote of further research he had done into the role played by excessive testosterone exposure in genetic females in the womb. Money now revealed that there was reason to think that such exposure affected not only masculinization of play preference, toy preference, and career goals (as he and Ehrhardt had reported eleven years earlier), but other behavior as well. “Th
e preliminary evidence indicates the possibility,” Money wrote, “that there is a greater incidence of bisexuality and homosexuality [among such girls] than would be expected by chance.”
That Money’s famous sex-reassigned twin had spent her entire prenatal life awash in a full complement of testosterone produced by the fetal testicles (a complement of testosterone some ten times the amount experienced by normal female fetuses) might have led some readers to conclude that the twin, at puberty, would in all likelihood manifest an erotic attraction to females; but on the all-important question of Brenda’s sexual orientation, Money (perhaps forgetting what he had told Ron and Janet about her lesbianism) professed himself unable to venture even an educated guess as to what her partner preference might one day be. He wrote in his concluding remarks on Brenda’s gender identity, “The final and conclusive evidence awaits the appearance of romantic interest and erotic imagery.”
* * *
In the eleven years that had elapsed since Bruce Reimer’s conversion to Brenda, none of her local doctors had ever met with John Money in person to discuss her case. But in the spring of 1978, Jeremy Winter was invited to deliver a lecture at the Johns Hopkins Medical School’s Reproductive Biology Seminar. While in Baltimore, Winter arranged to speak with Money. Their meeting took place at the Psychohormonal Research Unit on 4 April. Winter detailed for Money the extreme difficulty the local treatment team was having in implementing his plans for Brenda: she continued to refuse to submit to a genital exam; refused even to discuss the issue of vaginal surgery; refused to return to Baltimore; and often refused to take her hormone pills. According to Winter, Dr. Money was wholly unconcerned by the issues he raised.
“He was supremely confident,” Winter says. “Everything was perfect; there were no problems—and any concerns that I was raising were my naïveté and youth coming to the fore; and I would learn, in time, that everything was fine.”
Money’s own notes on the encounter confirm Winter’s impression. Money refers confidently to the time when Brenda will be able to “negotiate the decision [for surgery] herself”; alludes to his belief that Brenda’s “intense phobia of white coats and doctors” reflects only a deep-seated sense memory of her circumcision accident at eight months of age; and opines, “I rather strongly suspect that Brenda already knows that she once had a penis and probably that she had been considered [sic] a boy.” Still, this suspicion did not diminish Money’s belief that Brenda would soon agree to vaginal surgery—possibly even at Johns Hopkins. As his notes show, Money also told Winter about Brenda’s “intense rejection of any conversation regarding matters sexual, and of looking at books pertaining to any aspect of sex education.” According to Winter, Money showed him some of the sex education materials. “He showed me photographs that he would use, dirty pictures, to see whether Brenda was homosexual or bisexual or heterosexual,” Winter says.
Though unsettled by Money’s seeming unconcern about the problems he had raised and troubled by the materials Money had shown him, Winter nevertheless resolved to feel encouraged by the visit. It was a relief that the world-renowned expert on gender identity did not consider Brenda’s resistance to be an insurmountable obstacle to the eventual success of the sex reassignment. It was similarly a relief that Money, the world’s leading authority on sex change, had endorsed the local team’s approach to Brenda’s case. “I was a very junior person going to the expert,” Winter says, “and I was happy to get some reassurance.”
But the dramatic depth of Brenda’s resistance to Johns Hopkins and to the surgery was soon to be brought home to all concerned—especially John Money. On 2 May 1978, one month after Winter’s trip to Baltimore, the Reimers returned with Brenda and Brian for a counseling session with Dr. Money. Brenda had fought hard against the visit, agreeing to go only when Ron and Janet promised an expensive side trip to New York City as a bribe. Yet even with Manhattan as a pill sweetener, the visit would prove so traumatic for Brenda that it marked the last time she would ever consent to go to Baltimore.
That something remarkable had occurred during Brenda’s visit was obvious from a letter Money wrote to Winter several weeks after the encounter. Stating that “Brenda talked more extensively on this occasion than on her last visit,” Money went on to say, “She was especially at ease with two youthful students doing an elective with me. She was quite explicit, however, about avoiding references to sex and sex-related topics, and to prospective surgery. . . . [S]he could not tolerate further continuance of such talk, and went into the next room to join her brother. I followed, and in bringing the session to a close, put my hand on her shoulder in what most youngsters would accept as a reassurance. She fled in panic. One of the students followed and helped her recover her composure. They walked, saying little, for about a mile.” In concluding this oddly elliptical-sounding account of the events, Money referred to the student as “a woman.” What he did not mention was that the woman had begun life as a man. She was a male-to-female transexual whom Money had enlisted to speak to Brenda about the positive aspects of surgical construction of a vagina.
The Reimers’ trip to the unit had begun typically enough, which is to say, with Brenda displaying intense anxiety, anger, and depression—emotions that were reflected in the Sentence Completion Test she was made to fill out. “Compared to most families mine’s . . .” “a loser,” Brenda wrote. “I think most girls . . .” “aren’t very nice.” “I believe most women . . .” “aren’t very nice either.” “My feelings about married life are . . .” “rotten.” “If I had sex relations . . .” “I wouldn’t like it. Same if a boy would kiss me.” “To me the future looks . . .” “bad.”
But it was when Dr. Money introduced her to the transexual that Brenda’s typically despairing mood turned to pure, deep-running panic.
“Dr. Money said, ‘I’ve got someone for you to talk to who’s been through what you’re going to be going through,’ ” David recalls. Brenda was ushered into the presence of a person whom she immediately identified as a man wearing makeup, dressed in women’s clothing, with a woman’s hairstyle. When the person spoke, it was in a breathy, artificially high-pitched voice. “He’s telling me about the surgery,” David says, “how fantastic it was for him, and how his life turned out beautifully.”
Brenda sat immobile, silent, apparently listening. But the words reached her through a clamoring, rising terror in her mind. “I was thinking, ‘I’m going to end up like that?’ ” David says.
When the transexual finished speaking, she led Brenda back into Dr. Money’s office, where he sat waiting for her at his desk. Brenda sat in the armchair beside Money’s desk. The transexual sat on the adjacent sofa. Money’s transcripts of the meeting record what happened next.
“You do not have to have the operation for your sex organs if you don’t want it,” Money said. “And you can also change your mind and have it anytime you want to, whether you’re in your twenties, or your thirties, or whatever. But from now on you’re old enough to sign your own operative permit, and nobody can make you have an operation. As a matter of fact, nobody can make you take pills if you don’t want. And you know that very well, because all you have to do is tell lies about them, hmmm?”
Dr. Money talked on in this vein for almost ten minutes, shifting back and forth from trying to sound friendly and supportive to sounding threatening and angry. He said that no one should make her feel as if she were having things forced upon her—even as he relentlessly tried to convince her to have the surgery. He spoke about her “gender identity,” saying that she could not be a person unless she had one, and then he was talking about the operation again, about “sex organs for a female.”
Brenda tried to interrupt, but Dr. Money said he wanted to tell her “a very nice story” about a patient who had been born with “a birth defect of the sex organs.” Money began to talk about “clitorises” and “penises.” Brenda again tried to interrupt him. “Let me finish,” Money snapped. Recovering himself, he talked on about how this pa
tient had always refused, like Brenda, to discuss his sexuality when he was growing up. Money said that he had learned from this patient not to force children to talk about things that disturbed them. Yet at the same time, Money continued to press her to speak. “I want you to know that I’m going to be the one person in the world that you can tell anything to, because I’m not going to yell at you,” Money said. “And I’m not going to tell you you’re crazy. I’m just going to listen and be helpful and find the answer to it. And you can tell me anything.”
When Money finally fell silent, Brenda had only one question.
“Are you finished?” she said.
“We’re finished.”
Brenda got up and hurried toward Money’s office door. Money and the transexual moved toward her. The transexual was saying something about taking Brenda up to the fifth floor where they could be alone. Dr. Money reached out for her. She felt the psychologist’s fingers grasp her shoulder. Convinced that they were going to drag her off to the operating room, Brenda wrenched free of Money’s grasp. Today David cannot recall how he got out of Money’s office. “I remember running,” David says, “that’s all.”
“I heard the door slam open,” says Brian, who was sitting in the waiting room, “and—whoosh!—there goes Brenda. Bolted. I hear John Money yelling. I see a bunch of people with lab coats running after her.”
Janet and Ron, who were being interviewed in a nearby office, heard the commotion and came out into the corridor. “Dr. Money took off,” Janet says. “We stayed with his assistants, waiting, while he went chasing.”
Brenda ran blindly until she reached a set of stairs, which she dashed up, emerging onto a rooftop. The transexual had followed. Brenda crouched by a low brick wall that ran around the perimeter of the roof, trying to hide. David cannot recall what happened next. A report filed by the transexual (whose name has been whited out in the Psychohormonal Research Unit record) reveals that Brenda, with her pursuer close behind, fled down four flights of stairs and ran out of the hospital’s back exit into a parking lot. The transexual searched the hospital grounds—then spotted Brenda running into the main entrance. She gave chase but once again lost sight of Brenda.
As Nature Made Him Page 13