In pursuit of further data, doctors and researchers will almost certainly pay particularly close attention to events that began at Atlanta’s Northside Hospital in 1985, when on a single day two developmentally normal newborn boys suffered severe penile burns from bungled electrocautery circumcisions. One boy lost his penis entirely, the other a significant portion. The parents of the child in the former case agreed to sex reassignment of their child as a female; the other parents opted to have their child receive plastic surgery to create an artificial penis.
Here was another of those one-in-a-million chances, another unplanned experiment of fate, in which two children became ideal matched controls in a living laboratory experiment, this one offering researchers a unique comparison study of how best to deal with the calamity of penile loss: sex reassignment or phalloplasty ? With the children currently on the eve of their fourteenth birthdays, privacy issues have prevented much information on their condition from being released, and I was able to glean only minimal reports when I spoke with the several lawyers who represented the parents in their lawsuits against Northside Hospital.
Thomas Sampson is the lawyer who won a $2.2.8 million settlement for the parents of Antonio, the boy who is being raised as a male. According to Sampson, Antonio is doing better today than was ever expected at the time of his injury. He experienced a period of difficulty in his early school years, when he underwent several operations for phalloplasty and experienced some cruelty, both intentional and otherwise, from his peers. But now in tenth grade, his social situation is considerably better. He displays no difficulties with his identity as a male, though whether he will ever feel confident enough to have sexual intercourse with his artificial penis and to father his own children, only time will tell.
The fate of the other child is less well known and more carefully guarded. Castrated and converted to girlhood at less than two weeks of age, she is known in court documents simply as “Baby Doe.” For the last year and a half, I have sought word of her mental and emotional state from her lawyers and physicians, but they have refused all comment. What few facts I was able to verify independently did not augur particularly well. Her parents divorced while she was still young. Doe lives with her mother—although in a relationship whose future is unsure. According to a lawyer involved in her case, she was recently placed under the care of a court-appointed guardian.
I spoke to David about Baby Doe during my last trip to see him in Winnipeg in the summer of 1998. Deeply upset, he insisted on dictating a letter to the child’s parents, in which he offered himself for advice or support to them or their daughter. His letter went unanswered. “I wasn’t surprised,” David says. “I’ve been there, and so have my parents. They just need time.”
Since then David has found himself dreaming of Doe, who has appeared to him in his sleep as a mute younger sister desperately trying to communicate something through enigmatic scribblings on a child’s chalkboard. That David should feel a special kinship with Doe is not surprising, for not only has she undergone the same accident and treatment that have shaped David’s life, she also shares other uncanny similarities with him. Remarkably enough, both children injured at Atlanta’s Northside Hospital in 1985 happen to have been born on 22 August—twenty years to the day after David and Brian Reimer came into the world. The psychologist who consulted on Baby Doe’s case—five years after David announced his decision to live as a male—was Dr. John Money.
Photos
Brenda at age two, shortly after her surgical sex reassignment.
Janet with her twin baby boys, Brian and Bruce. The cataclysmic accident that would lead to Bruce’s sex change was still some months in the future.
Brenda and Brian as toddlers.
Brian and Brenda around the time that they started kindergarten.
Brian and Brenda Reimer—the ultimate “matched pair.”
Brenda at age ten. “Everyone is telling you that you’re a girl,” David would later say, “but you say to yourself, ‘I don’t feel like a girl.’ ”
Christmas, mid-1970s, with Brenda dressed in her best clothes for visiting her paternal grandparents.
Dr. John Money
Dr. Milton Diamond
Brian, Ron, and Janet on their way to what would be the family’s final trip to Baltimore, in May 1978. Brenda, the photographer, was careful to stay on the opposite side of the lens at this stage of her life.
Brenda at age twelve, shortly after she started estrogen therapy to promote the feminization of her figure.
Brian and Brenda at age fourteen, shortly before they were told the truth of Brenda’s birth.
David and Brian in May 1980 at their uncle’s wedding, where David made his public debut as a boy. David still carries the evidence of the binge-eating he had done, as Brenda, to disguise his breasts. They would be surgically removed five months later, and testosterone injections would soon make David catch up in height to his twin.
David and Brian, May 1980, at their uncle’s wedding.
David at age eighteen.
David and Jane on their wedding day, 22 September 1990. It was Jane’s reaction to the truth about David’s past that convinced him of her “true heart.”
Afterword
AS ITS TITLE WOULD SUGGEST, As Nature Made Him places considerable emphasis on the role that biology plays in the shaping of human sexuality. In that respect, the book was meant as a clear corrective to the extreme nurturist stance of the 1960s and 1970s, when biological influences on gender identity and sexual orientation were dismissed altogether—a view which still informs much of the thinking of the lay public even today. For me, learning about the role of prenatal hormones in hardwiring sexual behavior was eye-opening, and a degree of the urgency I felt in writing the book derived from the satisfying sense that I was bringing to readers facts probably unknown to them.
Yet while I consider David’s case to be among the strongest evidence yet available for the biological underpinnings of gender, I reject any reading of the book that reduces his story to simpleminded biological determinism—whether that reductionism is meant as a compliment to the book, or as a criticism. One reviewer, for instance, praised As Nature Made Him for showing that “gender is indeed biologically based and not learned at all.” Yet another criticized the book for the same supposed message: “[W]hen it comes to nature-nurture, I believe it’s not so much a matter of being right, but a matter of, emphasis. A deliberate emphasis on nurture is politically healthier, especially for women.” The first statement is preposterous (how can learning play no role “at all” in how an individual comes to understand his position in society?); the second equally so. Political health, or correctness, should play no role in scientific debate—unless, of course, the debate is purely academic theorizing, a kind of intellectual Ping-Pong, in which case nothing rides on it. Unfortunately, within the context of infant sex reassignment, everything rides on it, since it is only by continuing to assert nurture’s primacy over nature that physicians can continue to assign sexual identities to newborns through surgery, psychological engineering, and hormones. As David’s story shows, that is a risky practice indeed.
Happily, the medical profession has, in the wake of the book’s publication, shown a heretofore unprecedented willingness to re-examine the practice of infant sex reassignment—and to listen to the testimony of former patients. ISNA founder Cheryl Chase has been invited to speak to the American Academy of Pediatrics, and has joined a group of urologists to form the North American Task Force for Intersexuality, which is collecting long-term data from some two hundred cases of sex-reassigned people and evaluating the long-term effects of the procedure. In May 2000, she spoke at a conference at Johns Hopkins, where she delivered the final talk at the annual meeting of the Lawson Wilkins Pediatric Endocrine Society—perhaps the strongest evidence to date that the medical profession as a whole is willing to reassess the efficacy of infant sex reassignment—and the relative roles of genetics and environment in the making of boys and girls
, men and women.
None of this is to suggest that nurture plays no role in gender identity. Virtually every page of As Nature Made Him contains an environmental cue or clue that helped to reinforce what Brenda’s prenatally virilized brain and nervous system were telling her. Among these environmental cues, I would include the presence of an identical twin brother who so closely resembled Brenda and yet was, mystifyingly, of the opposite sex; the scarred and unfinished state of her genitals which contributed to her conviction that something was unusual about her assigned gender; the teasing and ostracization of peers and classmates who jeered at her for her masculinity; the growing realization on the part of Ron and Janet, around the time of Brenda’s seventh birthday, that the experiment was a failure; the trips to Johns Hopkins, where her genitals and sexual identity were of such obsessive interest to Money and his students; and indeed, the second-class status assigned to females in society—a condition that leads many dispirited girls to wish (around the time of puberty) that they could be boys. All of these factors, I’m convinced, played a role in undermining the experiment. I attribute the case’s final and complete collapse, however, to the pressing insistence of Brenda’s biological maleness—her awakening sexual attraction to girls; her inchoate but adamant aversion to possessing breasts and a vagina. For how many children, at the exquisitely awkward age of fourteen, will insist, upon threat of suicide, that they undergo full sex change, in plain view of neighbors, family, and friends? This almost incomprehensible act of courage on Brenda’s part speaks more convincingly than any other piece of evidence to the emphatic demands of our biology, and to the necessity that we—all of us—be allowed to live as we feel we must.
Indeed, it was this very courage of David’s which was my prime motivation in writing the book. Despite its medical-scientific context, I’ve always believed that this story transcends the incessant quibbling over the nature/nurture debate. David’s is a story about identity in its largest sense—not simply sexual identity. His story, for all its uniqueness, is a universal one, and reminds us how it is every person’s individual responsibility to define for himself who he is, and to assert that against a world that often opposes, ridicules, oppresses, or undermines him. It is perhaps as much to David’s innate will and strength, as it is to his prenatally organized brain and nervous system, that he owes his survival; not many children, at seven years old, could have faced down a man of John Money’s famously persuasive temperament. Yet he did so, as he staunchly refused to undergo a surgical procedure (vaginoplasty) which he instinctively knew would seal him into an identity not his own. For me, the emotional crescendo of the story comes in that moment directly after Ron Reimer revealed the stunning truth of her birth to Brenda—and her first question was not about how or why her parents could have made such a decision; it was not to ask how such a devastating circumcision accident could have occurred. Instead, she asked her birth name. She asked, in effect, Who am I? Kept so long from this ultimate knowledge, it was only through learning this essential truth that David was then able to begin assembling a life for himself.
* * *
No writer working in the wake of Janet Malcolm’s book The Journalist and the Murderer can pretend to obliviousness of the many sticky ethical issues surrounding the exploitation of another person’s life for the purposes of making one’s own living. David Reimer’s ordeal, in particular, seemed to highlight these inherent dilemmas of reporting. Not only had he endured sufferings of a singularly private, and potentially embarrassing, nature, but he was also wholly unsophisticated in the ways of publishing. Flying into Winnipeg for the first time in June 1997, I couldn’t help but think of Malcolm’s “morally indefensible” journalist who swoops into town, coaxes his subjects to reveal their secrets, then departs with his treasure hoard of painful and private facts, which he publishes for his own financial gain and professional advancement.
Hoping to mitigate these unhealthy conditions of journalism, I made two resolutions. First, I promised myself that I would attempt to recount David’s experiences in a tone, and within a context, that did not sensationalize them. Second, I arranged to share with David, fifty-fifty, the profits from the book. While this financial arrangement seemed the only proper way to proceed, it introduced the other great ethical dilemma of journalism: the paying of a source. Critics of the practice (and I’ve always been one of them) point out that sources who agree to speak for money will shape their testimony to fit the perceived needs of the person paying the money. While this is a danger in cases where supermarket tabloids use cash to induce an “insider” to spill dirt on celebrities, I felt we had a quite different situation here. Long before any financial remuneration entered the picture, David had told his story, at length, to Diamond and Sigmundson, who documented it in videotaped interviews; and he had spoken to me, over the course of six months, for my Rolling Stone article, without payment of any kind. Given the degree to which his life had already been documented, it would have been easy for me to detect if David were now straying from his story for reasons related to money; furthermore (and perhaps most important), there existed an extensive contemporaneous written record assembled by the various physicians who had treated Brenda since the age of twenty-two months—a record against which all of David’s (and his family’s) memories could be checked; my extra interviews with a raft of teachers, old classmates, and others close to the family further guaranteed that the Reimers’ account of their ordeal was as accurate as possible and untainted by the monetary reward that had now entered the picture. But perhaps the greatest safeguard of all was that David was not, in fact, agreeing to speak for money. As he often said during the research for this book, he would have participated in this project even if there had been no financial incentive. He was telling his story in order to correct a published record of his life that had stood for over twenty-five years—a published record which expressly denied the extraordinary torments he had undergone and which, to David’s everlasting horror, had led to similar anguish for untold numbers of children. Given the nature of this enterprise, no amount of money (I’m convinced) could have prompted David to lie about his past. And indeed, no one could have sat up with David until the small hours of the morning, night after night, and listened to him drag up memories of his blighted childhood, as I did, and doubt the veracity of his testimony.
Given my confidence that money played no part in tainting this story, I refrained from disclosing the details of my financial arrangement with David when writing the main body of this book. I do so now only to counter an insinuation made by John Money who, shortly before this book’s publication, released a book of his own in which, at an effort at preemptive strike, he reprinted details of a gossip column that mentioned the size of the advance paid for this book and that moviemakers had become interested in David’s story. “While money talks,” he wrote, “it does not necessarily guarantee the truth.” I do not think it is possible to read the final chapter of this book, in which David’s long monologue is printed, and to feel that you are hearing money talking. Likewise, David’s humiliating accounts of his junior high school years, when, in a bid to alleviate the unrelenting pressure of doctors and parents to have vaginal surgery, he actually attempted to behave as a girl—donning lipstick and skirts, attending school dances, allowing himself to be pecked on the cheek by a boy. Not until we began our deep interviews for the book did David dredge up this most shaming (but important) passage in his life. He had never mentioned it to Diamond and Sigmundson; he had refrained from mentioning it to me during the many months I interviewed him for Rolling Stone. That David should choose to volunteer this information to me for a book that he knew would be revealing his actual name, face, and location was my most convincing guarantee that, in participating with As Nature Made Him, David would allow nothing to stand in the way of the truth of his experience.
Of course, as we embarked on those interviews in late 1997, there was no predicting how the world would take David’s story. It was one thing for
him to have been written about in article-length stories and medical journals as “John/Joan,” quite another for him to step out as David Reimer, in a book. Would he join the ignominious John Wayne Bobbitt as fodder for late-night talk show jokes? Would supermarket tabloid photographers camp out on his lawn to get photos of “the boy who was raised as a girl”? Thankfully, he was spared these indignities. Upon its publication in February 2000, his story was greeted with universal compassion and respect by readers. Letters and emails flooded in from people expressing their admiration for his courage and survival. His neighbors, friends, and coworkers at the slaughterhouse (which closed shortly before the book’s publication) took the news of his past with equanimity. (Through a mutual friend, David was told that many of his coworkers had expressed sadness that David had never told them of his past.) Journalists and talk show hosts the world over requested interviews. David, standing behind his decision that his story should reach the widest possible audience, agreed to appear, undisguised, on a variety of these programs; among them, the Oprah Winfrey Show, Dateline NBC, and Good Morning America as well as a number of other TV and radio programs in the USA, Canada, Europe, and the Antipodes. In almost every instance, he was treated with remarkable sensitivity and tact by interviewers. David, in turn, refused to be just another entry in the unending parade of self-pitying victims who so often clutter our airwaves. Dry-eyed, forthright, blunt-spoken, he answered the questions put to him, never with an air of hoping to elicit pity (indeed, there is no emotion against which he responds with such impatience), and always with a finely calibrated sense of where the public’s need to know ends and his own privacy begins. Asked by Oprah Winfrey about the phalloplasty which restored to him the ability to have sex with his wife, David said that it resembles a normal organ, then looked out over the audience and said: “And that’s all I’m going to say about that”—which brought a round of cheers, laughter, and applause.
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