David Reimer

David Peter Reimer (August 22, 1965 – May 4, 2004) was a Canadian man born biologically male but raised female following medical advice and intervention after his penis was accidentally destroyed during a botched circumcision in infancy.^[1]

Psychologist John Money oversaw the case and reported the reassignment as successful and as evidence that gender identity is primarily learned. Academic sexologist Milton Diamond later reported that Reimer failed to identify as female since the age of 9 to 11,^[2] and transitioned to living as a male at age 15. Well known in medical circles for years anonymously as the "John/Joan" case, Reimer later went public with his story to help discourage similar medical practices. He later committed suicide after suffering years of severe depression, financial instability, and a troubled marriage.^[3]

History

David Reimer was born in Winnipeg, Manitoba. He was originally named Bruce, and his identical twin was named Brian. At the age of six months, after concern was raised about how both of them urinated, the boys were diagnosed with phimosis. They were referred for circumcision at the age of seven months. On April 27, 1966, a urologist performed the operation using the unconventional method of cauterization,^[4][5] but the procedure did not go as doctors had planned, and Bruce's penis was burned beyond surgical repair. The doctors chose not to operate on Brian, whose phimosis soon cleared without surgical intervention.^[6]

The parents, concerned about their son's prospects for future happiness and sexual function without a penis, took him to Johns Hopkins Hospital 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 of Gender Neutrality"—that gender identity developed primarily as a result of social learning from early childhood and that it could be changed with the appropriate behavioral interventions. The Reimers had seen Money being interviewed on the Canadian news program This Hour Has Seven Days, during which he discussed his theories about gender. He and 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, claiming that Reimer would be more likely to achieve successful, functional sexual maturation as a girl than as a boy.^[4] For Money, a case where identical twin boys were involved where one could be raised as a girl provided a perfect test of his theories.^[7][8]

Money and the Hopkins team persuaded the baby's parents that sex reassignment surgery would be in Reimer's best interest. At the age of 22 months, baby Bruce underwent an orchidectomy, in which his testes were surgically removed. He was reassigned to be raised as female and given the name Brenda. Psychological support for the reassignment and surgery was provided by John Money, who continued to see Reimer annually for about a decade for consultations 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, Reimer's identical twin brother, Brian, made an ideal control because the brothers shared genes, family environments, and the intrauterine environment. 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.

Reimer said that Dr. Money forced the twins to rehearse sexual acts involving "thrusting movements", with David playing the bottom role. Reimer said that, as a child, he had to get "down on all fours" with his brother, Brian Reimer, "up behind his butt" with "his crotch against" his "buttocks". Reimer said that Dr. Money forced David, in another sexual position, to have his "legs spread" with Brian on top. Reimer said that Dr. Money also forced the children to take their "clothes off" and engage in "genital inspections". On at "least one occasion", Reimer said that Dr. Money took a photograph of the two children doing these activities. Dr. Money's rationale for these various treatments was his belief that "childhood 'sexual rehearsal play'" was important for a "healthy adult gender identity".^[4]

For several years, Money reported on Reimer'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 behavior is so clearly that of an active little girl and so different from the boyish ways of her twin brother." Notes by a former student at Money's lab state that, during the follow-up visits, which occurred only once a year, Reimer's parents routinely lied to lab staff about the success of the procedure. The twin brother, Brian, later developed schizophrenia.^[8]

Reimer had experienced the visits to Baltimore as traumatic rather than therapeutic, and when Dr. Money started pressuring the family to bring him in for surgery during which a vagina would be constructed, the family discontinued the follow-up visits. From 22 months into his teenaged years, Reimer urinated through a hole that surgeons had placed in the abdomen. Estrogen was given during adolescence to induce breast development.

His case came to international attention in 1997 when he told his story to Milton Diamond, an academic sexologist who persuaded Reimer to allow him to report the outcome in order to dissuade physicians from treating other infants similarly.^[2] Soon after, Reimer went public with his story, and John Colapinto published a widely disseminated and influential account in Rolling Stone magazine in December 1997.^[9]

This was later expanded into a full-length book As Nature Made Him: The Boy Who Was Raised as a Girl,^[4] in which Colapinto described how—contrary to Money's reports—when living as Brenda, Reimer did not identify as a girl. He was ostracized and bullied by peers, and neither frilly dresses (which he was forced to wear during frigid Winnipeg winters)^[10] nor female hormones made him feel female. By the age of 13, Reimer was experiencing suicidal depression, and he told his parents he would take his own life if they made him see John Money again. Finally on March 14th, 1980, Reimer's parents told him the truth about his gender reassignment, following advice from Reimer's endocrinologist and psychiatrist. At 14, having been informed of his past by his father, Reimer decided to assume a male gender identity, calling himself David. By 1987, Reimer had undergone treatment to reverse the reassignment, including testosterone injections, a double mastectomy, and two phalloplasty operations. On September 22, 1990, he married Jane Fontaine and became a stepfather to her three children.

Death

In addition to his difficult lifelong relationship with his parents, Reimer had to deal with unemployment and the death of his brother Brian from an overdose of antidepressants on July 1, 2002. On May 2, 2004, his wife Jane told him she wanted to separate. On the morning of May 4, 2004, Reimer drove to a grocery store's parking lot and took his own life by shooting himself in the head with a sawed-off shotgun.^[11] He was 38 years old.^[3]

Legacy

For the first thirty years after Dr. Money's initial report that the reassignment had been a success, Dr. Money's view of the malleability of gender became the dominant viewpoint among physicians and doctors, reassuring them that sexual reassignment was the correct decision in certain instances, resulting in thousands of sexual reassignments.^[12]

The report and subsequent book about Reimer influenced several medical practices, reputations, and even current understanding of the biology of gender. The case accelerated the decline of sex reassignment and surgery for unambiguous XY infants with micropenis, various other rare congenital malformations, or penile loss in infancy.^[12]

David Reimer has often been mentioned by Intactivists, who use him as an example of what could happen to a man if his parents decide to circumcise him at birth, and the effect it can have on him throughout his life. Only a few years after David Reimer's birth, Canada began taking a stance against infant circumcision, and it is now uncommon there.^[13]

Colapinto's book described unpleasant childhood therapy sessions, implying that Money had ignored or concealed the developing evidence that Reimer's reassignment to female 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 and that the family was not honest with researchers.^[14]

The case has also been treated by Judith Butler in her 2004 book Undoing Gender, which examines gender, sex, psychoanalysis, and the medical treatment of intersex people. The case of Reimer is used to re-examine Butler's theory of performativity that she originally explored in Gender Trouble.

Documentaries

The BBC science series Horizon based two episodes on his life. "The Boy Who Was Turned into a Girl" aired in 2000 and "Dr. Money and the Boy with No Penis" in 2004.^[1][7][8]

In popular culture

• The Chicago Hope season 6 episode "Boys Will Be Girls" (2000) was based on Reimer's life. The episode explored the theme of a child's right not to undergo sexual reassignment surgery without consent.^[15]
• The Law & Order: Special Victims Unit season 6 episode "Identity" (2005) was based on David and Brian Reimer's lives and their treatment by Money.^[15]
• The Weakerthans song "Hymn of the Medical Oddity" is about Reimer.^[16]
• The Mental episode "House of Mirrors" (2009), Dr. Jack Gallagher meets a young girl named Heather Masters with suicidal tendencies, who was born a boy.

See also

• Gender identity
• Penectomy
• Genital modification and mutilation
• Herculine Barbin
• Nature versus nurture
• Phalloplasty
• History of intersex surgery

References

External links

• Dr. Money And The Boy With No Penis
• Transcript of NOVA program Sex: Unknown broadcast on PBS on October 30, 2001.
• David Reimer at Find a Grave