David Reimer

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David Reimer (August 22, 1965 – May 5, 2004) was a Canadian man who was born as a normal boy, but reassigned and raised as a girl in an attempt to improve his life after his penis was destroyed in a circumcision accident. The reassignment was ultimately unsuccessful and as an adult he resumed a male gender role and went public with his story to discourage similar medical practices.

He was born a normal male infant, one of identical twins, in Winnipeg, and was named 'Bruce'. At the age of 8 months, his penis was accidentally destroyed in the course of a circumcision using a Bovie Cautery Machine, a surgical device not designed for circumcisions.

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 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; most liberal academics in the late 1960s felt that all nearly all psychological and behavioral differences between males and females were learned. He and the physicians working with other young children born with abnormal genitalia felt that a penis could not be replaced but that a functional vagina could be constructed surgically and that he would be more likely to achieve successful, functional sexual maturation as a girl than as a boy.

They persuaded his parents that this course would be in Bruce's best interest, and at the age of 22 months, surgery was performed to remove his testes and construct a vagina. 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 he had shared not only the genes, but both the intrauterine and family environments. 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 or hormones.

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. 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 her family discontinued the follow-up visits. John Money published nothing further about the case to suggest the reassignment had not been successful.

Despite Money's accounts, Brenda did not feel like a girl. She was ostracized and bullied by peers, and neither frilly dresses nor female hormones made her feel female. In adolescence the child again began to assume a male gender role to match his male gender identity. By 1997 he had undergone surgery again to reverse the reassignment and was living as David Reimer. He had married a woman, and become a stepfather to her 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 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. They went on to elaborate the story in a book.

Although the book made David Reimer more comfortable financially, many other things went badly in his life, including a divorce, severe problems for his parents, and the suicide of his twin brother Brian. David Reimer took his own life with a gun in 2004.

Social impact of David Reimer's story

The report and subsequent book about Reimer influenced several medical practices and reputations, and even our current understanding of the determinants of gender identity. This disastrous 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 (described in more detail in intersex.)

It strengthened the arguments of those who feel that prenatal and early infant 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 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.

Unsurprisingly, the serious complication of this presumably incorrectly performed circumcision made David Reimer an instant "poster boy" for the political and cultural opponents of circumcision (intactivists) and all genital surgery in infants.

Among the repercussions was damage to John Money's reputation. Not only had his theory of gender plasticity been dealt a severe blow, but he appeared to have ignored or concealed the developing evidence that Brenda's reassignment was not going well. Whether Money had been misleading himself in the latter years he was seeing Brenda, or consciously misleading other therapists and doctors in his later publications about the case, his credibility and public reputation were hurt. His reputation was further blackened by Reimer's published accounts of bizarrely unpleasant childhood therapy sessions with Money.

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, and some people seized on this case as proof that physicians should not or could not attempt to help or treat the problems created by birth defects of the genitalia.

Finally, liberal theories of the malleability and cultural construction of gender identitity, already falling out of academic fashion in the 1990s, became harder to defend, as the case was used by many to argue that "nature" trumps "nurture". In the face of Reimer's appalling personal tragedy and Money's apparent self-delusion or deceit, few professionals felt secure enough to publicly question the accuracy of Reimer's recounted childhood experiences, nor whether the failure occurred because of the relatively late age of reassignment, nor how many more successful outcomes should be considered negated by this unequivocal failure.

External links

• Chalmers, Katie (May 10, 2004). Sad end to boy/girl life (http://www.canoe.ca/NewsStand/WinnipegSun/News/2004/05/10/453481.html). Winnipeg Sun.
• Colapinto, John (2000). As nature made him: The boy who was raised as a girl. New York:HarperCollins. ISBN 0060929596.
• Colapinto, John (June 3, 2004 12:58 PM PT). Gender gap: What were the real reasons behind David Reimer's suicide? (http://slate.msn.com/id/2101678/) "Medical Examiner," Slate.

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