"As Nature Made Him"
The Boy Who Was Raised As a Girl
Harper Collins/ Publishers
February 2000

 "As Nature Made Him" is a voyeuristic voyage into one family's personal tragedy.  The recent publication of this book by John Colapinto (JC) has brought into the spotlight a medical case which has figured prominently in the psychological literature and lay press for three decades. Most recently written by the author as an article for "Rolling Stone Magazine"(RSM) where the anonymity of the characters was retained, it has been expanded into a "cause célèbe" with the full names of characters and witnesses exposed, pictures included. If you haven't heard the story on Oprah Winfrey or Special Edition, I will briefly reiterate the essence of the story which the book documents so well.
 On August 22, 1965, a normal pair of identical male twins was born to Janet and Don Reimer in rural Manitoba. Bruce and Brian developed normally until age six months when they were brought for circumcision on the advice of their pediatrician.  With the injudicious use of a metal clamp surrounding this tiny organ and a malfunctioning electrocautery, Bruce's penis was obliterated in a flash. Ouch! This was not the first nor the last time that a penis has been injured during circumcision. The malpractice suit was settled for $66,000 in 1967.  But that was only the beginning of this family's misfortune.  Desperately looking for help in this predicament, they turned to the leading authority in the field of intersex and ambiguous genitalia, Dr. John Money at Johns Hopkins Medical University (JH).  Dr. Money suggested SRS and assured the family with only slight reservation, that Brenda née Bruce would grow up with a  female identity, if the proper role playing, counseling, HRT and SRS were carried out.  This was certainly an ambitious plan for the infant, but Dr. M. felt that he had the evidence for its intended success. At 22 months of age castration was performed and the plan initiated.  Brenda and Brian returned to JH at least annually to be counseled and studied so that her progress and development could be well documented in this academic setting.  To some this was seen as the definitive human experiment with a perfectly matched control, an identical twin, to prove the primacy of nurture over nature in psychosexual development.
 Through extensive interviews with the family JC learns that the best laid plans of mice and men will go astray. Brenda would never accept her new  role from the very start. She would rip off her dresses, want to urinate standing and basically just wanted to be like her twin brother.  The ensuing years would be just sheer hell for all.  With all the teasing at a new school each year  and Brenda's continued rejection of her female identity,  the family structure disintegrates with the father's alcoholism, the mother's hospitalization for depression and Brenda's attempted  suicides.  With cajoling, HRT is initiated at age 12  and with some feminine development, breasts and hips, Brenda does try her best to fit in with the wearing of makeup, feminine attire, walk, etc. But she never does pass.  And everyone, including Brenda, knew that something was amiss. Brenda constantly feels like a boy trapped in a girl's body.  Sound familiar!   At age 14 Brenda is told the story of her accident and the reason for her deformed genitalia  because the surgical completion of SRS is still on everybody's mind.  Like this would make her life complete. But in the next  few years, Brenda decides that she will become David, as in David and Goliath.  She stops the estrogens, starts Testosterone injections, dates and marries and lives happily ever after. Well not exactly!   There is the physical pain and suffering of multiple surgeries and 18 hospitalizations to replicate a functional penis and the psychological stress of JC and the press hounding David, his family and everybody related to him for information and interviews.  So in summation, this was a depressing read, but that is only half of the story.
 From the very first page,  JC gives us a second David and Goliath story to ponder.  He takes us into the world of the academic psychologist, where this case has received international prominence.  And here is where fact and fiction diverge. He casts Dr. Money, the eminent medical psychologist at JH, and his partner, the medical establishment, as Goliath and as David, Dr. Milton Diamond, a biologist, who as a Graduate student delivered the first challenge  to Dr. M's theories. Based on experiments in guinea pigs, Dr. D argued that our sexual preferences are hard wired in utero and there is no way they can be altered. When Dr. D published his paper John/Joan, i.e. Bruce/Brenda, in 1997 detailing the failure of the transformation which had been portrayed as successful in its earlier years, JC took this to mean that a deception had been perpetrated by Dr. M.  But we know that in the early years Dr. M was given encouragement by Janet and some of Brenda's role playing.  What we don't know was when Dr. M realized this was not to be.  JC then brings this story to his editor who encourages him  to pursue this further for RSM.  JC spends years pouring over lawyers' and hospital records, the tapes of Dr. M from the Psychohormonal Research Unit at JH, and in depth interviews with David,  the entire Reimer Family, Winnipeg psychiatrists, friends and enemies of Dr. M., except Dr. M.  We must now realize that these retrospective memories of up to thirty years are the only corroboration of the interpreted written record.  But despite the myriad quotes on each page, let me assure you that this not a scientific tome, when any first year medical student knows that the seminal vesicles cannot be removed from the scrotum. (p.54). This is not quality investigative reporting when even the principals of 3 incidents cannot remember them, despite what other purported witnesses say.  And finally the importance of this single case can be dismissed despite the fact that everyone has used it for their own ideological  purposes.  It has been said that  "Identical twins are the only people who begin their identity crisis at birth."
  What we find is an unparalleled vilification of Dr. M. , who is portrayed as dishonest, arrogant, prurient, sadistic, vile, I could go on forever. While Dr. D. is intellectually honest, self-effacing, rejected by the medical establishment and desiring to bring us nothing but the Truth.  In Medicine it has been said," Truth is very difficult to find and when you do find it, it only lasts ten years."  This does make a best seller though.  But if Dr. M is the Devil incarnate, then I will be the Devil's advocate, literally.  Let's remember that people are still arguing over the validity of the Theories of Freud, Einstein and Darwin, but no one can dispute the impact they have had on our lives. So it is with Dr. M whose career spans 50 years and whose prolific writings have been read by everyone in the field of "Sexual Psychology".
 So let us return to the Sixties and try with the retrospectoscope to understand what was happening with infants, who had ambiguous genitalia.
The Sexual Revolution was in full swing. With the advent of the pill, Christine Jorgenson and Playboy, there was a new openness to the discussion of sexual behavior.  We were just beginning to decipher the byproducts and influences of Testosterone (T) and Estrogen (E) on our lives.  The behavioral psychologists were ascribing traits like aggression, dominance and truculence to T.  There was the interpretation of body language and role playing of the sexes.  The psychiatrists were telling us that a child's sexual identification of himself or herself was not fixed until age three or four and the embryologists were telling us that urogenital ridge in the fetus would be female unless T  stimulated the development of male internal organs. And thrust into this world were thousands of babies, who didn't fit any pattern externally or internally, but whose parents desperately sought a quick answer to their dilemma.  Fortunately true hermaphrodism with both testes and ovaries only make up 10% of intersex abnormalities. But this condition is referred to in JC's book over and over.  What we find in 70% of the cases is female pseudohermaphrodism , genetically female with male appearing externals, who are easily converted to female status. No argument.  Now the remaining 20% is where the problem lies.  In the Sixties, we could detect a Y and XX  chromosomes, but not much more.  So what could we do with genetic males who had little or no male genitalia.
 On to the scene comes Dr. M who has written his doctoral dissertation on Intersex and has stated that some infants can adjust to this confused state without surgery.  But all across this country, surgeons are converting infants without a developed phallus to the female sex before age four.  Why? Because parents wanted a definitive sex yesterday and there were no techniques for construction of a penis or urethra, de novo. Even today after we have eliminated all the newly discovered correctable disorders, a lot of importance is placed on phallic size at birth.  And although microsurgical techniques have improved outcomes,  phalloplasty is still problematic. Now in the mid 50's Dr. M begins to unveil his papers on intersex and everybody begins to understand the gamut of sexual ambiguities.  By the time Dr. M reveals the SRS of David in 1973, SRS for infants has been in practice over a decade.  Dr. M continues to write and present his research cases and evidently pushes the wrong buttons in Puritanical America.  He is repeatedly accused by JC of collecting phallic art, using the words penis, vagina and fuck in front of children, showing sex pictures to children,  and on one occasion, if true, defending pedophilia in a Dutch magazine.  But this is the same Dr. M who treated TS's when no one would, formed the Gender Identity Clinic at JH, brought SRS to JH and presented TS's at Medical Grand Rounds instead of the Jerry Springer show.  Dr. M did not bully, as intimated, the most celebrated Professors of Surgery, Pediatric Endocrinology  and Plastic Surgery at JH.  He showed them a group of people in need, members of our TG community.  And I for one am indebted to his pioneering efforts. Well, I have told you of my bias, but what do we know of JC.'s bias. Absolutely nothing ! This is a tedious book to read but nevertheless a compelling work to ponder. This week it is Number 24 on the Times Best Seller list and it should stay there.