As Nature Made Him (24 page)

K
EITH
S
IGMUNDSON REMEMBERS
his discomfort on seeing the advertisement. It appeared, he says, sometime in the 1980s in an American Psychiatric Society newsletter, and it said: “Will whoever is treating the twins please report.” Below this entreaty was a name and address: Dr. Milton Diamond, University of Hawaii-Manoa, John A. Burns School of Medicine, Honolulu.

“I saw it,” Sigmundson says, “but I couldn’t bring myself to answer.”

In the ten years that had elapsed since Brenda’s switch to David in 1980, Sigmundson had toyed with the idea of publishing the true outcome of the case. He hadn’t done it, and for a very simple reason. “I was shit-scared of John Money,” he admits. “I didn’t know what it would do to my career.” It had been one thing for Sigmundson to cooperate with the BBC documentary and appear as an unidentified psychiatrist speaking about “difficulties” in the twin’s psychological adjustment. It would be quite another to challenge a man of Money’s power directly by publishing a signed article describing how his most widely publicized and influential case had failed from the outset. Sigmundson put the idea out of his head. Diamond’s ad was an awkward reminder. At first, Sigmundson almost answered it, but he had resisted the urge.

Money himself also mastered any urge he might have felt to publicize the case’s outcome. After his encounter with the BBC reporters in October 1979, he dropped all direct references to the case from his published papers, books, and public lectures. To many in the field of sexual development, his sudden silence on the subject was perplexing.

Virginia Prince, a pioneering transvestite activist who founded the first magazine for cross-dressers,
Transvestia
, in 1960, was one of those curious about the fate of the case, since it had played a significant role in her own acceptance of herself and her sexuality. Born a male, Charles Prince was in his early teens when he first started dressing in women’s clothes for erotic gratification—a clandestine activity that continued even after his marriage and the birth of his son. In his forties, Prince began to live full-time in the role of a woman, divorcing his second wife and changing his name to Virginia. Though a fully “out” transvestite by the time she learned of the twins case, Prince says that the story of the sex-changed baby nevertheless had a profound impact on her.

She first learned of it at a meeting of the Society for the Scientific Study of Sex (or Quad-S), an association of sex researchers and activists for which Money served as president for two years in the early 1970s. It was at a November 1972 Quad-S meeting in Palm Springs, California, that then-president Money gave a sneak preview of the twins case—one month before its wider unveiling at the American Association for the Advancement of Science in Washington, D.C.

“John presented pictures of the twins,” Prince recalls. “One photograph was of the two kids playing. The girl had a bow in her hair and was wearing a little dress; she’s sitting in the front of a wheelbarrow, and her brother is driving her around. The other was a portrait—a snapshot, but it was posed. The little boy’s got kind of a scowl on his face, and he’s not attempting to make a good showing. But the little girl is sitting up straight and smiling and looking at the camera, just as if she’s saying, ‘I’m happy as a clam.’ That’s the picture that got stamped on everybody’s mind.”

For Prince, Money’s twins case was encouraging proof that sex and gender were not an immutably preordained biological phenomenon. At every subsequent meeting with Money, Prince asked for an update on the twins’ progress. Ordinarily Money was happy to oblige. “He was very upbeat and happy with the results and proud [of] what was done,” says Prince. At a lecture in Los Angeles a decade later, that attitude had changed, Prince recalls. It had been some time since she had heard Money comment on the case, and Diamond’s paper on the BBC’s investigation was yet to be published. “I asked him, ‘Whatever became of the twins?’ ” Prince says. “He wasn’t very forthcoming. He seemed to be a little bit put out that I should ask the question. He was very short about it.”

At Johns Hopkins, Money grew similarly tight-lipped about the case. Deflecting questions about the twins when the topic arose on the wards or in his classroom, Money told especially inquisitive students and colleagues that he had “lost track” of the experiment after a “media invasion” by reporters. “He said that this family had been victimized by the BBC,” says Money’s former student Howard Devore, and that “the family and the case had been irreparably damaged as a result.” Money offered a similar explanation for his silence to his protégé, Dr. June Reinisch, a psychologist who had become head of the Kinsey Institute after studying with Money in the 1960s. “[He said] he’d been cut off from the family because they had somehow blamed him for the BBC,” Reinisch says.

This interpretation of events does not accord with Janet Reimer’s recollections. She says that even after the BBC’s visit to Winnipeg, she stayed in touch with Money. “I wrote him a letter about David switching back to being a boy and about what was happening in his life,” Janet says. “David had got his [settlement money from the hospital] by then. He was already dating girls—maybe not dating, but hanging out with girls.” Janet says that Money wrote back. “He said he would like to hear from David and Ron. And I wrote him a letter stating the truth: ‘Ron and David do not wish to communicate with you.’ I said, ‘I’m telling you that as a friend; I don’t want to give you a feeling of rejection, but they just don’t want to deal with you.’ ” Janet says that Money retained a studious neutrality in his letters about the news that Brenda was now David. “He never let on that he was disappointed,” Janet says. They continued to exchange letters sporadically through the 1980s. Money wrote to Janet about a trip he had made to Zimbabwe; he informed her of his bout with prostate cancer; and he mentioned the removal of his Psychohormonal Research Unit from the main campus of Johns Hopkins in 1986.

Apparently forgetting this exchange of letters, Money continued to insist to his scientific, academic, and medical colleagues that the case was “lost to follow-up”—a surprising claim if for no other reason than that the Reimers continued to live in the very house that Money had visited in 1979 and with the same telephone number that he had used to contact them.

While Money refrained from mentioning the twins case directly in his public statements after 1980, he continued to lecture on the efficacy of infant sex reassignment for boys with no penis, and Johns Hopkins Hospital continued to perform the procedure, even when an alternative treatment was developed in the mid-1970s by Dr. Mel Grumbach at the University of California, San Francisco, for cases of boys born with small penises. He discovered that he could increase phallus size in babies born with micropenis by giving injections of testosterone to the organ shortly after birth. In patients whose bodies were responsive to the hormone, the penis could be made to grow to a length that permitted standing urination and conventional copulation.

Grumbach spoke about the procedure at the Seventh Annual Birth Defects Institute Symposium on Genetic Mechanisms of Sexual Development, held in November 1976 in Albany, New York. He was surprised to discover that he could not earn an endorsement for the procedure from Johns Hopkins, still the single most influential hospital for intersex treatment. The meeting’s chairman, Johns Hopkins pediatric endocrinologist Robert Blizzard (who had worked as a consultant to Money on Bruce Reimer’s conversion to Brenda back in 1966), articulated the hospital’s decision not to adopt the California team’s treatment plan. “I think that we will be able to answer the question concerning the preference of rearing of those with [micropenis] in a few years—although not immediately,” Blizzard said in his closing remarks to the symposium. “I believe that Dr. Grumbach’s group on the West Coast is going to do what they believe is correct; namely, raise these children as boys; and our group on the East Coast are going to do what they think is correct; namely, raise these children as girls.”

John Money was Johns Hopkins’s most tireless promoter of that decision in the years that followed, stating in interviews, speeches, books, and papers that sex reassignment to girlhood was the sole option for baby boys with micropenis—or boys who, like David Reimer, had lost their penis to injury. At a meeting of the National Institute of Child Health and Human Development in September 1987, Money mentioned such infant sex changes as being among his most important clinical contributions to medical science. The occasion for Money’s comments was a ceremony at which he was being honored as one of four scientists in the country who had, for twenty-five consecutive years, been funded with taxpayers’ money by the National Institutes of Health. “In syndromes of male hermaphroditism and micropenis, and in cases of
ablatio penis
from circumcision trauma, when there is insufficient phallic tissue for surgical reconstruction of an adequate urinary and copulatory penis, a baby may be assigned and clinically habituated as a girl,” Money told the NIH audience in his acceptance speech. “In adulthood, comparison of such cases with those living as males without a penis shows a higher prevalence of satisfactory outcome in those living as females.”

Money’s comments were curious for at least two reasons: (1) no systematic follow-up studies had ever been published by Money, or Johns Hopkins, that demonstrated the prevalence of this satisfactory outcome, nor have there been in the years since Money’s remarks; and (2) at the time that he described the ability of doctors to successfully change the sex of
developmentally normal
boys to girls in cases of penis loss, the only such experiment he had followed from babyhood to adulthood was that of Brenda Reimer—an experiment that had failed fully seven years earlier, when Brenda had become David.

14

M
ILTON
D
IAMOND SAYS
that he cannot recall what spurred his decision to refocus his attention on the twins case at the dawn of the 1990s. He says that he had simply grown impatient with the silence around the experiment. “My thinking at that time was, This person has to be an
adult
now,” Diamond says. “We should be able to write an article about this.”

Further incentive for returning to the subject was soon provided by Money himself, who in 1991 published
Biographies of Gender and Hermaphroditism in Paired Comparisons
, a career-summing monograph on his forty years of work at the Psychohormonal Research Unit. Presenting his largest collection to date of “matched pairs” the book was Money’s latest defense of his theory that social learning overrides biological imperatives in the shaping of human sexual identity. Missing from the text was mention of the definitive test for his thesis—his ultimate matched pair: the sex-changed twin and her brother. In the book’s introduction, Money explained the mysterious absence of the case from this otherwise comprehensive volume—an absence that he insinuated owed something to the machinations of his longtime challenger, Milton Diamond.

“On the international academic scene,” Money wrote, “doctrinal rivalry regarding the origins of gender identity led to an alliance with an unscrupulous media”—here he inserted a parenthetical reference to Diamond’s 1982 paper on the troubled case—“that prematurely terminated a unique longitudinal study of identical twins. A BBC crew of television sleuths, incited by the prospect of airing a doctrinal dispute, traced the whereabouts of the twins and their family and unethically invaded their privacy for programming purposes.” Money provided no information about Brenda’s 1980 decision to become David, and this brief reference, with its hint that Diamond was somehow connected to the case’s premature termination, marked Money’s last published comment on the case.

Perhaps understandably, Diamond was disinclined to allow this innuendo-steeped passage to stand as the final historical word on the twins experiment. That the academic community at large accepted Money’s version of events was clear from yet another book published that year:
John Money: A Tribute
, a collection of essays written on the occasion of Money’s seventieth birthday. Replete with paeans to Money’s scholarship from longtime acolytes, including Anke Ehrhardt and June Reinisch, the volume also included a fulsome tribute from Dr. John Bancroft, a psychiatrist and clinical consultant at the Royal Edinburgh Hospital in Scotland, who is now director, of the Kinsey Institute. A behaviorist who was a believer in the primacy of rearing over biology in sexual orientation, Bancroft had taken this nurturist view to its logical conclusion in his clinical work. As a sex therapist in Great Britain, he had experimented with trying (in vain) to convert adult homosexuals to heterosexuality through aversion therapy. In his tribute to Money, Bancroft referred with tart disapproval to the “recurring attack from Diamond” and went on to cast doubts on the veracity of the information Diamond had reported from the BBC about the psychological difficulties Brenda had suffered.

“Money has reported her development at various stages, consistent with his theoretical expectations,” Bancroft wrote. “However, since the prepubertal stage, the scientific community has received no further authoritative reports, but rather rumors (not from Money) of troubled developments.” He moved on to defend Money’s decade-long silence on the case, casting it as evidence of Money’s scrupulous care for the emotional health of his research subjects. “In a case such as this,” wrote Bancroft, “when the attention of the scientific community (and in this case the media also) is focused on a particular individual, it is easy to see the need to withdraw and be silent to protect that individual; it must be extremely difficult to be the living test of a controversial theory!”

With his own academic integrity now being questioned, Milton Diamond did not have the luxury of withdrawing and being silent. Since the late 1970s and through the ’80s, he had made periodic inquiries (and placed at least one ad) seeking information from endocrinologists and psychiatrists about the case. But now he resolved to redouble his efforts to learn the fate of the twin.