As Nature Made Him (7 page)

Had he known of it at the time, Diamond might also have drawn upon an obscure paper in the foreign literature for his critique—a paper that had questioned the Johns Hopkins team’s protocols for intersex treatment some six years earlier. In a 1959 edition of
The Canadian Psychiatric Association Journal
, three Toronto physicians, Dr. Daniel Cappon, Dr. Calvin Ezrin, and Dr. Patrick Lynes, had pointed out serious flaws in the Hopkins team’s statistical and research methods. “[T]hese workers,” the Canadians wrote, “failed to relate the physical and psychological wholes of the person and only compared component parts without submitting these comparisons to mathematical validation.” In conducting their own research on a cohort of seventeen intersexual patients, the Canadian doctors took precautions that the Johns Hopkins team had not. To prevent subjective tainting of their results, the Canadians split their research team in two: one to study the patients from an endocrinologic perspective, the other to study the patients from a psychological perspective. For comparative purposes, the Canadian team also carried out research on a control group of nonhermaphrodites, as well as on a series of homosexuals and transvestites.

The team’s results showed that it was dangerous indeed to suppose that no link existed between an intersexual child’s biological makeup and its gender identity; that in fact the status of the chromosomes, gonads, or hormones might predispose a hermaphrodite child to identify more with one sex than the other in adulthood. Stating that the Johns Hopkins team had based its recommendations to surgeons on “shaky theory,” the Canadians had expressed particular unease about the recommendation that males born with tiny or nonexistent penises should, without exception, be castrated and converted into girls. Such sex-changed children, the Canadians had warned, “were liable to be brought up tragically incongruously with the main somatic sex.”

The Canadian team’s findings would have made a strong addition to Diamond’s exhaustive theoretical critique, but he did not learn of the paper’s existence until after his own was published (at which point he began to cite it in his own papers). “The Canadian paper got lost somewhere,” Diamond says. “It just died. I think it was maybe Hopkins compared to Podunk.” But in 1965, Diamond’s paper was published in a high-profile, well-respected American journal, the
Quarterly Review of Biology
, where it could not be missed—least of all by John Money, considering that the
Quarterly Review
was at that time published out of Johns Hopkins.

I was sitting with Diamond in his cluttered, windowless office on the campus of the University of Hawaii Medical School as he reminisced about these origins of his thirty-year-long scientific debate with John Money. It was June of 1997, just two months after Diamond and Sigmundson’s “John/Joan” paper had delivered a blow to his old rival. A mild-mannered sixty-four-year-old with frizzy graying hair and beard, Diamond was clearly exhausted from fielding the unending stream of phone calls, faxes, and letters from both reporters and fellow scientists requesting more information about, or an interview with, John/Joan. Dressed in a pale blue overlaundered T-shirt riddled with holes, a pair of jeans, and battered running shoes, Diamond told me that professors at the University of Hawaii are “paid in sunshine.” His putty-colored pallor suggested that he had not been drawing his full wages. Diamond had, in fact, spent the majority of his thirty years in Honolulu doing experiments or hunched over his computer in the tiny office he calls his “cave,” pumping out more than one hundred journal articles and eight books on sexuality. On the wall beside him was tacked a snapshot of his four daughters; on the messy desk in front of him were heaped papers, books, open journals, and boxed sets of both Robert Johnson and Bach tapes.

Diamond insists that he bore John Money no personal animus at the time of writing his 1965 article and that his intent was not to embarrass him. He says that his paper had merely been an effort to advance the field of knowledge in the time-honored scientific tradition of assertion and challenge. Diamond points out that after the article’s publication, he actually made an overture to Money, suggesting that they collaborate on an article. Though he recognized that they stood on opposite sides of the nature-nurture debate, Diamond believed this was precisely why their collaboration would be of particular value. He shakes his head and smiles at the naïveté that compelled him, a mere graduate student, to suggest a collaboration with one of the leading scientists in the field—a scientist whom, furthermore, he had just publicly challenged in a leading journal. “I really believed that it was an intellectually good thing to do,” Diamond says. Money evidently felt otherwise. “His attitude was, Why should I do anything with
you
?” Diamond says. “Who knows
you
?” Diamond admits that he was not completely surprised by the reaction. “I had challenged his theory, which he took as an argument against
him
. Which it wasn’t.”

Yet even a scientist less thin-skinned than John Money might have been stung by the calm, relentless logic of Diamond’s critique—which, near the end, raised the most rudimentary Science 101 objection to the unquestioning acceptance of Money’s theory of psychosexual neutrality in normal children. “To support [such a] theory,” Diamond wrote, “we have been presented with no instance of a normal individual appearing as an unequivocal male and being reared successfully as a female.” And Diamond had added: “If such an individual is available he has not been referred to by proponents of a ‘neutrality-at-birth’ theory. It may be assumed that such an individual will be hard to find.”

Hard—but not, as events transpired, impossible. For it was just one year and eight months after Diamond threw down this gauntlet in the
Quarterly Review of Biology
that Dr. John Money received a letter from a young mother in Winnipeg, Canada, describing the terrible circumcision accident that had befallen one of her identical twin baby boys.

3

R
ON AND
J
ANET
R
EIMER
made their first trip to Johns Hopkins in early 1967, shortly after seeing Dr. Money on TV. The young couple—aged twenty and twenty-one respectively—were awestruck by the vast domed medical center dominating the top of a rise on Baltimore’s Monument Street. Dr. Money’s Psychohormonal Research Unit was located in the Henry Phipps Psychiatric Clinic, a gloomy Victorian building tucked away off a back courtyard. The unit’s offices, located on the fourth floor, were reached by way of a rickety turn-of-the-century elevator. Money’s own inner sanctum (where most of his meetings with the Reimers would take place over the next eleven years) reflected the psychologist’s eccentric tastes in interior decoration. Furnished with a couch, Oriental rugs, and a profusion of potted plants, the room also featured brightly colored afghans thrown over the backs of armchairs, a collection of carved aboriginal sculptures of erect phalluses, vaginas, and breasts on a mantel, and a collection of primitive blowguns, darts, and masks hanging on the walls. The Reimers had certainly never seen anything like this before, but Dr. Money, with his smoothly confident, professional manner—not to mention the diplomas on his wall—made the Reimers feel that they were, finally, in the best possible hands. “I looked up to him like a god,” says Janet. “I accepted whatever he said.” And what Dr. Money had to say was exactly what the Reimers ached to hear.

In his many published versions of this first interview, Money has recounted how he spelled out to the young couple the advantages of sex reassignment for their baby—“using nontechnical words, diagrams, and photographs of children who had been reassigned.” He explained to Ron and Janet that their baby could be given a perfectly functional vagina—“adequate for sexual intercourse and for sexual pleasure, including orgasm.” He also explained to them that although their child would not, if changed into a girl, be able to bear children, she would develop psychologically as a woman and would find her erotic attraction to men. As a married woman she would be perfectly capable of adopting children of her own.

What is not clear from Money’s written accounts of this meeting is whether Janet and Ron, whose education at the time did not go beyond ninth and seventh grades, respectively, understood that such a procedure was in fact purely experimental—that while Money and his colleagues at Johns Hopkins had performed sex reassignments on hermaphrodite children, no such infant sex change had ever been attempted on a child born, like their Bruce, with normal genitals and nervous system. Today Ron and Janet say that this was a distinction they did not fully grasp until many years later. The crucial point they gleaned from Dr. Money was his conviction that the procedure had every chance for success. “I see no reason,” Janet recalls him saying, “that it shouldn’t work.”

Money’s eagerness to begin seemed evident in his recounting of the interview almost ten years later. “If the parents stood by their decision to reassign the child as a girl,” he wrote in
Sexual Signatures
, “surgeons could remove the testicles and construct feminine external genitals immediately. When she was eleven or twelve years old, she could be given the female hormones.”

If Dr. Money seemed to be in a hurry, he was. He explained to Ron and Janet that they would have to make up their minds quickly. For according to one of the finer points of his theory, the
gender identity gate
—Money’s term for that point after which a child has locked into an identity as male or female—comes at two and a half to three years of age. Bruce was now nineteen months. “The child was still young enough so that whichever assignment was made, erotic interest would almost certainly direct itself toward the opposite sex later on,” Money wrote, “but the time for reaching a final decision was already short.”

Ron and Janet, however, were not prepared to have Bruce immediately admitted to the hospital. They needed time to decide on something as momentous as having their child undergo a surgical sex change. They told Dr. Money that they would have to go home and think about it. Janet says that he made no secret of his impatience with the delay. Upon their return to Winnipeg, the couple received letters from him urging them to reach a final decision. “He wrote in a letter that we were ‘procrastinating,’ ” Janet recalls, “but we wanted to move slow because we had never heard of anything like this.”

Back home, Ron and Janet canvassed opinions. Their pediatrician recommended against such drastic treatment and stuck by his earlier advice that Ron and Janet wait until the child was of preschool age before beginning the long process of phalloplasty. Janet’s mother, Betty, was inclined to trust the expert from Baltimore but had no real opinion of her own. Ron decided not even to bring it up to his parents since he felt sure they would be against it.

Finally Ron and Janet realized that only they could decide the fate of their child. They alone were the ones living with the reminder, at each diaper change, of his terrible injury. Janet saw the benefits of changing their son into a daughter. “I didn’t know much back then,” she says, “and I thought women were the gentler sex. Mistakenly. I have since learned that women are the hard-core knockabout tough guys.
Men
are the gentler sex, by far, from my experience. But I thought, with his injury, it would be easier for Bruce to be raised as a girl—to be raised gently. He wouldn’t have to prove anything like a man had to.”

Ron, too, could see the benefits of changing Bruce’s sex. “You know how little boys are,” Ron says. “
Who can pee the furthest?
Whip out the wiener and whiz against the fence. Bruce wouldn’t be able to do that, and the other kids would wonder why.” And then, of course, there was the entire question of Bruce’s sex life. Ron could not even imagine the humiliations and frustrations that would entail. As a girl and woman, though, Bruce wouldn’t face all that, Ron reasoned. If what Dr. Money told them was true, she could live a normal life, she could get married, she could be happy.

Within days of their return from Baltimore, Ron and Janet stopped cutting the baby’s hair, allowing the soft, light brown locks to curl down past the ears. Janet used her sewing machine to turn his pajamas into girlish granny gowns. Their son had become, for Ron and Janet, their daughter. Dr. Money had counseled them, when deciding what to call their new daughter, to select a name beginning with the same letter as her former name and to avoid calling her after any female family members with whom her identity could become confused. Janet, following Dr. Money’s instructions, called her new baby daughter Brenda Lee.

There was, of course, still one more step to take. That summer, Ron and Janet left Brenda’s twin brother, Brian, with an aunt and uncle, then flew back to Baltimore with their daughter. Now twenty-two months old, she was still within the window that Money had established as safe for infant sex change. On Monday, 3 July 1967, Brenda underwent surgical castration in a gynecologic operating room at Johns Hopkins Hospital. The surgeon was Money’s Gender Identity Clinic cofounder, Dr. Howard Jones. Today Jones says he can recall few specifics about the case. He says that all decisions regarding reassignment of sex were the responsibility of Money and pediatric endocrinologist Dr. Robert Blizzard.

“My chief interest was the physical situation and the surgical potential,” Jones says. “Was the patient healthy and able to withstand the operation?—all that kind of stuff. The case was pretty well worked up before I ever got involved.” For Jones, the surgery on Brenda Reimer was like the routine castrations he had been performing on hermaphrodite babies over the previous twelve years—and apparently Johns Hopkins Hospital viewed the operation the same way. Officials of the hospital have declined all comment on the case, but a Johns Hopkins public relations person, JoAnne Rodgers, told me in the winter of 1998, “In all surgeries that were considered, in the sixties, to be experimental, there were protocols in place to have those approved by appropriate committees and boards.” Dr. Jones cannot recall that the hospital convened any special committee or board in the case of Bruce Reimer’s historic conversion to girlhood.