David Reimer (August 22, 1965 as Bruce Reimer â€“ May 4, 2004) was a Canadian man who was born as a healthy male, but was sexually reassigned and raised as female after his penis was accidentally destroyed during circumcision. Psychologist John Money oversaw the case and reported the reassignment as successful, and as evidence that gender identity is primarily learned. Milton Diamond later reported that Reimer never identified as female, and that he began living as male at age 14. Reimer later went public with his story to discourage similar medical practices. Due to years of severe depression and a dissolving marriage, he committed suicide.
David Reimer was born as a male identical twin in Winnipeg, Manitoba. His birth name was Bruce; his twin brother was named Brian. At the age of 6 months, after concern was raised about how both twins urinated, both boys were diagnosed with phimosis, a condition under which the male foreskin cannot be fully retracted. They were referred for circumcision at the age of 8 months. On April 27, 1966, a doctor who did not ordinarily perform circumcisions performed the operation using the unconventional method of cauterization. The procedure did not go as doctors had planned, and David Reimer's penis was burned beyond surgical repair.
Reimer's parents, concerned about their son's 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 developed primarily as a result of social learning from early childhood and 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, where he discussed his theories about gender. He, and other 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, and that Reimer would be more likely to achieve successful, functional sexual maturation as a girl than as a boy.
They persuaded his parents that sex reassignment would be in Reimer's best interest, and, at the age of 22 months, surgery was performed to remove his testes. 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 Reimer 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, Reimer had a twin brother, Brian Reimer, who made an ideal control since the two not only shared genes and family environments, but they had shared the intrauterine environment as well. 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.
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." Estrogen was given to Reimer when he reached adolescence to induce breast development. However, 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 created, the family discontinued the follow-up visits. John Money published nothing further about the case to suggest that the reassignment had not been successful.
Reimer's later account, written two decades later with John 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 nor female hormones made him feel female. By the age of 13, Reimer was experiencing suicidal depression, and told his parents he would commit suicide if they made him see John Money again. In 1980, Reimer's parents told him the truth about his gender reassignment, following advice from Reimer's endocrinologist and psychiatrist. At 14, Reimer decided to assume a male gender identity, calling himself David. By 1997, Reimer had undergone treatment to reverse the reassignment, including testosterone injections, a double mastectomy, and two phalloplasty operations. He also married a woman and became a stepfather to her 3 children.
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. 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. They went on to elaborate the story in a book, As Nature Made Him: The Boy Who Was Raised as a Girl.
Colapinto split the revenues from the book with Reimer, giving him financial security but not freedom from his problems. In addition to his life-long difficult relationship with his parents, Reimer had to deal with the death of his brother from an overdose of antidepressants in 2002, unemployment and separation from his wife Jane. On May 2, 2004, she told him she wished to temporarily separate; Reimer stormed out of the house and did not return. Two days later Jane Reimer received a call from the police that they had located her husband but he did not want his location revealed. Two hours later, they called again, informing her of his suicide. Reimer had returned home while she was out and retrieved a shotgun, sawing off its barrel before leaving. On the morning of May 5, he drove to the nearby parking lot of a grocery store, parked his car and fatally shot himself in the head.
Social effect of David Reimer's story
The report and subsequent book about Reimer influenced several medical practices and reputations, and even current understanding of the biology of gender. The 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.
It supported the arguments of those who feel that prenatal and early-infantile 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 insensitivity to its effects is more uncertain. For some people, the inability to predict gender identity 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. The Intersex Society of North America, who opposes involuntary sex-reassignment, treats the story of David Peter Reimer as a cautionary tale about why one should not needlessly modify the genitals of unconsenting minors.
Among the repercussions was damage to John Money's reputation. Not only had his theory of gender plasticity been dealt a severe blow, but Colapinto's book described bizarrely unpleasant childhood therapy sessions, and implied 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. However, David's brother and mother both agreed that the therapy was not "working" in the sense that Reimer wasn't in any way developing a female self-image. Dr. Money never publicly stated that his conclusions were incorrect.
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. Despite the uniqueness of this case, many people cited it as evidence that physicians should not attempt to surgically treat the problems created by birth defects of the genitalia. Finally, theories of the malleability and cultural construction of gender identity, already falling out of academic fashion in the 1990s, became harder to defend, as the case was used by many to argue that "nature" trumped "nurture".
- "David Reimer: The boy who lived as a girl", CBC News, July, 2002. Retrieved on 2006-01-20.
- Colapinto, J (2001). As Nature Made Him: The Boy Who Was Raised as a Girl. Harper Perennial. ISBN 0-06-092959-6. Revised in 2006
- Colapinto, John. "The True Story of John/Joan", Rolling Stone, 1997-12-11, pp. 54-97.
- Colapinto, J. "Gender Gap: What were the real reasons behind David Reimer's suicide?", Slate, 2004-06-03. Retrieved on 2009-02-13.
- Intersex Society of North America | A world free of shame, secrecy, and unwanted genital surgery
- "Being Brenda", Guardian Unlimited, 2004-05-12. Retrieved December 19, 2005
- "Sex: Unknown (transcript)", NOVA (TV series), 2001-10-30.
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