John Colapinto, the author of “As Nature Made Him: The Boy Who Was Raised As A Girl”, explores the details of a famous “twins case” study by the reputable psychologist/sexologist John Money and how it all went wrong. As a journalist forRolling Stone magazine, Colapinto first encountered the book’s protagonist, David Reimer, a few months after an article published in 1997 from the medical journalArchives of Pediatrics and Adolescent Medicine, written by Dr. Milton Diamond and Dr. Keith Sigmundson, disproved Money’s well-established theory about gender reassignment (Colapinto 2000, xiv).
After publishing his own article on the subject in Rolling Stone without revealing any details about Reimer’s identity, Colapinto convinced Reimer to “abandon the mask of John/Joan” for a feature book about his life (Calapinto 2000, xv). The author’s account was based on a number of sources: personal interviews with John Reimer, family members, friends and school teachers; private legal papers; therapy notes; Child Guidance Clinic reports; IQ tests; medical records; and psychological workups (Colapinto 2000, xvii). Colapinto investigates and reassesses the famous case study through these various sources and establishes some ethical dilemmas now facing the medical world; a direct result of decades of misinformation brought forth by the original “John/Joan” twins case.
In the book, “As Nature Made Him: The Boy Who Was Raised As A Girl”, Ron and Janet Reimer faced the biggest decision of their lives after a routine circumcision for their twin sons went horribly wrong. While Bruce’s brother Brian was left with a fully functioning penis, Bruce was the first twin to undergo the procedure and was left with a charred penis after the machine malfunctioned. After being unsatisfied by the efforts of local and regional doctors, the distraught parents sought help from Dr. Money after watching him as a guest on the “Canadian Broadcasting Corporation’s popular current affairs program This Hour Has Seven Days” (Colapinto 2000, p.18). Money quelled their fears and invited them to his research facility at John Hopkins in Baltimore where he used Bruce and Brian as the test subjects for his famous “John/Joan” case. Sadly to Money and his followers, his claim that “[I]f you tell a boy he is a girl, and raise him as one, he will want to do feminine things” was disproved upon the discovery that “Brenda” had abandoned her feminine gender as a teen and even renamed herself “David” (Colapinto 2000, p.70).
It would be hard to not have heard of the name Dr. John Money if one was in the social or medical field, as his name is synonymous with “gender identity” and the “sexual revolution”. Money was the first to coin the term “gender identity” and was dubbed “agent provocateur of the sexual revolution” in a 1975 issue of the New York Times (Colapinto 2000, p.28). With Money’s far reaching reputation as a leading authority on gender reassignment after his famous “John/Joan” twins case, his claims were “handed down and accepted as gospel by some”, according to pediatric endocrinologist Dr. Mel Grumbach (Colapinto 2000, p.76).
The basis of Money’s “gender identity” theory was rooted in his research of the Yolngu tribe and their “sexual rehearsal play”. His findings, while never verified by other researchers, “became a constant reference in almost every public utterance of Money’s for the next three decades” (Colapinto 2000, p.89). Money applied his findings from the remote Australian tribe to all of Western culture producing an ethics theory that would be “consistent across different cultures” instead of “emics ” theory, which would be culturally specific (Matsumoto 2008, p.24). The ultimate failure of the “John/Joan” twins case corroborates the findings of Amir & Sharon in 1988 and Gergen et al. in 1996 that “Psychological theories are only as good as their applicability to people in their real lives” (Matsumoto 2008, p.26).
Money was virtually unquestioned and unchallenged by all but one in the same field, a man by the name of Dr. Milton Diamond. While Money had a reputation as a great scientist he also had the reputation of an intimidating researcher with a sizable ego, as can be noted when he punched fellow researcher Diamond in the face during a conversation in which Diamond disagreed with Money’s core assertion that children “formed a conception of themselves as masculine or feminine solely through rearing”’ (Colapinto 2000, p.78, 32). This rage is also noted through the accounts retold by Reimer and his brother in which they were screamed at and told by Money to “remove their clothes and inspect each other’s genitals” when they defied him (Colapinto 2000, p.86).
Money’s ego may have interfered with his research, such as convincing his uninformed parents into removing Bruce’s testes in one of many surgeries as an infant, trying to coerce Brenda into having vaginal surgery, and omitting findings from school reports regarding her poor school functioning. I believe that all of this was subconsciously done by Dr. Money, but nevertheless his personal bias helped generate a more successful depiction of Brenda’s gender reassignment; helping prove his overall theory on “the power of nurture over nature” (Colapinto 2000, p.70). His theory placed sole emphasis on “gender-role ideology”, one of the many determining factors such as: “culture, biology, gender roles, and gender-role ideology (that) all interact to produce differences between the genders on a variety of psychological and behavioral outcomes” (Matsumoto 2008, p.157). While Reimer officially readopted his “male gender identity” as a teenager, he has rejected his female roles as early as first grade. If John Reimer is to be portrayed as the book’s protagonist, Dr. Money would indubitably be depicted as the antagonist.
Perhaps the most intriguing aspect of the “John/Joan” twins case was the fact that they were the perfect test subjects because they were identical twins. This would provide a better environment for any researcher to balance the “extraneous variables” that are not controllable in “case studies”, one of its core disadvantages. (Shaughnessy, 2006 p.334). Case study provide an opportunity ““to try out’ new therapeutic techniques”, which intrigued Money almost as much as the idea of challenging the scientific theory of “nature over nurture” (Shaughnessy, 2006 p.329). The evidence of case studies could also provide “tentative support” for his proposed theory of “nurture over nature” (Shaughnessy, 2006 p.329). This situation would be attractive to a host of researchers and Money’s ego was more than eager to “take the bait”. The problem is that Money claimed success too soon; going on National book tours with appearances on such shows as Oprah to promote a premature idea that was ultimately proved as inconclusive.
The topic of “intersexuality” is depicted in this book, as the findings of the “John/Joan” became the “’index case’ for treatment of intersexuality in infants” (http://pdfserve.galegroup.com/pdfserve/get_item/1/Sb88a90w16_1/SB096_01.pdf). “’Intersex’ is a general term for any form of congenital (inborn) mixed sex anatomy” and although Bruce Reimer wouldn’t technically qualify as “intersexed” because his sex anatomy was destroyed after birth, the same “gender-reassignment” treatment was applied to patients in either case until fairly recently (Melba 2002, p.6). Interestingly before this past decade, when “gender re-assignment” of intersexed babies was the norm, the majority of “intersexed” patients were altered and raised as females. This is because it was much easier to perform female surgical reassignment than male. If the purpose was to have a more attractive sexual organ, the vagina would certainly be the organ of choice to doctors, especially during the earliest of operations where procedures were still being developed. While Riemer’s parents were told that he would never be able to have a fully-functioning penis and would thus not be able to achieve happiness, his three children are proof that medical procedures have opened doors never previously thought as viable.
Perhaps another reason could be that it would be better accepted in our society as a female with manly traits than a man with female traits because, according to Matsumoto “for boys… a masculine, not androgynous, identity is associated with the highest level of self-acceptance” (2008, p.164). A female with both male-associated and female-associated traits actually have “higher levels of self acceptances than either feminine or masculine girls” (Matsumoto 2008, p.164). Dr. Money is able to rebuff Brenda’s “gender role” resistance by convincing her that she was just a “tomboy” meaning that she possessed both male and female-associated characteristics, but examples such as her “standing while peeing” indicate that she is more of a “masculine girl” than a “tomboy” and are aligned with the notion that “masculine girls” have lower self-acceptance than girls with both male-associated and female-associated attributes.
Colapinto’s book along with Jeffrey Eugenides’s book “Middlesex” and nonprofit groups like Intersex Society of North America have helped create awareness about “intersexuality” to break down the stereotypes and stigmatization associated with people that challenge “gender stereotypes” (Melba 2002, p.4)(Matsumoto 2008, p.156). This awareness over the past decade has helped delay doctors of intersexed children from “assigning a definitive sex at birth and given surgically altered genitalia and a gender identity to match” (Wood 2008, p.74). There are advocates that would like the medical field to rethink how they treat the estimated 2000 people each year in the U.S. that are born with intersex conditions by further evaluating “the varied—and often conflicting—perspectives of doctors, parents, intersexed people, and intersex rights activists” (Wood 2008, p.74). Perhaps the very notion that intersexuality is something that needs to be treated is more “socially motivated” to help preserve the “heteronormative assumptions about gender that have long been the basis for medical treatment” (Wood 2008, p.74). If these patients and their parents were given therapy to help accept their intersexuality and not change their outward appearance to conform to one specific gender, this may offer a more positive alternative to “treatment”.
The issue of ethics is something Philip Gruppuso considers greatly as he says, “You have to have an ethical framework in place before you can look at outcome data” (Melba 2002, p.5). Now a professor of pediatrics and biochemistry at Brown University, Gruppuso used to treat intersexed patients but had a change of heart after he learned about one of his patients “assigned female in infancy who wanted to switch to male at age 14” (Melba 2002, p.5). He realized that just because those in the medical mainstream responsible for deciding the fate of these intersexed babies based their decisions on Money’s “tentative support”, didn’t mean that they weren’t in fact doing more harm than good. Why would doctors be so willing to accept such a controversial theory as “nurture over nature” when biological and cross-cultural research has proven otherwise?
Perhaps Money was simply ignorant to the IRB ethical issues involving the research of minors such as the assessment of “The Risk/Benefit Ratio”. According to a pilot study conducted by Stroustrup, Kornetsky & Joffe entitled Knowledge of Regulations Governing Pediatric Research less than half (40 percent) could correctly answer a question about the concept of ”minimal risk” as defined through Federal regulations (2008, p.4). Maybe more frequent and consistent training could provide a better understanding for future case studies so that the incorrect “tentative support” such as the “John/John” findings wouldn’t negatively affect so many lives, which certainly extended beyond the standard definition of “minimal risk”.
David Reimer is a man that overcame nurture to reveal his true nature, but not without suffering tremendously. He is certainly not the only patient that has suffered from an unwanted gender reassignment surgery, as many intersexed patients such as Kiira Triea who referred to herself as a “lab rat” and was also treated at John Hopkins admits that her treatment prevented her from having “normal” happiness (Holmes, 2002 p.169). Reimer was treated worse than a person born with male and female sex organs because he was assigned a gender identity that was opposite his known biological sex. At least with intersex patients their true sex is not able to be determined, this leaves a wider and more guilt-free option to choose either sex equally.
Experiencing pain beyond the IRB definition of “minimal risk”, David experienced great mental and emotional stress, “a potential risk of psychological research” that should have been assessed by Dr. Money before the research was conducted (Shaughnessy 2006, p.65). Even with the support of his wife and children David was never fully able to conquer his fear and shame, and took his life shortly after sharing his raw experience with the reader. In the Book “As Nature Made Him: The Boy Who Was Raised As A Girl”, Colapinto was able to use the various sources at his disposal to create a better understanding of various issues regarding ethics in medicine while generating awareness about issues such as “intersexuality” in our society in efforts to help fracture negative stereotypes about the condition and the people that are affected by it.
Colapinto, J. (2000) As Nature Made Him: The Boy Who Was Raised As A Girl. New York: Harper Perennial Hausman, B. Do Boys Have To Be Boys? Gender, Narrativity, and the John/Joan Case. NWSA Journal, Fall 2000 v12 i3 p114. Retrieved on November 23, 2008 from Web site: pdfserve.galegroup.com...
Holmes, M. (2002, May). Rethinking the Meaning and Management of Intersexuality.Sexualities, 5(2), 159. Retrieved November 30, 2008, from Academic Search Premier database.
Matsumoto, D. & Juang, L. (2008). Culture and Psychology - 4th Edition. California. Thomson Wadsworth.
Melba, T. (2002, December). Intersex Interrupted. Contemporary Sexuality, 36(12), 1. Retrieved November 30, 2008, from Academic Search Premier database
Shaughnessy, J., Zechmeister, E., Zechmeister, J. (2006). Research Methods in Psychology- 7th Edition. New York. McGraw Hill.
Stroustrup, A., Kornetsky, S., & Joffe, S. (2008, September). Knowledge of Regulations Governing Pediatric Research: A Pilot Study. IRB: Ethics & Human Research, 30(5), 1-7. Retrieved November 30, 2008, from Academic Search Premier database.
WOOD, S. (2008, Fall2008). Fixing Sex: Intersex, Medical Authority, and Lived Experience. Bitch Magazine: Feminist Response to Pop Culture, Retrieved November 20, 2008, from Academic Search Premier database.