David Reimer

David Reimer (August 22, 1965 – May 5, 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. Academic sexologist Milton Diamond later reported that Reimer failed to identify as female since the age of 9 to 11, and that he began living as male at age 15. Reimer later went public with his story to discourage similar medical practices. He later committed suicide, owing to suffering years of severe depression, financial instability, and a troubled marriage.

History
David Reimer was born as Bruce, in Winnipeg, Manitoba. His identical twin was named Brian. At the age of 6 months, after concern was raised about how both of them urinated, the boys were diagnosed with phimosis. They were referred for circumcision at the age of 8 months. On April 27, 1966, a urologist performed the operation using the unconventional method of cauterization. The procedure did not go as doctors had planned, and Bruce's penis was burned beyond surgical repair. The doctors chose to not operate on Brian, whose phimosis soon cleared without surgical intervention.

The parents, concerned about their son's prospects for future happiness and sexual function without a penis, took him to Johns Hopkins Hospital 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 of Gender Neutrality'—that gender identity developed primarily as a result of social learning from early childhood and that it 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, during which he discussed his theories about gender. He and 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 surgery would be in Reimer's best interest. At the age of 22 months, Reimer underwent an orchidectomy, in which his testes were surgically removed. 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 annually for about a decade for consultations 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's twin brother, Brian, made an ideal control because the brothers shared genes, family environments, and the intrauterine environment. 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.

Dr. Money forced the twins to rehearse sexual acts involving "thrusting movements," with David playing the bottom role. David Reimer painfully recalled that, as a child, he had to get "down on all fours" with his brother, Brian Reimer, "up behind his butt" with "his crotch against" his "buttocks." Dr. Money forced David, in another sexual position, to have his "legs spread" with Brian on top. Dr. Money also forced the children to take their "clothes off" and engage in "genital inspections." On at "least one occasion," Dr. Money took a photograph of the two children doing these activities. Dr. Money's rationale for these various treatments was his belief that "childhood 'sexual rehearsal play'" was important for a "healthy adult gender identity."

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." Notes by a former student at Money's lab state that, during the followup visits, which occurred only once a year, Reimer's parents routinely lied to lab staff about the success of the procedure. The twin brother, Brian, later developed schizophrenia.

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 constructed, the family discontinued the follow-up visits. From 22 months into his teenaged years Reimer urinated through a hole that surgeons had placed in the abdomen. Estrogen was given during adolescence to induce breast development. Having no contact with the family once the visits were discontinued, John Money published nothing further about the case, which suggests that the reassignment had not been successful.

Reimer's account, written with John Colapinto two decades later, 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 (which he was forced to wear during frigid Winnipeg winters) 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. On September 22, 1990, he married Jane Fontaine and became a stepfather to her three 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 the book As Nature Made Him: The Boy Who Was Raised as a Girl.

Diamond and his collegue Sigmundson then wrote a longterm followup report in 1997

Death
In addition to his lifelong difficult relationship with his parents, Reimer had to deal with unemployment and the death of his brother Brian from an overdose of antidepressants on July 1, 2002. On May 2, 2004, his wife Jane told him she wanted to separate. On the morning of May 5, 2004, Reimer drove to a grocery store's parking lot and committed suicide by shooting himself in the head with a sawed-off shotgun. He was 38 years old.

Social legacy
For the first thirty years after Dr. Money's initial report that the reassignment had been a success, Dr. Money's view of the malleability of gender became the dominant viewpoint among physicians and doctors, reassuring them that sexual reassignment was the correct decision in certain instances, resulting in thousands of sexual reassignments.

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 or penile loss in infancy.

Colapinto's book described unpleasant childhood therapy sessions, implying 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 and that the family was not honest with researchers.

The case has been treated as well by Judith Butler in her 2004 book Undoing Gender which examines gender, sex, psychoanalysis and the medical treatment of intersex people. The case of Reimer is used to re-examine Butler's theory of performativity that she originally explored in Gender Trouble.