A fascinating and sad look at the on-going argument of Nature vs. Nurture with regard to gender identity in children. Sounds hideously dry and textbook-y, but it isn’t. It’s written by Rolling Stone writer Colapinto who obviously took great pains to get the full story of this medical horror story.

For those who are not familiar with the case from the 1960’s in the U.S.:  two infant twins, Brian and Bruce Reimer, went through a fairly normal circumcision surgery, except for Bruce, who had a truly incompetent surgeon who botched the whole thing and led to Bruce getting his penis cut off. Of course, this led to difficult decisions for his young and inexperienced parents: what to do that would be best for the young boy? Talking with a famous psychologist at Johns Hopkins Hospital, they are advised to raise Bruce as a girl instead of a boy.

The psychologist, Dr. John Money, believed (and may well still believe) that gender identity is malleable and if you raise the child correctly (according to him), then the child will have no problems being whichever gender has been assigned to them.

However, (and this is a big “however”), this doesn’t work. Bruce (now called Brenda) is treated like a girl and dressed like a girl, but this does not feel right to him. Year after year, Brenda’s parents take her to visit with Dr. Money (who has some questionable therapeutic tactics) and despite Brenda putting up a fight about this, she is still forced to visit him.

As the book continues, and we see Brenda struggle to grow up in the female gender, it gets heart-breaking to read about the well-meant collusion between the various medical authorities involved in her case. I don’t think they meant harm to anyone – they just didn’t know and all the info they had to base their decisions on were from Dr. Money (who was convinced that his theory was right). Treat Brenda as a girl, and she will accept that gender.

It’s not until her mid-teens that Brenda’s concerns are finally heard, and receives “permission” from her psychiatrist to be a boy. She has felt like a boy her whole life and couldn’t understand it as no one had told her of her medical history. (This was recommended by the nutty Dr. Money.)  Brenda (now calling himself David) was much happier but have the years of gender confusion done irreversible damage to him?

Colapinto does not lionize David – he does sound like a difficult person at times – but does a good job of allowing the reader to sympathize with most of the characters in this misery play. Looking back through time, it seems obvious in many ways that it would have been better for all if Brenda had been allowed to stay Bruce regardless of what his body looked like. However, this was before the internet; this was before it was acceptable to research your own medical condition and to question your medical team. Doctors were the Expert Authority, and for this young married couple in Winnipeg, they had no other way to know any differently.

The only clearly wrong character was the psychologist who, using faulty data, managed to ruin four lives from afar without any punishment from anyone.

This book sounds hideously depressing, but it’s not really. It reads like a long investigative journalistic piece (which is not surprising considering that Colapinto is just that). He does a good job of weaving the various threads together to make a coherent whole, and although the book has not been updated with David’s most recent history, a quick internet search shows the conclusion.

It must have been very difficult for David – who could he blame? The surgeon who botched the early operation? His parents who were ill-educated on this issue? A very persuasive psychologist at a well-known hospital who acted as though this was the only thing to be done? I think the buck stopped with Dr. Money, myself, and how he can live with himself for these decisions… I am not sure.

David’s story opened the world’s eyes to the problems associated with surgical gender assignment for children who are born intersexual. What would you have done in his parents’ position?

There is still an ongoing debate about this so it seems that the issue has not been solved yet.

Anyway, an  interesting book on a fascinating subject. Nature or Nurture? It seems that Nature will win.