Sex-surgery case contains ethical and medical lessons

The Argument

There are clear imperatives to be drawn from the disastrous 1965 Bruce-Brenda operation and its aftermath.

March 12, 2000|By Thomas N. Wise | Thomas N. Wise,Special to the Sun

Medical treatments can be classified mainly either as: (1) Those based on exact knowledge of how a drug works; or (2) treatments where the cause is unknown but repeated experiences have led to successful outcomes.

Unfortunately, physicians are often faced with complex problems for which there are no clear treatments.

This mandates experimental drugs or procedures. Sex-change surgery still fits into this experimental category since we don't have long-term outcomes for such individuals.

Is such irreversible surgery really a treatment for a strongly held conviction that one is trapped inside the wrong body? Such beliefs usually are indicative of a mental illness -- as such patients rarely have medical conditions that cause sexual ambiguity. Sadly, I have evaluated transsexuals, men who became women, who found the surgery to be a dreadful mistake and wished to revert back to the male anatomy. It was too late!

Sex changes are generally performed upon consenting adults, but what about surgery performed on a hapless child mutilated at birth by a medical error? "As Nature Made Him: The Boy Who Was Raised As a Girl" by John Colapinto (HarperCollins, 279 pages, $26) poses this question.

The book paints a stark picture of victims and villains. In 1965, Bruce, a normal 8-month-old boy, lost his penis due to a botched circumcision procedure, while his identical twin Brian remained intact. The twin's parents went to Dr. John Money, the noted sex researcher at Johns Hopkins Hospital, who confidently stated that he could "make children into whatever sex seemed best and the child could be raised happily in that sex."

At 22 months of age, Bruce was surgically castrated and reassigned into "Brenda."

Money believed that gender, a sense of maleness or femaleness, was primarily determined by environment, with lesser contributions from biology. Studying Brenda and Brian as they grew up was a unique opportunity to test this belief.

To be fair to Money, it must be remembered that in 1967 when the reassignment was performed, the option of penile reconstruction was very limited and sex change seemed a plausible option. Money also recognized that there was a time urgency to reassign Bruce into Brenda, since such changes worked only if the transformation occurred at a very young age. Twenty-two months proved to be too late.

The real problem was inadequate, if not misleading, scientific reporting of Brenda's adaptation to gender change.

Brenda had no sense of femininity, she detested dresses and dolls and craved guns and rough play. With her ungainly gait and sloppy appearance, she was isolated and taunted by schoolmates. Her misery was compounded by abysmal school performance.

Over the next decade, psychiatrists tried to convince her to behave like a happy little girl. Her whole family fell into an emotional maelstrom of suicide attempts, alcoholism and behavior problems.

During early adolescence, Brenda was not allowed in the girls' bathroom in her high school by abusive schoolmates and was forced to relieve herself in an alley. At 15, her father told her of her true biological designation. Immediately relieved, Brenda reverted to the male role and renamed himself David to symbolize overcoming the Goliath-like obstacles he had faced.

Difficulties did not abate. David made three suicide attempts and underwent many painful operations to reconstruct a penis. Finally he achieved some emotional equilibrium. Now happily married, he is a devoted stepfather of his wife's three children. In television interviews, David seems beset by past demons of Brenda and her adolescent tormentors. He also ruminates about what might have been had there had been no sex change.

Unfortunately, in publications and lectures, Money reported the reassignment to be a glowing success. In his classic text, "Man and Women, Boy and Girl," Brenda is portrayed as being "tomboyish" and the "dominant twin" but also being very interested in dolls.

He wrote that Brenda's mother reported, "I've never seen a little girl so neat and tidy ... she is very proud of herself when she put on a new dress ... ." For more than two decades, it was axiomatic to many behavioral scientists that this experiment demonstrated the primacy of environment over biology.

In 1979, a BBC documentary on gender depicted Brenda's miserable situation; but Money refused to retreat from his position about the case's success.

Money surely had heard about the documentary, since Dr. Milton Diamond, another sex researcher, reviewed the BBC data in a medical journal in 1982. Diamond had beseeched Money to collaborate in a follow-up of the twins but was met with dismissive disdain. Diamond finally contacted David directly and reported upon his terrible journey from infant boy to dysfunctional girl to grown man.

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