- Over the last six episodes of My Butterfly Arose podcast,
I've begun talking about what I am learning about sex,
sexuality, and gender through the lenses
of both biology and culture.
This has included books about gender through the eyes
of a primatologist, the experiences
of a person born intersex, and a broader
and deeper view of
how intersex people in particular have been seen
and treated by society, by medical professionals,
and how intersex people see themselves.
I also did an episode about some of my own experiences
as a transgender woman.
In this episode, I will talk about the case
of a person whose life got caught up in a confluence
of medical mistakes
and errors that took place in a cultural space where sex
and gender are surrounded by outdated belief systems.
The outcome was very harmful to the patient
and their family, and I think it offers a challenge
on two fronts.
One is to not look away from painful experiences in
medicine, but to use them as a way to improve our system
of medical care delivery.
The other is the challenge of being recognized
as an expert in medicine while maintaining a sense
of humility in the face of a complex reality.
To prepare for this episode of Butterfly Arose,
I read the Kindle edition of the book
as Nature Made him the boy who was raised as a girl
by John Lopinto.
That boy was given
or referred to by different names over his lifetime,
but ended up claiming the name David Rimer,
and that is the name I will use here.
He was born in identical twin in August, 1965.
His young parents, John and Janet Reimer, lived in Canada
and had moved to the city to escape
what they felt was a limited worldview they grew up in
in their first months.
Their mother, as Mr.
Cola Pinto says, examined their son's penises
and noticed that their foreskins seemed
to be sealing up at the tip
and making it difficult for the boys to pass water.
She took the babies to see her pediatrician who explained
that they were suffering from a condition called theosis.
It was not rare, he said,
and was easily remedied by circumcision
or removal of the for of the penis
Circumcision when done is usually performed on newborn
babies, but by this time the boys were eight months of age.
This meant that they had to be anesthetized
because at this age, they would likely feel
and react more strongly
to the operation than a newborn baby.
The doctor who did the operation on David is described
by K Pinto as a general practitioner
who was less experienced at doing circumcisions than
knows who usually did them.
Apparently none
of the more experienced practitioners were available.
For some reason, she used an electric cauterizing machine
rather than a scalpel to remove David's foreskin.
The machine was set at the minimum,
but failed to cut through the skin
after increasing the amount of heat going
through the needle twice.
The result was a botched circumcision.
You could read the book yourself
to see the horrible details,
but in the end, David's penis was completely destroyed.
So right away we have two mistakes.
Having a doctor do the circumcision
who was less experienced,
and then that doctor would, her first attempt failed,
just kept increasing the heat rather than stopping
and figuring out a better way to proceed.
The ability of surgeons in the 1960s to create a new penis
so that at least David could urinate through.
It was in the very early days
and hope that even that could be successful were
as Kop Pinto quotes, the doctors as saying,
quite optimistic,
the older brother's FAMs problem later cleared up on his own
and he never got a circumcised.
An article I read from the National Institutes of Health
says that studies from 1949
and 1968 showed
that circumcision was not needed in most cases of FAMs.
Perhaps watchful waiting could have been used,
but the doctor who operated on David might not have known
that, or maybe she was reacting
to the mother's distress over her son's difficulties
and thinking that she was being supportive
by doing the operation immediately rather than waiting,
but both boys were taken home
as David's parents worried about what to do
and how this would affect his life.
He was evaluated by Dr.
GL Adamson, head of the Department of Neurology
and Psychiatry at a nearby clinic.
Mr. Lopinto quotes the doctor as saying
he will be unable to live a normal sexual life from the time
of adolescence that he will be unable to consummate marriage
or have normal heterosexual relations in that he will have
to recognize that he is incomplete, physically defective,
and that he must live apart.
Just note those last words of the doctor.
Of course, without a penis, David would not be able
to experience penile vaginal sex,
and that was a physical fact he would have to live with.
But saying that he will be incomplete is a definition of him
that imagines his whole self as being defined
by the lack of a penis
and saying he will have to live apart has truth,
only insofar as the society around him chooses
to treat him negatively rather than embracing him
as a fellow human being
who just has a challenge not of his own making.
What if the doctor had instead said something like the
following, your beautiful son has experienced a
serious medical error by the doctor,
and it will be a real challenge for both him
and the medical world to deal with, but we are here for you.
We will try to connect you with researchers, surgeons,
and doctors who are working on a fix for this problem.
This presumes a world more like today where patients
and families have more input into improving
how healthcare is delivered.
What if there had been a group supporting those whose sons
experienced this trauma?
What a difference either one
of those could have made in the life of this family.
Mr. Lopinto, in many ways does a good job
of describing the dilemma of David's parents
as they grappled with what to do for their son.
They wondered whether he would be ostracized and bullied
because he could not stand and pee like the other boys.
How would the family, including their other son be treated?
The local newspapers soon printed stories about their case,
even though no names were given in the stories,
this publicity left them feeling even more isolated.
The parents stopped going out very much afraid
that a babysitter would spread gossip
after changing David's diaper.
In addition, his father, when he mentioned what happened
to friends at work was treated to jokes for the parents.
All this was disheartening.
John and Janet Rimer took their boys home
and did the best they could with their situation.
They worried that there was no fix
for David's destroyed penis.
Everything seemed to reinforce John and Janet's fears
and feelings of isolation.
The words of Dr. Adamson, for example, are riddled
with unexamined beliefs.
What is the definition of a normal sex life?
Even the idea that a marriage needs to be consummated
by vaginal penetrating sex is filled
with cultural assumptions.
Many people enjoy sexual pleasures in ways
that do not solely depend on penile vaginal intercourse,
and this worldview leaves out the ways gays
and lesbians can have full sexual lives without
what the doctor is claiming is normal.
In addition, the work mate's reaction
of making jokes rather than offering sympathy
or support perhaps reflects their own fear of being seen
as different or at least a way of dealing with something
that made them uncomfortable.
I believe this is an example of when lack
of scientific knowledge can combine
with negative cultural beliefs to make it harder for people
to be just accepted as they are
or to find good solutions to hard problems,
but the Rhymers thought they had found a potential solution.
One evening in February, 1967, they happened
to be watching a popular current affairs program
on the Canadian Broadcasting Corporation.
When they saw an interview with Dr.
John Money, they listened as Dr.
Money talked about his work doing gender affirming
surgeries, and at one point a transgender woman was
introduced in Mr.
Coop Pinto's words quote until four years ago.
Her name was Richard Ron and Janet Gaped at the TV screen.
It was their first glimpse ever of a transsexual.
It was one thing to hear Dr.
Money talk about sex change in the abstract.
It was another to see it with their own eyes.
Ron and Janet could hardly believe it if they hadn't
been told that Mrs.
Baranski was born a man. They would never have guessed it.
Even knowing it, it was hard to believe
she looked like an attractive even sexy woman.
The way she moved, walked, sat, even her voice
despite an ever so slight Huskiness had the timber
of a woman's as she said hello to her host and fellow guest.
Soon after the show, they contacted Dr.
Money who agreed to meet with them.
I just want to note a couple of things at this point.
One is that the description in Mr.
Op Pinto's books uses the terms trisexual and sex change.
Most people I know who are transgender or her work
and gender affirming care today would not use this
terminology because we know that it is possible
for your gender identity
and physical sex characteristics at birth to not match.
While gender affirming care can change your external sex
characteristics and certain hormone levels in your body,
it does not change your chromosomes
or how you developed physical sex characteristics
in the womb.
Another thing to note is that in 1967, as it was
until very recently, doctors
and surgeons just assumed that for babies
and young children who were born with a variation
of sex characteristics
or intersex, the right thing to do was
to operate on their bodies to make them fit what the doctors
believed would be their true sex.
Happily, this assumption has been challenged
by intersex people
and supporters active in working for the rights
of intersex people and in many hospitals
and healthcare systems.
Today, this would not be done. Dr.
Money was one of those who arranged such surgeries
for people born intersex
and did some of the early research into people
who had come out as transgender as well.
He wrongly applied his beliefs
and assumptions about people born intersex
to David's situation.
Let's also note that David was not born either
with a variation of sex characteristics
that would fit the classification of intersex
or as transgender or non-binary.
As he began to claim agency for his own life as a teenager
and adult, he came out
as the cisgender heterosexual male he was from birth,
but David's parents were trying to figure out how
to raise their son in a world not very friendly
to boys without a penis
or even those with a penis very much shorter than the
average, a world with very negative beliefs about people
who did not fit the image of two absolutely
distinct categories of male
and female with no significant variations
or who are not heterosexual in their love
lives and attractions.
This is why the TV show and their conversation with Dr.
Money turned out to be convincing for them.
He offered the hope that their child could be raised
as a heterosexual girl.
This seemed to them under the existing cultural
circumstances to offer the possibility of David being seen
as a normal child living a normal life.
When they spoke with Dr.
Money in person, his words
and body language exhibited great confidence about his
theories and practices.
As John Lopinto says at his book,
after so many months of grim predictions, bleak prognosis
and hopelessness, Dr.
Money's words, Janet says, felt like a balm.
Someone she says was finally listening.
After talking with him
and thinking about it for a while,
they decided to follow Dr.
Money's advice. In July of 1967,
David was operated on by Dr.
Money's colleague at his clinic, Dr. Howard Jones.
David's testicles were removed
and scrotum fashioned into a rudimentary exterior vagina.
Dr. Money told David's parents that they must dress David
and treat him like a girl starting immediately,
and they must not tell him about the medical error
that destroyed his penis
or even that he was born with a penis.
They must talk about him
and treat him like a girl consistently
for the process to be successful.
He said ultimately it was not successful for David
and in several ways his experience has similarities
with that of Pigeon.
Bogus Pigeon was born with a variation
of sex characteristics that we call intersex.
As I reported in episode six of Butterfly Arose
pigeon was also operated on as a baby
and their parents were told to raise them as a girl.
I see four important similarities between their stories.
In both cases, these babies were operated on for conditions
that were not life-threatening.
In both cases, the doctors were motivated in part by
what they believed they knew in terms of medical
and psychosocial knowledge.
In both cases, the parents were told to dress their children
as girls and treat them like they were girls
and to never tell them about their actual condition,
and in both cases, the doctors
and the parents of these children were trying
to navigate a culture in which Iex people
and boys born with very short penises
or who lost them to accident
or medical error were seen through lenses
of very negative stereotype.
As Katrina Caris says in her book, fixing Sex
that I reported on in episode seven quote,
far from existing outside culture
biomedicine is a cultural entity
that not only has unparalleled discursive
and practical powers to define
and determine what it is to be normatively human,
but also to withstand alternative constructions
and challenges to its version of normativity unquote.
Ms. Cartis goes on to say that historically, the effort
to enforce the sex binary,
even when a specific person's body did not conform to it,
was also bound up with cultural fears
and negative stereotypes about same sex attraction.
Pigeon Pagon
and David Rimer had bodies that were seen as
outside the boundaries of normal for very different reasons,
but they experienced similar and very harmful treatments.
Both courageously faced their circumstances
as they grew older and built lives
that reflected their true selves.
Both went on to rebuild emotional connection
and trust with their families.
In later life, David Reimer developed a remarkably nuanced
view about the world He lived and grew up in.
Colapinto quotes David Rimer on his experiences facing male
chauvinism at work on page 263 of the Kindle Edition.
The guys at work don't know what happened to me.
I mean, I work in a slaughterhouse.
All men can you imagine there's the freak
who wore dresses as a kid.
He imagines them saying They give you
that male chauvinist crap all the time,
like they're always saying that they're the boss at home.
They look at me and ask me, who's the boss?
I say, look, man, in my home, it's a partnership.
It doesn't mean I wimp out.
Sometimes I get my way and sometimes I don't get my way,
but either way, it's a partnership.
I mean, who wants a woman with no brains
who follows you blindly?
That's more like a slave than a wife?
You don't want a slave.
You want somebody with their own opinions, somebody
who puts you on the right track, someone
to show you the right direction.
It's very hard to talk to somebody who's stone cold stupid
who follows you blindly.
Then Op Pinto further quotes David as saying,
but you know, if I had had a normal life
and none of this had ever happened to me,
I'd probably be one of these chauvinistic kind of guys
where the guy goes to work, breaks his back, comes home
and sucks down a beer and watches sports,
and if I saw someone like me out on tv,
I'd sit there saying, oh God, that's sick.
That's how I would be so knowing that this person is me,
you could realize how sick I feel.
Looking back on all this, you wish
to God you could switch places with anybody.
David's and pigeon stories were both hard for me to read,
yet it is important that they were written.
Part of the motivation
for change in my experience comes from real life stories,
but stories of individual people are just one facet
of the information we need to create a better, more just
and compassionate healthcare system.
We are complex beings and much of who we are
and how we develop defies simple answers.
One thing that David's
and pigeon stories reflects is an ongoing argument over the
role of our biological processes versus environmental
factors in our development from inception to adulthood.
This has been called the nature versus Nurture debate.
Dr. Money was one of several researchers
and doctors who argued for a stronger role of nurture.
This is part of the reason he gave the rhymers the advice
to raise their son as a girl.
On page 280 of his book,
John Lopinto talks about David's courage
and lets us know a reason why writing it was
meaningful to him.
He says, indeed, it was this very courage
of David's, which was my prime
motivation in writing the book.
Despite its medical scientific context, I've always believed
that this story transcends the incessant quibbling over the
nature nurture debate.
David's is a story about identity in its largest sense,
not simply sexual identity.
His story for all its uniqueness is a universal one
and reminds us how it is every person's individual
responsibility to define for himself who he is
and to assert that against the world
that often opposes ridicules, oppresses or undermines him.
In the next episode of Butterfly Arose,
I will go more deeply into what I've learned
so far about the challenges medical researchers
and doctors face as they work
to develop knowledge about we humans
that can help us live healthier lives
and the role our existing cultural beliefs
and human frailty can play in that work.
Thank you for listening.
Please remember, you can find the books
and articles I reference in my podcasts
on my emily p
newberry.substack.com website.
I have two pages with links for both of my podcasts.