Tomorrow’s People: Changing attitudes to transgender issues

A man who played a large part in paving the way for our modern understanding of sex, gender and sexuality is speaking at the Queensland Transgender, Sistergirl, and Gender Diverse Conference in Cairns this August. Andrew Shaw spoke to Dr Milton Diamond about his landmark work in the field of gender assignment and the devastation a wrong surgical choice can cause...

IN CANADA in the Sixties an eight-month-old baby called Bruce, one of twin boys, was given a circumcision to resolve a urinary tract problem. The operation went horribly wrong, the penis was accidentally destroyed. Desperate for help, the boy’s parents went to psychologist John Money at Johns Hopkins Hospital in Baltimore.

Money held to the theory of ‘Gender Neutrality’ – that gender was created through social learning. He told the baby boy’s parents that he could be brought up as a girl. Surgery was performed to enable Brenda Reimer, as he was now called, to urinate through his abdomen. He was dressed in girl’s clothes, at 22 months his testes were removed. Later on he was given hormone treatment.

Although Brenda was not intersex, the case became the benchmark for treatment of children born with ambiguous genitalia; that is, remove the penis and raise the child as a girl. Money had little to do with Brenda after his initial contact and it was generally understood – but not by all – that Brenda was living a fruitful life as a girl.

He was not. By the age of 14, a severely depressed and bullied Brenda decided to take matters into his own hands, took for himself the name David, and began to live as the boy he knew he always was. By 1997 he had had a double mastectomy, was taking testosterone and had phallosplasty operations.

That’s when he told his story to Dr Milton Diamond, from the John A. Burns School of Medicine in Hawaii. Diamond, a sexologist trained in anatomy and psychology and now the director of the Pacific Center for Sex and Society at the University of Hawaii, had long had his doubts about Money’s David Reimer case.

“The concept that people were neutral at birth was promulgated by a psychologist called John Money at the Johns Hopkins Institute,” Diamond says over the phone from Honolulu. “That was in the Fifties and it gave physicians what they saw as a simple way of dealing with what they saw as these problems. They considered them problems of kids born with ambiguous genitalia. They figured, ‘Hey here’s a solution! It doesn’t make any difference, Money says, if you can bring them up as a boy or a girl!’ If you were a surgeon, which would you think it would be easier to do – make the genitals male or female?”

Female, I suggest.

“Exactly, that’s what they thought. So they took all these males and made them into females. Most of them, when they got to puberty, said, ‘What the hell is this?’ Even though they never knew what had happened to them, never.

“I didn’t know what happened in [the David Reimer] case. So I said to myself I want to find that case and find out what really happened. Money had talked about it and wrote about it, but never would say where this kid was. It didn’t fit with anything I believed, so I said I wanted proof. After what turned out to be a long search I was able to find him. I contacted the psychiatrist he was seeing and through the psychiatrist got to David. Of course, he was living as a male. When he was 14 he told his parents, ‘I’ll commit suicide’. Since then many physicians have changed their minds and now they understand. But unfortunately not all.”

In 2004, after a series of personal problems, including the death of his brother and his wife indicating she wanted a separation, David Reimer committed suicide. “And part of the reason he said – not all of it, but part of it – was flashbacks he kept having to being brought up as a girl. The trouble is, it’s not a single case.”

Diamond is coming out to Cairns for the Queensland Transgender, Sistergirl and Gender Diverse Conference in August. For his presentations, he says he wants to show the breadth of people who are involved in trans and intersex conditions. “Too often there are stereotypes and I’d like to dispel some of those.”

On the Pacific Center’s homepage is the statement: “Nature loves variety. Unfortunately, society hates it.” Diamond says many people still believe in the view that transgender people are mentally ill. In fact, this is reflected in the DSM, the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, which is currently under review, and still retains an element of prejudice.

“It refers to ‘gender identity disorder’. It’s under debate, there’s a committee. But I’ve written that I don’t think it’s a disorder, either one, intersex or transsexualism. I think they are normal variations and differences. [But] society looks at these individuals and thinks, ‘Why don’t they just continue as everybody else does? If society says you’re a male, then live like a male!’ etc, etc.”

Diamond’s career is dedicated to overturning Money’s conception of gender and sexuality as learnt behaviour, imposed on a child by society. He is calling for a moratorium on infant gender assignment surgery. “Why give them something that they don’t want when they’re 12?” he says. “There’s scar tissue, they’ve lost something. They’ve never gained anything. It’s never been shown that they’ve gained anything by it. It’s made the parents maybe feel better, maybe; it’s made the physicians feel better, maybe. But there’s no evidence that’s ever been shown.”

Related to this is his lobbying for a mandatory registry of the treatments given to transgender people. He says a precedent exists, in cancer research. “In America, if someone gets cancer, that case is recorded and their treatment is recorded, so that ten years down the line we can see which ones were good treatments and others which were bad. So our treatment has been getting better. Well, there’s no records of how people are treated for transsexuality, for example. Right now it can go 180 degrees different.

"Let’s say you were a patient, would you want some evidence which way things should go? All I’m saying is let society do that, let society record.”

He believes intersex people would be happy to contribute to a registry, which would be anonymous. He would like to extend the registry to transsexuals as well. “Yes – and I know many want to live stealth. But all I can say is their secrecy is going to be preserved. The only thing we want is their treatment. Many of them say, for example, ‘I don’t have to go to a psychologist or a psychiatrist, I can do it myself.’ That’s fine! I just want to record how successful that is, because maybe it would make things easier for future transsexuals. I know that what I’m proposing doesn’t help yesterday’s people, I’m trying to help tomorrow’s people.”

Diamond believes a transsexual is a person who has an intersex condition of the brain: “An [intersex person] is someone who has components of both male and female in the same body. What I’m saying is that in the transsexual it’s the brain that has both male and female components. So in other words a transsexual says, ‘I know I have a penis and testicles, but that’s not me. I know in my head I think like a female and I want to live like a female.’ We know from neurological studies that there are components of the brains of male transsexuals that are more like females and in female transsexuals that are more like males. So there is biological evidence.”

John Money died in 2006. There’s a possibly apocryphal story that he and Diamond once came to blows at a conference, Diamond has said he has no recollection of such an incident. But what does Diamond now consider to be Money’s legacy?

“He popularised and legitimised talking about sex and I think he had many good ideas.” But on Money’s theory of gender neutrality, he remains doggedly opposed: “I think that happened to be one of his bad ones.”

Queensland Transgender, Sistergirl and Gender Diverse Conference, August 24-25, 2012. Rydges Esplanade Resort, Cairns. Registrations close August 6. Details: transconference.org.au