As Nature Made Him (15 page)

Money replied on 17 January and in a breezy tone professed himself very pleased that Dr. Moggey had become involved in Brenda’s case. He explained that the second stage of Brenda’s vaginal surgery had not yet been performed due to the child’s “fanatical fear of hospitals”—a fear, Money wrote, “that I have encountered on only one other occasion in 25 years of work at Johns Hopkins.” He added that mention of hormone treatments or surgery induced in Brenda a “panic so intense that it’s impossible to broach any conversation on such matters without the child fleeing from the room, screaming.” Nevertheless, Money continued, there was now “an urgency” that Brenda’s fears be overcome, because the need for hormone therapy and surgery was rapidly increasing with her approaching adolescence. “It will be one of the best things you can do for her if you can help her break down this extraordinary veto,” he wrote. Dismissing Moggey’s suggestion that Ron and Janet had not adjusted to Brenda’s sex change, Money added, “With regard to the help that you can give the parents, I think it is not so much with regard to helping them adjust to the sex reassignment, as it is to helping them adjust to one another”—specifically, Money added, by helping Janet control her depressive mood swings.

Moggey (having already found a psychiatrist for Janet, whose moods would soon stabilize with antidepressants) was nonplused by Money’s reply. “I thought, There are more problems here than are controlled by the mother,” she says. Yet inclined to defer to the famous psychologist’s apparently greater knowledge and experience of the case, Moggey forged on in her sessions with Brenda, reassuring the child that she was indeed a girl and impressing upon her the necessity that she return to Johns Hopkins to undergo surgery on her genitals.

“But the resistance!” Moggey says. Sullen, angry, unresponsive, Brenda often simply refused to speak, scowling and directing her gaze to the floor. Mere mention of the word
penis
or
vagina
would induce in the child an explosive panic. Brenda remained immovable on the subject of vaginal surgery or returning to the Psychohormonal Research Unit. “Won’t look at pictures of female bodies with Dr. Money,” Moggey noted on 20 January. “Won’t accept going to see Dr. Money.”

Struck by the obvious depth of the child’s aversion and concerned that Money had not yet grasped the severity of the problems that Brenda and her family had been laboring under, Moggey wrote to him again on 2 February. This time she wrote at greater length and was explicit about Brenda’s problems: she explained that the child was two years behind her peers academically and had not progressed well in school “from day one”; that Brian was “embarrassed” by Brenda’s “tomboy like behavior”; that Brenda was having trouble making friends and talked openly about being different from other girls; that she was “not interested in developing female shape,” felt anything to do with her body was “dirty,” was still refusing surgery, and had expressed embarrassment about her trips to Baltimore where “a man [was] showing her pictures of nude bodies”; and that furthermore “she is saying no to returning to see you and threatens to run away if this is necessary.” Moggey ended the letter by saying that despite Brenda’s resistance, she was continuing to work toward making the girl return to Baltimore, “as I do feel Brenda needs to start her hormone therapy and start developing female characteristics.”

Money’s reply, dated 9 February, was brief. Failing to allude even glancingly to the many issues raised by Moggey, he simply reiterated his great pleasure that the psychiatrist had become involved, his happiness in working “in closest collaboration” with her, and his “great relief” that Moggey was helping to prepare Brenda for her return to Johns Hopkins.

Money’s relief was to be short-lived. After two more months of trying—in vain—to convince Brenda to return to Johns Hopkins, Moggey decided that no amount of therapy could remove the girl’s fierce resistance. That spring Moggey spoke to Ron and Janet about the alternative of Brenda’s undergoing the vaginal surgery not in Baltimore, but in Winnipeg—a plan that would not only save considerable time, energy, and money for the Reimers, but also remove for Brenda the deep anxiety associated with her visits to Johns Hopkins.

Still Ron and Janet expressed trepidation about deviating in any way from Money’s program. They would agree to it only if Dr. Money himself approved the plan. On 18 April, Moggey wrote to him again and apprised him of the proposal to have Brenda’s surgery performed in Winnipeg—“unless,” she added, “there is some particular reason for returning to Johns Hopkins.”

As it happened, Money considered there to be many reasons for the child to return to Johns Hopkins. He outlined these reasons in a two-page, single-spaced letter that seemed to carry, under its surface smoothness, a strong undertone of desperation at the prospect of losing control of, and contact with, his most famous research subject.

“It goes without saying the Reimers have freedom of choice with respect to location of professional services,” Money began. “I shall go along with their decision, whatever it is. Nonetheless, I believe their wisest decision will be not to lose their Johns Hopkins contact, but to work out a joint program of cooperation between us and Brenda’s local specialists.” Citing the “unique” benefits of the “close collaboration between medical psychology, endocrinology and surgery” at Johns Hopkins, which, Money claimed, “eliminates the possibility of conflicting opinions among experts not accustomed to working together,” he also extolled the vagina-building skills of Howard Jones, the surgeon who had castrated Brenda a decade earlier and who was scheduled to construct her artificial genitals. Yet apparently aware that even his own formidable powers of persuasion were not quite up to the task of explaining why it was more practicable for the child to travel two thousand miles for a complicated operation requiring lengthy follow-up care (rather than have the surgery in a hospital just minutes from home), Money concluded his letter with a plea that regardless of where the surgery was done, he not lose contact with Brenda. “I would like to continue seeing her,” he wrote, “on approximately an annual basis in the future as in the past.”

Only when the Reimers saw that Dr. Money would not stand in the way of Brenda’s having the surgery in Winnipeg did they agree to the change in plan. But on the issue of Brenda’s returning to Baltimore for her annual follow-ups, Ron and Janet found themselves once again persuaded by Money’s eloquence. They decided that if Brenda’s fears could be overcome by the local psychiatrists, they would continue to bring her to the Psychohormonal Research Unit for her yearly counseling sessions with Dr. Money. “We felt like we had nowhere else to turn,” says Janet. “No one knew us, or Brenda, as well as Dr. Money did.”

8

I
n the spring of Brenda’s sixth-grade year at Agassiz Drive, her case was transferred to a new psychiatrist when Dr. Moggey, for family reasons, had to leave Winnipeg and go to live in Brandon, a small town some fifty miles north of the city. Moggey referred Brenda to Dr. Janice Ingimundson, a thirty-two-year-old alumna of the University of Manitoba Medical School. Ingimundson was a coolly rational Freudian whose considerable wit and warmth were carefully concealed under a scrupulously correct analytic detachment. Not a member of the city’s Child Guidance Clinic, Ingimundson had her own private practice, which she operated out of an office in downtown Winnipeg. Her first session with Brenda was on 6 May 1977. She recalls being taken aback at her first glimpse of the patient.

“All the documentation claimed that this child had accepted her gender identity as a female,” Ingimundson says. “Yet my one visual memory of this youngster is of kind of a”—she curls her hands into fists and bends her elbows in a boxer’s pose—“
tough girl
. A rather boyish-looking girl. Rugged.”

Little that Brenda said in her sessions contradicted Ingimundson’s first impression. Though at times Brenda said what she thought the psychiatrist wanted to hear (“I want to be pretty; I’m a girl, not a boy”), in the same breath she would inevitably reveal contradictory feelings about herself. She defended her preference for boy’s clothing, telling Ingimundson, “I like dressing like this. It doesn’t feel right to be in a dress, like I shouldn’t be in one.” Asked about her feelings for boys, Brenda said she “wants to beat up on [them]” and then added a comment that offered almost an embarrassment of riches for a devotee of Freudian symbolism. If a boy “laid a finger on her,” Brenda told the psychiatrist, “she would take her father’s ax and cut it off.” When Ingimundson tried to touch on the topic of vaginal surgery, Brenda grew especially truculent. “I have decided not to have that,” she informed the psychiatrist, “and I don’t want to talk about it.”

Troubled by such statements, Ingimundson nevertheless took Dr. Money’s word that Brenda had formed a female gender identity. The psychiatrist felt she had little choice. “I thought, The decision has been made,” Ingimundson says. “If you open up this can of worms now and say, ‘Maybe this was the wrong decision’—well, who is going to do that?” Accordingly, Ingimundson (like Moggey before her) resolved to work hard to assure Brenda that she was a girl and urge her to submit as soon as possible to the vaginal surgery. Yet from their first session on, Ingimundson was uncomfortable with every aspect of the case—and in particular her sense that on some subconscious level the child knew that she was a boy, yet knew she must not speak of it.

“You’d talk to her,” Ingimundson explains, “and conventionally masculine interests would come forward. Which is not surprising; you see that in girls. But her embarrassment—not embarrassment, but her
difficulty
—in talking about those kinds of interests was acute. She didn’t want to expose them. She used to say she had a ‘secret.’ She talked about wanting to be a ‘detective.’ She wanted to solve the mystery. That’s the therapeutic puzzle: she wants to know, but she doesn’t want to know. People in therapy want to know, but they
don’t
want to know. They want to know only if it’s good news.”

And according to Ingimundson, it was clear that Brenda had come to believe that the truth was anything but good news. Ingimundson continues: “Brenda was basically saying, ‘There’s nothing wrong with me, why do these people want to cut into me?’ And in retrospect, she was
right
. ‘I’m a boy, I’m a male, so in that sense, there’s nothing wrong with me; but anatomically, if I’m a girl, then there
is
something wrong with me.’ So this is the bind that she’s in. ‘If I admit that I’m a boy, then I have to admit that there’s something wrong with me anatomically. And if I admit that there’s something wrong with me anatomically,
what happened
?’ ”

Thus convinced that Brenda’s resistance stemmed from her inkling that she was not being told the whole truth about herself, Ingimundson, after their second session, talked to Brenda’s parents. She urged Ron and Janet to begin preparing Brenda against the day when she would be informed about the circumstances of her birth, the accident she had suffered, and her subsequent sex change. “She has to be told,” Ingimundson said, “and she has to be helped in accepting it.” Only then, the psychiatrist believed, would Brenda recognize that there was no choice but to go forward with the vaginal surgery. In her notes, Ingimundson registered Ron’s and Janet’s terror at the prospect of telling Brenda the truth.

“I kind of wish that
you
could tell her,” Janet said. But Ingimundson assured her that it was more appropriate for Brenda to hear the truth from her parents. They should go slowly at first, laying the groundwork. Meanwhile Ingimundson would prepare Brenda emotionally for the final revelation.

A few days later, Ron had a private talk with Brenda. Sitting on the edge of her bed, he managed to choke out the statement that when Brenda was a baby, a doctor had “made a mistake down there” and that the surgery she was going to have was so that “other doctors” could fix up the “first doctor’s mistake.” Ron found it impossible to make any mention of Brenda’s true birth status, her sex change, or in any way to explain what this “mistake” had been. Nor did Brenda evince any interest in these matters; in fact, her reaction seemed to suggest that she wanted to hear nothing more about them. As Ron later reported to Ingimundson, Brenda’s sole response to his mysterious utterances about the “doctor who made a mistake” was to ask, “Did you beat him up?”

Today David explains that Ron’s halting talk of an “accident” did nothing to tip Brenda off to the fact that she was a male who had been surgically changed into a girl. “You’re not going to think of that in a million years,” David says. “So I didn’t know
what
he was talking about—and I didn’t want to know.”

Meanwhile Brenda was having her usual difficulties at school. “She has only been in the school for 4 days, and principal related peer problems,” scribbled the school’s social worker in Brenda’s file. “Teasing—‘looks like a boy, etc.’ ”

As the school year progressed, however, Brenda was gradually accepted into a small clique of misfit tomboys led by a girl named Heather Legarry, a short-haired brunet with an open smile. “I had been the subject of shunning several times throughout those early school years,” says Heather today. “I knew what it was like, and I never would do that to another person—ever.” Brenda, she says, seemed a natural candidate for inclusion in the group of tomboys who played soccer and dodge ball, climbed the jungle gym, and rode bikes. Though distrustful, at first, of Heather’s overtures, Brenda finally dropped her guard and began to hang around with Heather and her friends. “Heather was the first friend I ever had,” David says. “I didn’t know what a friend
was
.”

Heather, for her part, valued Brenda as a girl devoid of the duplicity and backstabbing that had poisoned so many of her relations with girls in the past and that even threatened the harmony of her current clique of tomboys. “Brenda didn’t speak much,” Heather says, “but when she did she was never vindictive or false. She was very honest. If she told me something was black or white, it was.”