because it’s never too late to challenge a bad idea

[sophiaserpentia]

Originally published at Monstrous Regiment. You can comment here or there.

This diatribe by Paul McHugh, at one time Psychiatrist-in-Chief of Johns Hopkins University, against transsexualism is not news. But since encountering the text of it online last week, i have been pondering how to respond. I think the best response i can give is a line-by-line answer.

When the practice of sex-change surgery first emerged back in the early 1970s, I would often remind its advocating psychiatrists that with other patients, alcoholics in particular, they would quote the Serenity Prayer, “God, give me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Where did they get the idea that our sexual identity (“gender” was the term they preferred) as men or women was in the category of things that could be changed?

McHugh is a gender essentialist. That is, he believes that at some point in our early development it is determined that we will be a man or a woman, and once this differentiation occurs it is complete, profound, and eternal. Furthermore, this differentiation is based on externally-verifiable clues; in cases of ambiguity an answer can be imposed on someone by society or by an expert with absolute certainty.

This external imposition has nothing to do with one’s individual experience; experience is squishy, unreliable, not to be trusted. Individual variation is seen as aberrance, which is most properly dealt with by being corrected in accordance with the proscriptive norm. For example, the woman who is not subservient or sufficiently maternal is aberrant and must be corrected.

This position is normative; it breaks the human experience down into categories by which individual experience and performance is given a value judgment as “normal” or “aberrant.” In other words, in the gender-essentialist view of the human condition, you are either a “normal man,” a “normal woman,” an “aberrant man,” or an “aberrant woman.”

This position does not recognize transsexualism. People who report an experience of gender incongruence between their body and mind are aberrant, in that we must be delusional.

Once that the gender essentialist declares that i am delusional, there is nothing i can say to him or her. The gender essentialist, confronted with my account of my experience which cannot be reconciled with his or her belief system, has chosen to resolve the dilemma by putting his or her hand over my mouth. So we know from this that the entire article will consist of speaking at transsexual women rather than speaking with us.

Prepare to be depressed. This is long, so i’m putting it behind a cut.

Their regular response was to show me their patients. Men (and until recently they were all men) with whom I spoke before their surgery would tell me that their bodies and sexual identities were at variance. Those I met after surgery would tell me that the surgery and hormone treatments that had made them “women” had also made them happy and contented. None of these encounters were persuasive, however. The post-surgical subjects struck me as caricatures of women. They wore high heels, copious makeup, and flamboyant clothing; they spoke about how they found themselves able to give vent to their natural inclinations for peace, domesticity, and gentleness—but their large hands, prominent Adam’s apples, and thick facial features were incongruous (and would become more so as they aged). Women psychiatrists whom I sent to talk with them would intuitively see through the disguise and the exaggerated postures. “Gals know gals,” one said to me, “and that’s a guy.”

See what i mean? There is nothing i can say to the gender essentialist. I can tell him or her that transition has made me “happy and contented.” But what i say doesn’t matter, see? It’s all about what he sees and thinks. And if he finds transsexual women to be unconvincing as women, then that is all that matters to him.

Have i met gallae like those he describes above? Yes. (But, of course, if they are not able to ‘pass’ as women i do not, like Dr. McHugh, use this to dismiss the accuracy of their accounts of their inner life.) Have i met many who were not like that at all? Yes.

But, see, his description of “transwomen i have encountered” is also quite obviously normative. He doesn’t say how many gallae he met. Assuming it’s more than, say, half a dozen, it’s a near statistical certainty he at some point met a galla who was not flamboyantly dressed, did not have a prominent adam’s apple, or think that ‘becoming a woman’ made it possible to only now be gentle and passive. If it’s less than half a dozen, then he is basing his conclusions of a large and diverse class of people based on a sample which is too small — and surely he wouldn’t have done that, prejudice is unethical. So, either his sample size was skewed and unrepresentative, or he simply did not see or recognize visual cues incompatible with his prejudgment of gallae as aberrant men.

The subjects before the surgery struck me as even more strange, as they struggled to convince anyone who might influence the decision for their surgery.

Yes, a word about that. I like the way one galla put it: she ran out of ways not to transition. That’s the way it felt for me, too. I tried everything else first: ignoring it, compromising as a part-time crossdresser, being ‘unconventionally male,’ suppressing it, talking it through with therapists, you name it. None of it worked.

Anyone who is ever tempted to ask a galla, “Why don’t you just be an unconventional man?” had better be prepared for a sarcastic, “Gee, why didn’t i think of that!?” And then ask yourself if maybe you just never see those for whom one of these other compromises did work.

If anything else had worked, we’d have stuck with that. Seeking transsexual therapy is a last resort (none of it is the least bit pleasant), and if we seem a little desperate, maybe it’s because, metaphorically speaking, we have just crawled across a desert without a canteen of water.

So here we sit in a psychiatrist’s office, looking for that water, and we find it dangled like a carrot. Can we convince them we’re really thirsty? Bear in mind that quite a few of these psychiatrists point to the piece of paper on their wall and use it as proof that they know what is going on inside us better than we do. Their whims determine who will and who won’t get access to these often lifesaving treatments. Yet it is our fault if we find we have to manipulate them or the system to get treatment.

First, they spent an unusual amount of time thinking and talking about sex and their sexual experiences; their sexual hungers and adventures seemed to preoccupy them.

Wow, ask someone to talk about their sexual identity and their sexual experiences come up! Imagine that. It is again our fault for wanting to talk about sex with a psychiatrist.

Second, discussion of babies or children provoked little interest from them; indeed, they seemed indifferent to children.

Because if they were really women, their attention would be consumed all the time with wanting babies and children. More gender essentialism; see how it feeds itself? It is an unassailable ideological fortress.

But third, and most remarkable, many of these men-who-claimed-to-be-women reported that they found women sexually attractive and that they saw themselves as “lesbians.”

And the normativity feeds itself once again. This time it takes the form of heteronormativity. Dr. McHugh is puzzled by the existence of any transgender woman — or, indeed, of any woman at all — who finds other women sexually attractive. In effect he’s saying to us, “If you really want to be a woman, then what you must mean is, you really want to marry and serve a man. So if that is not what you want, then your claim is contradictory.”

When I noted to their champions that their psychological leanings seemed more like those of men than of women, I would get various replies, mostly to the effect that in making such judgments I was drawing on sexual stereotypes.

Duh? But you don’t ever listen to anyone, do you, Dr. McHugh?

Until 1975, when I became psychiatrist-in-chief at Johns Hopkins Hospital, I could usually keep my own counsel on these matters. But once I was given authority over all the practices in the psychiatry department I realized that if I were passive I would be tacitly co-opted in encouraging sex-change surgery in the very department that had originally proposed and still defended it. I decided to challenge what I considered to be a misdirection of psychiatry and to demand more information both before and after their operations.

Two issues presented themselves as targets for study. First, I wanted to test the claim that men who had undergone sex-change surgery found resolution for their many general psychological problems.

So, in other words, if having the surgery did not solve all their problems, he was going to deem it a failure.

Is it reasonable to expect any treatment to solve anyone’s ‘general psychological problems’? I suggest it is not. Dr. McHugh set this up to fail.

Second (and this was more ambitious), I wanted to see whether male infants with ambiguous genitalia who were being surgically transformed into females and raised as girls did, as the theory (again from Hopkins) claimed, settle easily into the sexual identity that was chosen for them.

“More ambitious,” yes, that’s one way to describe this. “Intellectually dishonest” is the term i would use, personally.

Allow me to paraphrase what Dr. McHugh wanted to do here. He was taking intersex children who were being surgically altered into girls, telling their parents to raise them as girls, and using the success or failure of this venture as a yardstick by which to judge the success of transsexual treatment.

This is like saying, since you can peel an orange with your hands, you must be able to peel an apple with your hands too!

Again, this was a venture set up to fail.

See, the difference between an intersex infant and a transsexual adult is this: the transsexual adult has talked about their experience and asked for treatment. The intersex infant was not asked about their gender identity, and was not asked if they wanted surgery. But why should this distinction matter to someone who has already silenced us?

The first issue was easier and required only that I encourage the ongoing research of a member of the faculty who was an accomplished student of human sexual behavior. The psychiatrist and psychoanalyst Jon Meyer was already developing a means of following up with adults who received sex-change operations at Hopkins in order to see how much the surgery had helped them. He found that most of the patients he tracked down some years after their surgery were contented with what they had done and that only a few regretted it. But in every other respect, they were little changed in their psychological condition. They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled.

We saw the results as demonstrating that just as these men enjoyed cross-dressing as women before the operation so they enjoyed cross-living after it. But they were no better in their psychological integration or any easier to live with. With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.

Fix our minds and not our genitalia? Gee, why didn’t we think of that before?

Since transsexual treatment did not fix all our problems, he deemed it a failure. Is there any other treatment in the history of medicine or psychiatry that was judged by the standard of being expected to fix all of someone’s problems?

Thanks to this research, Dr. Meyer was able to make some sense of the mental disorders that were driving this request for unusual and radical treatment. Most of the cases fell into one of two quite different groups. One group consisted of conflicted and guilt-ridden homosexual men who saw a sex-change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with men. The other group, mostly older men, consisted of heterosexual (and some bisexual) males who found intense sexual arousal in cross-dressing as females. …

Further study of similar subjects in the psychiatric services of the Clark Institute in Toronto identified these men by the auto-arousal they experienced in imitating sexually seductive females. Many of them imagined that their displays might be sexually arousing to onlookers, especially to females. …The name eventually coined in Toronto to describe this form of sexual misdirection was “autogynephilia.” Once again I concluded that to provide a surgical alteration to the body of these unfortunate people was to collaborate with a mental disorder rather than to treat it.

“Concluded?” Or had already made up his mind and fixed the evidence to suit it?

I’m completely puzzled by Dr. Meyer’s findings because i have met so few transsexual women who meet either description. Yes, i’ve met numerous cross-dressers who fetishized femininity and could perhaps be described as “autogynephilic.” But not so many transsexual women.

And as for “conflicted homosexual men,” i’m not sure how to evaluate this claim. I could answer it if more had been said about it. But i will say that of the many transwomen i know who are attracted to men, i can’t imagine a single one of them calling this depiction anything but dismissive and insulting.

I’m utterly confused though as to how they managed to find that most of the transsexual patients they dealt with fit into these two categories. If i were to poll the gallae i know, i’d be honestly surprised to find a significant number with accounts matching either case to any degree whatsoever.

I’m not going to include the very long passage describing the course of research on intersex children. You can read the whole thing at the link posted at the top. The study involved a collection of genetic-male infants with cloacal exstrophy who were surgically given female genitalia and raised as girls.

About half of these poor children insisted from the time they were first able to articulate their experience that they were boys. Ironically, he uses this as proof that transsexual experience is invalid.

Ironically, i say? Dr. McHugh writes that he took this as proof that gender identity is not socially constructed. But, few transsexual people would ever claim that gender identity is socially constructed. Gender roles, yes, sure, socially constructed. But not gender identity. He’s attacking a claim we never made, a tactic known as “attacking a strawman.” We gallae know that gender identity is not socially constructed because if it was, we’d all be happy as boys. Most of us had parents who knew we were turning out to be odd and turned up the heat, pushing even harder for us to act like little boys. It still didn’t work. You can’t tell someone to be a boy or a girl counter to their own identity and have it work.

I have witnessed a great deal of damage from sex-reassignment. The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes. Their parents usually lived with guilt over their decisions—second-guessing themselves and somewhat ashamed of the fabrication, both surgical and social, they had imposed on their sons.

He writes with no sense of irony whatsoever that imposing a gender identity on someone causes damage, and then goes on to support imposing a male gender identity on gallae.

As for the adults who came to us claiming to have discovered their “true” sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.

Collaborating with madness. Well, from one madwoman to a psychiatrist: up yours, Dr. McHugh.