bias, body dysmorphia, born again, Christian identity, control group, core identity, delusion, Dr. John Money, fallacy of the excluded middle, Gender Identity, Gender Identity Clinic, gender incongruence, Gender role, Gender variance, Johns Hopkins, Karolinska Institute, Lynn Conway, mental illness, nature vs nurture, Op Ed, patient satisfaction, Paul McHugh, peer review, Sex reassignment surgery, transsexual children, Wall Street Journal
On June 12, 2014, an Op Ed article by Dr. Paul McHugh was highly critical of the prevailing trends in the treatment protocols of transsexuals, in particular with regard to the use of surgery. At the core of his argument is Dr. McHugh’s persistence in believing that transsexuals are mentally ill and suffering from some sort of delusion rather than there being authenticity to some people having gender incongruence between mind and body.
For copyright reasons, I am posting a link the Dr. McHugh’s Op Ed rather than reprinting it here. My rebuttal follows the link.
Dr. McHugh wonders why 25% of those tracked in the Vanderbilt and Portman studies would persist in having transgender “feelings”. Could it be that the subjects know who they are? Just because the majority of children who display gender non-conformity eventually abandon their experimentation and settle into a gender role that matches their body parts does not invalidate the experience of those of us whose incongruent gender identity persists.
The doctor’s bias is revealed when he calls them “feelings”. To borrow a phrase from Tom Scholz of the music group, Boston, what transsexuals experience is “more than a feeling”. It is common for us to describe our life in our target gender as authentic. We know who and what we are.
When I was seven years old, I wanted to be at various times a scientist, a policeman or centerfielder for the Dodgers. At the same age, I knew I was female. There was no “wannabe” aspect to it all. It was knowledge. Any conflict came from external forces. Now that I have been living full-time, I have a peace hitherto unknown to me.
Dr. McHugh is proud of the fact that he shut down the Gender Identity Clinic at Johns Hopkins. Then again, he admitted in an article in American Scholar (“Psychiatric Misadventures”, Autumn 1992, as reprinted on the website of Lock Haven University) that he came to that institution with the intention of ending sex-change surgeries. When one has an agenda, studies can be designed with bias and the results interpreted with bias. So even when Dr. John Money, certainly no supporter of nature over nurture, argued that another colleague had grossly distorted results to reach the conclusion that the GIC should be terminated (and many outside peer reviews agreed with Money), Money was overruled.
Dr. McHugh touts the 2011 Karolinska Institute study as affirmation of his early position. Upon review of this study, significant problems with it are obvious to someone who understands the transsexual population. The sex-reassigned persons are compared to a control group of individuals who had no history of gender variation. Historically, the study group faces far greater discrimination, experiences far more violence against them, tend to be underemployed and underinsured, are far more likely to encounter negative prejudice when attempting to establish a meaningful and lasting personal relationship, and are often ostracized by their own families and support structures like the church. Therefore, it is no surprise that their outcomes will not compare favorably with a control group that generally does not face that same onslaught of obstacles.
I suggest that if the study group was compared to a control group from another, non-gender related, marginalized group, the comparison would be far more equal. For example, what if a random sample of American blacks was chosen as the control population? Yet even then, blacks do not face above average rejection in personal relationships, and are not rejected by their families or their local place of worship.
Furthermore, Dr. McHugh offers no proof of any other psychiatric intervention that yields better results. Nor does he offer proof of psychiatric treatments that can “cure” transsexuality. If a cancer treatment had only a 20% success rate, would he propose that it be dropped even if there are no better alternatives? Or would he be grateful that 20% were healed?
Moving on to the doctor’s description of three so-called “subgroups” of transsexuals, he crafts descriptions that subtly attempt to exclude everyone from being a legitimate candidate for SRS. The transsexuals in the first two subgroups come out of the closet too old for it to be trusted. Those in the last subgroup are too young to be considered trustworthy.
But a careful read of Dr. McHugh’s last subgroup shows that he is guilty of the fallacy of the excluded middle. The doctor’s point of view appears to be that nearly 80% of gender questioning children will eventually lead their lives in gender roles consistent with their anatomy. Even so, is he proposing that the other 20% be kicked to the curb? The persistence of the feelings that he found so puzzling earlier in his Op Ed is not puzzling to me and many of his colleagues. The simple reason is that the identity is true. Genuine gender identity is at the core of who we are as individuals. In any other circumstance, attempts to tinker with core identity would immediately be seen for what it is: brainwashing.
Despite the doctor’s overt protests and denials, his own statistics point to the fact that some people are truly transsexual. And for those of us who make an informed choice for SRS (and there are many transsexuals who choose to be non-op), it is an important and viable part of our treatment.
Yes, screening procedures should continue to be refined and improved. Any person misdiagnosed and altered creates the very situation that authentic transsexuals need to escape. And yes, since the treatment of minors with strong and persistent transsexual symptoms is in its incipient stages, at least fifty years behind the treatment of adults, we need to continue to work on proper ethical protocols that make sure that the child is helped and guided to the best possible result rather than being pushed toward a result that reflects the practitioner’s bias in either direction.
I also agree somewhat with the doctor on what surgery does not accomplish. But in part that is because the medical profession has misnamed the surgery. This is why many of us are now using the term “confirming” as in “Gender Confirming Surgery”. At this time, surgery can only make changes that help the body conform more closely to your gender identity. But with all the advances in stem cell research with the ability to grow organs, who knows what will be possible in the future, perhaps the near future. Even so, surgery cannot change your gender. If you were female before, you will be female after. But we are still left with Dr. McHugh’s unsupported assumption that a person’s gender identity must have a 1:1 correlation with a single body part. Where’s the scientific proof? Taken to absurdity to prove the absurd, it validates those women who accuse men of thinking with that same body part.
There are still more problems with Dr. McHugh’s Op Ed article:
– It ignores brain studies which indicate a correlation between transsexual brains and the normative brain of their target gender. The growing evidence of physical causes of incongruent gender identity is an inconvenient truth to those who label transsexuals as delusional, or suffering from mental disorders such as body dysmorphia.
– It arrogantly and cavalierly dismisses the importance of patient satisfaction. All else being equal, shouldn’t that be primary? The quoted studies do not claim that the circumstances get worse, but rather that they tend to show little change. I contend that if patients are more satisfied with their lot in life, even when it has changed little, is evidence that SRS is beneficial.
– It insults devoted parents, many of whom were not part of the “diversity” crowd when they faced a gender non-conforming child, who have seen that child transformed from an intransigent, tantrum-throwing monster into a happy, calm, obedient and well-adjusted child upon being allowed to live life in his or her target gender.
– It discounts the success stories of people like Lynn Conway and the many other success stories that she features on her website. Does Dr. McHugh believe that these examples of transsexuals who have gone on to live successful, productive lives would have been better off untreated, marginalized, miserable and broken?
Finally, a little bit about my own personal experience for what it is worth. I became aware of my female identity at age seven, which I have since learned is the average age for transsexuals. I have never considered myself ugly or hated my genitals. They merely seem as out of place as a soda can would be in the hand of Venus in Botticelli’s painting.
I qualify for Mensa. I am a college graduate and have been gainfully employed or self-employed for most of my adult life. I have no psychiatric or mental health therapy history prior to my gender counselling that began in May 2012. During the intake by my gender counselor, she questioned me as to whether I experienced a whole laundry list of mental health issues such as sleep problems, eating disorders, anger, depression, a desire to hurt myself, and so on. To every one of those questions, my truthful answer was “no”.
Like most transsexuals my age, I tried to cure myself. But I reached a point when I could no longer deny that this had to be dealt with head on. Many of the people in my life closest to me affirm that it has been positive for me. Many of my personal relationships have improved. I am pleased with the results and expect that life will also improve if bottom surgery is performed after a thoughtful review of all relevant factors.
I am intelligent and aware enough to know the difference between how it feels to want to be something and how it feels to know what I am. One other thing: I also know how it feels to undergo a major identity change in a totally separate area of life. Twenty-five years ago this month, I received Jesus Christ into my life as my personal Lord and Savior. As a new creature in Christ, I have a new spiritual identity. My female identity persisted after this experience, even in the face of opposition from many in evangelical circles. Comparing and contrasting the two, I understand that my Christian identity is the result of a profound life change while my female gender identity is innate and permanent.
People close to me note that since I transitioned, I am happier and no longer in conflict. As a Christian, I know that happiness can be ephemeral and pleasure deceitful. But you cannot counterfeit peace and joy. Since living full-time as a female, my peace and joy has increased abundantly.
But wait! I forgot that there are those in the mental health profession with the view that people who believe they have a personal relationship with God are also delusional. Maybe I shouldn’t have mentioned that I am born again. Oh well.
But the fruit of the Spirit is love, joy, peace, longsuffering, gentleness, goodness, faith, Meekness, temperance: against such there is no law. – Galatians 5:22-23