Posted on 06/17/2015 9:11:58 AM PDT by xzins
The idea that one’s sex is a feeling, not a fact, has permeated our culture and is leaving casualties in its wake. Gender dysphoria should be treated with psychotherapy, not surgery.
For forty years as the University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School—twenty-six of which were also spent as Psychiatrist in Chief of Johns Hopkins Hospital—I’ve been studying people who claim to be transgender. Over that time, I’ve watched the phenomenon change and expand in remarkable ways.
A rare issue of a few men—both homosexual and heterosexual men, including some who sought sex-change surgery because they were erotically aroused by the thought or image of themselves as women—has spread to include women as well as men. Even young boys and girls have begun to present themselves as of the opposite sex. Over the last ten or fifteen years, this phenomenon has increased in prevalence, seemingly exponentially. Now, almost everyone has heard of or met such a person.
Publicity, especially from early examples such as “Christine” Jorgenson, “Jan” Morris, and “Renee” Richards, has promoted the idea that one’s biological sex is a choice, leading to widespread cultural acceptance of the concept. And, that idea, quickly accepted in the 1980s, has since run through the American public like a revelation or “meme” affecting much of our thought about sex.
The champions of this meme, encouraged by their alliance with the broader LGBT movement, claim that whether you are a man or a woman, a boy or a girl, is more of a disposition or feeling about yourself than a fact of nature. And, much like any other feeling, it can change at any time, and for all sorts of reasons. Therefore, no one could predict who would swap this fact of their makeup, nor could one justifiably criticize such a decision.
At Johns Hopkins, after pioneering sex-change surgery, we demonstrated that the practice brought no important benefits. As a result, we stopped offering that form of treatment in the 1970s. Our efforts, though, had little influence on the emergence of this new idea about sex, or upon the expansion of the number of “transgendered” among young and old.
Olympic Athlete Turned "Pin-Up" Girl
This history may clarify some aspects of the latest high-profile transgender claimant. Bruce Jenner, the 1976 Olympic decathlon champion, is turning away from his titular identity as one of the “world’s greatest male athletes.” Jenner announced recently that he “identifies as a woman” and, with medical and surgical help, is busy reconstructing his physique.
I have not met or examined Jenner, but his behavior resembles that of some of the transgender males we have studied over the years. These men wanted to display themselves in sexy ways, wearing provocative female garb. More often than not, while claiming to be a woman in a man’s body, they declared themselves to be “lesbians” (attracted to other women). The photograph of the posed, corseted, breast-boosted Bruce Jenner (a man in his mid-sixties, but flaunting himself as if a “pin-up” girl in her twenties or thirties) on the cover of Vanity Fair suggests that he may fit the behavioral mold that Ray Blanchard has dubbed an expression of “autogynephilia”—from gynephilia (attracted to women) and auto (in the form of oneself).
The Emperor’s New Clothes
But the meme—that your sex is a feeling, not a biological fact, and can change at any time—marches on through our society. In a way, it’s reminiscent of the Hans Christian Andersen tale, The Emperor’s New Clothes. In that tale, the Emperor, believing that he wore an outfit of special beauty imperceptible to the rude or uncultured, paraded naked through his town to the huzzahs of courtiers and citizens anxious about their reputations. Many onlookers to the contemporary transgender parade, knowing that a disfavored opinion is worse than bad taste today, similarly fear to identify it as a misapprehension.
FILE - In this June 19, 2014, file photo, Laverne Cox arrives at the Critics' Choice Television Awards at the Beverly Hilton Hotel on Thursday, June 19, 2014, in Beverly Hills, Calif. President Barack Obama during his first year in office became the first chief executive to say "transgender" in a speech, the first to name transgender political appointees and the first to prohibit job bias against transgender government workers. He also signed hate crime legislation that represented the first federal civil rights protections for transgender people in U.S. history. (Photo by Richard Shotwell/Invision/AP, File) I am ever trying to be the boy among the bystanders who points to what’s real. I do so not only because truth matters, but also because overlooked amid the hoopla—enhanced now by Bruce Jenner’s celebrity and Annie Leibovitz’s photography—stand many victims. Think, for example, of the parents whom no one—not doctors, schools, nor even churches—will help to rescue their children from these strange notions of being transgendered and the problematic lives these notions herald. These youngsters now far outnumber the Bruce Jenner type of transgender. Although they may be encouraged by his public reception, these children generally come to their ideas about their sex not through erotic interests but through a variety of youthful psychosocial conflicts and concerns.
First, though, let us address the basic assumption of the contemporary parade: the idea that exchange of one’s sex is possible. It, like the storied Emperor, is starkly, nakedly false. Transgendered men do not become women, nor do transgendered women become men. All (including Bruce Jenner) become feminized men or masculinized women, counterfeits or impersonators of the sex with which they “identify.” In that lies their problematic future.
When “the tumult and shouting dies,” it proves not easy nor wise to live in a counterfeit sexual garb. The most thorough follow-up of sex-reassigned people—extending over thirty years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest. Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers.
How to Treat Gender Dysphoria
So how should we make sense of this matter today? As with any mental phenomenon, what’s crucial is noting its fundamental characteristic and then identifying the many ways in which that characteristic can manifest itself.
The central issue with all transgender subjects is one of assumption—the assumption that one’s sexual nature is misaligned with one’s biological sex. This problematic assumption comes about in several different ways, and these distinctions in its generation determine how to manage and treat it.
Based on the photographic evidence one might guess Bruce Jenner falls into the group of men who come to their disordered assumption through being sexually aroused by the image of themselves as women. He could have been treated for this misaligned arousal with psychotherapy and medication. Instead, he found his way to surgeons who worked him over as he wished. Others have already commented on his stereotypic caricature of women as decorative “babes” (“I look forward to wearing nail polish until it chips off,” he said to Diane Sawyer)—a view that understandably infuriates feminists—and his odd sense that only feelings, not facts, matter here.
For his sake, however, I do hope that he receives regular, attentive follow-up care, as his psychological serenity in the future is doubtful. Future men with similar feelings and intentions should be treated for those feelings rather than being encouraged to undergo bodily changes. Group therapies are now available for them.
Most young boys and girls who come seeking sex-reassignment are utterly different from Jenner. They have no erotic interest driving their quest. Rather, they come with psychosocial issues—conflicts over the prospects, expectations, and roles that they sense are attached to their given sex—and presume that sex-reassignment will ease or resolve them.
The grim fact is that most of these youngsters do not find therapists willing to assess and guide them in ways that permit them to work out their conflicts and correct their assumptions. Rather, they and their families find only “gender counselors” who encourage them in their sexual misassumptions.
Those with Gender Dysphoria Need Evidence-Based Care
There are several reasons for this absence of coherence in our mental health system. Important among them is the fact that both the state and federal governments are actively seeking to block any treatments that can be construed as challenging the assumptions and choices of transgendered youngsters. “As part of our dedication to protecting America’s youth, this administration supports efforts to ban the use of conversion therapy for minors,” said Valerie Jarrett, a senior advisor to President Obama.
In two states, a doctor who would look into the psychological history of a transgendered boy or girl in search of a resolvable conflict could lose his or her license to practice medicine. By contrast, such a physician would not be penalized if he or she started such a patient on hormones that would block puberty and might stunt growth.
What is needed now is public clamor for coherent science—biological and therapeutic science—examining the real effects of these efforts to “support” transgendering. Although much is made of a rare “intersex” individual, no evidence supports the claim that people such as Bruce Jenner have a biological source for their transgender assumptions. Plenty of evidence demonstrates that with him and most others, transgendering is a psychological rather than a biological matter.
In fact, gender dysphoria—the official psychiatric term for feeling oneself to be of the opposite sex—belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder. Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction. The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it. With youngsters, this is best done in family therapy.
The larger issue is the meme itself. The idea that one’s sex is fluid and a matter open to choice runs unquestioned through our culture and is reflected everywhere in the media, the theater, the classroom, and in many medical clinics. It has taken on cult-like features: its own special lingo, internet chat rooms providing slick answers to new recruits, and clubs for easy access to dresses and styles supporting the sex change. It is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges.
But gird your loins if you would confront this matter. Hell hath no fury like a vested interest masquerading as a moral principle.
Paul McHugh, MD, is University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School and the former psychiatrist in chief at Johns Hopkins Hospital. He is the author of “The Mind Has Mountains: Reflections on Society and Psychiatry.”
I’ve wondered about that. He’s obviously near retirement, so I assume he’s unleashed a “what the hell, let’s tell the truth” bomb on the snipers of the left.
The best counter or defense against that is a fully functioning brain. Something that an alarming number of people in this country lack.
Freudian slip?
I knew there was something about me, I’m a gynephiliac.
Communist Goals (1963) Congressional Record--Appendix, pp. A34-A35 January 10, 1963
38. Transfer some of the powers of arrest from the police to social agencies. Treat all behavioral problems as psychiatric disorders which no one but psychiatrists can understand [or treat].
39. Dominate the psychiatric profession and use mental health laws as a means of gaining coercive control over those who oppose Communist goals.
40. Discredit the family as an institution. Encourage promiscuity and easy divorce.
41. Emphasize the need to raise children away from the negative influence of parents. Attribute prejudices, mental blocks and retarding of children to suppressive influence of parents.
I feel like a spider today. The worst part about that is I’m arachnophobic.
I think this guy has spoken out before on the issue. He falls into the camp of too old and too accomplished to give a rodent’s rear end about the consequences of speaking the truth. My guess is they will have to fire him if they want him gone.
When I was a child, I used to wish I had been born a boy because back then it seemed to me that boys were considered better and more life and career options were available to them. I also mostly played with boys because they did more fun stuff.
Thank God I WAS born back then, because I probably would have all kinds of people telling me as a kid today that I AM a boy!
I would have thought by now with women’s lib and the wussification of men kids wouldn’t have these problems. I honestly think evil people are putting it in there heads.
How long before Obamacare requires gender reassignment surgery at Johns Hopkins (and other places)??
It appears we may be witnessing the advent of another exploded career, courtesy of the tolerant left and their loyalty oath nazis.
Relatively speaking, the idea that a surgeon or a pill a day can turn Bruce Jenner into a woman is not as crazy as many liberal idea. It’s 100% false, of course, but it’s harmless compared to the idea that 50 or million real votes plus fraud in the right districts can turn Obama into a president of the United States.
In the vast majority of cases, yes. In the great majority of cases where people consider themselves to be the other sex, yes. In Jenner's case, certainly.
But you could look up "SRY gene" and "androgen insensitivity," just because the other side will go after you when you say x means x and y means y, in the way of a diversion proving the ignorance of their opponents.
As has been discussed above this new freak show America was promoted by the mass media over many years. Homosexuality was promoted by both the entertainment and information media. It doesn’t matter what the topic is whether it is climate change, homosexuality or transgender once the politically correct position becomes known all who differ will be ostracized and punished.
Follow the source and it is radical politics. Follow the money and you will see that it comes from the Democrat party and liberal foundations.
LOL!!!
The enthusiastic welcome given to “transgender children” is a perversion and has caused “for the children” to devolve into “to the children.”
Getting back to a belief in God, that He made you the way you are, your color and gender, and that your body is a Temple; that you are to care for it by living a healthy life-style - all of these teachings, were they to be followed by more than a fraction of the population today, would alleviate much of the mental & physical problems we’re seeing today.
Do you remember when some twenty or so years ago psychiatrists were attributing all sorts of psychological problems to having been molested by your parents? This crazy meme spread throughout the country causing much pain to those involved. Some grown children even sued their parents because they believed that they had been molested by their parents even though they had no memory of this happening.
I think you are right.
I have never heard of the Nazi T4 program, could you please tell me what it is?
Very well done article, of possible interest
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