More About Sexual Reassignment Surgery

April 11, 2011: Chaz Bono and girlfriend Jennifer Elia arrive at the 22nd annual GLADD Media Awards in Los Angeles. (Reuters)

Recently, I advised parents to not allow their children to watch Chaz Bono compete on Dancing With the Stars.

I stand by that advice.

I believe that mainstreaming behavior makes it more likely that others will engage in that behavior. I believe this is particularly true for those who are still forming a psychological identity—a firm sense of self. Children and adolescents certainly fit those criteria. There is a wealth of scientific data supporting that view, but many activists and media personalities and even some mental health professionals have taken issue with that claim.

Even the President of the American Psychiatric Association, Dr. John M. Oldham, claimed that there is no evidence that watching someone with gender reassignment surgery glorified by the media would have no effect on anyone in the population. Disingenuously, in my opinion,Oldham did not mention that there is also no evidence to the contrary, and that the issue has not been studied in any comprehensive manner.

When I contacted Oldham to discuss this with him, he refused to take the call. His office refused to grant me an interview with Oldham.

Oldham has been very active in organized psychiatry while the profession has largely abandoned insight-oriented psychotherapy as a healing art.

The trouble is that following my critics’ reasoning would imply that the longstanding tradition (backed by scientific evidence) of restricting networks from showing people smoking (and, to use the Bono analogy) saying how free and healthy they feel, and even being given standing ovations for it, should be reversed. Networks, my critics apparently believe, should be not only free, but encouraged, to have contestants on game shows who are heroin dependent, come on television sporting their drug paraphernalia, have embraced the use of opiates as their lifestyle and who are applauded for their autonomy.

Opioid dependence is, after all, a recognized psychiatric disorder in the DSM IV-TR, just like Gender Identity Disorder. Why would we discriminate against someone with a known psychiatric condition? Similarly, networks should be encouraged to have people on game shows who suffer with anorexia and who wish wholeheartedly—and quite sincerely—to be 80 pounds. They should cue the audience to get to their feet and applaud. What could the risk of that be?

I believe the risks are clear. I believe (and judging from supportive e-mails I have received) many professionals agree and many millions of Americans agree.

Lest you think me a lone wolf in my thinking—that most or all transgender reassignment surgery represents the collaboration of misguided psychiatrists and plastic surgeons (and television producers)—you might look into the teachings of Dr. Paul McHugh.

McHugh was the Henry Phipps Professor of Psychiatry and the director of the Department of Psychiatry and Behavioral Science at Johns Hopkins University, and psychiatrist-in-chief at the Johns Hopkins Hospital from 1975 to 2001. In 2008, he received the “Sarnat Award” from the Institute of Medicine for his work in mental health.

In 2004, Dr. McHugh wrote these words:
. . . We as psychiatrists should work to discourage those adults who seek surgical sex reassignment. When Hopkins announced that it would stop doing these procedures in adults with sexual dysphoria, many other hospitals followed suit, but some medical centers still carry out this surgery . . . . I am disappointed but not surprised by this, given that some surgeons and medical centers can be persuaded to carry out almost any kind of surgery, when pressed by patients . . .

The most astonishing example is the surgeon in England who is prepared to amputate the legs of patients who claim to find sexual excitement in gazing at and exhibiting stumps of amputated legs.

At any rate, we at Hopkins hold that official psychiatry has good evidence to argue against this kind of treatment and should begin to close down the practice everywhere.

. . . Without any fixed position on what is given in human nature, any manipulation of it can be defended as legitimate. A practice that appears to give people what they want—and what some of them are prepared to clamor for—turns out to be difficult to combat with ordinary professional experience and wisdom. Even controlled trials or careful follow-up studies to ensure that the practice itself is not damaging are often resisted and the results rejected.

. . . 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. 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.

Now, as for those journalists who contend that I have no experience from which to opine about gender identity disorder or sexual reassignment surgery or the influence of media on public behavior, please note I graduated the Johns Hopkins School of Medicine where I studied with  McHugh himself. I also studied with Dr. Fred Berlin, Director of the Sexual Behavior Consultation Unit at Johns Hopkins. I am also a recipient of the American Medical Association’s Jerry Pettis Award for communicating science to the public and a former Fellow of the American Association of the Advancement of Science.

At the request of the then-President of the American Psychiatric Association, my mentor Dr. Carol Nadelson, I authored two books for the American Psychiatric Press, the publishing arm of the American Psychiatric Association, aimed at explaining psychiatric reasoning to the public.

I am not presenting my bonafides to impress anyone, but rather to counter the claims of media personalities and journalists, who contend that my experience is inferior to that of Oldham and that I should, therefore, essentially stand down and shut up.

Not a chance. Not ever. I was trained by legendary psychiatrists of independent mind and critical thinking. To bow down to anyone’s social agenda and shut down the light of proper inquiry would be to do them a disservice. They put too much effort into making me the healer I am for me to forsake them.