Paul McHugh Defames Transsexual Women:

 

Paul McHugh (the Vatican's advisor on sexual matters and an avid J. Michael Bailey supporter) monstrously defamed and ridiculed transsexual women in a Catholic magazine article in 2004.

 

As a member of the Institute of Medicine of the National Academy of Sciences and of G. W. Bush's President's Council on Bioethics, McHugh had by then gained considerable clout in scientific circles - and exploited that clout to pathologize transitioned women, especially by promoting the publication of J. Michael Bailey's transphobic book.

 

Since that time, major Catholic media have often cited McHugh's article - in an escalation of trans-bashing by the Catholic hierarchy, as evidenced in the notes further below. For more on McHugh's defamation of trans women, see also Andrea James' Webpage about McHugh and Monica Roberts essay "Why Is The Catholic Church Hatin' On Transpeople?"

 

 

Contents:

1. Background and commentary on our initial reactions to McHugh's statements.

2. "Surgical Sex", by Paul McHugh,

    First Things: The Journal of Religion, Culture and Public Life, November 2004.

3. "Transsexual Truths?", Letter to the editor by Jennifer Usher, 

    First Things: The Journal of Religion, Culture and Public Life, February 2005

4. Ongoing citations of McHugh's article (as if it were "science") by transphobic religious ideologues.

5. Further evidence of McHugh's extreme Catholic ideology

 


 

1. Commentary on the McHugh article:

 

 

In November 2004, psychiatrist Paul McHugh (the Vatican's advisor on sexual matters) came out openly and stated his "scientific" position on "sex changes".  The article is full of the usual BBL ideology regarding transsexualism, most of which (as you can see in this article) goes directly all the way back to McHugh and his colleague Jon Meyer at Johns Hopkins in the 1970's.  The article is entitled "Surgical Sex", and it can be found at the following Catholic Church website:

 

http://www.firstthings.com/ftissues/ft0411/articles/mchugh.htm

 

This article is the latest in a long series of attacks on "sex changes" by McHugh, going all the way back to his personality conflicts and confrontations with John Money at Johns Hopkins in the 70's, with McHugh personally being responsible for closing down the gender clinic there. For more of the historical background on McHugh, see Andrea James' page "Paul McHugh on Transsexualism"

 

In his recent article, McHugh is ruthless in his caricaturing of transsexual women, which he does in a manner reminiscent of school-yard bullies instead of "famous scientists".  In the article he mocks these women and ridicules them in the grossest of ways:

 

"...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)...."

 

Here we see him making fun of women who, through no fault of their own, had been forced by fate to be masculinized by testosterone, and who had then in many clinics been forced to dress as caricatures of women (in high heels and with lots of makeup) during extended "real life tests" (RLT) as part of the forced-protocol for obtaining access to surgeries.

 

Furthermore, many of the old clinics forced trans women into RLT without the benefit of hormones, only prescribing hormones after an extended RLT (a practice is still enforced at The Clarke Institute in Canada - now called the CAMH).

 

McHugh's remarks are thus seen as incredibly offensive - he is seen as ridiculing the very clients that those old clinics forced into the torture of RLT and social transition without the benefit of hormones. And of course McHugh ignores any and all effects of the many modern treatments, including FFS, that can correct the masculinization-effects which McHugh ridicules. Thus he is playing on crude social stereotypes of trans women as "men in dresses", taunting and humiliating them in absentia in the process.

 

 

 

Then, a little further along, we discover that McHugh apparently sees himself as the instigator and principal propagator of the now infamous "two-type" theory of transsexualism.  Furthermore, since he apparently believes that he has won the scientific war against sex changes by convincing the Vatican to denounce transsexualism in 2000, and by supporting Mr. Bailey's book on the inside at the National Academy of Sciences in 2003-2004, he thinks it is now time to tell the history of his great success! 

 

In telling this story, he reduces the contribution of The Clarke (namely sexologist Ray Blanchard) to that of merely confirming his and Meyer's ideas from the mid-1970's. This greatly reduces Blanchard's "fame" as the "discoverer" of anything, and pushes the two-type theory back to a time in the 70's when psychiatric theories of transsexualism (and homosexuality too) were just prejudices in disguise:

 

  

"... 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. As they had grown older, they had become eager to add more verisimilitude to their costumes and either sought or had suggested to them a surgical transformation that would include breast implants, penile amputation, and pelvic reconstruction to resemble a woman. ... 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."

 
 

These assertions, based on research in the 1970's, suggest why Blanchard (and later J. Michael Bailey and Anne Lawrence) also constantly refer to intense, early-onset transsexualism as "extreme effeminate homosexuality", rather than as a form of innate gender feelings in conflict with body sex.  These assertions come down to us from a time when homosexuality was openly pathologized by psychiatrists - a time when psychiatrists' knee-jerk reactions were that trans women were simply "gay men". 

 

However, unscientific thought they are, these assertions have been forcefully propagated for over 30 years by this very Paul McHugh, who has been in a position to make them stick in psychiatric circles - even in the face of rapidly mounting and massive counter-evidence against them.

 

We strongly suspect that when the Bailey book came out, McHugh launched this same kind of tirade against transsexual women inside the National Academies. McHugh is a member of the Institute of Medicine of the National Academy of Sciences and a member of the current President's Council on Bioethics. He would have been the very "top authority" whom the leaders of the Academies turned to to learn about transsexualism. No one there would have realized that McHugh has been on a personal Catholic religious rampage against "sex changes", and has had a closed mind on this entire subject, for the past 30 years.

 

Is is any wonder then, that the National Academies refused to ever meet with any of the many professional/scientific/academic trans women who wrote and complained when the Academies published the Bailey book?  After all, the Academies' elite insider McHugh paints a picture of us as being witchlike creatures, creatures who would frighten any normal person to death if they had to be in the same room with us!  Thus is it any wonder the National Academies gave us the silent treatment?

 

And now, egotist that he is, McHugh is trying to steal Blanchard's thunder by declaring that psychoanalyst Jon Meyer and he (McHugh) were actually the researchers who originated the two-type theory of transsexual mental illness, which we shall from now on call the "Meyer-McHugh theory".  According to McHugh, Blanchard merely made some confirming measurements, somewhat in the vein that Bailey "made some confirming observations of transsexuals in Chicago", and then gave a catchy name to one of the types.  But in his mind it is really he, McHugh, who figured this all out once and for all, way back in the 1970's.

 

You will also notice in his article that McHugh also takes credit for causing and sponsoring William Reiner's pioneering work on the cloacal exstrophy cases. By doing this, he moves into a position to "speak for Reiner", and thus more easily misspeak regarding the Reiner's main findings regarding the nature of gender.  McHugh even has the nerve to ask regarding trans women,

” 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?",

i.e., suggesting that transitioners expect SRS to change their inner identities, when in fact SRS is done to confirm and accommodate to one's existing inner identity.  McHugh refuses to believe gendered feelings and gendered identities exist independent of body sex - even though Reiner's work amply demonstrates such independent-of-body-sex inner feeling and identities.

 

Of course Reiner can openly tell the story regarding his pioneering work on the negative impacts of many intersex infant surgeries without alienating McHugh.  He can help bring more wisdom and compassion to the treatment of infant intersex kids, who in the past have been arbitrarily assigned to a gender based on "practical surgical considerations" rather than waiting till they can speak and act for themselves and give their parents some clue as to their inner identities.  McHugh loved these results, because they helped him "stop sex changes" (and in the cases of intersex infants, this was usually a correct thing to do).

 

We wonder though, will Reiner have to wait for McHugh to pass on before telling the overall implications of his results more fully?  After all, Reiner's cloacal exstrophy follow-ups are to gender what the moons of Jupiter were to astronomy:  The very visible and undeniable reality of something mysterious at the time that had been previously denied (by the Catholic Church). In this case we see stark evidence for gendered feelings and identities that are not based on body sex and upbringing, feelings and identities that emerge strongly during childhood and that cry out for social and physical expression.

 

 

 

William Reiner left Johns Hopkins around a year ago or so, and is now at University of Oklahoma at Oklahoma City. He heads a program in pediatric urology and is doing research there. 

 

But even so, can Reiner really follow-up and talk about those broader implications of his research results?  Any such discussions would challenge McHugh's position on gender. McHugh has a powerful stranglehold in elite scientific circles on opinion in that area, and we've seen the power wielded by McHugh against those who dare disagree with him (for example, John Money).  Would Reiner dare to openly contradict McHugh's misinterpretations of the cloacal exstrophy results regarding innate gender identity independent of body sex?  Only time will tell. 

 

Note that we do see him coming close to this, when talking about intersex kids growing up (it is just a short step to talking about trans kids this way) in the following quotes from a recent article entitled "Living in between, but no longer in silence" (NYU News), by Kim Llerena:

 

Since the 1950s, surgery has been the preferred method among urologists for dealing with intersex bodies, by "normalizing" genitalia so that children could grow up in a definitive male or female role. Recently, however, new evidence has led some urologists to concede that the genitals do not make the man - or the woman.

 

"I don't think it matters whether you assign a sex or you don't, or even whether you assign the correct sex," said Dr. William Reiner, a professor in the urology department at the University of Oklahoma Health Sciences Center. "A child is going to identify [himself or herself]. A child's sexual identity can only be known by the child."

 

In any event, William Reiner is a brilliant scientist and a gentleman and in the end his pioneering work will speak for itself.  He will make his mark in scientific history not by the domineering pushing of unsound pet theories as did Money and McHugh, but by doing it the hard way: by doing good science.

 

 

 

Meantime, by prematurely grasping for his place in history, McHugh has now tipped his hand in his essay.  He WANTS people to know about his important role in the Vatican decision to denounce transsexualism. He wants people to know about his role in the National Academies' publication and promotion of the Bailey book, a book that the prestigious Southern Poverty Law Center (SPLC) has called "Queer Science".  He wants to be "appreciated" for what he considers to be his important scientific efforts to "stop sex changes".

However, the publication of this incredibly offensive and overstated Catholic magazine article may prove to be quite a blunder by McHugh: 

 

His irrational and unscientific hatred of transsexual women shows through too clearly, in his gross ridiculing and caricaturing of trans women.

 

He even has the nerve to comment about how transitioning women talked incessantly about sex in their psychiatric interviews - when it was the interviewer-psychiatrists themselves who would talk about nothing else but sex! 

 

He's also seen, out in the open, overlooking obvious "other interpretations of key data" much like Money did.  And, for example, he has totally ignored the evidence of decades-worth of successful transitions by thousands of women.

 

He then concludes his article by calling gender variance "madness". 

 

McHugh is seen here doing great and tragic harm by making ego-maniacal warped-science pronouncements about transsexual people, just as Money did in his efforts to promote infant genital surgery on intersex kids.

 

 

 

They are two of a kind:  Money and McHugh.

 

Money for decades pushed sex reassignments of intersex infants, under a bogus theory of gender.  Money insisted wrongly that gender is socially constructed and that intersex boys could be turned into girls if reassigned surgically early enough. He then deliberately prevented mounting counter-evidence to his theory from being widely revealed to his scientific colleagues.  For several decades he pushed and promoted the practice of infant intersex surgeries, even in the face of mounting evidence that his theory was incorrect.

 

McHugh has for decades tried to stop transsexual sex reassignments, under a bogus theory that trans women are homosexual men or sexual paraphilics. By power of position and personality he stopped (not only the infant genital surgeries, but also) the transsexual surgeries at John's Hopkins. He then deliberately prevented mounting counter-evidence to his theory from being widely revealed to his scientific colleagues. For decades now he has pushed and promoted the idea that "sex changes are wrong", even in the face of mounting evidence that his theory was incorrect - evidence that transsexual transitions can work out extremely well.
 

In the end, just like Money, McHugh will go down in history as a devil of a man who shattered the lives of tens of thousands of gender variant people.  I think we should help him along in this, by making sure his "important role" in history is fully documented and well-remembered.

 

Lynn Conway
 

November 26, 2004

 

 

 


 

2. FIRST THINGS

The Journal of Religion, Culture and Public Life

http://www.firstthings.com/ftissues/ft0411/articles/mchugh.htm

 

Surgical Sex


Paul McHugh


Copyright (c) 2004 First Things 147 (November 2004): 34-38.

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?

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.”

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

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. 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. These claims had generated the opinion in psychiatric circles that one’s “sex” and one’s “gender” were distinct matters, sex being genetically and hormonally determined from conception, while gender was culturally shaped by the actions of family and others during childhood.

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.

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. As they had grown older, they had become eager to add more verisimilitude to their costumes and either sought or had suggested to them a surgical transformation that would include breast implants, penile amputation, and pelvic reconstruction to resemble a woman.

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. This idea, a form of “sex in the head” (D. H. Lawrence), was what provoked their first adventure in dressing up in women’s undergarments and had eventually led them toward the surgical option. Because most of them found women to be the objects of their interest they identified themselves to the psychiatrists as lesbians. 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.

This information and the improved understanding of what we had been doing led us to stop prescribing sex-change operations for adults at Hopkins—much, I’m glad to say, to the relief of several of our plastic surgeons who had previously been commandeered to carry out the procedures. And with this solution to the first issue I could turn to the second—namely, the practice of surgically assigning femaleness to male newborns who at birth had malformed, sexually ambiguous genitalia and severe phallic defects. This practice, more the province of the pediatric department than of my own, was nonetheless of concern to psychiatrists because the opinions generated around these cases helped to form the view that sexual identity was a matter of cultural conditioning rather than something fundamental to the human constitution.

Several conditions, fortunately rare, can lead to the misconstruction of the genito-urinary tract during embryonic life. When such a condition occurs in a male, the easiest form of plastic surgery by far, with a view to correcting the abnormality and gaining a cosmetically satisfactory appearance, is to remove all the male parts, including the testes, and to construct from the tissues available a labial and vaginal configuration. This action provides these malformed babies with female-looking genital anatomy regardless of their genetic sex. Given the claim that the sexual identity of the child would easily follow the genital appearance if backed up by familial and cultural support, the pediatric surgeons took to constructing female-like genitalia for both females with an XX chromosome constitution and males with an XY so as to make them all look like little girls, and they were to be raised as girls by their parents.

All this was done of course with consent of the parents who, distressed by these grievous malformations in their newborns, were persuaded by the pediatric endocrinologists and consulting psychologists to accept transformational surgery for their sons. They were told that their child’s sexual identity (again his “gender”) would simply conform to environmental conditioning. If the parents consistently responded to the child as a girl now that his genital structure resembled a girl’s, he would accept that role without much travail.

This proposal presented the parents with a critical decision. The doctors increased the pressure behind the proposal by noting to the parents that a decision had to be made promptly because a child’s sexual identity settles in by about age two or three. The process of inducing the child into the female role should start immediately, with name, birth certificate, baby paraphernalia, etc. With the surgeons ready and the physicians confident, the parents were faced with an offer difficult to refuse (although, interestingly, a few parents did refuse this advice and decided to let nature take its course).

I thought these professional opinions and the choices being pressed on the parents rested upon anecdotal evidence that was hard to verify and even harder to replicate. Despite the confidence of their advocates, they lacked substantial empirical support. I encouraged one of our resident psychiatrists, William G. Reiner (already interested in the subject because prior to his psychiatric training he had been a pediatric urologist and had witnessed the problem from the other side), to set about doing a systematic follow-up of these children—particularly the males transformed into females in infancy—so as to determine just how sexually integrated they became as adults.

The results here were even more startling than in Meyer’s work. Reiner picked out for intensive study cloacal exstrophy, because it would best test the idea that cultural influence plays the foremost role in producing sexual identity. Cloacal exstrophy is an embryonic misdirection that produces a gross abnormality of pelvic anatomy such that the bladder and the genitalia are badly deformed at birth. The male penis fails to form and the bladder and urinary tract are not separated distinctly from the gastrointestinal tract. But crucial to Reiner’s study is the fact that the embryonic development of these unfortunate males is not hormonally different from that of normal males. They develop within a male-typical prenatal hormonal milieu provided by their Y chromosome and by their normal testicular function. This exposes these growing embryos/fetuses to the male hormone testosterone—just like all males in their mother’s womb.

Although animal research had long since shown that male sexual behavior was directly derived from this exposure to testosterone during embryonic life, this fact did not deter the pediatric practice of surgically treating male infants with this grievous anomaly by castration (amputating their testes and any vestigial male genital structures) and vaginal construction, so that they could be raised as girls. This practice had become almost universal by the mid-1970s. Such cases offered Reiner the best test of the two aspects of the doctrine underlying such treatment: (1) that humans at birth are neutral as to their sexual identity, and (2) that for humans it is the postnatal, cultural, nonhormonal influences, especially those of early childhood, that most influence their ultimate sexual identity. Males with cloacal exstrophy were regularly altered surgically to resemble females, and their parents were instructed to raise them as girls. But would the fact that they had had the full testosterone exposure in utero defeat the attempt to raise them as girls? Answers might become evident with the careful follow-up that Reiner was launching.

Before describing his results, I should note that the doctors proposing this treatment for the males with cloacal exstrophy understood and acknowledged that they were introducing a number of new and severe physical problems for these males. These infants, of course, had no ovaries, and their testes were surgically amputated, which meant that they had to receive exogenous hormones for life. They would also be denied by the same surgery any opportunity for fertility later on. One could not ask the little patient about his willingness to pay this price. These were considered by the physicians advising the parents to be acceptable burdens to bear in order to avoid distress in childhood about malformed genital structures, and it was hoped that they could follow a conflict-free direction in their maturation as girls and women.

Reiner, however, discovered that such re-engineered males were almost never comfortable as females once they became aware of themselves and the world. From the start of their active play life, they behaved spontaneously like boys and were obviously different from their sisters and other girls, enjoying rough-and-tumble games but not dolls and “playing house.” Later on, most of those individuals who learned that they were actually genetic males wished to reconstitute their lives as males (some even asked for surgical reconstruction and male hormone replacement)—and all this despite the earnest efforts by their parents to treat them as girls.

Reiner’s results, reported in the January 22, 2004, issue of the New England Journal of Medicine, are worth recounting. He followed up sixteen genetic males with cloacal exstrophy seen at Hopkins, of whom fourteen underwent neonatal assignment to femaleness socially, legally, and surgically. The other two parents refused the advice of the pediatricians and raised their sons as boys. Eight of the fourteen subjects assigned to be females had since declared themselves to be male. Five were living as females, and one lived with unclear sexual identity. The two raised as males had remained male. All sixteen of these people had interests that were typical of males, such as hunting, ice hockey, karate, and bobsledding. Reiner concluded from this work that the sexual identity followed the genetic constitution. Male-type tendencies (vigorous play, sexual arousal by females, and physical aggressiveness) followed the testosterone-rich intrauterine fetal development of the people he studied, regardless of efforts to socialize them as females after birth.

Having looked at the Reiner and Meyer studies, we in the Johns Hopkins Psychiatry Department eventually concluded that human sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo. Male hormones sexualize the brain and the mind. Sexual dysphoria—a sense of disquiet in one’s sexual role—naturally occurs amongst those rare males who are raised as females in an effort to correct an infantile genital structural problem. A seemingly similar disquiet can be socially induced in apparently constitutionally normal males, in association with (and presumably prompted by) serious behavioral aberrations, amongst which are conflicted homosexual orientations and the remarkable male deviation now called autogynephilia.

Quite clearly, then, we 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. Thailand has several centers that do the surgery “no questions asked” for anyone with the money to pay for it and the means to travel to Thailand. 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 with sexual deviations, especially if those patients find a psychiatrist to vouch for them. 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.

For children with birth defects the most rational approach at this moment is to correct promptly any of the major urological defects they face, but to postpone any decision about sexual identity until much later, while raising the child according to its genetic sex. Medical caretakers and parents can strive to make the child aware that aspects of sexual identity will emerge as he or she grows. Settling on what to do about it should await maturation and the child’s appreciation of his or her own identity.

Proper care, including good parenting, means helping the child through the medical and social difficulties presented by the genital anatomy but in the process protecting what tissues can be retained, in particular the gonads. This effort must continue to the point where the child can see the problem of a life role more clearly as a sexually differentiated individual emerges from within. Then as the young person gains a sense of responsibility for the result, he or she can be helped through any surgical constructions that are desired. Genuine informed consent derives only from the person who is going to live with the outcome and cannot rest upon the decisions of others who believe they “know best.”

How are these ideas now being received? I think tolerably well. The “transgender” activists (now often allied with gay liberation movements) still argue that their members are entitled to whatever surgery they want, and they still claim that their sexual dysphoria represents a true conception of their sexual identity. They have made some protests against the diagnosis of autogynephilia as a mechanism to generate demands for sex-change operations, but they have offered little evidence to refute the diagnosis. Psychiatrists are taking better sexual histories from those requesting sex-change and are discovering more examples of this strange male exhibitionist proclivity.

Much of the enthusiasm for the quick-fix approach to birth defects expired when the anecdotal evidence about the much-publicized case of a male twin raised as a girl proved to be bogus. The psychologist in charge hid, by actually misreporting, the news that the boy, despite the efforts of his parents to treat him and raise him as a girl, had constantly challenged their treatment of him, ultimately found out about the deception, and restored himself as a male. Sadly, he carried an additional diagnosis of major depression and ultimately committed suicide.

I think the issue of sex-change for males is no longer one in which much can be said for the other side. But I have learned from the experience that the toughest challenge is trying to gain agreement to seek empirical evidence for opinions about sex and sexual behavior, even when the opinions seem on their face unreasonable. One might expect that those who claim that sexual identity has no biological or physical basis would bring forth more evidence to persuade others. But as I’ve learned, there is a deep prejudice in favor of the idea that nature is totally malleable.

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.

Paul McHugh is University Distinguished Service Professor of Psychiatry at Johns Hopkins University.

 


 

3. FIRST THINGS

The Journal of Religion, Culture and Public Life

 

Correspondence
(February 2005)


Copyright (c) 2005 First Things 150 (February 2005): 2-4.

 

Transsexual Truths?

In “Surgical Sex” (November 2004) Paul McHugh is certainly right to assert that sexual identity (or, as I prefer, gender) is not subject to change; it is most certainly inherent. About nearly everything else, however, Dr. McHugh is quite wrong. To begin with, I honestly have to wonder how many transsexuals Dr. McHugh has encountered, either before or after surgery.  While some do match his descriptions, most of those I know have actually been quite successful in their transformation and are indistinguishable from other women.

Contrary to Dr. McHugh’s claims, many transsexual women show considerable interest in children and many mourn the fact that they will never be able to bear a child. I myself have cried bitter tears over this. And yes, some transsexual women do identify as lesbian—just like women who are not transsexual. Likewise, many transsexual men identify as gay.  Such is to be expected if transsexualism is more than just a choice.

The report published by Jon Meyer (and cited authoritatively by Dr. McHugh) was met with considerable skepticism at the time it was published. It was widely criticized for methodological flaws, while other studies have shown that Meyer’s study was incorrect in its conclusions. Nevertheless, it was used by Johns Hopkins as an excuse to shut down its gender identity clinic. I also note that Dr. McHugh mentions the Clarke Institute. The fact is that this agency has a notorious reputation for mistreating transsexual patients, forcing them to meet unreasonable standards, and denying them the hormones needed to modify their bodies.

One wonders why Dr. McHugh would choose such a cruel approach to the treatment of transsexuals. Sex- reassignment surgery has proven to be the only successful treatment for these patients, and yet for some reason he wishes to deny this. He makes a rather clumsy attempt to justify his position by comparing the treatment of adults who are transsexual with the treatment of children who are intersexed. Ironically, the arguments for one contradict the arguments for the other. Children who are intersexed have traditionally been surgically altered in whatever manner is simplest. This has often resulted in a child who has a male brain being given a female body. As Dr. McHugh points out, such a child is tormented by the attempt to force him to live at odds with his natural inclinations. And yet, he cannot find the compassion to provide treatment to those who, for whatever reason, were born male but whose brains were not sexualized as male in the womb. Even though both groups face the same set of problems, Dr. McHugh sets out to protect one group while effectively punishing the other.

Jennifer Usher
San Francisco, California


 

 

4. Ongoing citations of McHugh's article (as if it were "science")

by transphobic religious ideologues

 

 

McHugh's offensive article in First Things was immediately propagated by groups such as "Concerned Women for America". On October 22, 2004, CWFA posted the following news item on their website (including a voice interview). Note the blatant duplicity in this article, which refers to the 1979 closing of the Johns Hopkins gender clinic as if it had just happened - instead of being old history long bypassed by later scientific, medical and clinical events:

 

"Research Condemns Sex-Change Operations:  "Johns Hopkins University has stopped performing sex change operations, both on adults and on infants born with ambiguous genitalia. The move is the result of long-term research showing once again that some things, like sexual identity, can not be changed surgically. Martha Kleder spoke with Dr. Janice Crouse, senior fellow with the Beverly LaHaye Institute, on this work of Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins University, published in the November, 2004 issue of First Things." CWFA.org, 10-22-04.

http://www.cwfa.org/articles/6573/CWA/family/index.htm

 

 

It also wasn't long before McHugh's article was exploited to support Executive Branch policy-making: On October 15, 2005 the Internal Revenue Service disallowed a woman's tax deduction for sex reassignment surgery (SRS) - citing McHugh's teachings in the Catholic religious magazine as a basis for its decision. 

 

This IRS ruling was duplicitous in the same manner as had been CWFA, citing the Hopkins clinic closing as if it had just recently happened. For more information on this ruling see:

http://ai.eecs.umich.edu/people/conway/TS/Legal%20Issues/Taxes/IRS%20SRS%20Rulings.html

 

 

In 2008, The Pilot (the official newspaper of the Catholic Archdiocese of Boston) continued the citation of McHugh's First Things essay (along with pronouncements by reversionist Zucker) as if it has been published in a scientific journal, in an article berating efforts to improve public understanding of gender-variant children:

 

January 4, 2008: "Educating our Children" - "According to experts in the field Dr. Kenneth Zucker and Susan Bradley, these children have many other problems beside gender identity disorder. When gender identity disorder is identified early and treated, it can be resolved. . . .

 

Dr. Paul McHugh of Johns Hopkins University, where the so-called “sex change” operations were promoted in the past, looked into the results of such treatments when he took over. He found the claims unconvincing and discontinued the practice. He wrote:

“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 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.”

 

 

The impact of McHugh's teaching on Catholic thinking is then seen in examples such as the refusal by a Catholic hospital of routine cosmetic surgery on a transitioned woman. Where will the escalation of Catholic transphobia end? Perhaps in the refusal of any and all medical care to transitioned women?:

 

January 8, 2008: Lifesite: "Catholic Hospital Sued for Refusing Breast Surgery to Make Man Look Like A Woman" - "A man named Charlene Hastings, referred to in the media as a "transgender woman", has launched a suit against Seton Medical Center, a Catholic hospital in San Mateo County, near San Francisco, claiming officials had discriminated against him because of his "sex-change operation."

 

January 10, 2008: California Catholic Daily: "God made you a man - Bay Area Catholic hospital sued for refusing to facilitate transgender surgery" - "According to Hastings, the inquiry elicited the following responses from a Seton surgical coordinator: “It’s not God’s will,” “God made you a man.”

 


 


 

5. Further evidence of McHugh's extreme Catholic ideology
 

See the following news report for an example of the extreme positions taken by Catholic ideologue Paul McHugh. In this case he is quoted as opposing an abortion for a 10 year old girl who had been raped:

 

July 25, 2009: New York Times: “An Abortion Battle, Fought to the Death” - "One expert, Paul McHugh, a professor of psychiatry at Johns Hopkins, then discussed the files — though not identities — in a videotaped interview arranged by anti-abortion activists that quickly made its way to Mr. O’Reilly and others in the news media. . . “I can only tell you,” he said in his taped interview, “that from these records, anybody could have gotten an abortion if they wanted one.”  Yet Dr. McHugh’s description of the files left out crucial bits of context. He failed to mention, for example, that one patient was a 10-year-old girl, 28 weeks pregnant, who had been raped by an adult relative. Asked about this omission by The New York Times, Dr. McHugh said that while the girl’s case was “terrible,” it did not change his assessment: “She did not have something irreversible that abortion could correct.””

 

 


 

This page is part of Lynn Conway's  "Investigation into the publication of J. Michael Bailey's book on transsexualism by the National Academies"