Ray Blanchard and the Clarke Institute: Patient experiences

Editor's note: This is part of a larger section of the Bailey-Blanchard-Lawrence clearninghouse, on Bailey's book The Man Who Would Be Queen and the theories that inform it.

Although the notoriety of the Clarke Institute and Ray Blanchard's involvement is generally known among transsexual women, there is no online repository of first-hand accounts. This page seeks to remedy that.

We are collecting the experiences of people who had direct dealings with Blanchard through The Clarke Institute. If you or someone you know would like to share your experience, please contact me. We will be happy to consider giving your information a permanent and anonymous home.

Background

According to patients forced to use the Gender Identity Clinic at the Clarke, it is just a two-day-a-week operation. It's a sub-unit of the sexology department, whose main job is to work with convicted sex offenders. Trans patients have to go into the locked, secure, 4th floor section, where the
convicted sex offenders are held. Patients used the same hallways, waiting rooms, and offices as sex offenders, and the people who saw you simply changed hats depending on who they were seeing.

In order to receive federally-funded mental and medical services, patients had to submit to various types of sexualized testing given to criminals, including detailed descriptions of masturbatory fantasies and in some cases penile plethysmography.

It is my intent to show that this is not only questionable scientifically, it is potentially unethical. I feel it is as unethical as a lawyer forcing clients to submit to similar testing in order to receive federally-funded professional services.

For more, see "Male gender dysphorics, paedophiles, and fetishists": how Ray Blanchard sees us

Clarke Clinic Experiences

By Ruth Bramham

My first experience of the Clarke’s Gender Identity Clinic dates back to 1977.

To set the scene, I was married with a 3 year-old son and my longstanding GID conflict was definitely causing much stress in my life, to the point that my wife spilled the beans to our family doctor. To my great surprise I found a sympathetic ear. My past experiences with the medical profession on this subject had definitely not been happy. (Oh go get married you silly little boy and it will go away! I did, “it” didn’t.) The doctor contacted the Clarke and I was promised an appointment.

It was almost 6 months later when I was notified of the December appointment dates and times. I was given 10 days notice for a series of interviews that would take up four full days. I held a senior position in a major construction related company. The week of the interviews I had annual meetings and seminars already arranged. Needless to say I told them I was busy. Their attitude was to treat me like a recalcitrant child and put me to the bottom of the waiting list.

I am known for a my acerbic wit in letter writing when the need arises. I let them know I was not amused, not a know-nothing, and certainly not going to wait for another six months. I received new dates within the time frame I “suggested” (February).

Those interviews and the procedures I had to endure were a shock. It was as if I was a sex offender being evaluated for serious sexual deviations. The line of questioning was all about my sexual experiences, masturbation, fantasies, etc., as related to crossdressing. The penile sensitivity testing was particularly demeaning as were the photographic sessions. Six weeks later I received the results of this “evaluation”–I was deemed to be a transvestite with transsexual tendencies. They told my wife that with psychotherapy I could learn to control my “urges”. At the time I kept a diary of everything that went on in my meeting with the Clarke staff. It would have made interesting reading today. My wife found it years later and consigned it to the garbage, along with everything she could find of mine related to transsexuality.

I endured about a year of psychotherapy, becoming more and more depressed. I knew I wasn’t a transvestite, but back then, if I was married with a child, I couldn’t possibly be transsexual. After all, true transsexuals had to be homosexual and attracted to men. (It was odd that female-to-male TSs were never, ever mentioned.) Everything came to a head when my wife finally decided she’d had enough and I was told to leave just before Christmas 1978. I had never lived alone in my life.

The Clarke psychotherapist was no help. In fact he hardly uttered a word during our bi-weekly sessions. The only direct suggestion I ever received from him was: “If you want to be a woman, you have to go out and be one, full time, for at least a year.” There would be no help or guidance. That was counter-productive to proving I was really a woman. At the time, I was 34 years old, 6'-0", 170lbs, very athletic and extremely hairy with a noticeably balding head. I also had a fairly deep baritone voice. In my mind, there was no way of accomplishing the switch to their satisfaction. I tried for one day. I shaved my arms and legs, “borrowed” one of my mother’s wigs and got dressed–yes, I had a fairly reasonable wardrobe of conservative clothes. I made one trip to the local mall, was read by a couple of local yokels (mid-town Toronto) and had to run for it. I was scared silly. My psychotherapist just laughed at me when I told him. “What did you expect?” he asked. “There’s no way you’ll pass for a woman.” I was crushed.

Later I learned that the Clarke’s idea of passing successfully was limited to the so-called homosexual TSs. It was inconceivable to them that a “secondary” TS could ever pass successfully 24/7. Part-time passing was not acceptable. Blanchard then was but a twinkle in Dr. Freund’s eye....

Early in the morning of March 25th 1979, I tried to commit suicide. God had other ideas. I had a profound, religious experience that left me exhausted–and sleeping like a baby for the first time in many months. All the pain, stress and the obsessive nature of my GID was gone when I awoke the next morning. What was still there was my distinct sense of self-identification as a woman. The psychotherapist was very skeptical as I explained what had happened. I never saw him again. I did rejoin my family, now able to cope with my sense of self.

In fact I didn’t return to the Clarke for another three years after my wife and I broke up and divorced in 1982. For the next three years I saw Dr. Betty Steiner every six months and was allowed to have a “palliative” dose of hormones (a contraceptive pill called Ovral - 0.5mg Estradiol + ). This was my “stand pat” period. Despite being discouraged from doing so by Dr. Steiner et al, I met many more TSs, helped run a support group, wrote articles and generally educated myself like never before. Boy, did I ever have my eyes opened!

And I met Dr. Ray Blanchard and Len Clemmensen. However, I was never invited to their early group therapy sessions which began somewhere around 1983. At the support group meetings Clarke bashing was the sport of choice.... yes, even back then! Generally, the most common complaint was their intransigence over diagnosis. It was always “Prove it”. “Show us you really are a woman by living and working full time. Bring us your pay stubs and documented proof you are working in the gender you aspire to. And we’ll see you every six months.”

Dr. Steiner retired in 1986 (I think) after producing the infamous tome that was the first attempt to bring together the collective “wisdom” of GID research to that date. “Gender Dysphoria: Development, Research, Management”. I recognized myself as one of the anomalies mentioned! No wonder she wanted to see me regularly for so long! Messrs. Blanchard, Clemmensen, Freund, Zucker et al all had a hand in its writing.

In 1985 I somewhat reluctantly reunited with ex-wife and son as he was definitely “off-the-rails”. Being both Christians, “living in sin” was not an option. We remarried, and I was forced to cut ties with both the Clarke and the TS community. All items of my “sinful” nature we expunged from my life. My wife made doubly sure not even a single scribbled note remained. Thus began a period of enforced self denial as my son was put back on track.

My relationship with my wife was purely platonic. I had no interest in sex. In fact I’d always had a problem with sex. I found it a real chore, distasteful and not “right”. The word for it is “asexual”. It was a condition, I learned, that the folk at the Clarke took with a large grain of salt. After all, I had fathered a child, hadn’t I?

This marriage lasted five years believe it or not, the last two with me living in the basement. During those two years, I was finally invited to join the Blanchard/Clemmensen “Gender Solutions Group”. What a farce! It was basically meant to explore alternate solutions to surgery, accepting your chosen “lifestyle”, and discussing ongoing daily difficulties. Most of those attending were not transsexual, being a mix of crossdressers, she-males, non-ops and up to four TSs. The views of the TSs were rarely heard above the aggressive cacophony of the CDers and she-males. It was definitely an “us vs. them” atmosphere played to the hilt by the “good cop bad cop” routine of Blanchard and Clemmensen, the latter usually being the “good cop”. He received much teasing from the others because of his relatively quiet manner (like us TSs...). Of course our Mr. Clemmensen was hiding a deep secret of his own. Today “he” is known as Maxine Petersen.

It was during this time that I met Dr. Steiner’s replacement as head of the Gender Identity Clinic, Dr. Robert Dickey. He would not authorize me taking hormones again, despite my previous record with Dr. Steiner. “Things have changed,” he said. It was also early in this period that the clinic was moved to the 4th floor of 250 College Street, apparently to consolidate all the departments within the Division of Forensic Psychiatry. We now met with the staff in a high security area behind locked doors. As you will have gathered by now, the Clarke Clinic staff had no interest in looking after the needs of their patients. Seeing the regulars every six months was adequate and the others could be viewed during the group therapy sessions. Yes, the Clarke Clinic is purely a research establishment, with staff working mainly on their Forensic Psychiatry duties and part-time on Gender Clinic duties. With no unauthorized access allowed, there was no possibility of forming any sort of benign, helping relationship. It is the epitome of a “gatekeeping” establishment.

Fast forward to 1992. I was working in London Ontario and had met “Karen”, a postop TS woman who had a horrendous story to tell about the Clarke. I now saw another side to the rigidity of their position. But that’s another story. The Fall of 1992 saw me out of work (the recession) on hormones at last through an independent endocrinologist introduced to me by Karen. Dr. Dickey was not amused.

Then, in November, I was diagnosed with Mycoplasmal Pneumonia with Pleurisy. Part of the symptoms for this consists of coughing up some blood in your sputum. I was. Frequently. Two series of anti-biotics failed to clear it up as it went from one lung to the other. By Christmas I was well enough to have Christmas Dinner with my father. I relapsed shortly thereafter. By the end of January, they didn’t know what to do, so I was sent to see a pulmonary specialist. After a lung scan revealed multiple (20+) blood clots in both lungs, I was hurriedly admitted to hospital. After some further discussion, the hormones were targeted as the culprit, and in turn, Deep Vein Thrombosis in my right leg. Nobody had warned me that taking hormones had potentially nasty side effects. Obviously I recovered. Obviously God wanted me around a little longer!

On leaving hospital at the end of February, I made the decision to begin transition full time 24/7, cold turkey! It was now or never. My next appointment with the Clarke Clinic was only a week away. So I showed up in “Ruth” mode dressed appropriately. Another quirk of theirs was the insistence that we MTFs dress unambiguously, that is, we show up for appointments there in a skirt or dress, not pants.

I expected to see Dr. Dickey. Instead an intern appeared to interview me.... as if this was my first visit there! And yes, he asked all the most inappropriate sex centred questions, about fantasies, masturbation, etc. I told him not to waste my time as those questions had been asked many times before and to please read my file! He actually commented to me that he was new to this and to be patient with him. There was no supervisor with him. I had to remind him to note that I was now presenting in the female role full time. It was before this visit to the Clarke that I learned that Len Clemmensen was now Maxine Petersen. I met with her briefly in the corridor. She had stayed on the job during transition. Talk about the ultimate, benign employer. Basically she was her own supervisor with help from Blanchard and Dickey.

In consultation a few weeks later with my endocrinologist, we discussed how I could resume taking hormones. Since the hospitalization I had been taking Warfarin to keep my blood from clotting. Now he suggested I could resume hormones at a low dose level coupled with the Warfarin. To be on the safe side, he suggested I undergo an bilateral orchidectomy, so that the low dose would have a more significant effect... i.e., cut off the source of the dreaded testosterone. Being in Canada and covered by a pretty comprehensive government medical plan, I was able to have the cost covered. By July, I was back on hormones (Premarin @ 1.25mg.).

Needless to say when Dr. Dickey found out I was reprimanded for not informing him prior to the surgery, as he frowned on such surgery so early in the transition. It was irreversible you know! I then discovered he had not started the clock ticking for the official two year transition period to qualify for government funded SRS. I had not provided proof that I was now working, or going to school, or volunteering full time. He wanted signed timesheets or pay stubs or school attendance records! Fortunately I had started volunteering full time at the local Employment Help Centre. So I had to arrange with the office manager to fill out time sheets every week (being volunteer based they didn’t usually do that). I could see that the Clarke Clinic was going to make my journey as difficult as possible.

The bout with pneumonia and DVTs had left me with a severe depletion in lung capacity. I was out of breath after walking up four steps. Working full time three months after discharge, even as a volunteer, was exhausting, but I knew I had to do it, or wait even longer for surgery. (We were still deep in a recession with no hope for paid work even if I had the stamina for it. My unemployment benefits expired and I was forced on to welfare.) I was seen twice more over the next year (1993-94). They tried to question my records, but my supervisor wrote to them confirming everything. I had let the other staff in on what I was going through. The support I received from them was nothing short of exemplary.

The second year, I took a government self employment programme, being one of the 12 selected from 120 applicants. Dickey had told me bluntly that self employment was out of the question as I could not satisfy the third party verification. Again I had to bare my soul to the supervisor, and again I received full cooperation, even to the extent of a custom designed reporting form especially for the Clarke!

My two year Real Life Test was officially completed in July 1995. In June, I tried to arrange for the final interview. I was ignored for three months. My letters, faxes, phone calls went unanswered. It was as if the place had shut down for the Summer. Finally, mid September I received a short note confirming the date for September 29th. I would see Dr. Dickey and one other. My appointment with Dickey was for 8:00 a.m. Although I had to drive into Toronto from London I didn’t argue. However, by 11:00 a.m. he still had not shown up and his secretary could not locate him. I was sitting in the lobby of the Forensic Psychiatry department at times in the company of very suspicious characters under escort. He finally breezed in, unapologetic, at 12:15 p.m. The meeting was over in just 15 minutes. I had his blessing. The second appointment was at a different location with, guess what, the same neophyte doctor (then an intern) who interviewed me two years before. He didn’t remember me. And he started to ask me the same old questions! I couldn’t believe my ears! So I gave him a quick lesson–Gender Identity 101–including a lesson on the Harry Benjamin Standards. Response? “Oh yes, I heard there were some sort of guidelines for this. You know more about them than I do...” I nearly fell over. Here was the doctor responsible for my second letter admitting he knew next to nothing about the subject! I bit my tongue.

Two weeks later, Maxine Petersen gave me the SRS surgeon’s name (Dalrymple in London England) and permission to make initial contact with him. I did, via fax, the same day. Of course he knew nothing about me as the Clarke had yet to send any paperwork. Despite this we set up a tentative surgery date for November 29th. October expired and November was well under way with still no formal authorization letter from the Clarke. I started a fax and phone blitz. At last I was contacted by the government health plan office to tell me they had just received the paperwork from the Clarke (November 10th). The letter I was to carry with me to England would be mailed to me. Five days later I received a faxed copy, but it wasn’t until the 20th that I received the actual document, just one week before departure for England. By the way, the government plan only covered the surgery itself, not the travel and hotel expenses. Fortunately my dad, God bless him, came up with the money for that.

I returned to Canada on December 9th, sore but very satisfied. The Clarke had done their best to prevent or at least delay the inevitable. I was now free of them. At last I was comfortable in my own skin, the woman I was meant to be. I did see Dr. Dickey once more but they haven’t bothered to follow up since.

Update 25 May 2003

One last thought:

When I first went to the Clarke, I was calling myself Kim Kershaw (Kershaw was an old family name that my grandfather had dropped). I was told quite bluntly that was not acceptable. My name must be unequivocally female. Androgynous names were not allowed. I believe this still holds true today. My family was not keen (understatement!) on me continuing to identify as a "Bramham," hence the complete change.

Once I was independent of family influence (1990) I resolved not to give in to that type of pressure any more. So I just changed my Christian
names to appease the Clarke and maintained my surname. Besides I really like the name "Ruth"! It's biblical too! I am Ruth Deborah Bramham, Clarke survivor.

See also Experiences at the Clarke Institute by several clients.

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