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Paul McHugh on transsexualism
Main article: Paul McHugh
Paul R. McHugh (born 1931) is an American psychiatrist who is a key figure in the academic pathologization of sex and gender minorities. McHugh famously shut down the gender identity clinic at Johns Hopkins, arguing that gender variance is essentially a lifestyle choice or an ideology.
In this section
Paul McHugh bibliography
Paul McHugh's peer-reviewed journal articles
Selected passages and quotations
From journalist John Colapinto:
"McHugh has always reserved special scorn for the practice of sex-change surgery on adult transsexuals. Classifying transsexualism as merely one symptom in a larger complex of personality disorders, McHugh had long believed that psychiatrists should treat such patients with the talking cure, not radical, irreversible surgeries. In a 1992 article in the American Scholar, McHugh lambasted transsexual surgery as 'the most radical therapy ever encouraged by twentieth century psychiatrists' and likened its popularity to the once widespread practice of frontal lobotomy."[1]
From USA Today:
"McHugh is a leading proponent of the notion that the cause is not biological, that transgender people have chosen this path. He halted the university hospital's practice of performing gender reassignment surgeries in the late 1970s because, he says, a study indicated that postoperative transsexuals were no happier than they were before the operation. "You can live any way you want, but don't come to us and ask us to give medical resources to this proposal of yours, because we think it's a social construct and not a condition of nature," McHugh says. "No one has demonstrated any physical mechanism or physical problem that causes this. The burden of proof is on them to prove that.""[2]
From historian Joanne Meyerowitz:
"In the late 1970s, however, the climate began to change. The first signs were seen at Johns Hopkins, where the chairman of the Psychiatry department, Dr. Joel Elkes, was replaced by Dr. Paul McHugh. McHugh saw SRS as unnecessary mutilation, and set out to kill the program. He assigned Dr. John Meyer to do a long-term follow-up study of 50 transsexuals who underwent SRS at Johns Hopkins. Meyer's report, issued in 1977, claimed that SRS confers no objective advantage in terms of social rehabilitation for transsexuals. Although the paper was widely criticized as flawed, it led to the October 1979 closing of the Johns Hopkins Gender Identity Clinic."[3]
From sexologist J. Michael Bailey:
"McHugh objected that clinicians naively accepted transsexual patients' histories of having been quite feminine, when there was ample evidence in many cases that the histories were false (for example, a married man who presents as conventionally masculine). This objection is often correct, though it has no obvious relevance to the advisability of sex reassignment. Furthermore, and more importantly, McHugh argued that it is simply wrong for physicians to "mutilate" perfectly good organs because the transsexual patient's troubled mind wants this: "[The focus on surgery] has distracted effort from genuine investigations attempting to find out just what has gone wrong for these people--what has, by their testimony, given them years of torment and psychological distress and prompted them to accept these grim and disfiguring surgical procedures. McHugh's concerns are worth taking seriously. Consider the case of the man erotically obsessed with having his leg amputated. Would it be advisable or even ethical to remove the leg? And McHugh is correct that interest in sex reassignment medicine has far exceeded interest in changing the minds of transsexual people so they do not want to change their sex. Transsexualism is, after all, a condition of the mind and brain."[4]
Excerpt from Psychiatric Misadventures by Paul R. McHugh
This interrelationship of cultural antinomianism and a psychiatric misplaced
emphasis is seen at its grimmest in the practice known as sex-reassignment
surgery. I happen to know about this because Johns Hopkins was one of the
places in the United States where this practice was given its start. It was
part of my intention, when I arrived in Baltimore in 1975, to help end it.
Not uncommonly, a person comes to the clinic and says something like, "As
long as I can remember, I've thought I was in the wrong body. True, I've married
and had a couple of kids, and I've had a number of homosexual encounters,
but always, in the back and now more often in the front of my mind, there's
this idea that actually I'm more a woman than a man."
When we ask what he has done about this, the man often says, "I've tried
dressing like a woman and feel quite comfortable. I've eve made myself up
and gone out in public. I can get away with it because it's all so natural
to me. I'm here because all this male equipment is disgusting to me. I want
medical help to change my body: hormone treatments, silicone implants, surgical
amputation of my genitalia, and the construction of a vagina. Will you do
it?" The patient claims it is a torture for him to live as a man, especially
now that he has read in the newspapers about the possibility of switching
surgically to womanhood. Upon examination it is not difficult to identify
other mental and personality difficulties in him, but he is primarily disquieted
because of his intrusive thoughts that his sex is not a settled issue in his
life.
Experts say that "gender identity," a sense of one's own maleness
or femaleness, is complicated. They believe that it will emerge through the
step-like features of most complex developmental processes in which nature
and nurture combine. They venture that, although their research on those born
with genital and hormonal abnormalities may not apply to a person with normal
bodily structures, something must have gone wrong in this patient's early
and formative life to cause him to feel as he does. Why not help him look
more like what he says he feels? Our surgeons can do it. What the hell!
The skills of our plastic surgeons, particularly on the genito-urinary system,
are impressive. They were obtained, however, not to treat the gender identity
problem, but to repair congenital defects, injuries, and the effects of destructive
diseases such as cancer in this region of the body.
That you can get something done doesn't always mean that you should do it.
In sex reassignment cases, there are so many problems right at the start.
The patient's claim that this has been a lifelong problem is seldom checked
with others who have known him since childhood. It seems so intrusive and
untrusting to discuss the problem with others, even though they might provide
a better gage of the seriousness of the problem, how it emerged, its fluctuations
of intensity over time, and its connection with other experiences. When you
discuss what the patient means by "feeling like a woman," you often
get a sex stereotype in return--something that woman physicians note immediately
is a male caricature of women's attitudes and interests. One of our patients,
for example, said that, as a woman, he would be more "invested with being
than with doing."
It is not obvious how this patient's feeling that he is a woman trapped in
a man's body differs from the feeling of a patient with anorexia nervosa that
she is obese despite her emaciated, cachectic state. We don't do liposuction
on anorexics. Why amputate the genitals of these poor men? Surely, the fault
is in the mind not the member.
Yet, if you justify augmenting breasts for women who feel underendowed, why
not do it and more for the man who wants to be a woman? A plastic surgeon
at Johns Hopkins provided the voice of reality for me on this matter based
on his practice and his natural awe at the mystery of the body. One day while
we were talking about it, he said to me: "Imagine what it's like to get
up at dawn and think about spending the day slashing with a knife at perfectly
well-formed organs, because you psychiatrists do not understand what is the
problem here but hope surgery may do the poor wretch some good."
The zeal for this sex-change surgery--perhaps, with the exception of frontal
lobotomy, the most radical therapy ever encouraged by twentieth century psychiatrists--did
not derive from critical reasoning or thoughtful assessments. These were so
faulty that no one holds them up anymore as standards for launching any therapeutic
exercise, let alone one so irretrievable as a sex-change operation. The energy
came from the fashions of the seventies that invaded the clinic--if you can
do it and he wants it, why not do it? It was all tied up with the spirit of
doing your thing, following your bliss, an aesthetic that sees diversity as
everything and can accept any idea, including that of permanent sex change,
as interesting and that views resistance to such ideas as uptight if not oppressive.
Moral matters should have some salience here. These include the waste of human
resources; the confusions imposed on society where these men/women insist
on acceptance, even in athletic competition, with women; the encouragement
of the "illusion of technique," which assumes that the body is like
a suit of clothes to be hemmed and stitched to style; and, finally, the ghastliness
of the mutilated anatomy. But lay these strong moral objections aside and
consider only that this surgical practice has distracted effort from genuine
investigations attempting to find out just what has gone wrong for these people--what
has, by their testimony, given them years of torment and psychological distress
and prompted them to accept these grim and disfiguring surgical procedures.
We need to know how to prevent such sadness, indeed horror. We have to learn
how to manage this condition as a mental disorder when we fail to prevent
it. If it depends on child rearing, then let's hear about its inner dynamics
so that parents can be taught to guide their children properly. If it is an
aspect of confusion tied to homosexuality, we need to understand its nature
and exactly how to manage it as a manifestation of serious mental disorder
among homosexual individuals. But instead of attempting to learn enough to
accomplish these worthy goals, psychiatrists collaborated in a exercise of
folly with distressed people during a time when "do your own thing"
had something akin to the force of a command. As physicians, psychiatrists,
when they give in to this, abandon the role of protecting patients from their
symptoms and become little more than technicians working on behalf of a cultural
force. [5]
From the conservative Washington Times:
If you found the clergy sex abuse scandal shocking, prepare for another jolt:
the Catholic bishops are getting their "expert" advice on pedophilia
from people who have covered up or even defended sex between men and children.
The bishops recently chose Dr. Paul McHugh, former chairman of the Department
of Psychiatry and Behavioral Sciences at John Hopkins University School of
Medicine, as chief behavioral scientist for their new clergy sex crimes review
board. Yet Dr. McHugh once said Johns Hopkins' Sexual Disorders Clinic, which
treats molesters, was justified in concealing multiple incidents of child
rape and fondling to police, despite a state law requiring staffers to report
them.
"We did what we thought was appropriate," said Dr. McHugh, then
director of Hopkins' Department of Psychiatry and Behavioral Sciences, which
oversaw the sex clinic. He agreed with his subordinate, clinic head Fred Berlin,
who broke the then-new child sexual abuse law on the grounds that it might
keep child molesters from seeking treatment.[6]
References
1. Colapinto, John (). As nature made him: the boy who was raised as a girl.
2. Friess, Steve (February 26, 2009). For some, shadow of regret cast over gender switch. USA Today
3. Meyerowitz, Joanne. How Sex Changed
4. Bailey, J. Michael (2003). The Man Who Would Be Queen: The science of gender-bending and transsexualism. Joseph Henry Press
5. McHugh, Paul (1992). Psychiatric Misadventures
6. Judith Reisman and Dennis Jarrard (August 21, 2002). Strange
bedfellows Washington Times
Neoconservative/Catholic links
McHugh penned a piece for First Things, the neoconservative publication from
The Institute on Religion and Public Life, "an interreligious, nonpartisan
research and education institute whose purpose is to advance a religiously informed
public philosophy for the ordering of society.”
Exerpts from Right
Web on IRPL:
Both the institute and its journal function, in large part, as the institutional
vehicles for the conservative religious philosophy of Richard John Neuhaus,
a Catholic priest and neocon stalwart. In the early 1970s Richard John Neuhaus
was a liberal, antiwar Lutheran minister, who became associated with the neoconservative
camp by the end of the decade.
The Institute for Public Policy and Religion quickly established itself as
staunchly neoconservative and recruited Midge Decter to serve on its board
at about the same time that she was invited to join the board of the Heritage
Foundation. In 1991 Neuhaus became a Roman Catholic priest.
The rise of the Institute on Religion and Public Life (and the absence of
similar institutes controlled by traditional conservatives) illustrates the
declining fortunes and influence of the Old Guard and demonstrates the neoconservative
ability to integrate a traditional rightist position--the centrality of religion
and ethics in politics and society--into the neoconservative ideological agenda.
In December 2004, McHugh wrote a rather revisionist history of transsexualism:
http://www.firstthings.com/ftissues/ft0411/articles/mchugh.htm
As with the "Psychiatric Misadventures" piece, McHugh takes credit
for dismantling the gender program at Johns Hopkins, and for creating the idea
of differential diagnosis. The article cites work done by Ray
Blanchard at Toronto's notorious Clarke
Institute. The Johns Hopkins people under McHugh were advocating a differential
diagnosis many years before Blanchard gave it his name. JHU proposed for those
who weren’t “classic” or “primary” that they were “transvestitic
applicants for sex reassignment” [1] who are “aging” [2] and
“distressed,” [3] suffering from “pseudotranssexualism,”
[4] or a “non-transsexual” variant of “gender identity disorder”
(GIDAANT). [5]
This letter was published in response:
http://www.firstthings.com/ftissues/ft0502/correspondence.html
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
References:
1. Wise TN, Meyer JK (1980). The border area between transvestism and gender
dysphoria: transvestic applicants for sex reassignment. Archives of Sexual Behavior
. 1980 Aug;9(4):327-42.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7416946
2. Lothstein LM (1979). Psychological treatment of transsexualism and sexual
identity disorders: some recent attempts. Archives of Sexual Behavior . 1979
Sep;8(5):431-44
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=496624
3. Wise TN, Dupkin C, Meyer JK (1981). Partners of distressed transvestites.
American Journal of Psychiatry . 1981 Sep;138(9):1221-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7270729
4. Wise TN, Lucas J (1981). Pseudotranssexualism: iatrogenic gender dysphoria.
Journal of Homosexuality . 1981 Spring;6(3):61-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7341667
5. American Psychiatric Association (1987). Diagnostic and Statistical Manual
of Mental Disorders (DSM III-R).
http://www.amazon.com/exec/obidos/tg/detail/-/0871400499/qid=1094416834/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books
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