Thomas Nathan Wise, MD

Wise is one of several people at Johns Hopkins involved in the repression of trans people through psychiatry.

Wise graduated from Duke University School of Medicine and went on to complete an internship at Boston City Hospital and residencies at Georgetown University Medical Center and Downstate Medical Center-State University of New York, Brooklyn, where he also completed a Fellowship in the Division of Liaison Medicine. He is Chairman of the Department of Psychiatry at Inova Fairfax Hospital and Medical Director of Behavioral Services at Inova Health Systems, Falls Church, Virginia. He is listed as licensed in Virginia only. His current academic appointments consist of Professor of Psychiatry at Georgetown University School of Medicine and Professor of Psychiatry & Behavioral Sciences at Johns Hopkins School of Medicine.

Wise also serves as Editor-in-Chief of the journal Psychosomatics, is President of the Board of Directors at American Psychiatric Publishing, and is active on many other journals as an editorial board member and reviewer. He is board certified by the American Board of Psychiatry and Neurology and his past activities include American Psychiatric Association Liaison to the American College of Physicians and Program Committee of the American Psychosomatic Society.

Wise's major areas of interest include integrating psychiatry into general medical health care systems, the role of consultation-liaison psychiatry in education, research and practice, personality factors that modify reactions to medical illness, and the psychiatric aspects of gastroenterology.

Wise began publishing in 1975. Many papers involve combinations of psychiatric and somatic diagnoses (i.e. renal disease and depression, or dermatitis and dissociative periods).

His first paper specifically on sexuality discussed it in relation to chronic illness and other concurrent physical problems. His first paper to discuss gender variance in particular was titled "Psychotherapy of an aging transvestite," published the year Paul McHugh and Jon Meyer shut down the Hopkins gender clinic. The abstract is almost laughable in its terminology:

Proper categorization of individuals with gender dysphoria allows rational psychotherapy. The treatment of an aging transvestite who requested sexual reassignment is presented to demonstrate the clinical features of the disorder and the course of the illness. The initial task was to place the patient into the proper clinical category of individuals with gender dysphorias. The clinical details of this disorder include an episoidic course with individuals who have previously had clear masculine identities. In the past they have been labeled secondary or marginal transsexuals as well as fetishtic cross-dressers. The patient, who had a long-standing history of cross-dressing, reacted to specific life stresses by the symptomatic wish for sexual reassignment. The individual psychotherapy consisted of phases of symptomatic expression, emerging depression, interpersonal awareness, symptom resolution and disavowel [sic] of the wish for sexual reassignment. The genesis of this perversion appears to be identification with a phallic maternal figure. Discussion of the descriptive and dynamic literature is reported in relation to the reported case. Identification of important losses in this patient's recent life allowed proper diagnosis and appropriate ongoing therapy to prevent the patient from irreversible surgery for a condition that was a symptom not an ingrained belief of gender dysphoria.

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Center for Marital and Sexual Health, Sexual Behaviors Consultation Unit

Director: Peter J. Fagan, Ph.D.

Associate Director: Cynthia S. Osborne, M.S.W.

Medical Director: Chester W. Schmidt Jr., M.D.

Director of Research: Thomas N. Wise, M.D.

Web: http://www.hopkinsmedicine.org/jhhpsychiatry/sbcu1.html

Fagan and Schmidt are frequent co-authors. See Schmidt profile following this one for details.

Below are citations and abstracts (when available) from relevant articles by Wise. I have included some of these (such as articles on pedophilia, coprophilia and amputee fetishism) not because they are directly relevant to you, but because Wise sees these as variants of the "disease" you have. I have also included articles pertaining to involuntary commitment, which he most certainly endorses. Based on what you told me about his responses, I have marked three articles in red as probably indicative of how he views the situation with you and Dale (again, I am not suggesting he is correct, but that these seem to reflect his mindset).

LeBuffe FP, Granger SI, Wise TN. The Virginia Commitment Law: clinical characteristics of patients hospitalized involuntarily by court order. Bull Am Acad Psychiatry Law. 1979;7(4):411-21.

Wise TN, Meyer JK. Transvestism: previous findings and new areas for inquiry. J Sex Marital Ther. 1980 Summer;6(2):116-28.

The transvestite is a heterosexual fetishistic cross-dresser. The phenomenology of the disorder reveals individuals to be heterosexual males who have usually married and fathered children. The course of the disorder is unknown. Many transvestites note genital arousal from cross-dressing abates, yet continue episodically to wear women's clothes. A small segment of these individuals become gender dysphoric and seek sexual reassignment. Etiologic explanations include pregenital psychopathology in the genesis of the condition. The treatment for transvestism remains disappointing although behavior modification may offer individuals who wish to change their transvestitic behavior some hope. This review suggests new areas for inquiry and possible research strategies.

Wise TN, Meyer JK. The border area between transvestism and gender dysphoria: transvestitic applicants for sex reassignment. Arch Sex Behav. 1980 Aug;9(4):327-42.

Clinical variants among the population of applicants for sex reassignment have been previously categorized. These coherent entities were introduced in an effort to sharpen the clinical presentation of syndromic diversity as well as to enhance the specificity of prognosis and outcome. The description of the so-called younger and aging transvestite has been further investigated. Although the initial group of reported transvestitic patients was small, it was suggested that these individuals constituted a coherent group definable in terms of demographic variables, past history, current crises, psychodynamics, clinical course, and special risks. This investigation presents a supplementary series of aging and younger transvestites who have applied for sexual reassignment. Since the original report, further elucidation of the characteristics of both groups have emerged. The theoretical implications of these categories have become clearer. The data support the original content of the classification as an aid to evaluation, prognosis, and treatment.

Wise TN, Lucas J. Pseudotranssexualism: iatrogenic gender dysphoria. J Homosex.   1981 Spring;6(3):61-6.

Individuals who wish sexual reassignment can be classified according to clinical entities. It is essential to recognize which clinical entities promote gender dysphoria. A complication arising in the intensive psychotherapy of a woman unhappy with her biologic sex is presented. A 32-year-old homosexual woman entered treatment with a female therapist for depression. Despite occasional fantasies of impregnating her therapist, the patient at first demonstrated no gender dysphoria. When her therapist actually did become pregnant, however, the patient began consciously to wish that she herself were male and stigmatized her homosexuality. During a two-week separation in treatment, the patient actively sought sexual reassignment. The role of eroticized transference is discussed to explain the emergency of gender dysphoria.

Wise TN, Dupkin C, Meyer JK. Partners of distressed transvestites. Am J Psychiatry.   1981 Sep;138(9):1221-4.

The authors studied partners of 18 transvestites who sought consultation because of their disorder. They found that all of these women were moral masochists and that all tolerated the self-centered, obsessive-compulsive behavior of their transvestic spouses. Many of these women had experienced multiple losses and poor parenting, and their transvestic partners fulfilled their dependency needs. The authors recommend supportive and insight-oriented therapy for such women who, in order to stay with a transvestic man, sacrifice their own self-esteem and desire to engage in a mutual relationship.

Brantley JT, Wise TN. Antiandrogenic treatment of a gender-dysphoric transvestite. J Sex Marital Ther. 1985 Summer;11(2):109-12.

A synthetic ovarian hormone, diethylstilbestrol, was used to reduce the desire to cross-dress in a 65-year-old, gender-dysphoric transvestite. Antiandrogens may be of use in treating patients refractory or inaccessible to other clinical approaches.

Wise TN. Coping with a transvestitic mate: clinical implications. J Sex Marital Ther.   1985 Winter;11(4):293-300.

The transvestite's mate often seeks psychiatric consultation following discovery of her partner's cross-dressing. The clinical management of such situations is complex and mandates investigation of how such women have coped with the knowledge that their partner wears women's clothes for sexual arousal. This report reviews the coping styles of 20 women married or living with transvestitic men. Depression, hostility, sadism and alcohol abuse were methods utilized to cope with their perverse mate. Therapeutic strategies are discussed to help such women during the initial stages of a consultation so that they may develop sufficient insight and information to intelligently manage the dilemma in which they find themselves.

Wise TN, Berlin R. Involuntary hospitalization: an issue for the consultation-liaison psychiatrist. Gen Hosp Psychiatry.   1987 Jan;9(1):40-4.

Little has been written about the issue of involuntary hospitalization in consultation-liaison psychiatry. Nevertheless, patients frequently seen in medical and surgical settings may be judged to be a danger to themselves or others because of psychiatric disorders that cloud cognition, impair judgment, or modify insight, and judicial or administrative proceedings leading to involuntary commitment may be needed. The C-L psychiatrist will be the physician most knowledgeable about the concepts of involuntary hospitalization, competency and informed consent. Clinical examples illustrate issues that may arise.

Frances A, Wise TN. Treating a man who wears women's clothes. Hosp Community Psychiatry.   1987 Mar;38(3):233-4.

Fagan PJ, Wise TN, Derogatis LR, Schmidt CW. Distressed transvestites. Psychometric characteristics. J Nerv Ment Dis.   1988 Oct;176(10):626-32.

Transvestic fetishism is characterized by eroticized cross-dressing in a heterosexual male. Twenty-one transvestites who were seeking psychiatric consultation were evaluated using the Derogatis Sexual Functioning Inventory (DSFI) and the Brief Symptom Inventory (BSI). They were compared with 45 heterosexual married males. The transvestic group was significantly more distressed on most dimensions of the BSI. The transvestic group displayed a more negative body image, a more feminine gender role perception, and less experience than the comparison group on the DSFI. Those transvestites who had no homosexual experience were less frequently gender dysphoric but more frequently had a concurrent axis I disorder. The transvestite with recent homosexual experience reported an earlier age when cross-dressing began. These findings are discussed in the context of previous research on transvestism.

Wise TN. Transvestitic fetishism: diagnosis and treatment. Psychiatr Med.   1990;8(4):75-84.

Wise TN, Fagan PJ, Schmidt CW, Ponticas Y, Costa PT. Personality and sexual functioning of transvestitic fetishists and other paraphilics. J Nerv Ment Dis.   1991 Nov;179(11):694-8.

Utilizing the NEO Personality Inventory (NEO-PI) and the Derogatis Sexual Functioning Inventory (DSFI), 24 transvestitic fetishists (TVs) were compared with a similar clinic-evaluated group of 26 other paraphilics (OPs). The data replicated previous results and extended them by showing that TVs did not differ from OPs on most dimensions of the NEO-PI and the DSFI. Both groups were significantly higher on neuroticism and significantly lower on agreeableness than the NEO-PI male normative population. The other paraphilic group tended to score lower on conscientiousness than the TVs and the normative comparison group. For nine of the 10 DSFI variables, there were no significant differences between the TVs and the OPs. The TVs were significantly higher than the OPs on role identity, indicating a more feminine identification. Both the TVs and OPs reported elevated levels of fantasy. The implications of these findings suggest that, in general, TVs and OPs are more similar than they are different, with a common personality profile and a similar pattern of sexual functioning.

Wise TN, Goldberg RL. Escalation of a fetish: coprophagia in a nonpsychotic adult of normal intelligence. J Sex Marital Ther.   1995 Winter;21(4):272-5.

A 47-year-old man is described whose fetish of fecal smearing, coprophilia, escalated to coprophagia in a setting of depression and alcohol abuse. The case is the first described in a nonpsychotic adult of normal intelligence. Treatment focused upon the depression and substance abuse as well as on the psychodynamic issues that fostered his despair and allowed the fetish to evolve into coprophagia.

Wise TN, Kalyanam RC. Amputee fetishism and genital mutilation: case report and literature review. J Sex Marital Ther.   2000 Oct-Dec;26(4):339-44.

A case is presented of a 49-year-old man who amputated his penis following instructions that he had obtained from the Internet. The patient had a long-standing amputee fetish, which evolved into eroticized genital mutilation. The transformation of the preferred fetish occurred in a setting of depression due to environmental stressors. The literature about amputee fetishism, also called "apotemnophilia," is reviewed, and possible connections with the genital mutilation are discussed.

Osborne C, Wise TN. Split gender identity: problem or solution? Proposed parameters for addressing the gender dysphoric patient. J Sex Marital Ther.   2002 Mar-Apr;28(2):165-73.

Working with the gender dysphoric patient is complex because of the various clinical issues that arise. One issue that has not been addressed in the psychiatric literature is whether to address the patient with the biologically congruent pronoun or name or with the patient's preferred-gender pronoun or cross-gender name. This article presents clinical examples that allow a template to be developed for pronoun use in working with such patients. Whether the clinician uses biologically congruent names and pronouns may depend upon the patient's progress in adopting the cross gender role as well whether family or friends either know or accept such changes. In certain situations, such as meetings with family members, the therapist may address the patient with gender congruent names; whereas on other occasions use cross-gender pronouns or names.

Fagan PJ, Wise TN, Schmidt CW Jr, Berlin FS. Pedophilia. JAMA.   2002 Nov 20;288(19):2458-65. JAMA. Comment in: 2003 Mar 12;289(10):1243; author reply 1243-4.

This article addresses the risk factors associated with the psychiatric disorder pedophilia, its treatment, and treatment outcomes. It addresses physician responsibilities associated with case identification of victims and possible roles in the medical management of pedophilia. The essential feature of pedophilia is that an individual is sexually attracted exclusively or in part to prepubescent children. While pedophilia may be limited to fantasies and impulses, pedophilic behaviors are the primary concern of both the mental health and criminal justice systems. Remote risk factors for development of pedophilia often include the individual having been sexually abused as a child. Proximate risk factors for its behavioral expression are prevalence of comorbid psychiatric disorders and substance abuse disorders. Current treatment goals focus on stopping the behavior and achieving long-term behavioral control in the community. Common treatment methods are cognitive-behavioral, group therapy, and, when appropriate, medications such as androgen-lowering agents that can act as sexual appetite suppressants. Meta-analyses have established that treatment is more effective than nontreatment in preventing recidivism of sexual offenders in general, a finding that has a high probability of application to individuals with pedophilia. Pedophilia is a chronic psychiatric disorder, but it is treatable in terms of developing strategies for preventing behavioral expression. Ultimately, reducing the prevalence of pedophilic behavior requires further collaboration between the criminal justice system and the health care communities.

Wise TN, Birket-Smith M. The somatoform disorders for DSM-V: the need for changes in process and content. Psychosomatics.   2002 Nov-Dec;43(6):437-40.

Books Wise wrote, edited or contributed to:

Restoring Intimacy: The Patient's Guide to Maintaining Relationships During Depression by Drew Pinsky et al

Psychiatry for Primary Care Physicians by Larry S. Goldman, et al

Understanding Managed Care: An Introduction for Health Care Professionals by T. N. Wise, et al

Anxiety and Depressive Disorders in the Medical Patient (Clinical Practice, No 4)

by Leonard R. Derogatis, Thomas N. Wise

Research Paradigms in Psychosomatic Medicine (Advances in Psychosomatic Medicine, Vol 17) by Giovanni A. Fava, Thomas N. Wise