PSYCHIATRY IS A RUDIMENTARY MEDICAL ART. It lacks easy access to proof of its proposals even as it deals with disorders of the most complex features of human life–mind and behaviour. Yet, probably because of the earlier examples of Freud and Jung, a belief persists that psychiatrists are entitled to special privileges-that they know the secret of human nature–and thus can venture beyond their clinic-based competencies to instruct on non-medical matters: interpreting literature, counselling the electorate, prescribing for the millennium.

At The Johns Hopkins University, my better days are spent teaching psychiatry to residents and medical students. As I attempt to make clear to them what psychiatrists actually do know and how they know it, I am often aware that I am drawing them back from trendy thought, redirecting them from Salvationist aspirations toward the traditional concerns of psychiatry, which is about the differentiation, understanding, and treatment of the mentally ill.

Part of my justification for curbing my students’ expansive impulses is that they have enough to learn, and several things to unlearn, about patients. Such sciences as epidemiology, genetics, and neuropharmacology, which support and surround psychiatry today, are bringing new power to our practice just as science did for internal medicine and surgery earlier in this century. Only those physicians with critical capacities–who see the conceptual structure of this discipline and can distinguish valid from invalid opinions–will be competent to make use of these new scientific concepts and technologies in productive ways. I want my students to number among those who will transform psychiatry in the future.

But my other justification for corralling their enthusiasms is the sense that the intermingling of psychiatry with contemporary culture is excessive and injures both parties. During the thirty years of my professional experience, I have witnessed the power of cultural fashion to lead psychiatric thought and practice off in false, eve disastrous, directions. I have become familiar with how these fashions and their consequences caused psychiatry to lose its moorings. Roughly every ten years, from the mid-1960s on, psychiatric practice has condoned some bizarre misdirection, proving how all too often the discipline has been the captive of the culture.

Each misdirection was the consequence of one of three common medical mistakes–oversimplification, misplaced emphasis, or pure invention. Psychiatry may be more vulnerable to such errors than other clinical endeavours, given its lack of checks and correctives, such as the autopsies and laboratory tests that protect other medical specialties. But for each error, cultural fashion provided the inclination and the impetus. When caught up by the social suppositions of their time, psychiatrists can do much harm.

The claim that schizophrenic patients are in any sense living a alternative “life style” that our institutions were inhibiting was of course fatuous. It is now obvious to every citizen of our cities that these patients have impaired capacities to comprehend the world and that they need protection and serious active treatment. Without such help, they drift back to precisely the place Dorothea Dix found them 150 years ago.

From the faddish idea of institutions as essentially oppressive emerged a nuance that became more dominant as the 1970s progressed. This was that social custom was itself oppressive. In fact, according to this view, all standards by which behaviours are judged are simply matters of opinion–and emotional opinions at that, likely to be enforced but never justified. In the 1970s, this antinomian idea fuelled several psychiatric misdirections.

A challenge to standards can affect at least the discourse in a psychiatric clinic, if not the practice. These challenges are expressed in such slogans as “Do your own thing,” “Whose life is it anyway?” “Be sure to get your own,” or Joseph Campbell’s “Follow your bliss.” All of these slogans are familiar to psychiatrists trying to redirect confused, depressed, and often self-belittling patients. Such is their pervasiveness in the culture that they may even divert psychiatrists into misplaced emphases in their understanding of patients.

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.

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Excerpt from “Psychiatric Misadventures” Paul R. McHugh 1992

Read the full text here: http://www.lhup.edu/~dsimanek/mchugh.htm

The American Psychiatric Association (APA) has never issued any resource documents, treatment guidelines, or position statements on transgenderism since they inserted transgenderism as a pathological diagnosis into their DSM following the de-pathologization of homosexuality over thirty years ago.

Although the diagnosis of Gender Identity Disorder was created by the APA and the practice of medicalizing social sex roles is largely carried out on the authority of the APA’s professional membership, up until this point the psychiatric establishment has deferred to WPATH (World Professional Association for Transgender Health).

WPATH guidelines for psychiatric/medical/surgical “treatment” of “gender” have never been based on any research or study into the treatments they advocate. Instead, the guidelines were created by those interested in making a living off the burgeoning gender treatment market. As the practice of genderiam explodes in popularity (some clinics showing a doubling of business ANNUALLY) tension between the APA and WPATH has grown.

In April 2011 the APA formed a Task Force to evaluate transgenderism and issue recommendations for the formation of the APA’s own treatment guidelines and resources, which would remove APA members from practicing under WPATH guidelines and introduce professional standards based on actual medical research. WPATH responded to APA concerns (and the impending breach in WPATH authority) by attempting for the first time to attach research citations to the most recent version of their treatment guidelines (version 7), issued in September 2011. [PDF here: http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf%5D

As expected, the updated WPATH standards of care guide offered no pretense of objectivity or professionalism and reads as more of a genderist political manifesto. Citations attached were cherry-picked to support the WPATH political platform, many attached haphazardly. Indeed, WPATH 7 even uses previous (scientifically unsupported) versions of it’s own guidelines as a citation supporting the new ones!  Kind of a big no-no. WPATH’s badly implemented strategy to introduce citations was inadequate to halt the momentum of the APA Task Force’s move to break from WPATH’s authority.

 

The APA Task Force issued their findings Monday in the 28 page “Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder” that you can access as either HTML or downloadable PDF here:

http://www.springerlink.com/content/65145105t4000220/?MUD=MP

 

Here are a  few random excerpts followed by the Task Force recommendations:

Read the rest of this entry »

Quick follow-up on this Post: Transgender: Time to Change

Fundamentalist sex-role essentialists have been successful in efforts to prevent Lesbian and Gay Psychiatrists from meeting to discuss treatment of sex roles in their field. Transgender lobbyists claim that lesbians and gays have no right to discuss increasing medical sterilization of children who fail to conform to traditional sex roles. They also maintain feminists have no right to publicly discuss sex roles, as such discussion offends their belief in the essential nature of sex roles.

Christian Conservatives, Muslim Fundamentalists, Orthodox Jews, Transgenderists and other right wing groups believe sex roles are innate to one’s physical sex.  In many cases these groups demand sex role incongruence be “corrected” with drugs and surgical “treatment”, altering the appearance of physical sex to protect the status quo. This extends to children as young as eight years old whom gender essentialists advocate treating with drugs to prevent sexual maturity in expectation of surgical sterilization. Most of the children being “treated” for sex role incongruence are lesbian and gay.

RCP sponsors of the Lesbian and Gay conference announced today that the conference was being cancelled due to poor ticket sales leading up to the May 20th event following weeks of complaints from sex-role fundamentalists that the conference, which featured sex-role critique was offensive to their beliefs.

Prior to the cancellation Charing Cross Hospital, which runs the largest “Gender Clinic” in the UK  (and claims to “treat” individuals suffering from sex role dysphoria – distress associated with a mismatch between psychological sex role and natally assigned sex) publicly withdrew it’s support from the Lesbian and Gay group when it realized that the event may include some critique of the sex roles they claim to treat.

The RCP is to be complimented for attempting to arrange a conference critical of the sex-roles held so dearly by gender fundamentalists and also for bravely addressing the practices of many of their professional colleagues in promoting sex role compliance.

Gender believers may have bullied yet another Gay and Lesbian group into keeping their sex-role conversations private but they cannot and will not stem the increasing tide of awareness of how such sex-role fundamentalism is harmful to women, to gays and lesbians, and to children.

TRANSGENDER: TIME TO CHANGE

A meeting organised by the

Royal College of Psychiatrists’

Gay and Lesbian Special Interest Group

Friday 20th May, 2011

15 Belgrave Square, London SW1X 8PG

“This will be an extremely stimulating meeting exploring the most recent academic, clinical and contemporary thinking on transgender issues, for all people interested in this field.

SPEAKERS:

Domenico Di Ceglie M.D. Dip.Psychiat (It), FRCPysch

Domenico Di Ceglie is Director of Training Development and Research, Gender Identity Development Service (GIDS) at the Tavistock & Portman NHS Foundation Trust, London and Consultant Child and Adolescent Psychiatrist, Honorary Senior Lecturer, Department of Clinical, Educational and Health Psychology, University College London.

Previously Director, GIDS (1989-2009) and Consultant Child and Adolescent Psychiatrist in the Adolescent Department, Tavistock Clinic; Honorary Senior Lecturer, The Royal Free and University College Medical School, London; Visiting Professor in Adolescent Psychiatry, University of Perugia, Italy (1992-1996); Psychotherapist (retired) Lincoln Centre for Psychotherapy, London.

He has a longstanding interest in adolescence and has worked in adolescent in-patient units and has been widely involved in consultative work to organisations and to professional networks.  He has been Organising Tutor of an MA course accredited by the University of East London in Adolescent Mental Health for professionals.

In 1989 he founded a specialist service for children, adolescents and their families facing gender identity issues at St. George’s Hospital, London, now based at the Tavistock & Portman NHS Foundation Trust. He was the service Director until March 2009. The GIDS provides a multi-disciplinary service countrywide, consultation, training and research and has been nationally designated and funded by the National Specialised Commissioning Group, UK. He has developed models of care and treatment for children and adolescents with gender identity disorder and has been involved in research projects.  He has published papers about his work and edited a book “A Stranger in My Own Body – Atypical Gender Identity Development and Mental Health” (Karnac Books, London).  He was highly commended in the Health & Social Care Awards, 2004.  He gives frequent lectures in the UK and abroad and has undertaken extensive research in the area of Gender Identity

Julie Bindel, Journalist

Julie Bindel has been involved in campaigning to end violence against women and children for 30 years. She is the co-editor of The Map of My Life: The Story of Emma Humphreys, Astraia Press, 2003, and a number of chapters and papers on topics such as domestic violence and homicide, rape, stalking and harassment, and trafficking and prostitution. She currently divides her time between research and journalism. In 2010 Julie was named by the Independent on Sunday as one of the 100 most influential people from the lesbian and gay community in the UK.

Christina Richards BSc (Hons), MSc, MBPsS, Senior Specialist Psychology Associate

Christina Richards is Senior Specialist Psychology Associate at the WLMHT Gender Identity Clinic (Charing Cross) where she practices individual and group psychotherapy as well as psychological assessment. She is also a part time postgraduate lecturer on sexuality and mental health. She has published several chapters and papers and, along with Dr Penny Lenihan at the WLMHT GIC and Dr Meg Barker at the Open University, will have her first book: Sexuality and gender for counsellors, psychologists and health professionals: A practical guide published by Sage in 2012

James Barrett, Lead Clinician, Gender Identity Clinic

James Barrett is a Consultant Psychiatrist and Senior Lecturer and is the Lead Clinician at the West London Mental Health Gender Identity Clinic (Charing Cross). Over the last 25 years working in this field he has assessed and treated about six thousand patients. He is the Editor of and main psychiatric contributor to: Transsexual and Other Disorders of Gender Identity: A Practical Guide to Management, which is the standard text in the field.  He is also a General Medical Council Assessor and Supervisor, a College Fellow and Examiner, a keen cyclist and the holder of a British Cheese Society Diploma.

Az Hakeem, Consultant Psychiatrist and Psychotherapist

Az Hakeem has run a specialist psychotherapy service for patients with transgender and other gender identity disorders from the Portman Clinic for over a decade. The service is the only one of its kind in the UK’s NHS and covers a national catchment area. Patients are seen for assessment and psychotherapy either individual or group of a modified analytic model specifically tailored for gender identity patients on which he has published numerous papers over recent years.

Az Hakeem is also the Head of The Dartmouth Park Unit, a specialist Mentalization Based Personality Disorder Service which he was instrumental in setting up for Camden & Islington NHS Foundation Trust five years ago. He is a Tutor and external advisor for the College and also delivers teaching to medical undergraduates at University College London.  Az Hakeem also works as a psychiatrist for the media and has been involved in a number of television programmes both on and off screen.”

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This upcoming conference of gay and lesbian psychiatrists on the topic of treatment modalities for transgender clients has the trans-jacktivist communities up in arms.

Dominic Di Ceglie has long stated how problematic current transgenderist “treatments” of drugs and surgery are for the youth population he treats, a full 25% of whom rapidly drop the whole transgender philosophy upon entering talk therapy. Not to mention the overwhelming majority of gender role non-conforming  children (98%) turn out to be homosexual or to a lesser degree hetero non-trans adults.

Az Hakeem is the author of “Transsexualism: A case of The Emperor’s New Clothes?”, “Changing Sex or Changing Minds: Specialist Psychotherapy and Transsexuality”, and “Deconstructing Gender in Trans-Gender Identities” as well as other psychiatric papers and remains one of the only practitioners of psychiatric treatment available to transgender patients in the UK which integrates analysis of cultural gender norms.

Predictably, pro-medical/surgical treatment trans-jactivists, who have long fought to prevent any further scientific study of, or alternative treatment for transgenderism are responding with the usual tactics of abuse and harassment. Notably, M2Ts have singled out feminist lesbian journalist Julie Bindel for the most egregious abuse.

Anti-Gay and Lesbian and Anti-feminist Trans-jacktivist Paris Lees

Trans-Jacktivist Paris Lees

Spokesman for UK non-profit The Gender Trust:

Has started an online campaign called “Julie Bindel’s Genitals” on Facebook and WordPress:

Paris Lees' campaign

Like many tran activists Mr. Lees has confused a diagram of the female reproductive system with “genitals”. This is common among a male population that believes cosmetic surgery that transforms their penis into a rough visual approximation of exterior female genitalia “makes them women”. Anti-feminist activist Mr. Lees, who claims on his YouTube page that he is employed by the Millivres Prowler Group , has not included any of the male conference participants in his campaign nor their genitals or reproductive systems. Mr Lees main objection to Bindel seems to be her feminist analysis, as he states:

“And furthermore, I am a rad fem. I am reclaiming the term. There is nothing radical about Bindel’s rather stale and circular brand of feminism. She and various other bigoted cis ‘thinkers’ have suspected for quite some time that trans women who identify as feminists are merely trying to enter women’s ideological space. So let’s do it.

Henceforth, ‘rad fem’ will refer to a trans person who believes that the personal is political, that biology does not equal destiny, that human beings deserve bodily autonomy and that it is morally objectionable to place meanings and judgments onto other people’s gendered bodies. It means a belief in equality and judging people on their words and actions – and not their appearance. In short, it will now mean everything that the words ‘Julie Bindel’ do not.

Enjoy Julie Bindel’s genitals.”

"Transwomen" raped by own genitals

Seems this upcoming conference (or at least Julie Bindel’s invite to speak) has the anti-organic treatment option crowd up to their usual tricks. This is yet another split among the increasingly failing transgender political coalition, as the minority of trans who agree with increased treatment options get tossed yet again under the bus by pro-surgical anti-feminist transgenders.