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A Legendary Psychiatrist Says “No” to Sex “Re-Assignment” Surgery

By Walter Donway

January 16, 2017

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Sex is biological while gender is an individual’s psychological relationship with the world, especially the opposite sex, rooted in an individual’s understanding, ideas, attitudes, and characteristic behavior. If so, “gender” cannot be biologically determined unless we invoke the long-discredited theory of innate (in-born) ideas. It follows that a boy or girl may accept ideas, attitudes, values, and behavior at odds with their biology.

Periodically, a horrific new theory will grip psychiatry, perhaps questioned initially as strange and startling, but then spreading like a new infectious disease, adopted as a “breakthrough” in treatment, with hundreds, then thousands, and then tens of thousands of “patients” under treatment.

National and international professional organizations and academies can be relied upon to succumb to pressure to declare the new procedure an effective treatment for a heretofore neglected disorder. The rare dissenter from the stampede to orthodoxy will be ridiculed, his reputation attacked, competence questioned, and employer pressured to dismiss him.

In March of last year, the Huffington Post carried a prominent article by Brynn Tannehill that attacked Paul McHugh as systematically endangering children, spreading dangerous myths in the name of science, a serial liar, founder of an organization designated by the Southern Poverty Law Center as a “hate group,” and responsible for the deaths of children now and to come.

Paul J. McHugh, M.D., is Distinguished Professor of Psychiatry at Johns Hopkins University Medical Center. From 1975 till 2001, he was the Henry Phipps Professor of Psychiatry and the director of the Department of Psychiatry and Behavioral Science at the Johns Hopkins University. At the same time, he was psychiatrist-in-chief at the Johns Hopkins Hospital.

Brynn Tannehill, now a woman, has a degree in computer science from the U.S. Naval Academy, and from 1997 to 2010, as characterized by Huffington Post, had a distinguished military career. Since then, says the Post, “… she has written for OutServe magazine, The New Civil Rights Movement, and Queer Mental Health as a blogger and featured columnist. Brynn and her wife Janis currently live in Springfield, VA, with their three children.”

Ms. Tannehill, you have gathered, is awfully pissed off at Dr. McHugh. I don’t pretend to be neutral. I understand the rage of Ms. Tannehill, who chose transsexual surgery and has made a life based on that choice. But, in my view, she wishes for science itself to swing into alignment with her choice, confirming it, and that is a price we cannot afford to pay for her ease of mind.

The boy’s belief that he is a girl should not be “treated” by surgically removing the boy’s sex organs and employing hormones lifelong to give him female characteristics.

Dr. McHugh, now 86, is a rare medical professional and scientist today, who speaks publicly, forcefully, and unapologetically against the latest new radical departure in psychiatry: “sex reassignment surgery for transgender people.” He maintains that a boy, for example, who feels certain that he is a girl has a well-known psychiatric problem, a “disorder of assumption.” And that this disorder can be treated like any other powerful feeling that is strongly in conflict with the facts.

Just because this boy feels he is a woman trapped in a man’s body does not make it true. Just as other disordered assumptions or beliefs about reality are not “cured” by changing reality, the boy’s belief that he is a girl should not be “treated” by surgically removing the boy’s sex organs and employing hormones lifelong to give him female characteristics. If a patient has a mistaken perception, or feeling, about reality, the answer is not to change reality.

As Dr. McHugh comments: If, when a patient’s emotions or ideas do not square with reality, the solution is to change reality, then psychiatry has no role.

It is unclear how many sex-reassignment surgeries are performed in the United States each year because there is no reporting requirement.  It may be fewer than 1,000 a year—perhaps just hundreds. The trans-sexual surgery “capital” of the world is Thailand, where the price is radically less, but there are no reliable statistics on how many castrations and other trans-sexual surgeries are performed.

One thing we do know is that some of those who have undergone the removal of their genitals, and entered into the lifelong intense hormone therapy that accompanies it, are fierce advocates of the validity and necessity of the operation–as witness Ms. Tannehill. Others regret it and point to studies showing very high rates of depression and suicide after the operation.

Take a few moments, now, to return to my initial thesis about the radical new treatments that occasionally sweep through psychiatry.

In the 1930’s, scientists in Europe began experimenting with surgery that focused on that part of the brain in the forehead, over the eyes, called the “frontal cortex”—believed today to mediate executive functions (choice, self-direction, and motivational drive). Cut out this part of the brain, literally “scrape” away its connections to the rest of the brain, and you alter behavior, and especially, you reduce the anxiety and aggression associated with paranoid schizophrenia. It is called a “frontal lobotomy.”

Today, the frontal lobotomy craze is viewed as a tragic and scarcely believable madness that seized American psychiatry and left, in its wake, patients who spent the rest of their lives as pacified inmates of state mental hospitals.

The lobotomized patient exhibited less “aggression”—and less depression. The craze for the frontal lobotomy, soon after its peak in the 1940s—some 40,000 patients in America already had been lobotomized—came under bitter criticism, with calls for the Nobel Foundation to withdraw its prize from Antonio Egas Montiz, the Portuguese neurologist who developed the operation. Today, the frontal lobotomy craze is viewed as a tragic and scarcely believable madness that seized American psychiatry and left, in its wake, patients who spent the rest of their lives as pacified inmates of state mental hospitals.

Another “breakthrough” in treatment seized the profession in the 1990’s and few, today, caught up in the advocacy of trans-sexual surgery as the only “humane” option, recall that a single towering figure in psychiatry led the opposition to this fad called “recovered memory”— that is, the idea that people could suddenly and spontaneously remember childhood sexual abuse of which they had been completely unaware.

At first, a few seemingly totally respectable individuals—administrators of schools, teachers—were abruptly arrested to screaming headlines of hidden sex abuse of children. A mental-health practitioner of some kind, convinced that most resistant emotional conflicts were caused by submerged and forgotten childhood sexual abuse, would obtain a “confession” from a patient that such abuse had indeed occurred. The therapist would notify the authorities; the police would arrive to arrest the named individuals.

Hundreds of school administrators, teachers, and parents were arrested and charged. Paul McHugh at Johns Hopkins became a dissenter at great cost to his reputation. The charges against “abusers” began to include witchcraft rites of sexual torture. McHugh’s simple-minded question, then, as now, with young “patients” believing themselves “trapped” in the wrong body, was: Just because, after months of pressure in therapy, they at last attest to “remembering” it, is it true?

By this time, the matter was in the courts all over America and McHugh organized a group to support those charged and to provide professional testimony in court. In case after case, it emerged that the “patient” had been told that he or she must “remember” or never be “cured.” That drugs had been used to “free” blocked memory. That patients who had a memory “breakthrough” then were isolated in hospital wards to be only with others who had had such “breakthroughs.”

Case after case of alleged “recovered memories” of abuse was defeated in court. In the end, most “patients” were tearfully confessing that they really did not recall these things. But families split apart by these accusations in many instances never came back together.

Case after case of alleged “recovered memories” of abuse was defeated in court. In the end, most “patients” were tearfully confessing that they really did not recall these things. But families split apart by these accusations in many instances never came back together. Some individuals served jail sentences for alleged but unsupported accusations of sex crimes against children; some are still incarcerated.

Dr. Paul McHugh broke the back of this psychiatric witch hunt, leading psychiatry out of its trip back to the Dark Ages, saving thousands of individuals from the searing pain of standing falsely accused of sexually abusing their children or children entrusted to them. Among the best accounts of the entire sorry episode is Dr. Hugh’s own book published in 2008: Try To Remember: Psychiatry’s Clash Over Meaning, Memory, and Mind.

And so, we come to the present, and Paul McHugh, at 86, still revered at Hopkins, which has not forgotten that he alone stood up to the “recovered memory” fad, is singled out as the Grand Inquisitor of the trans-sexual surgery movement.

Conviction of the kind that motivates Dr. McHugh has its foundations in philosophy, uncommon in our age of Pragmatism posing as orthodoxy that is now being swept away by Postmodernist ideology. McHugh was born in Lawrence, Massachusetts, brought up a Catholic, and today still professes that religion. Graduating from Harvard College and Harvard Medical School, and choosing to pursue psychiatry, he encountered a mentor who warned him that the prevailing psychiatric training, Freudian psychoanalysis, was unscientific, not rooted in genuine research, and ultimately unsustainable. McHugh turned toward neuroscience—and predictably paid the price for rejecting the psychoanalytic orthodoxy.

A rising star at Massachusetts General Hospital, then elsewhere, he came to Johns Hopkins and by force of personality and intellect turned the renowned department away from psychoanalysis toward psychiatry rooted in brain science. It is enough to say, perhaps, that his position and leadership “survived” the legendary battle with the “recovered memory” craze.

The Huffington Post article by “transgender” advocate, Brynn Tannehill, is just one furious protest that McHugh, the dean of American psychiatry, opposes trans-sexual surgery. The specific occasion giving rise to the Huffington Post attack by Ms. Tannehill is Dr. McHugh’s lending his name to the American College of Pediatricians. Here, science, medicine, and the medical profession enter the realm of politics and ideology.

In 2005, the American Academy of Pediatrics, the “official” organization of pediatrics, with 60,000 members, officially endorsed the adoption of children by gay “couples.” Its president at that time, Dr. Joseph Zanga, resigned in protest. He created an alternative organization to carry forward what he saw as the mission to protect the health and future of children and the functionality of the family. That organization, the American College of Pediatricians, has only about 500 members, and is supported by Dr. McHugh.

Ms. Tannehill dismisses members of the Academy as “mostly Catholic” and that is true. Grasping that the view of human sexuality, sexual function, “gender,” and the nature and role of marriage and family advanced by Postmodernism is ideological—not scientific and certainly not medical—the Academy makes explicit its philosophy. It arises out of the Aristotelian and Thomist philosophical tradition of the Roman Catholicism. Thus, the Academy does not urge that abortions be made illegal, or inaccessible, but opposes abortion morally, especially in its role as birth-control-of-first-resort for hundreds of thousands of women every year. Likewise, the Academy does not oppose contraceptives, but notes that the optimally effective means of avoiding unwanted pregnancy is abstinence from sex until marriage—and that parents should at least mention this to their children. These are not popular positions, today, among the “educated elite”—i.e., primarily those actively shaping public opinion. But the issue of “re-assignment” surgery, the most extreme Postmodernist position on human sexuality, can be considered separately.

The best-known dissent from enthusiastic endorsement of trans-sexual surgery by American pediatrics and pediatric psychiatry is an article in the Wall Street Journal in June 2014. It became the eye of such a cyclone of rage by the trans-sexual/trans-gender movement that the WSJ published an update in May 2016. The article is by Paul McHugh, and entitled, “Transgender Surgery Isn’t the Solution,” with the subtitle, “A drastic physical change does not address psycho-social troubles.”

In that brief article, Dr. McHugh refers to the scientific literature. He also admits that under his leadership, Johns Hopkins initiated the country’s first major program of trans-sexual surgery. And that, in 1979, also under his leadership, Hopkins closed the program. Why? A study found that most of the people who had undergone this type of surgery “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.” The treatment had been tried, monitored and evaluated, and found inefficacious or worse.

The article in the Huffington Post does not fail to offer arguments against Dr. McHugh’s article and for “reassignment” surgery. In fact, Ms. Tannehill makes points so technical and laden with jargon that few readers will be able to judge what she claims are “obvious” misstatements or deliberate lies by Dr. McHugh. It is odd to see this technical material in the Huffington Post, not known for inaccessibly high-brow articles.

For example, Dr. McHugh and the American College of Pediatricians argue that biologically humans are sexually binary, born either male or female; the few exceptions, such as babies born without defined genitals, are all recognized as abnormalities to be repaired. But, we are not born with a “gender,” a psychological identification as a man or woman. We acquire that as we grow up.

The crucial point is that sexual biology is what it is, but “gender” is a psychological interpretation and adaptation to biological reality.

As I understand this position, sex is biological while gender is an individual’s psychological relationship with the world, especially the opposite sex, rooted in an individual’s understanding, ideas, attitudes, and characteristic behavior. If so, “gender” cannot be biologically determined unless we invoke the long-discredited theory of innate (in-born) ideas. It follows that a boy or girl may accept ideas, attitudes, values, and behavior at odds with their biology. Dr. McHugh argues that a boy or girl does not become aware of their “true gender”—“Oh, my God, I’m actually a woman.” They develop a gender self-concept that does or does not reflect their biological reality.

Confronting this position, it is essential for advocates of sex “re-assignment” to argue that “gender,” as well as sex, is biologically determined. Thus, Ms. Tannehill replies: “Sex, and chromosomes, are different than gender and gender identity … chromosomes do not equal sex, and sex doesn’t equal gender. They [Academy of Pediatricians and Dr. McHugh] acknowledge intersex individuals exist, but not what that means. People can have a 46-XY karyotype, and appear and identify as female. They can even have children.” She refers to “over 150 papers, dissertations, and other peer-reviewed sources that have found biological origins of gender identity and gendered behavior …”

You may agree with me that few if any readers will be able to use this material to grasp the “obvious” error in Dr. McHugh’s points. A reader seeking affirmation of the case for “re-assignment” surgery—and, indeed, the entire ideology that has accreted around the “trans” movement—will finish the article reassured that criticisms or doubts are simply the uninformed, unscientific carping of those who have failed to read the 150 “peer-reviewed sources” on gender identity. It is not surprising that all those studies point to some basis or starting point of gender identity in biology. Gender would not exist without biology because gender is our psychological coming-to-terms with our sexual biology: it is our understanding of our biological sexual nature, our relationship to the opposite sex, and all that it implies. When that psychological development of a sexual identity arises out of our biological sexual nature, and is consistent with it, our gender identification is healthy (consistent with reality); when we develop a gender–a psychological sexual identity–inconsistent with our biological nature, the door is open to “gender identity” disorders, the yearning for our biology to change to square with our psychology. But then, we have accepted the postmodernist premise that mind decides what is true, then reality must change to confirm it. Carried far enough, that is a journey that ends in madness.

The psychology of gender identity is an individual’s understanding, interpretation, ideas, and attitudes toward his or her biological reality. The crucial point is that sexual biology is what it is, but “gender” is a psychological interpretation and adaptation to biological reality. And here is the crux: a young man or woman does not “discover” his or her “real” gender, to which sexual biology must be surgically shaped to conform. There is no innate, biologically determined “gender.” Gender is a psychological adaptation to biological facts—an adaptation that can go tragically wrong.

The Tannehill article is but one ferocious denunciation of those like Dr. McHugh who would withhold their sanction from the crusade to encourage, legitimize, and even valorize any young man or woman who wishes to surgically transform his or her body to square with his or her feelings. The operation, today, is not the last resort for the tiny minority of individuals born sexually indeterminate—usually caused by hormonal abnormalities—but an option proffered to every adolescent (or anyone else) with uncertain sexual self-perceptions. Schools nationwide, psychotherapists, and parents are warned not to discourage these doubts and conflicts. It is viewed as little short of criminal to suggest that the feelings might be “treated” by psychotherapy—or by just growing up a little more.

The fanaticism sweeping American psychiatry today has the same characteristics as the frontal lobotomy and “recovered memory” crazes. Both appeared, at the outset, to be bizarre departures from commonsense.

Information circulated by the American College of Pediatricians takes strong exception to this trend. And so, the Southern Poverty Law Center has labeled the American College of Pediatricians a “hate group” for its statements about gay, lesbian, and trans-gendered individuals. I stated at the outside that I am not neutral in this controversy. Whatever its history, today the Southern Poverty Law Center is best described as promiscuously “indiscriminate,” utterly lacking a moral compass, and not worth discussing.

The fanaticism sweeping American psychiatry today has the same characteristics as the frontal lobotomy and “recovered memory” crazes. Both appeared, at the outset, to be bizarre departures from commonsense. And so, too, did the prescription to surgically remove the genitals of a boy or girl who professes to be “trapped” in the wrong body. Urged by politically powerful gay/lesbian organizations in New York, the state’s governor, Andrew Cuomo, recently made it illegal for any health practitioner to collect health insurance payments for treatment with the goal of helping a patient reach a fuller perspective on the desire to be of the opposite sex. The goal of the gay/lesbian lobby was to make such ‘adjustment to biological reality’ treatment as nearly illegal as possible.

Government restrictions on what mental health professionals may or may not discuss, or treat, should be rejected; that is a matter for the professional and the patient. Government should not support reimbursement for any “re-assignment” treatment; the procedure’s medical necessity is to say the least unestablished; reimbursement never would have been considered without the political power of the transgender lobby.

Dr. McHugh and the American College of Pediatricians, in contrast, are trying to inform schools and parents that the overwhelming majority of adolescents confused and questioning their sexual orientation end up comfortable with their biological nature. Their desire to be the opposite sex should be treated by a psychiatrist or a clinical psychologist, not by a surgeon with a scalpel.

To forestall an unfolding catastrophe on the scale of frontal lobotomy, “recovery memory,” or, for that matter, eugenics, minimal steps should be to make illegal any major elective surgery or other treatment, including any “re-assignment” surgery, until adulthood. Any government restrictions on what mental health professionals may or may not discuss, or treat, should be rejected; that is a matter for the professional and the patient. Government should not support reimbursement for any “re-assignment” treatment; the procedure’s medical necessity is to say the least unestablished; reimbursement never would have been considered without the political power of the transgender lobby.

In the end, though, the medical professions, including pediatrics and psychiatry, are morally responsible. Like frontal lobotomies, “recovered memories,” and eugenics, the professions themselves will end the tragedy—as they began it. And, as all history demonstrates, it will be a desperately few members of the profession who lead in restoring its integrity.

And perhaps that is the reason for the abandonment of all restraint in the attack on Dr. Paul McHugh, the Johns Hopkins Medical Institution, and anyone seeking to stay the surgeon’s knife ready to alter the bodies of American boys and girls in obeisance to the ideology of Postmodernism.

 

Rest in peace, Tony.

I dedicate this article to my uncle, Anthony. Caught up in the whirling blades of the frontal lobotomy craze, he spent half a century of his life as a pacified inmate of Worcester State Mental Hospital and died there. His parents, and his brother, my father, were persuaded by psychiatric professionals that the full faith and credit of the psychiatric profession endorsed the frontal lobotomy operation. And they consented to the tragedy. Rest in peace, Tony.

 

 

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