The Meyer study, cowritten with Donna Reter, noted the generally positive (good or satisfactory) outcomes reported by other researchers but reached a different conclusion. “Sex reassignment surgery confers no objective advantage in terms of social rehabilitation, although it remains subjectively satisfying to those who have rigorously pursued a trial period and who have undergone it.” Meyer and Reter based this conclusion on a comparison of fifteen patients who underwent surgery at Hopkins compared with thirty-five who had not completed the Hopkins program but who, in some cases, continued to pursue sex reassignment and later underwent surgery elsewhere. “While not a rigorous control group, they provided the only available approximation to it,” Meyer and Reter note of the latter group.
“Social rehabilitation” of the two groups was compared using a number of socioeconomic indicators, including job and educational levels, psychiatric and arrest history, frequency of change of residence, and cohabitation with “gender-appropriate” or “gender-inappropriate” partners. A numerical value was assigned to each of these categories in the Adjustment Scoring System. “Most of the scoring is self-evident,” Meyer and Reter note, though “if the patient is male requesting reassignment as female, a gender appropriate cohabitation or marriage means that he lives with or marries a man as a female; a non-gender appropriate situation would be one in which the patient, while requesting sex reassignment, nonetheless cohabitated or married as a man.” Male-to-female transsexuals who had female roommates, girlfriends, or wives were thus assigned negative scores, while marriage to a “gender-appropriate” partner was scored +2, a marker of successful adjustment on a par with a rise in socioeconomic status.
Critics have noted that “the most serious problem with this scale is its arbitrary character… it assigns the same score (—1) to someone who is arrested as someone who cohabits with a non-gender appropriate person. From this same set of cryptic values comes the assertion that being arrested and jailed (—2) is not as bad as being admitted to a psychiatric hospital (—3) or that having a job as a plumber (Hollings-head level 4) is as good (+2) as being married to a member of the gender-appropriate sex (+2). On what basis are these values assigned?” The same authors note that “there is confusion on the variable of cohabitation, particularly since Meyer never specifies whether this implies seuxal intimacy, interpersonal sharing or both. One can infer from the scoring assignment that a transsexual would be better living with no one (o) than with a person of the non-gender appropriate sex (—1) … Does Meyer mean to say that living in isolation is more adaptive than living with someone whatever his/her sex?”
Similarly, continued interaction with therapists and psychiatrists after surgery is viewed as a negative (psychiatric contact = —1, outpatient treatment = —2, and hospitalization = —3), as is failing to improve one’s socioeconomic status (as measured by the Hollingshead job scale). Meyer and Reter’s “objective” values of adjustment seem exceedingly value-laden in retrospect. Moreover, their failure to include any measure of personal satisfaction or happiness in the Adjustment Scale has been almost universally criticized, especially since “none of the operated patients voiced regrets at reassignment, the operative loss of reproductive organs, or substitution of opposite sex facsimiles (except one, previously noted),” as Meyer and Reter acknowledge. In other words, despite their unchanged socioeconomic status, continued tendency to change jobs and residences, and generally insecure and unsettled lives, those who underwent sex-reassignment surgery at the Johns Hopkins clinic appeared nearly universally happy with the results.
Ben Barres, the Stanford neurobiologist who transitioned in his early forties after a lifetime of gender dysphoria, confirms the importance of including affective data in any study attempting to assess the success of sex-reassignment surgery. “I’ve never met a transsexual who wasn’t enormously psychically better [after the surgery],” Barres says. “And the studies I’ve read say that something like 95 percent are very happy that they did it. And in medicine, you don’t usually find that kind of success rate. That’s unheard of, to find a treatment that has a 95 percent success rate. So it seems to me that the actual facts are totally opposite to what this guy [Meyer] said.”
The feelings of happiness and contentment expressed by postoperative transsexuals are irrelevant in the view of Paul McHugh, who closed the Johns Hopkins clinic after the Meyer study. “Maybe it matters to them, but it doesn’t matter to us as psychiatrists. We’re not happy doctors. We’re not out there saying, ‘What do you think would make you happy? Would you like a third arm?’ That’s not what we are,” he says. “The best will in the world would be to say, ‘These people have psychological problems that are dependent on the fact that they are fixed in the wrong body, and their psychological problems will melt away if we treat this. If we do this, it will make them better.’ But we found that they were no better! So we thought, ‘Maybe we’re just masquerading here. We’d like to think that they are better and they aren’t.’” McHugh dismisses sex-change surgery and the misery that drives it as “a craze” that started in the sixties and has been gathering steam ever since. “Crazes are crazes,” he says. “They build up, and they build up in a particular kind of way. We’ve been sold a bill of goods, and vulnerable people are picking this up and running with it. And it will continue to be a craze for a while as they support one another and as our communication systems, for example the Internet, promote it.”
McHugh’s perspective is anathema to most transgendered people, and yet one can find support for certain elements of his critique in the literature of the community itself. In her memoir, The Man-Made Doll, for example, author Patricia Morgan tells a harrowing tale of prostitution, rape, and abuse—both before and after her surgery with Elmer Belt in the seventies—and of the way that sex-reassignment surgery became popular among the crowd of gay and transgendered prostitutes with whom she worked the streets. Morgan says that despite her struggles she was able to make the transition to “straight” life because she had a realistic view of what to expect. Others were not so fortunate, she claims. “There are far too many fags and TVs [transves-tites] around today who think that sex-change surgery is the answer to all their problems,” Morgan writes.For most of them, it merely means trading one set of problems for another. They’ve lived so long in the underworld of fags and TVs, of pimps and prostitutes, that they’re not equipped to cope with the everyday world. They have no idea of what “straight” society is like. To them, it’s a fantasy land, like a child’s conception of the grown-up world. Many of those who go through sex-change surgery think they’ll wind up as sex symbols, love goddesses, movie stars. They think they’ll be transformed overnight into dazzling creatures who’ll sweep men off their feet and have millionaires clamoring to set them up in penthouses. It’s quite a comedown for someone who has such illusions to find out she’s just another broad—and not necessarily a very good-looking one—and that she still has to hustle to make a living.
Morgan also has sharp words for the underground surgeons who were beginning to offer sex-change surgery on demand. “A dozen years ago, when I had my operation, it was a rare thing. Now sex-change surgery has become as common as blue jeans, and many people are getting it who shouldn’t,” she charges. “For this I blame the doctors. Once I thought highly of doctors who did sex-change surgery. I regarded them as saviors of souls. Now I realize that they’re rip-off artists just like everyone else. … Very few of them send their patients to psychiatric counseling to find out if they’ll be able to function as women.” Bluntly, she lists the challenges that confronted transwomen after reassignment in that era. “The girl who had sex-change surgery gets rejected by her family. She isn’t able to hold a job. Most don’t have experience or education. Some have legal problems, because their papers still list them as men. Others get fired when their bosses find out. She can’t live the life of a normal woman. A man might fall for her, but when he finds out what she is, he says goodbye.”
Patricia Morgan’s
assessment is couched in the tough talk of the streets, not the formal language of academia, but she reaches a conclusion similar to that of Jon Meyer’s infamous study. Far from solving their problems, sex reassignment created a whole new set of problems for some troubled individuals, challenges that overwhelmed their fragile coping mechanisms. “Three of the sex-changes I’ve known are now dead—either from suicide or from overdoses of drugs,” says Morgan. “And I’ve heard stories of about twenty others who’ve wound up the same way. … I might have wound up the same way myself, but as I said, I’ve been lucky.” By the end of the book, Morgan has left prostitution and is living on an income generated by her purchase of real estate, funded by an older gentleman who loves and supports her.
The difficulty of distinguishing those individuals who might benefit from sex-reassignment surgery from those who would be crushed under the weight of postsurgical adjustment problems was a major preoccupation of the university researchers. They sought to define characteristics in prospective clients that might predict success in post-surgical life. For this reason, the university clinics have been lambasted by members of the trans community for creating a myth of the “classic” male-to-female transsexual. A classic transsexual was essentially a traditional woman who happened to have been born in a male body. She was attractive, with feminine mannerisms and a feminine outlook, and had felt like a girl all of her life. She was, above all, heterosexual and desired marriage and, when possible, children by adoption or step-parenting. “Back in those days, they used to say that you had to be hyper-feminine to transition, and I’d say, ‘This isn’t me. So maybe I’m not transsexual,’” says Dr. Dana Beyer, who transitioned in 2003 at the age of fifty-one. “If the only true transsexuals are Jayne Mansfield types, how the hell am I ever going to meet the criteria?”
Members of the trans community, with their sophisticated pre-Internet communications network, quickly sussed out the conservative criteria that the clinics were using to choose candidates for surgery. In a self-fulfilling prophecy that would be comic if it weren’t so tragic, candidates for sex-reassignment thus began presenting themselves to researchers as demure heterosexuals who wanted nothing more than a good man and a stable home, with lots of delightful children running around. In fact, many MTFs were attracted to women both before and after sex reassignment, but were careful to keep this fact hidden, knowing that it would destroy their chances of being accepted for surgery.
The university researchers began to sense the deception and to probe deeper, eventually discovering that many of their patients weren’t exactly the transsexual June Cleavers of their intake interviews. “They all claim that they are the same, but I don’t believe that they are,” Paul McHugh says today. “Most of them, the beginning ones, the ones that we were seeing here at Hopkins, were all men wanting to be women. And it was obvious that they weren’t women. They were caricatures of women. They had ideas in their mind about what it meant to be a woman, and you brought a woman into the room to talk to them and the woman quickly got the idea, ‘That’s no woman!’ Secondly, many of them would say, I am a woman in a man’s body, but I’m a lesbian.’ That’s crazy,” McHugh exclaims with some heat. “That’s a long way around for a guy to get a girl. That’s just nuts,” he says.
Echoing the conservative view of gender roles and sexual orientation that guided the decisions of the Johns Hopkins Gender Identity Clinic, and eventually led to its closure, McHugh says, “Look, in this situation, the issue for the person who is making the claim is to prove to you that they really are a woman. When they start saying that they are lesbians, that should increase your level of doubt. Then they have no maternal feelings—none, zip! I think that maternal feelings are a common quality of women. Do you think that the only thing it takes to be a woman is genitalia? No. There is a psychology to womanhood. We’ve just touched on two elements of that psychology which many of these guys coming to be women don’t have.”
Admitting that some genetic women, socialized as women throughout their lives, also lack maternal feeling and also desire other women, McHugh nonetheless maintains that the population of transsexual women ought to reflect statistically the same prevalence of maternal feeling and heterosexuality as natal women. “It’s our job as doctors to look at this issue closely when somebody says, ‘I’m a woman in a man’s body’ And when you look closely, these are the things that pop out immediately. These are not the subtle things about womanhood that women can pick out, but these are the things that anybody, common sense, would say ‘This person says that he’s a woman, but he’s a lesbian.’ Gee, you know, guys like women more than women like women. Secondly—geez, you know, where’s the feeling for children, maternal feelings? It’s zero here.”
Operating with this set of assumptions, McHugh and the researchers who shared them began to view the transsexual people who presented themselves at the Johns Hopkins Gender Identity Clinic with distaste. Clearly, using their criteria, these individuals were not women. Many of them were, in Paul McHugh’s view, “aging transvestites—the kind of people who had been going to Victoria’s Secret since they were twelve years old. And Johns Hopkins is not a branch of Victoria’s Secret!” McHugh characterizes Money’s early advocacy of transsexuals as an ideology. “It’s still an ideology,” he says. “ I believe in transsexuals, and I believe this is what they should be able to do.’ It was an ideology. It was not psychiatry and it was not medicine and it was not science.”
However, the research that might have made the study of gender variance something more substantial than an “ideology” came to an abrupt end when the Johns Hopkins clinic closed in 1979 and most of the other university clinics followed suit. “One of the things that I think was so tragic about SRS being forced off of medical school campuses is that it meant that almost all good research came to an abrupt end. That to me is a tragedy because there’s just so much research crying out to be done,” says Ben Barres of Stanford. At Johns Hopkins, research on gender variance took a conservative turn after the closing of the Gender Identity Clinic, one that denies the medical legitimacy of the condition that Harry Benjamin and John Money sought to define. “Our clinic is still looking at these patients; we still try to help them,” Paul McHugh says. “We tell them that we’re not going to do this surgery on them, because it’s not right. We don’t tell them to stop going to Victoria’s Secret. It’s up to them. But we tell them that they are not correct and that science doesn’t bear them out and their psychology doesn’t bear them out.”
Transsexual people themselves rue the changes at Hopkins set in place by McHugh. “Hopkins’s cachet with transsexual people desperately seeking services remained, so since 1979 those poor patients who didn’t know any better were seen at Hopkins’s Sexual Behaviors Consultation Unit (SBCU), which continued to do research on them but made them pay $150 per visit for that privilege,” says Jessica Xavier, a local activist who in 2000 carried out a needs-assessment survey on transgender health care in the District of Columbia. “They also stopped referrals for sex-reassignment surgery, which McHugh was quoted as calling ‘psychosurgery’ and hoped would go the way of pre-frontal lobotomies. If seen at the SBCU, a transsexual patient would be fortunate indeed to get referred for endocrinology.”
According to Paul McHugh, the incorporation of the diagnosis of transsexuality and later “gender identity disorder” in the Diagnostic and Statistical Manual has only “sustained the misdirection” put in place by John Money and other researchers. “People were being harmed, subjected to a ferocious surgery and being encouraged in an overvalued idea that doesn’t for most of them make sense,” McHugh maintains. “Fundamentally at the root of all this is an idea that is shared by other people in the environment, that is, by other people like Dr. Money, for example—the idea that sex is socially assigned and that it could be changed. These individuals take that idea up and it becomes a ruling passion for them. They don’t think about anything else and it becomes a part of what they call their identity. They have talk
ed themselves into this just like other people have talked themselves into the idea that they are not thin enough.”
McHugh is nonetheless willing to concede that researchers may someday find a biological explanation for at least some forms of gender variance. “If people are afflicted in fetal life by an abnormal hormonal thing, they can have all kinds of peculiar sexual attitudes when they come out,” he admits. But he is quick to distinguish between individuals who can prove that they were subject to “an abnormal hormonal thing” in prenatal life from those who, for whatever reason, choose to dress and live as members of a sex other than that dictated by their anatomy. And he remains adamantly opposed to any form of surgical intervention for the latter group. “This surgery is serious surgery and it’s a misuse of resources when I don’t think that the problem lies in the bodily structure.”
Despite the controversy surrounding sex-change surgery and his ongoing battle with adversaries within Johns Hopkins and without, John Money was continuously funded by the National Institutes of Health for more than thirty-five years, from the start of his career to its ignominious end. In June 1997, Milton Diamond and Keith Sigmund-son published an article in the Archives of Pediatrics and Adolescent Medicine that cast doubt not only on Money’s theories but also on his credibility as a researcher. Sigmundson had for many years overseen the care of Money’s most famous patient, a twin boy named David Reimer, who had been raised as a girl after his penis was accidentally severed during a circumcision. Money had long used this case (identified as “John/Joan” in the Diamond article) as proof that the sex of assignment and rearing trumped all other variables in the formation of gender identity in normatively sexed, as well as intersexual, children. Despite her XY genotype and male genital and endocrine profile at birth, “Joan” was a normal little girl, Money asserted in scientific articles, books, lectures, and interviews, who “preferred dresses to pants, enjoyed wearing her hair ribbons, bracelets and frilly blouses, and loved being her Daddy’s little sweetheart.” Sigmundson, who had witnessed firsthand the acute misery suffered by the child and his family as the boy’s masculinity asserted itself in the face of repeated efforts to convince him that he was a girl, had been contacted by Diamond, who sought information about the child for many years.
The Riddle of Gender Page 17