Link Wednesday #2: Is Caitlyn Jenner Mentally Ill?


(~1350 words: analyzing Paul McHugh’s dealing with transgender issues)

Caitlyn Jenner’s last interview as Bruce Jenner occurred a little over a month ago. Then on June 1, 2015, she announced herself to the world with her new name and a cover shot. This prompted comments ranging from support to denigration.

So this link Wednesday has to do with one psychiatrist in particular who holds a lot of clout with conservatives who oppose to transgender persons (or what transgender people do, not their persons, according to the rhetoric).

1. “Surgical Sex” by Paul McHugh

Paul McHugh hopkinsmedicine.org

Paul McHugh
hopkinsmedicine.org

Paul McHugh was the longtime chief psychiatrist, professor of psychiatry, and department head at Johns Hopkins University and Johns Hopkins Hospital. He has gained much publicity for his position against SRS. In this article published on First Things (see their About page here), he discusses why he opposes it. He primarily found the desire for SRS solely in men who could not deal with their own homosexual attraction and sexual experience. He wished to test his unease with these men by testing 1) if an operation resolved other “psychosocial issues” (“relationships, work, and emotions”) in them and 2) if operations performed on boys with abnormal genitals combined with raising the them as girls allowed them to be gender-adjusted in adult life as women.

Concerning his first inquiry, McHugh followed Jon Meyer’s research. Meyer had spoken with SRS patients years after their surgeries, finding that they were largely satisfied with their choice. McHugh inferred, though, that the surgery did not resolve other psychological issues present in them.

Concerning his second inquiry, he followed the research of William G. Reiner. First, Reiner used comparative anatomy to conclude that even if boys were surgically altered postpartum, they had still been exposed to testosterone in utero. These young children, though raised as girls, preferred “boy” play: “enjoying rough-and-tumble games but not dolls and ‘playing house.’” Reiner’s case study on 16 “genetic males with cloacal exstrophy” found that once the youths had learned about their birth sex:

  • 8 boys declared themselves male
  • 5 continued to live as females
  • 1 lived in sexual ambiguity
  • (2 had parents who had elected not to have the surgery performed on their children)

McHugh then concluded that gender identity flows not from socialization, but from genetics and intrauterine encounters with testosterone. I have two issues with McHugh’s inferences from the data and studies. The first has to do with the propriety of his first inquiry: is it appropriate to ask if SRS solves other psychological problems in a person? I’ll propose something and let you think about it: does gall bladder surgery have benefits for asthma sufferers? McHugh admitted that men who underwent SRS were satisfied with the results in the majority of cases. His contention is that it did not solve attendant psychological issues. Should that be expected? If I suffer from bipolar disorder, schizophrenia, and obsessive-compulsive personality disorder, will treatment for one diagnosis work for the other two? Some medications help multiple things. For example, Depakote can be used as a treatment for seizures, migraines, or the manic phase of bipolar disorder. But this isn’t always the case, and to expect one treatment to affect multiple issues doesn’t seem reasonable to me.

My second issue has to do with McHugh’s use of Reiner: “sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo. Male hormones sexualize the brain and the mind.” If effects in the uterus are primarily what account for sexual identity, why did nearly 43% of the boys operated on live as females—i.e., according to socialization—or ambiguously? Wouldn’t his claim call for a much higher ratio of “boyness” trying to overcome female socialization? Can a claim for naturalness/normalcy hold if it only accounts for roughly 57% of the sample?

2. “Transgender Surgery Isn’t the Solution”

(Google the title; if you click on this link, you have to subscribe in order to read the full article)

I came across this article when another article referenced it. That article had the catchy snippets in its title: “Johns Hopkins Psychiatrist: Transgender is ‘Mental Disorder;’ [sic] Sex Change ‘Biologically Impossible.’” (check out what the DSM-V says about it being a mental disorder; thanks to Brynn Tannehill; In the upcoming weeks, when I discuss the “institution” aspect of religion, I will discuss the politics of classification) While I read that article, I wanted to read the original. It is imperative in research to see what writers/speakers do with their sources in order to see if there are unstated motivations beneath their stated intentions.

I want to draw attention to one statistic provided by McHugh:

When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.(Monte’s emphasis)

He also refers again to his reason for stopping sex surgery at Johns Hopkins: “surgically treated patients” were satisfied with the surgery, but didn’t experience relief from other “psychosocial” issues which he doesn’t detail here.

In this article, he produces a much more relevant study to his aims. The Karolinska Institute in Sweden conducted a 30+ year longitudinal study on over 300 people who had undergone SRS. He highlights two things. One, 10 years following the surgery brought about mental health issues, and two, the patients had a 20-fold suicide mortality rate when compared with the general population.

Concerning the Vanderbilt/Portman study, McHugh admits that no one knows for sure why gender dysphoria continues in 25% of individuals who experience it as children. With him, I don’t know what to do with this. It could have genetic or social contributors, or a combination of the two. We just don’t know. However, he’s the psychiatrist, and he doesn’t offer any alternatives to SRS (besides “devoted parenting” for children and adolescents) or help. If you’re a public intellectual offering your two cents, provide some solutions.

The second study concerns me. That suicide statistic is astounding. An article by Mari Brighe (about The Transadvocate here) critiquing McHugh’s op-ed detailed many of his misuses of data, including the following quote from the Karolinska study:

It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit. (Monte’s emphasis)

Further links in the article cite differences in androgen receptors between transgender and cisgender men and a difference in brain anatomy between transgender women who haven’t yet undergone hormonal treatment (the article calls them “male-to-female (MTF) transsexuals”) and cisgender men.

What I take from this is that transgender persons need more access to mental health resources, but that a ban on SRS in itself would not “fix” them. With high suicide rates, abuse from families of origin, mistreatment by police and hospitals, and homelessness, exclusionary tactics like negative labels are not helpful. Labels more often than not serve to categorize a group as “Not us,” that can then serve as a shield of indifference to real complaints, issues, and needs.

So is Caitlyn Jenner mentally ill on account of being transgender? The DSM says no. I think the question might be missing an issue, though. My question is, do Jenner and people like her have access to mental health, relational, financial, occupational, housing, and other resources that I enjoy because no one is obstructing my access according to my appearance? I guess a person could say, “Stop trying to be something you’re not. Make your appearance more normal and you won’t have these problems.” To me that’s like saying, “Stop practicing Christianity, because it’s against your nature. You won’t have relational problems associated with being resisted because of your religious observance.”

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