I have just been reading a disturbing book: Paper Genders by Walt Heyer. First published in 2011, it is an important document because, as the author writes in his subtitle, it is about “Pulling the Mask off the Transgender Phenomenon”. This phenomenon, as readers will have noticed, is being increasingly thrust into the public forum as more and more people are given space to write of their (or their children’s) problems identifying with their gender.
I find something slightly sinister about this publicity – but not, I hasten to add, with its victims. I am reminded of the huge and implacable advance of the movement to change the ancient, biological and religious definition of marriage and the success it has had in the western world (though not in Africa, China, in East European countries or in Russia.) Are we now to see a similar assault on the ancient, biological and religious difference of gender as either male or female? Or can you change your gender simply because you feel you are living in the wrong body? Transgender people believe you can.
This is not the same as having a rare intersex condition, where babies are born with both male and female organs and where there is genuine confusion at birth as to their sex. Corrective surgery at a later stage is often advised in cases like this. People who become transgender have been identified as to their sex at birth in the straightforward way; but at some stage they reject this birth gender for the opposite one. Needless to say, this causes much heartbreak and pain for all concerned, not least the sufferer.
The question raised by Heyer’s book is: what should the medical, surgical and psychological fraternity do when faced by such cases? Is it ethical to offer hormonal and chemical treatment and finally gender reassignment surgery to patients or should they be offered psychotherapy and other help instead, in order to help them come to terms with their biology and their DNA?
Heyer is clear that patients are suffering from a mental disorder for which they require the right kind of treatment – not radical surgery which, as his title indicates, cannot actually deliver the emotional and mental peace that people are desperately seeking. In other words, you cannot change your sex, even if on paper – ie your birth certificate, your passport and other official documents – it states that you have done so.
To those who might challenge the assumptions of Paper Genders and say Heyer doesn’t know what he is talking about, he would respond, “Yes I do.” For Heyer himself, born a boy, and who later married, who had a family and who was a successful businessman, was deeply unhappy in his male identity for many years.
Finally, in his 50s, he underwent gender reassignment surgery. He found temporary relief in his new female role, but this was then followed by deep regret and a return to living as a man. His description of his childhood is telling: he was regularly sexually abused by a male relative, regularly dressed as a girl by his grandmother and later propositioned by a homosexual priest. These early experiences caused him such distress that he felt the only way to resolve his unhappiness was a complete change of sex.
Heyer’s book does provide references for the research he has done to prove his argument. In particular he mentions that John Hopkins University School of Medicine in the US, which pioneered psychosurgery in the 1960s, chose to close down its unit in 1979 after a four-year study of 50 transsexuals. The study concluded that there was no evidence “that surgery cures psychiatric disturbance”.
Dr Paul McHugh, the Director of the Department of Psychiatry and Behavioural Sciences, stated that “Hopkins was fundamentally cooperating with a mental illness”. Dr Jon Meyer, who carried out the research, concluded that “Surgery is not a proper treatment for a psychiatric disorder.”
Heyer’s book is unsatisfactory in some ways: it is repetitive, unstructured, uses emotive language and launches into a condemnation of other forms of psychosexual surgery such as the fashionable lobotomies done on certain patients through the 1930s until the 1960s (that surgery is now rightly discredited).
However, he does raise two important questions that I have yet to see answered by the medical profession engaged in gender reassignment surgery: could the patients’ problems be psychological in nature (ie they really need skilled and long-term psychotherapy)? And does radical surgery and a change of gender on paper actually bring a resolution to their problems? Heyer suggests that the mental distress and rates of suicide after surgery are as great as the distress and suicidal thoughts before it. The media, keen to explain how wonderful the film The Danish Girl is – but not the tragic aftermath of the surgery done to the Danish transsexual involved – also has a responsibility here.
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