On the Science of Changing Sex

It was the best of times…

Posted in Transsexual Field Studies by Kay Brown on June 21, 2017

Kay Brown 2010…It was the worst of times   Or, That ’70s Show

In the May 1974 issue of the Western Journal of Medicine, two back to back articles appeared, one from a number of doctors reporting on a grand rounds at UCSD hospital that included Robert J. Stoller and one from Norman M. Fisk.  Reading them both now is not only a window on the past, but explains where we are now and how we got here.

I can’t write about this period without flashing back on my own life and what was happening at the time.  In May of ’74, I was just about to turn 17, finishing my Junior year in high school.  My favorite class was “Individual Voice”, solo singing but I was also really enjoying one other class, “Cosmology; Stellar and Galactic Evolution” I was taking at a local college, taught by a NASA astronomer.  I got an “A” in the class, of course.  I was also summer job hunting and landed my dream job as a nanny taking care of two boys for a local family for $50 a week (~$250 in today’s money).  I was also desperately searching at the library for any and all information I could find on transsexuality and how I could get HRT and SRS.  That search led me to the Stanford Gender Dysphoria Clinic and Dr. Fisk.

In early ’75, after much drama with my parents, who were separated and soon to be divorced, I finally convinced them to let me go to the clinic (but failed to mention that they performed SRS, etc.), which meant first being evaluated by Dr. Fisk.  During the first interview, I got the very distinct impression that he didn’t believe a word I said, though it was all the absolute truth.  From his article, we can see why,

“The concept of gender dysphoria syndrome grew out of clinical necessity very much in an organic, naturalistic fashion.  This occurred because virtually all patients who initially presented for screening provided us with a totally pat psychobiography which seemed almost to be well rehearsed or prepared, particularly in the salients pertaining to differential diagnoses. It would be accurate to say that of the initial 30 to 40 non-psychotic patients screened, all presented as virtual textbook cases of classical transsexualism.  Remembering the old medical saw that “the last time one sees a textbook case is when one closes the textbook,” it was apparent that this group of patients were so intent upon obtaining sex conversion operations that they had availed themselves of the germane literature and had successfully prepared themselves to pass initial screening.  In some instances they had rehearsed friends, spouses and family members in a similar fashion.”

During a later interview, in the company of my mother, who with obvious disapprobation and the mistaken notion that the clinic was to “cure” me, answered his questions about my early childhood saying,

“He was very different than his brothers.  All of their friends were boys, his were all girls. … He was very prissy.  I could dress him in clean clothes on Monday and they would still be clean on Friday. … I’ve known he wanted to live as a girl for years.  I just felt that was wrong.”

In the next interview, in company with my father, who tried to argue with him about what should be done about me after learning that I had been diagnosed as transsexual, Dr. Fisk replied,

“Denial will not serve.  You will win some battles but lose the war.”

That made Dr. Fisk my hero for life!  And he should be a hero to every transsexual who has come after, since it is Dr. Fisk who changed the way transgender people are treated that continues today,

Within the first two to three years of our investigation, it became apparent that when non-fabricated or, more precisely, honest and candid psychobiographies were obtained from our patient population, there was indeed a great deal of diversity and deviance from what had been defined as the symptoms of “classical transsexualism.”  Moreover, the overtly present common denominator was the high level of dysphoria concerning the individual’s gender of assignment or rearing  … employing the diagnostic term gender dysphoria syndrome, our indications for surgical sex conversion therapy have been broadened. Patients now clearly understand that had they been interviewed five or ten or twenty years ago, they would have been diagnosed as not being classical transsexuals. These patients are informed that a diagnosis of transsexualism is not in our view the only valid criterion for deciding who receives surgical sex conversion. Moreover, we practice the rather pragmatic dictum that nothing succeeds quite like success and therefore our criteria for surgical sex reassignment or conversion are more phenomenologically oriented. … Obviously, by liberalizing the indications for sex conversion through conceptualizing patients as having gender dysphoria, we also are committed to provide a program for patients encompassing many factors related to a total overall rehabilitative experience. These include vocational counseling and guidance, psychological and psychiatric supportive therapy, grooming clinics where role-appropriate behaviors are taught, explained and practiced, legal assistance, and, probably of most benefit, an opportunity is afforded to meet and interact with other patients who have successfully negotiated gender reorientation or who are in various phases of reorientation. This program employs some former patients as counselors to persons with gender disorders.

But that’s not to say that my experiences with the clinic were all good.  In fact, personal repercussions of some of what Fisk describes in glowing self-congratulatory fashion were severe.  I’m not alone in experiencing these issues.  While Fisk’s liberalization had eliminated the absolute need for a differential diagnoses for purposes of determining who was to receive services, it has led to a false belief within the trans* communities that there are no differences on the one hand and to the harmful homogenization of treatment protocols on the other.  It is important to note that the Stanford clinic did know that there were in fact two types and organized their services around helping those most in need of “gender reorientation”.

Having seen the best of times… we now turn to the worst of times.

During psychiatric grand rounds at a UCSD hospital, a 20 year old androphilic transwoman is paraded in front of a large group.  The author of the article describing the event uses masculine pronouns to introduce her to his readers and give a bit of her history, then switches to feminine pronouns.  Here’s an excerpt,

“She was told that this interview would be part of a training session on transsexualism so that people in the Department of Psychiatry could learn more about it. She was also told that this session will have no bearing on her treatment, continuing evaluation, or the decision regarding her operation. She understands that coming here is entirely voluntary.  (The patient, whom we shall call Gloria, was escorted into the room. She wore women’s clothing, was heavily made up, and quite attractive.  She was introduced to Dr. Parzen, who interviewed her before a group of approximately 100 staff members and residents. The following are selected excerpts from that interview.)”

Does anyone today believe that “Gloria” didn’t fully understand that her voluntary cooperation was actually mandatory if she was to successfully navigate this clinic’s hoops?  Certainly she did given the times, as Dr. Parzen says,

“These patients become good actors and tend to be paranoid toward anyone who might push them to betray themselves in a way that might jeopardize their surgical treatment.  Gloria had already established a personal relationship with Dr. Millman, and his feelings about her will ultimately determine what will happen to her.”

The doctors had ultimate power of granting or denying services and transfolk knew it!  What’s interesting is that the doctors knew that the they knew it, but saw nothing wrong with this imbalance of power save for complaining about what transsexuals do in the face of such asymmetric power,

Certainly she is quite protective about herself at this point. She is awfully close to getting what she wants, and she isn’t going to tell me anything that might interfere with that. She does not know my orientation, and she isn’t crazy, and therefore isn’t going to present material that might be interpreted wrongly from her point of view.  Transsexual patients classically tend to be very manipulative and very secretive. They tell you what they want you to know, and they have learned through much experience to read and to manipulate medical staff.

I could go on with the odd ideation that these physicians have that relied on classical Freudian psychoanalysis, not to mention the incredibly disrespectful things these doctors said about “Gloria” and transgender people in general, but I don’t need to as the articles have been scanned and available for all to read.

Further Reading:

Essay on differential diagnoses and transsexual taxonomy use in the 1970s.

References:

Fisk, N., “Editorial: Gender dysphoria syndrome–the conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multi-dimensional rehabilitative regimen.” (1974) Western Journal of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130142/

Judd, et al., “Male Transsexualism”, (1974) Western Journal of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130141/


 

Fun Reading:

All the Stars are Suns ebook completeSincerity Espinoza didn’t go looking for trouble, it found her. All she wants out of life is the chance to go to the stars but she is caught in a web of misunderstandings, political & legal maneuvering, and the growing threat of terrorist plots by religious fanatics. She has a secret that if found out too soon could mean not only her own death but the ruin of the hope for humanity ever going to the stars. But even amidst momentous events, life is still about the small moments of love, laughter, and sadness.   Available as an ebook at Amazon and Kindle Unlimited.

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