On the Science of Changing Sex

The Elephant in the Room

Posted in Transsexual Field Studies by Kay Brown on November 9, 2017

female_scientistOr, Is the “Third Type” of MTF Transgender Simply Mentally Ill ??

In the mid ’90s, during a conversation in my kitchen, where we often held our transactivism strategy sessions over coffee, JoAnna McNamara remarked one day that I was the only transsexual she knew who wasn’t mentally ill.  Actually, she used the term, “crazy”.  I was taken aback by her declaration and asked for expansion and explanation.  She listed a number of people we both knew in common and told me of other numerous examples.  Most of them were actually fairly reasonable examples of anxiety and depression associated with typical late transitioning woes (i.e. divorce, job loss, being regularly clocked in public, etc.).  But some of the stories about these same individuals involved episodes that would indeed indicate serious departures from rational behavior, most especially of delusions and even psychotic breaks, that she had either witnessed first hand or had credible accounts from others.

This fit with some stories that I have been told by a number of care providers who have confided in me… and of my own personal experience.

One of the most famous individuals I met was Angela Keyes Douglas, AKA Douglas Keyes.  When I first met Douglas, in 1977, s/he was living in Berkeley as… well… not really a woman so much as s/he didn’t really pass or even really try, and seemed totally oblivious to how people reacted to him/her.  It was obvious to me that s/he was “off”… and I mean “off“.  We maintained a distant connection for decades.  Douglas had SRS sometime in the ’80s and moved to Florida.  Eventually Douglas returned to living as a man full-time.  I would get mail from him that was off the chart “off“… sometimes friendly, sometimes threatening.  He claimed that he was a CIA or FBI agent and was turning me in for my “crimes”.  He also wrote about the “blue lizard aliens” running our government, when he wasn’t writing about the “Illuminati”.  Clearly, Douglas was psychotic, probably schizophrenic.

Another individual, who was never famous, was my roommate for a time in late ’77 early ’78.  I won’t use her name.  She was in her mid 20’s, very pretty, had transitioned and had SRS paid for by her family while in college and was then working as a computer programmer in Silicon Valley.  However, she was “off”… and I mean “off“.  I didn’t realize it when I first moved in.  Given her age of transition, I had initially thought she must be a transkid.  WRONG !  On the surface, she seemed sweet and put together, until you noticed that she never left the apartment except to go to work.  She had exactly one close friend, a lesbian who I believe she had a serious crush on.  She hated and was terrified of men, all men, but especially gay men.  She had this fixed delusion that all gay men were sexual predators out to seduce her, perhaps violently rape her.  It would seem that part of her motivation for transition was to escape the notice of gay men.  Oh… did I mention that she was heavily medicated on thioridazine?  Thioridazine is a powerful anti-psychotic prescribed as a treatment for schizophrenia.  Well, things went down-hill for us as roommates pretty fast when she discovered that I was actively dating… oopsie… men!  She went off on me one evening using homophobic slurs and after that began having and sharing with others a delusional paranoia fixed on me.  Obviously, I moved out after only a very short time.  In the mid-80’s, I accidentally ran into her in the lobby of a hotel.  I greeted her in a kindly and friendly manner… to which she responded like a startled rabbit and literally ran full tilt away from me!

I had another roommate, who again I will not use her name, who was subject to severe bouts of debilitating depression.  However, she also had times when she was filled with energy, able to achieve amazing things.  But there was a dark side to that energy.  During those times, she would hold very odd ideas, conspiracy theories, etc.  Sometimes, these ideas involved those close to her.  She also took dangerous, reckless, risks that would frighten me in the extreme when I was witness to them.  Perhaps you recognize the symptoms?  I believe that she suffered from bipolar disorder w/ paranoid delusions.

These examples are not the only ones that I have witnessed personally…

This issue has not gone unnoted in the literature on transsexuality / transgenderism.  Norman Fisk, in his seminal paper introducing the concept of “gender dysphoria syndrome” also wrote about the ‘third type’ that they saw applying for sex reassignment at the Stanford Clinic,

“Finally, many psychotic patients have a severe type of gender confusion.  Twenty percent of all of our patients contacting our program are overtly psychotic and of course are referred for or given appropriate psychiatric treatment.”

Could this explain the “third type” that consistently disavows ever having experienced either exclusive androphilia or autogynephilia, insisting that they represent a third type?  Well, no, not completely anyway.  We know that many who deny autogynephilia are in fact falsely making such a claim.  However, these psychotic individuals could represent a portion of them and thus serve as a true, “third type”.  On the other hand, they could simply be a subset of one or the other, or even of both, of the already well established two types, simply evincing a co-morbid condition.  That at 20 to 46%, this could alternatively mean that those who suffer from gender dysphoria are especially likely to have such co-morbid conditions, as Lawrence describes,

Some cases of MtF transsexualism are associated with and plausibly attributable to other comorbid psychiatric disorders, especially psychotic conditions such as schizophrenia or bipolar disorder. Á Campo, Nijman, Merckelbach, and Evers (2003) reported on a large survey of Dutch psychiatrists, who had evaluated 584 patients with cross-gender identification and possible GID; in 46% of these patients, the psychiatrists interpreted cross-gender identification as an epiphenomenon of other psychiatric problems, including psychotic, mood, dissociative, and personality disorders. Brown and Jones (2016) observed that, among 5135 persons (69% male) diagnosed with GID, transsexualism, or transvestism who had received care from the U.S. Veterans Administration, 32% had also received a diagnosis of “serious mental illness,” meaning “diagnoses associated with psychotic symptoms” (p. 128), including schizophrenia- and bipolar-spectrum disorders. Thus, comorbid psychotic disorders and other severe mental illnesses may account for some cases of MtF transsexualism in nonandrophilic persons who deny autogynephilia — and for some cases of MtF transsexualism in androphilic persons as well.

Mental illness within the transcommunity has been the elephant in the room.  It’s time we talked about it openly and compassionately.

(Epilog 11/12/2017:  JoAnna, herself suffering from serious mental illness, committed suicide less than a year after the conversation discussed above.)

Further Reading:

Essay on Clinical difference between the two types w/ allusions to differential vulnerability to mental illness

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/

Lawrence, A., “Autogynephilia and the Typology of Male-to-Female Transsexualism: Concepts and Controversies”, European Psychologist, 22, 39-54. (2017)
http://www.annelawrence.com/autogynephilia_&_MtF_typology.html

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