Thursday, June 4, 2015


This video from

I have already had some indication that my comments about Caitlyn Jenner yesterday bothered some people. I expect to see posts on my personal Facebook page which laud individuals who are transgender or who live transsexual lives. Fine. I share the admiration for anyone who is truthful about his/her feelings, regardless of gender, race, sexual preference, ethnicity, even religion. After all, as a licensed health care provider for almost 40 years, I have depended on patients to share their truths with me to help them. I was trained to do this. I have trained others to do this.
I did not criticize Caitlyn Jenner for sharing her truth publicly. I did criticize her support of a culture of self-delusion. Reports after Caitlyn's photo shoot for Vanity Fair indicated that she is a confused and troubled human being in the hands of people who seemingly care little for her as a person and more for her as a commodity. Her plastic surgeon reportedly dismissed her anxiety and remorse as "normal". What is normal about Caitlyn's life? I would suggest, very little.
I have shared the following anecdote before. I helped treat a transgender male-to-female in his early 20s in 1976, my first year out of nursing school, at a state facility where I was employed as an R.N.. He had recently been castrated after years of hormone therapy. He began gender alteration at the age of 18, after he had already had one psychotic episode. He had already been diagnosed as a paranoid schizophrenic. It was an unusually early diagnosis of this severe mental disorder, but there was generational schizophrenia throughout his family of origin. He was admitted to my unit after a suicide attempt.
His gender alteration treatment exacerbated his schizophrenia. Despite this, he demanded gender change from his plastic surgeon, psychotherapist and general practitioner. Why? He told me on our initial interview that his long-term lover, who began having anal sex with him when he was 16, was a lieutenant in the local organized crime syndicate in his Italian-American community. He said the lover threatened to leave him if he did not have the full gender change done. He said this would leave him open to harassment, perhaps death, in his neighborhood.
I spent about a month working with this young person, as I recall. I was the only openly gay person who worked on my unit. The chief psychiatrist thought it would be helpful for me to work with this client, because he, the psychiatrist, felt that a wrong had been perpetrated on this young person by a homophobic culture in his community. I agreed.
Our treatment plan entailed removing the patient from the toxic community. We got a living situation in place with a subsidy. We arranged for a new therapist and outpatient group therapy. We got a medication regime going which the patient seemed satisfied with. Our greatest challenge was helping the patient mourn, at that time, irreversible loss of the patient's choice of what gender best suited the healthy mind, not the biochemically confused schizophrenic mind.  You see, once the patient was medicated and the mind cleared, the patient began to voice an understanding that he may have matured into a gay man, if he had had the proper treatment and support. It was too late for that.
The homophobic medical providers and the homophobic "straight" adolescent-abusing lover had worked in concert to deprive that person of choices, serious life-altering-every-single-day choices. This is not the only case with similar issues I have encountered in my career and in my personal life.
Now, I am not equating gender dysphoria with mental illness by any means. I have known some seemingly happy and well adjusted transgender individuals. What I am saying is that mutilation of otherwise healthy bodies is being performed by medical providers without any strictly established universal criteria based in measured biochemical or biophysical science.

Individual practitioners in this field have too much discretion and too little oversight. Choices are potentially being taken away, not given, when a patient is transformed by hormones and surgery, if there are other factors which are ignored. If human beings are looked in a limited way as simply male or simply female by medical providers, who should know better in 2015, without extensive research data from psychiatry and biochemistry, then society is continuing to enforce a fundamentalist two-gender world at the potential expense of confused and/or homophobic patients. This is not progress. Some people need to find out who they are over many years before they can happily be who they are. No surgical intervention magically "cures" deep emotional conflict and suffering.  
A schizophrenic or severe obsessive, who may not be diagnosed by a therapist,  may cut off his arm because it "doesn't feel right". In fact, some surgeons have removed limbs from patients with this type of dysphoria. These doctors have rationalized their actions by saying it made the patient feel better. However, with the advance of psychotropic medications, this outcome does not justify the mutilation. The mutilation denies the patient future function and choices irreversibly.
My concern about Caitlyn Jenner's glossy promotion of his own gender confusion, hailed by the ignorant and voyeuristic as "coming out" and "brave", is that more people like my former patients will be damaged by being rushed through a mill of sex reassignment for profit without strenuous guidelines and process. Right now, there is no uncontested body of hard science.

I am concerned that scientific research into gender dysphoria will cease, because it will be considered politically incorrect or impractical. Impractical means too costly or not profitable for plastic surgeons. I am concerned that homophobic cultures, communities and medical providers will see gender reassignment as an easy way to bully gay men and lesbian women into rigid gender roles without taking the time or trouble to deal with entrenched homophobia within themselves. This is why I regret the carte blanche support given to gender reassignment by the Western LGBT political establishment. I feel this rush to validate any medically engineered gender change as an absolute right ignores the more complex cultural, biochemical, ethical and psychological issues.

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