Just as NARTH wants people to believe that homosexuality is "abnormal" and "curable", they would dearly like us all to believe that transsexualism is somehow invalid. (Go ask a transsexual sometime how they feel about someone else declaring their entire life experience "invalid")
The author of this boldly titled paper is Sander J. Breiner - a man who's involvement in sexuality appears to start and end with NARTH, most of his online CV is in domains well outside the domain, much less focused on the highly specialized field of gender identity. This gap in Breiner's background is significant because it influences his analysis of evidence that he cites.
I'll scroll to the end of Breiner's argument to start with because it contains an important gem that reveals his assumptions:
However, when an adult who is normal in appearance and functioning believes there is something ugly or defective in their appearance that needs to be changed, it is clear that there is a psychological problem of some significance.
The more pervasive and extensive is this misperception of himself, the more significant is the psychological problem. The more the patient is willing to do extensive surgical intervention (especially when it is destructive), the more serious is the psychological problem.
Superficially, Breiner is almost sounding reasonable here. However, in making this claim, he is confusing two distinct diagnostic categories. He is claiming (quite incorrectly) that Gender Identity Disorder as a variation of Body Dismorphic Disorder.
Let's consider the key criteria for both for a moment:
Body Dismorphic Disorder:
A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).
Gender Identity Disorder:
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
(4) intense desire to participate in the stereotypical games and pastimes of the other sex
(5) strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
What I'd like to draw your attention to is the fact that the emphasis NOT upon the physiology, but in fact upon the social role associated with a given gender:
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
Which is dramatically at odds with Body Dismorphic Disorder, where the focus is very much upon the physical manifestation of the body:
A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
The point I'm trying to get to here is that when we are talking about transsexualism, we are talking more about the social role which an individual lives in far more than the physical changes that are associated with the condition, and that is such a key distinction that it calls into question a great deal of Dr. Breiner's analysis.
Individually, the topics that Breiner attempts to string together to arrive at his conclusion that in fact a transsexual is not a transsexual suffer from some basic logical errors, and inferences that simply do not hold up to scrutiny.
The transsexual male, who was not part of a university/medical school treatment program, will often take hormone treatment (self-prescribed and administered); and play a feminine role with unsuspecting heterosexual males (often as a prostitute). They will play the part as if they are a passive feminine object. Their approach has many masochistic behavioral qualities. However, their thinking about how they are tricking, fooling and using others has a clearly sadistic dynamic. Their histories almost invariably demonstrate a mother figure who is at least domineering, manipulative and controlling.
This is quite amusing, as it is filled with a series of completely invalid assumptions and associations.
1. Inference: Many transsexuals are prostitutes. Although there are sex-trade workers who are transsexual, they are often in that world out of economic necessity, rather than out of any real choice.
2. Claim: Transsexuals come from dysfunctional backgrounds. This is so blatantly false it isn't even funny. By far the majority come from perfectly normal family backgrounds. Although some percentage may well have bad family histories, such sweeping generalizations simply don't hold together when you explore the stories of these people more rationally.
3. In emphasizing a specific subgroup of the overall population of transsexuals, Breiner is creating the false association between gender identity and sexual identity - suggesting by inference that there is an enormous physical, sexual component to the psychological motivations involved. Again, as with Michael Bailey's thinking, Breiner has made the very fundamental error of inferring that this is very fundamental to the picture when it is not.
Breiner goes on to discuss "his experiences" with a gender identity program at Wayne State University, which I can find no trace of either the program nor of Breiner's participation in it. (If any readers out there are familiar with this program, please feel free to pass on what you know - if you have references to it, that would be great!)
My clinical experience in participating with the Wayne State University program has been corroborated by others at the University as well as at Johns Hopkins University, a medical school even larger and with a longer-lasting program.
Of course, what Breiner isn't telling us here is that most of the formalized "Gender Clinic" programs run by University and hospital organizations gradually closed down over the late 1980s and early 1990s. Why? In part because they had run their course as useful constructs for both transsexual patients and the legitimate need to have a more rigorous understanding of the condition itself. This doesn't mean that treatment doesn't exist, but that it has taken on a more flexible form with the individual patient an active participant in the progression.
However, let us move on to examining Breiner's observations about the outcomes of those formalized programs, shall we?
He is a well spoken and reasonable, dependable historian; well spoken and seemingly reasonable in all areas -- except how he feels about himself in terms of his gender and his body image. He describes himself as somehow feeling that something inside is trying to come out -- that somehow or other -- the real self is being restricted and limited.
This is actually a surprisingly reasonable statement in itself. It is hardly surprising given the social taboos that wrap around the often conjoined subjects of gender and sexuality that an adult will present a cautiously worded, almost hesitant sounding description of themselves and their emotional state. That there would be room for "doubts" to be examined is easily understood as a perfectly rational response to a lifetime spent avoiding themselves.
All tests by psychologists and psychiatrists in testing his judgment of reality (except in his body image) is within normal limits. There is no evidence of psychosis or any significant problems in any other area than his body image (related to gender only). He is cooperative and patient and helpful in his manner. His only area of insistence is concerning his belief about his body and the need to become a woman. He is not afraid of psychological and psychiatric evaluation. However, he is not interested in intensive psychoanalytic/psychotherapy for a period of months or years. He firmly believes that his problem is not psychological but that it is truly on an organic basis.
Around about this point, Breiner starts to go awry, and either has misunderstood or misrepresented his clients. I suspect that a lot of patients have never really considered the origins of their condition when they present for treatment. However, it is also quite understandable that many would assume that feelings that had followed them since early childhood would be seen as having some very fundamental cause. What Breiner should be taking away from this observation is the fact that transsexuals often present with feelings that they have struggled with ever since they were very young. Feelings which have caused them a great deal of anxiety and distress, and that no matter what the patient has tried have resurfaced some time later.
Further, by the time the patient is asking for clinical help, what the client believes to be the "origins" of their state is quite immaterial.
Initially, there is less tension and discomfort psychologically experienced by the patient. He begins to feel better about himself and hopeful about his future as a woman. Despite the physical, social and economic discomforts, he is positive and cooperative in every way in the program. ...Between six months to two years following the completion and healing of the surgery the surgeons begin to request more evaluations from the psychiatric division of this program. The surgeons do not understand what is transpiring because the patient is now asking for more surgery.
This is an interesting pattern that Breiner is putting forward. It feels a little too anecdotal to me. Although there are some number of patients who do pursue additional surgery to address various physical issues that they feel make them 'less than ideal' in their chosen gender, Breiner merely gives us the anecdote without really putting forth any concrete evidence that measures the frequency of such occurrances, nor does he address what the psychiatric evaluations he alludes to found.
I think Breiner would be wise to consider the intense pressure that society exerts upon women to be "beautiful" by often arbitrary standards. Given that a Male to Female transsexual comes to life in the world of women with a few "handicaps" by the common measures of beauty, it should come as little surprise that some will resort to drastic measures to conform. Looking more rationally, it's hardly as if genetic women don't engage in similar practices.
Having presented us with an anecdotal "pattern", Breiner brings us to his grand revelation about transsexuality:
At this point in the process, I, along with other psychoanalyst colleagues concluded that the disturbed body image was not an organic at all, but was strictly a psychological problem. It could not be solved by organic manipulation [surgery, hormones], no matter how well intentioned or brilliantly successful it was done.
Rationally speaking, current medical interventions intended to assist transsexuals are limited in scope and the outcomes are necessarily imperfect. Whether the root cause of transsexualism is organic (e.g. a genetic variation or a difference in brain structure) is almost irrelevant, in my view. If the cause is "purely psychological", that doesn't invalidate the basic path of treatment - especially in the absence of any reasonable alternatives in treatment.
But the significance of the psychological difficulty should not be minimized by a patient's seeming success socially and professionally in other areas. This principle of isolated significant psychopathology indicating serious psychological problems (despite their ability to function in all other areas of life) is well known psychiatrically, historically, and by the judiciary.
This conclusion became so well established at Wayne State University that the program was eventually discontinued. The much larger and more extensive program at Johns Hopkins University and medical school in Baltimore, Maryland was discontinued for the same reason.
In short, Breiner would like us not to provide relief to transsexuals because he believes that there is some "underlying, unknown" psychopathology that has not yet been identified. We know that that transsexuals aren't delusional in any clinical sense, nor by his own experience, has there been any significant evidence of other serious psychological problems - just the distress that results from a lifetime spent feeling as though one should be living in a different gender role.
While Breiner's hypothesis that there is some "deep underlying psychopathology" involved that is driving the patient, his claim is just that - a claim. Since Christine Jorgensen became a public figure in the 1950s, we have the work of a great many people that do not provide evidence of "hidden" psychological issues.
In fact, Breiner is violating the principles of Occam's Razor by supposing some unknown pathology. Most of what he is raising as points to suggest that transsexualism isn't real are readily explained in terms of the social and societal pressures that shape the lives of every person in this world, and are hardly surprising or necessarily unique to transsexuals.
7 comments:
Let’s drop the pretense of science and recognize bigotry and malice for what it is. The treatment by SANDER J. BREINER, M. D. of Transsexuals would be no less an atrocity as that perpetrated by the Nazi’s. He disregards fact, medical evidence, and the body of evidence collected by his peers. I suspect that his position is based upon what may be his own insecurity and possible gender and sexual conflicts. In any regard his profile of Transsexuality does not mach my situation or proclivity of action. He is amiss using credentials to cover his own issues. As an M.D. he is suspect at best.
Every ten minutes a child is born, 1/2500, in which the doctor cannot determine the sex, or gender. These children are Intersex; they are born into a life of not male or female. Likewise in similar fashion the Transsexual is identified with a Bioneurological congenital condition they too are locked into something not quite so clearly defined as male, or female. The best we can do is live as close to what we seem to believe we are. That may preclude the wants, and often ignorant and bigoted beliefs of others. In what case do we ignore this issue and abandon the children who now cannot hide? How can anyone continue in hate and prejudice so as to deny simple equality and justice? It is either time for change and understanding, or simply wheedle out the transgender element as inhuman and adopt the final solution as Hitler visualized? Not an easy thing to resolve, but one that is present and will not go away.
I can appreciate another’s opinion, and the freedom to express same, But I would hope they would be with regard to the children, teens, and emerging adults, and all who are not so fortunate to have been born by someone’s idea of “normal.”
Stellewriter,
I basically agree with you - Breiner's reasoning and arguments are flawed.
At this time, I do not claim to "know" the underlying causality for transsexualism.
I am inclined to suspect strongly that it is a matter of multiple factors interacting, and that there is no singular causal factor. Many causal explanations have been postulated, but none of them have been backed by adequate data. (Mostly, the data has tended to suggest that any given hypothesis may describe some subset of the transsexual population, but certainly not all)
The fact that transsexualism often echoes in a patient's earliest memories - long before any "sexual identity" is recognizable as well as the resistance to "avoidance" therapy strategies suggests that whatever the cause, transsexuals cannot, and should not, ignore their condition.
Nor should treatment be denied to those individuals.
If one were able to collect and have access to all of the research and suppressed findings, we would likely see much bioneurological evidence pointing to endocrine blocking agents, i.e. DES, pollution, and the like. Again why I took exception to NARTH and the blatant approach to putting everyone in the same dirty little box, while at the same time ignoring what evidence has already surfaced.
I really do not appreciate being codified as gay, a sex worker, and some kind of slime that needs eradication from society. NARTH is dangerous! As a Conservative Christian Parent and Transsexual, I think they are REALLY dangerous!
If one were able to collect and have access to all of the research and suppressed findings, we would likely see much bioneurological evidence
Part of me would like to believe that you are correct in this supposition. However, evidence that I imagine exists is just as questionable as Breiner's claim of an unseen, unobservable underlying psychopathology. Therefore, I tend to lean towards a "we really don't know the causes" stance.
I really do not appreciate being codified as gay, a sex worker, and some kind of slime that needs eradication from society. NARTH is dangerous!
Agreed. I certainly wasn't agreeing with the Breiner/Bailey emphasis on sexual identity and sexual activity in their models. It quite simply flies in the face of far too much evidence that speaks to the contrary.
The fundamental dishonesty of organizations like NARTH is why I write about them when they open their mouths and spew such garbage. NARTH is an attempt to wrap bigotry in the cloak of respectability, and that cloak needs to be torn off them at every turn.
In fact, they were all pleased initially with the success of their transforming a man into a nice, if not a beautiful, young woman. Now the medical staff was dissatisfied with the patient's dissatisfaction; and they turned the case back to the psychiatric division to "solve" the problem.
And of course, women never get dissatisfied with their appearance. Any young woman not actually physically deformed would never request a boob job or nose job, especially if they've felt ugly all their life - or actually looked "not beautiful".
And it's not as if there was any social stigma or danger of violence to any woman suspected (due to her un-beautiful appearance) of once looking like a man. That never happens, does it?
Jesus Wept! The Stupidity, it hurts!
Breiner is the same genius who claims that tolerance education can cause "a neurological problem"
http://www.narth.com/docs/curricula.html
(6th paragraph down)
Hi, Yuki here. ; )
"The transsexual male, who was not part of a university/medical school treatment program, will often take hormone treatment (self-prescribed and administered); and play a feminine role with unsuspecting heterosexual males (often as a prostitute). They will play the part as if they are a passive feminine object. Their approach has many masochistic behavioral qualities. However, their thinking about how they are tricking, fooling and using others has a clearly sadistic dynamic. Their histories almost invariably demonstrate a mother figure who is at least domineering, manipulative and controlling."
Just an obsevation. These statement do no hold ground on any scientific dialogue on transsexualism. And Dr Breiner's assertion that a MTF is a "transsexual male" and most of them desire to cruise for men as "prostitutes" are already broken theories when MTFs are supposed to be addressed as "transsexual females" and most of us actually are surviving without cruising for men.
Such perversed thinking in Dr Breiner's part would only add to the bias of an already questionable association such as NARTH. And any transsexual research done on the foundations of such bias would not hold ground in any medical professional and mental health reviews.
Dr Breiner's research "conclusions" can be at best laughable during a comedy time coffee break by even laymen standards, especially as the general public are becoming more educated and exposed to the truths of what transsexuals really are.
Anyway, on a more let-my-hair-down note, if you wish to see more wild and carried away misrepresentations and misinformations on gender identity disorder that would make you go "they really feed people this kind of trash?", go back to the site Ex-Gay Watch, the latest article on Randy Thomas again. Posted some things there on the comments section that would make you go $#!!.
Anyway, how should I address you? The "M" one or the "G" one here. In any case, I read some articles here and I am impressed. So I would add your link on my blogroll. You can do the same if you want. Take care hon. Muah. : )
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