GENDER IDENTITY PROBLEMS

Transsexuals may need help, not surgery

AN important issue overlooked in the controversy over the transsexual, would-be police person is whether gender reassignment surgery can ever be justified.

Dr Paul McHugh, director of psychiatry at Johns Hopkins School of Medicine, said “a patient’s feeling that he is a woman trapped in a man’s body is not obviously different from an anorexic woman’s feeling that she is drastcally overweight”.

“We don’t do liposuction on anorexics. Why amputate the genitals of these poor men? Surely the fault is in the mind, not the member.”

In the 1970s, McHugh halted sex-change operations at Johns Hopkins, calling them “perhaps with the exception of frontal lobotomy, the most radical therapy ever encouraged by 20th century psychiatrists”.

His conclusion was that reputable surgeons should not be in the business of carving up a healthy body to satisfy a feeling about what that body should be.

A new argument against sex-change operations is the developing demand for a different kind of surgery, where people ask to have one or more healthy limbs cut off This condition is known as apotemnophilia. Last year, a surgeon in Scotland drew heavy publicity for amputating the healthy legs of two patients. His hospital stopped him before he could amputate the leg of a third.

Minnesota bioethicist Carl Elliott notes that “clinicians and patients alike often suggest apotemnophilia is like gender-identity disorder and that amputation is like sex-reassignment surgery”.

What is needed before more men are cut up is a review of the castrations to date to determine whether the victims are any happier and have had their psychological problems resolved, or whether they are still dysfunctional in one or more ways and would have been better treated with psychiatry.

Above were the headlines five months after the Herald Sun published my letter of July 14. The paper was reporting on the case of a man suing doctors he claims wrongly advised him to have a sex-change operation. Alan Finch, 34, alleges he was misdiagnosed as a transsexual when he sought help from the Gender Identity Clinic, Monash Medical Centre. Taxpayers will be asked to fund his legal fight against Southern Help, two psychiatrists, an obstetrician and a plastic surgeon.

Mr. Finch, who was 19 at the time, claims he was inadequately counselled and advised too quickly to have a sex-change operation. His lawyer said Mr. Finch would ask the County Court to award "significant compensation" for pain, suffering, medical costs and loss of earning capacity. The claim could amount to hundreds of thousands of dollars. Mr. Finch alleges he visited the clinic in 1986 suffering psychiatric problems he believed were caused by "gender dysphoria and/or confused gender identity". He alleges he was diagnosed as "suffering from transsexualism" after three consultations and advised that gender reassignment was an appropriate treatment. His transformation to "Helen" was completed two years later.

However in 1996 he realised the sex change had been a mistake. He alleges the clinic's diagnosis did not meet the criteria of someone suffering from transsexualism, such as a conviction since childhood that he was a woman and a preoccupation with stereotyped female activities. He also alleges that doctors did not take an adequate history, including details of a poor relationship with his father that he claims may have contributed to his sexual identity confusion.

Mr. Finch is asking Legal Aid, on the grounds of public interest, to fund his case, to be heard by a jury. His lawyer said it was in the public interest to look at what the Centre is doing and whether or not it is operating within the appropriate guidelines. (More recently a 15-year-old girl wants reassignment as a boy. It will involve double mastectomies and her mother is understandably worried).

Mr. Finch suffers chronic depression and has difficulty keeping jobs because of the sex change. Though he has had breast implants removed and taken hormones to revert to being a man, he has been told gender reassignment is irreversible. "He will never really be in a position where he will be able to live normally as a male again", his lawyer said.

“The Deconstruction of Gender”, which includes the story of the identical twin boys, one of whom his parents tried to raise as a girl aftere he was accidentally mutilated in a circumscision procedure is available from Endeavour Forum for $ 3.00 Phone 9822 5218.