Transsexual Causation, the American Psychiatric Association, and Interpol

A sweeping from the dustbin of history, an extract from History: Interpol and the Nazi Party:

When Interpol was 1st established in 1924, Vienna was chosen as its "permanent" home by fixing in the constitution that the head of the Austrian federal police would automatically lead the organization from the capital of that nation.
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Undaunted by growing Nazi participation, U.S. Attorney General Homer Cummings recommended to the Congress, a mere 2 weeks after Hitler's take-over of Austria and Interpol, that the U.S. formally join the group "as advocated by Director Hoover." Since Secretary of State Cordell Hull had no objection to the membership "from the point of view of our international relations," Congress voted the money and as of June 8, 1938, the U.S. was officially a member of Interpol. The U.S. was a member of a Nazi-run organization for only $1,500 annual dues.
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Reinhard Heydrich, appointed to head the Nazi SS, became Interpol's new president, announcing that "Under its new German leadership [Interpol will] be a real center of criminal police." On December 8, 1941, Berlin was named as Interpol's new home and the move was made. Sharing a villa in Wannsee, a wealthy suburb of Berlin, with the Gestapo, Interpol was placed under Heydrich's Sicherheitdienst (SD) or Security Police.

Why have I been reminded of this recently? What faint echoes are there of an organisation with worthy aims shall we say, "misdirected" by a "fringe" group that is no doubt concerned with the issues at hand, but rather better known for other, more questionable activities? Read on, all will become clear. It's only a faint echo, and those involved aren't monsters. Just... "fringe".

But first, a talk about Transsexuality, and the causation thereof. I was recently asked what non-Freudian based theory there was about the cause of transsexuality. here's what I replied. My apologies for being repetitious in parts, but there's some novel stuff too.

The brain is a sexually dimorphic organ. The brains of men and women differ. Now just as there are flat-chested women and gynacamastic men, there's overlap, and different parts of the brain may be more or less conformal to the typically male or typically female pattern.

All sexually dimorphic organs are subject to cross-gendering, "Intersex", where a body that is mostly of one pattern can have bits more typical of the other. See any good site on Intersex to show the hundreds of different syndromes and how things can go wrong. Sometimes it's due to chromosomal causes, where the chromosomes aren't all 46xx(F) or 46xy(M), but 47xxy, or 45x, or a mixture such as 46xx/47xxy.
Sometimes it's due to other genetic causes, as when the cells aren't sensitive to the male sex hormone testosterone, so the body develops as mainly female, regardless of chromosomes. Often it's due to non-genetic causes, usually hormonal abnormalities in the womb, and sometimes it just happens for causes unknown, like many other congenital conditions.

Now since all other sexually dimorphic organs are subject to Intersex, how come the brain is uniquely immune? Or is it? In fact, there's evidence that it isn't.

Zhou J.-N, Hofman M.A, Gooren L.J, Swaab D.F (1997)
A Sex Difference in the Human Brain and its Relation to Transsexuality.
(PDF at http://www.harrybenjaminsyndrome-info.org/pdf/BSTc.pdf)

Kruijver F.P.M, Zhou J.-N, Pool C.W., Swaab D.F. (2000)
Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic
Nucleus (PDF at http://www.harrybenjaminsyndrome-info.org/pdf/brainsex1.pdf)

Male and Female brains differ, both on the coarse scale (BSTc layer of the hypothalamus) and fine scale (number of neurons - brain cells - in each structure). Autopsies on transsexual women, that is, women with mostly male bodies, have shown they have female pattern brains in this respect.

Note that gay men have male pattern brains though in this respect.

The brain is a complex organ, with many different parts. It's entirely possible, even usual, to have some parts more typically feminine, and other parts more typically masculine. What really matters is what parts are what, and to what degree.

Now if this is true, then we should expect to see the differences showing up in fMRI images - "brain scans" of living people. And we do.

From ArzteZeitung, 2007

"Radiologists can now confirm what transsexuals report - that they feel “trapped in the wrong body” - on the basis of the activation of the brain when presented with erotic stimuli. There is obviously a biological correlation with the subjective feelings."

This experiment took a number of men, a number of women, and an equal number of TS women. The TS women had the same pattern of neural activity in the lymbic nucleus (part of the brain) that the other women did .

So it's all nice and neat, everything proven beyond any doubt, right?

Well, not exactly. You see, the numbers in the experiments are too small for comfort. We still don't know which parts of the brain are responsible for gender identity, though we have a good idea now. The BSTc differences between men and women only happen at puberty, yet we know gender identity is formed before then. That means the BSTc difference is a symptom, not a cause. Moreover, the brains of infants are "undifferentiated pudding", lots of neurons but few connections. In theory, there's no difference, so we should be able to grow up either way, depending on environment. Except it doesn't work that way, differences between boys and girls are measureable at 18 months in terms of attention-span and reaction to basic stimuli. We don't know why, but we can deduce that there's something going on that we haven't detected yet.

We know from the cases of surgical intervention on Intersexed infants to "normalise" them that sometimes it works, and sometimes it doesn't, so we sometimes get surgically-created transsexuals (see the infamous David Reimer case). We also know that those mothers who took the drug DES in the first trimester and have genetically male children give birth to transsexual girl babies 500 times more often than they should by random chance. If the brains of newborn infants were as plastic as psychologists theories would indicate, this would not happen. (Even the non-TS "DES sons" are usually Intersexed in other ways too BTW)

We know that those Intersexed genetic males with 5ARD or 17BHDD, so they get a "natural apparent sex change" from FtoM at puberty can be divided into three groups: those to whom it is a massive relief from transsexuality, those to whom it's just something that happens and they don't really care, and those to whom it's a nightmare, a descent into transsexuality. It appears that the three groups might broadly be the same size, but we don't know, there's too little data to be sure. We know all three groups exist, that's all.

As for the German experiment - they only looked at straight men and straight women, and it could be that they haven't found a biological basis for TS, just for sexual orientation. They didn't state whether any of the TS sample were lesbian or not. We do know that the differences detectable at autopsy aren't due to hormone treatment, as they also autopsied a number of men taking similar hormones (greater doses usually) to combat cancer, and their masculine brains were unaffected.

So all we can say is that it is "true on the balance of probabilities" rather than "proven beyond reasonable doubt". And only that assuming there isn't some more compelling evidence for another theory.

There's a lot of evidence that TS women can be divided broadly into two groups. Those that transition early, and those that transition late. The ones that transition early tend to be androphillic (attracted to men), and to have bodies that are gracile, easily transformed by hormones into pretty girls. They tend to have difficulty "passing" as boys from an early age.

The ones that transition late may be andro or gynephillic (attracted to men, women, or either), and are less gracile, and have no difficulty "passing" as men. They even sometimes have difficulty "passing" as women after treatment, and this appears independant of physical appearance, more a matter of body language and instinctive behaviour than anything else. They also tend to be good at engineering and science, with both the linear/analytic/deductive male-typical thinking and parallel/creative/intuitive female-typical thinking modes available to them. TS men follow the same broad categories (swapping boys for girls, and andro- for gynaphillia), but with one exception: they all tend to transition early.

The Neurological theory accounts for this as follows: basically, different parts of the brain are affected, and societal pressures account for the rest.

For example, until the mid 1990s, it was impossible for most TS women who were lesbian to obtain medical help in transition. It was also impossible for anyone not gracile and able to look pretty in a conventional sense. Such women were denied treatment as being "poor candidates". They transitioned as soon as they could.
In the late 50's, 60's and early 70's, there was no Internet, and no access to the data about transition we have today. Moreover, Homosexuality was punishable in many jurisdictions by prison terms of 10 years or more. The "Gay Underground" had access to data about transsexual transition, but those who had no "in" with that shadowy, furtive and underground culture (as it was then) because they didn't think of themselves as gay, had no idea that transition even existed, except as something a few freaks did at a cost of half a million dollars in today's terms in foreign locations.

Those who could do "the boy act" with some success did so, as it was their only means of survival. Those who could not mainly died, with only a handful of survivors who managed to transition despite the difficulties still alive today. Those whose neurology was less affected, so they had masculine or masculinised instincts regarding body language and mannerisms were able to cope, especially if they had typically masculine bodies. Their first opportunity to transition started less than 15 years ago. Because of their mixed neurology, they tend to be in Computer Science, the technically creative arts, the Military, or other areas where both creativity and logic are required. Many Intersexed people are the same in that area.

Now the main competing theory is AGP (AutoGynePhilia) theory, a theory based in the Freudian concept that every single human motivation is sexual in nature. In AGP theory, the early transitioners are really gay boys who want to have sex with straight men. The late transitioners have a paraphilia, a fetish, that makes them want to have female bodies based on misdirected male sexual urges (Autogynephilia). This last is associated with talents for the military, computer science, or the creative arts for reasons unknown, and the neurological evidence is swept under the carpet as an irrelevant, unexplained phenomenon based on dubious evidence. As for FtoMs, they're all inexplicable and may not even exist. Any testimony by any TS women which contradicts this is a lie, and they must all be pathological liars as so many of them contradict it.

All men are heterosexual, gay, or liars too, bisexuality doesn't exist in men, those who say they're bisexual are gay. Except in transsexuals, where those claiming to be bisexual have to actually be non-gay to make it all work. And women are all bisexual. The evidence that many late transitioning women end up being androphillic is ignored as an unexplained phenomenon, or maybe they're just lying.

If we're not careful, that last is going to be enshrined as the official position of the American Psychiatric Association.

Why do I say this? Well, the American Psychiatric Association is revising their Diagnostic Standard Manual, the DSM, from version 4 to version 5 - DSM-IV to DSM-V. This will list all the various psychiatric disorders so far identified, how to diagnose them and differentiate them from other similar disorders. This manual is something of a "Shrink's Bible", used worldwide, not just in the USA. It is capital-A Authoritative.

From a recent news release of the APA, announcing the makeup of the panel revising the DSM in the area of sexual disorders:

Sexual and Gender Identity Disorders Work Group

Kenneth J. Zucker, Ph.D. (Chair) Head, Gender Identity Service Clinic, Child, Youth, and Family Program Centre for Addiction and Mental Health Toronto, Ontario, Canada

Irving M. Binik, Ph.D. Professor Department of Psychology McGill University Montreal, Quebec, Canada

Ray Blanchard, Ph.D. Professor, Department of Psychiatry University of Toronto Head of Clinical Sexology Services Centre for Addiction and Mental Health Toronto, Ontario, Canada

Peggy T. Cohen-Kettenis, Ph.D. Head of the Department of Medical Psychology VU University Medical Center Amsterdam, The Netherlands

Jack Drescher, M.D. Clinical Assistant Professor of Psychiatry, New York Medical College Associate Attending Psychiatrist, St. Luke'sRoosevelt Hospital Center New York, NY

Cynthia Graham, Ph.D. Research Tutor Oxford Doctoral Course in Clinical Psychology Isis Education Centre Warneford Hospital Headington, Oxfordshire, United Kingdom

Richard B. Krueger, M.D. Medical Director, Sexual Behavior Clinic Department of Psychiatry New York State Psychiatric Institute and Columbia University New York, NY

Niklas Långström, M.D., Ph.D. Associate Professor Centre for Violence Prevention Karolinska Institutet Stockholm, Sweden

Heino F. L. Meyer-Bahlburg, Dr. rer. nat. Professor of Clinical Psychology Department of Psychiatry College of Physicians & Surgeons Columbia University New York, NY

Robert Taylor Segraves, M.D., Ph.D. Chairperson Department of Psychiatry MetroHealth Medical Center Cleveland, OH

One thing stands out: both the head and one of the panellists hail from the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. This was formerly known as the "Clarke Institute", and by it's detractors, "Jurassic Clarke". It, and its staff, are "controversial" to say the least. Many in the World Professional Association for Transgender Health (WPATH - formerly HBIGDA) would describe them as "fringe". This is the only institute that has two members on the panel.

Dr. Ray Blanchard resigned from the Harry Benjamin International Gender Dysphoria Association (HBIGDA) in protest to the ethics investigation of his protégé, J. Michael Bailey. Blanchard, a psychiatrist, member of a eugenics think tank, and vocal proponent of repathologizing homosexuality as a mental illness, still runs Toronto’s Clarke Institute as a maximum security processing facility, using the same procedures, locked rooms and shared space areas for pedophiles, rapists, homosexuals, and transsexuals.

From Rodkin D. Sex and Transsexuals. Chicago Reader December 12, 2003, a quote which shows the importance of the DSM even outside the USA:

Blanchard, who happens to be an American citizen, says a DSM listing has different implications in Canada than in the U.S. "This question of whether autogynephilia should be listed as a disorder is strictly an American preoccupation," he says. "In the U.S. there is no universal health insurance plan, so people will pay for their SRS out of their own pocket. But in most of the Western world, where there is government-run health insurance, in order for their sex reassignment to be paid for, it has to be a disorder, it has to be in the DSM. Health plans don't pay for surgery that is elective. They pay for surgery that is medically necessary."

Thereby completely missing the point: broken legs are not in the DSM. Surgically correctable congenital conditions are not in the DSM. If Transsexuality, like Intersex, is a biological condition, it belongs with the other biological disorders, not the psychiatric ones. The disabling distress, the GD or "Gender Dysphoria" caused by lack of treatment for the condition does though, so his job is safe, especially in determining what degree of surgical, hormonal, and supportive treatment is required to deal with the psychic damage caused by the distress. The "resultant co-morbidities" of being driven insane by decades of psychic torment.

He points out that from 1970 to '99 the Ontario Health Insurance Plan covered sex-reassignment surgery for patients who'd been approved for it by the Clarke Institute. But the conservative government that came to power in 1999 stopped paying for it. "Now a group of transsexuals have brought a human rights complaint against removal of sex-reassignment surgery as a benefit," he says. "Their argument is that this is a recognized treatment for a psychiatric disorder. It's got to remain in the DSM. The DSM has no formal jurisdiction in Canada, but in fact it's taken as the standard."

Note "autogynephilia" not "transsexuality" or "gender dysphoria". As was said at the rather polemical transgender roadmap:

Many are beginning to question whether these diagnoses are really necessary in order to receive health services. Many are even questioning whether these are diseases at all. Because Blanchard and several cronies are heavily involved in the DSM's language about these "disorders," it is likely that we will see a pitched battle about this matter when the next DSM revision is made.

Indeed, a prediction that has come to pass. And it appears they've won.

The Chair, Kenneth Zucker is best known for his "Reparative Therapy" to "cure" gender-variant children. here, I'll quote what was said about him by one of his admirers:

Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual.
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First, he thinks that family dynamics play a large role in childhood GID (Gender Identity Disorder)—not necessarily in the origins of cross-gendered behavior, but in their persistence.
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So the first prong of Zucker’s approach is family therapy.
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The second prong is therapy for the boy, to help him adjust to the idea that he cannot become a girl, and to help teach him how to minimize social ostracism. Zucker does not teach boys how to walk in a manly fashion, but he does give them feedback about the likely consequences of taking a doll to school.
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The third prong is key. Zucker says simply: “The Barbies have to go.” He has nothing against Barbie dolls, of course. He means something more general. Feminine toys and accoutrements—including Barbie dolls, girls’ shoes, dresses, purses, and princess gowns—are no longer to be tolerated at home, much less bought for the child.
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Failure to intervene increases the chances of transsexualism in adulthood, which Zucker considers a bad outcome. ... Why put boys at risk for this when they can become gay men happy to be men?

Better a normal, effeminate gay boy than an icky girl! And it's all the parents' fault too. Gender Variant Kids should be terrorised into conformity.

Those quotes are from Michael Bailey, by the way, the one who so famously said that young, pretty transsexual women are "peculiarly fitted to be prostitutes" due to their sexual appetities, (which of course are entirely absent in "real women" as everyone knows). *SIGH*

Jack Drescher, also on the panel, is best known for his labelling of Reparative Therapy of the kind advocated by Zucker as Junk Science practiced only by Quacks. It doesn't take a Rocket Scientist to predict Fireworks.

Ray Blanchard I've already dealt with, but I must say a number of things to complete the picture. He's a giant in his field, he's done some excellent research and data gathering. It's only his conclusions, ones forced on him by his early training as a Freudian psych unaware of such new-fangled notions as MRI imaging, brain lesions causing psychiatric illnesses and the like that make him "beyond the fringe".

Peggy T. Cohen-Kettenis is a specialist on Neuroanatomy, and the difference between male and female brains, including transsexuals.

Heino F. L. Meyer-Bahlburg is an endocrinological specialist, who knows a lot about the role of pre-natal hormones on gender development, and is the only one who has knowledge about Intersex conditions.

Of the rest, none have any specialised knowledge about Gender.

Niklas Långström specialises in violent male sex offenders
Irving M Binik specialises in female orgasmic disorders
Robert Taylor Segraves specialises in sexual dysfunctions, impotence etc
Cynthia Graham specialises in sex therapy with respect to contraceptive use
Richard B. Krueger again specialises in sex offenders

Now Ray Blanchard, despite his unique views that all transsexuals, without exception, are gay boys or perverts, does not believe that sex reassignment should be denied them, and he believes this on strictly humanitarian grounds. He doesn't see that others in the legal and political areas, those who pass laws about this, just might not agree with his highly principled stance.

Others do though. The ones who have suffered as the result. They tend to think the worst, and are seldom disappointed. I'll quote from Organisation Intersex International. I apologise for the alphabet-soup of acronyms, they're a hazard of the profession when dealing with Intersex issues.
DSD - disorders of sexual development (Intersex by any other name)
NC-CAH NonClassical Congenital Adrenal Hyperplasia (what I'm being treated for)
17 Beta HSD 3 - 17BHDD, a cellular hormonal conversion problem leading to feminisation at birth, and masculinisation later. Similar to 5ARDS, 5 alpha reductase dediciency syndrome :

Next, I would think that they would classify the syndromes which they have been studying and have been frustrated about the most lately, and those are the 3 in which patients are MOST likely (more than surgeons) to request a reassignment. These categories are 5 alpha reductase 2 deficiency, NC-CAH, and 17 Beta HSD 3. There have already been studies on 5 alpha in transsexuals which found that M to F's don't have 5 alpha. Thus, those who wish to reject a male assignment will be labeled as paraphilic, and those who want to live as males will make this appear more justifiable, plus this will fuel their desire against feminizing surgeries Those who virilize at puberty and insist on masculinizing surgeries will be those whom they will seek to find grant money for in order to investigate if autoandrophilia (the counterpart in “females” of autogynephilia) exists. Then, because they have found such a high incidence of NC-CAH in F to M transsexuals, they will likely claim that CAH is similar to F to M transsexualism. Those who wish to live as males will continue to pull in more grant money because they will be more than tomboys: they will be autoandrophilics. Homosexuals would be the only other category.

Here is the progression I see in how DSD is important in reframing intersex as a sexual fetish (or paraphilia).

A) M to F TRANSSEXUALS will be the first to be classified as paraphilic. Then-

B) "DSD persons" who would not have been called intersex under the LESS inclusive category of intersex, if they reject their gender assignment, will be labeled as paraphilic. Then-

C) the conditions which PATIENT initiated gender re-assignment is requested (most common in 5 alpha, CAH, and 17 Beta) will be classified as paraphilic. Then-

D) Autoandrophilia will be created for female to male transsexuals.

E) people who were always considered intersexed, who reject their assignment, will be labeled as paraphilic.
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The problem is not autogynephilia per se. It is the conflation of intersex issues (or people with DSD’s) with something unrelated to why many people with intersex variations reject their gender assignment which is problematic.

We in the intersexed and trans community risk ending up in a situation where:

Surgeons who perform intersex normalization surgeries without the consent of the child will always be right.
Surgeons who offer sex reassignment surgeries to adults with informed consent will always be wrong.

Many stakeholders involved in intersex treatment benefit from this, especially the surgeons and pediatric endocrinologists. Unfortunately, the main victims are the intersexed children themselves.

And that is why both Intersex and Transsexual groups are up in arms about this. The more scientifically literate, and that is a very high percentage, because of the "junk science" that will likely lead to greater persecution. The rest because of the insult such views offer us, to be mischaracterised and misrepresented in such a blatant way, our honest narratives dismissed as lies by lunatics.

Should this state of affairs be allowed to continue, should the fringe views of a few paleolithic neo-Freudians be adopted as Gospel, then an avalanche of discriminatory regulation will likely ensue. The long-standing rights to correct birth certificates, to marry in the correct gender, even to work near children, will likely be withdrawn. After all, we'll be officially "self-mutilating male perverts or gays" according to the APA, no matter what the specialists in the area might say.

Now you know why I'm reminded of those far off days in the 1930's. The echoes are faint, the people involved all well-meaning, but the consequences for people like me could be catastrophic.