A Minority View of Transsexuality

From the Frontispiece of ‘Lectures on Violence Perversion and Delinquency’, part of the Portman Papers, containing articles by staff at the Portman Clinic, selected and edited by staff at the Portman Clinic, and peer-reviewed by staff at the Portman Clinic. :

“The Portman Clinic has been applying a psychoanalytic framework to the understanding and treatment of violent, perverse, criminal and delinquent patients since its foundations in the early 1930s. All Portman Clinic patients have crossed the boundary from fantasy and impulse to action – action that defies legal and moral boundaries but that also breaches the body boundary of the victims. Ultimately, the violence underlying most of such violent, perverse and delinquent action also attacks and disturbs the mind of both the victim, be that an individual or society and that of the perpetrator. In this volume, contemporary staff describe their thinking and clinical work. Theoretical underpinnings for the understanding of perversion and violence, questions of risk and ethics and the institutional difficulties which emerge during the care of these patients are presented alongside chapters on clinical work with adults and adolescents, including chapters on pedophilia, the compulsive use of internet pornography and transsexuality. ”

Quotes from the article (emphasis in the original)

p190:

“A recent ruling in the European Court of Human Rights resulted in the decision that a postoperative male to female trans-sexual had the right to marry a biological male (2002). In response to this I and a number of other clinicians wrote a letter which appeared in the national press stating our views on the condition and how we felt that such a decision by the European Court of Human Rights was a victory of fantasy over reality…”

“Of course neither I nor any of the other clinicians with whom I work are opposed to a trans-sexual being allowed the right to marry,

How generous of him. I have been treated with such affability, such condescension, as I would never have dared to hope for. as was said in "Pride and Prejudice".

but our objections are that they be allowed as a person of the sex they are not. If legislation was to change to allow individuals of the same sex to marry, then this would allow trans-sexuals to marry individuals of either gender without problems. It seems that the recent ruling is a step backwards for the right of same-sex marriage, an issue that affects homosexuals in this country and to prevent them from having the opportunity of marriage. It seems that rather than change this legislation (although the recent developments in ‘civil partnerships’ goes some way towards this) the ruling for trans-sexuals that it is not acceptable for members of the same sex to marry with the exception that it is acceptable if one of the sexes can at least have the suitably deceptive appearance of the other sex.”

p.191

“A similarly related ongoing battle is the fight for the trans-sexual to be allowed to change the gender specified in the birth certificate. Again, we are faced with deception.”

“A further illustration of the deception would be the possibility arising in the event of both of the aforementioned pieces of legislation. They could result in a man marrying what he presumed to be a woman who had a female passport, a birth certificate declaring him to be female at time of birth, who is taken to be female and an individual whom he believed he could marry and who could be the mother of his children but in reality his wife actually being a man.”

p192

“This is followed by the psychiatric profession entering in the ultimate collusion with the psychosis manifest in their insistence that these patients dress up and live in their desired gender role for two years, in order to ascertain how successful the deceptive process can be.”

Elsewhere the author states that this psychosis is an encapsulated psychosis, which is why the patient doesn’t show any signs of mental illness. The same justification as the old Soviet diagnosis of “sluggish schizophrenia”.

No reference to reports of results of course. Such things are below them. No references at all, really.Of the case reports, none meet the ICD-10 diagnostic criteria for Transsexuality.

See also this letter written by... you guessed it... staff at the Portman Clinic.

Sir - The recent judgment in the European Court of Human Rights (report, July 12), in which a post-operative transsexual person was granted permission to marry in his adopted gender role, is a victory of fantasy over reality.

The experience of many psychiatrists, psychoanalysts and psychotherapists working with transsexual patients is that they are individuals who, for complex reasons, need to escape from an intolerable psychological reality into a more comfortable fantasy. By attempting to live as a member of the opposite sex, they try to avoid internal conflict, which may otherwise prove to be too distressing.

It is a measure of the urgency and desperation of their situation that they frequently seek surgery to make their fantasy real. By carrying out a "sex change" operation on their bodies, they hope to eliminate the conflict in their minds. Unfortunately, what many patients find is that they are left with a mutilated body, but the internal conflicts remain.

Through years of psychoanalytic psychotherapy, some patients begin to understand the origins of their painful conflicting feelings and can find new ways of dealing with them, other than by trying to alter their bodies. The recent legal victory risks reinforcing a false belief that it is possible to actually change a person's gender. It might also strengthen the view that the only solution to psychic pain is a legal or surgical one.

Sira Dermen, Dr Damian Gamble, Dr Az Hakeem and five others Portman Clinic, London NW3 12:01AM BST 15 Jul 2002

Oddly enough, they've not published any record of the results of their "talking cure" in long-term follow-up. Neither has anyone else.

The issue here is the PoMo snake oil. The labelling of GID as a "psychosis" when it meets none of the diagnostic criteria for that - like calling Clostridium Botulinum a "virus", or the Fibula a Tibia.

The a priori assumption is that Transsexuality is a pathological, dangerous and violent form of delusional insanity.

That these are "violent, perverse, criminal and delinquent patients".

Making no exceptions, the lectures state that "ALL Portman Clinic patients have crossed the boundary from fantasy and impulse to action – action that defies legal and moral boundaries but that also breaches the body boundary of the victims."

So who are the victims here? The patients themselves? No, that's made clear in the distinction between "victim" and "perpetrator". Society is the victim. Society gets disturbed, just as Society was disturbed by "Sluggish Schizophrenia with Delusions of Democracy".

"Ultimately, the violence underlying most of such violent, perverse and delinquent action also attacks and disturbs the mind of both the victim, be that an individual OR SOCIETY and that of the perpetrator"

It is a classical case of political or ideological diagnosis. The "violence", as with the "hooliganism" of the Russian Dissidents, is only to socially and politically acceptable beliefs. The same as with the previous diagnoses of "drapetomania" - the psychosis of slaves desiring emancipation - and "suffragette hysteria" - the psychosis of women wanting to vote.

As for "encapsulated psychosis"? Possible, yes. Controversial, certainly. How could one test for its existence?

Subjectively speaking, I'd have to believe it, having experienced it as a defence mechanism for many years. I had to "forget" things and deny objective evidence in order to believe on a superficial level that I was male. The alternative was literally unthinkable, as in "I was unable to think it" regardless of observable facts. Yet in other ways, I was relatively well-adjusted, with only a few signs of eccentricity and, not exactly bizarre, but inexplicable quirks of behaviour.

It's scary because, once you realise that it happened once, you also realise that if it happens again, you will have no insight into it, and must therefore listen to what others say.

Getting back to the view of Trans and Intersexed people who object to their assignment of sex at birth... this view, that they are "violent, perverse, criminal and delinquent" while once very much in the mainstream (before 1965 anyway) is no longer fashionable. So it seems Dr Haleem must change with the times.

On 20th May, Dr Az Hakeem is due to speak to the Gay and Lesbian Special Interest Group of the Royal College of Psychiatrists.

Dr Az Hakeem: Deconstructing Gender and Parallel Processes:
Features specific to a Specialist Transgender Psychotherapy Service

Dr Hakeem's recent works:
Deconstructing Gender in Trans-Gender Identities'. Group Analysis. The International Journal of Group Analysis Volume 43 Issue 2, June 2010

In this theoretically informed clinical study the author draws upon the psychoanalytic and group therapeutic literature in addition to the works of Judith Butler and his own clinical group analytic work with trans-gender in order to discuss the author’s hypothesis that binary gender rigidity stands at the core of trans-gender states. The author suggests that the analytic task is to deconstruct gender and trans-gender constructions in working with these patients. In addition to working towards greater analytic understanding such an endeavour may also be considered as a social, political and cultural exercise in working towards shifts in our societal foundation matrix.

Small group psychotherapy is used as a medium for these observations and as the basis for this study.

Parallel Processes': Observed in the Patient, Therapy and Organization. Group Analysis. The International Journal of Group Analysis Volume 43 Issue 4, December 2010

In this theoretically informed clinical study the author introduces the term ‘parallel process’. Five parallel processes of ‘confusion’, ‘genital-centrality’, ‘binary rigidity’, ‘rejection’, and the ‘questioning of authenticity’ are observed in the analytic material presented by trans-gender patients in specialist small group psychotherapy, and observed similarly in the organizational context in which the group takes place. The author provides a theoretical explanation for the occurrence of such parallel processes. The author concludes that the term ‘parallel processes’ describes a phenomenon currently without definition in the existing group-analytic vocabulary and suggests it should be added as a group-analytic term to describe the processes that are clinically and theoretically detailed in this article.

Wait a sec... didn't he write about "... a false belief that it is possible to actually change a person's gender."? Now he's saying that Binary Gender Rigidity is the problem, and Gender should be deconstructed?



Full text (omitting the non-traditional Cromwell verse) here.

UPDATE: From Dr Hakeem's website

Whilst most people are familiar with transsexuality and gender reassignment as a physical intervention for transsexuals, there is little awareness around those people who do not fit neatly into a typical 'transsexual' diagnosis and for whom gender reassignment may not therefore be a suitable option. Such people may have a less certain, less fixed, more fluid, confused or intermittent sense of their gender identity and clearly a permanent gender reassignment physical intervention is not a suitable option for such people. Others may have conditions which similarly presents with confusion, dissatisfaction or unhappiness in relation to their sex/ gender or bodies but who do not neatly fit a diagnosis of transsexual and for whom physical gender reassignment is not considered either by themselves or professionals as a suitable option.
...
If a person is assessed and is clearly seeking physical gender reassignment and has no uncertainty about this then they are referred to the appropriate gender clinic. For other patients who may have more atypical gender presentations such as those described above they may be suitable for a specially tailored psychotherapeutic intervention aimed at further clarifying and establishing an understanding and certainty of their sense of gender which may or may not correlate with their biological sex.

Traditionally, psychotherapists have had very little experience of working with transgender and speculative hypotheses have been constructed based on only a few cases. Having been involved in therapeutic work with over a hundred patients with transgender and other gender identities for over a decade; my own understanding and attitudes to this field have been moulded and informed by my patients over this time. The evolution of my understanding of the condition is reflected in the qualitative shifts evident in the papers I have written in this field. For many years now I have moved away from what appeared in my early published work as appeared in 'A Case of The Emperors' New Clothes'. The reader will notice qualitative shifts successively up to my latest paper 'Parallel Processes' which gives an up to date and accurate account of the my specialist work in this area and the issues clinicians and institutions face in this work.

Well said. When the facts change, I change my opinions too.