Wednesday, June 3, 2015

Transgender surgery. A civil rights issue?

Dr McHugh doesnt think so, and he has just said so in the WSJ.

Yet policy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention. This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes.

The transgendered suffer a disorder of "assumption" like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one's maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.

At the heart of the problem is confusion over the nature of the transgendered. "Sex change" is biologically impossible. People who undergo sex-reassignment surgery do not change from men to women or vice versa. Rather, they become feminized men or masculinized women. Claiming that this is civil-rights matter and encouraging surgical intervention is in reality to collaborate with and promote a mental disorder.

Dr. McHugh, former psychiatrist in chief at Johns Hopkins Hospital, is the author of "Try to Remember: Psychiatry's Clash Over Meaning, Memory, and Mind" (Dana Press, 2008).

What do you think?

I think some, very few, people have such severe gender dysphoria that they really should change their own gender identification to the opposite sex. i.e., I think there are (and have seen, though not managed) patients who, as children, are completely and totally unhappy about their gender. There are young boys who endlessly dream of being a girl and young girls who desperately want to be boys. I assume some of the same carries over into adult life. If gender dysphoria is powerful and persistent, why not allow them to live as the opposite gender?
But I also think any surgery is cosmetic and is not a medical necessity and should not be done to children. I realize that this is a bit of a muddled position. It's a muddled topic. I am wary of surgery because it is so hard to reverse and is such a "physical" treatment for what is, after all, a psychological issue... a problem that the patient may think will be helped by surgery, but that the data (and the surgical procedures themselves) suggest is not cured by surgery in the sense of "no more problem".

The SJW community is fully committed to this cause and it has mainstream liberal support. But I am not sure the SJW community has thought it through. Just as an example, the same community is committed to the belief that sex roles are social constructs, not biological. That leads to obvious difficulties with this topic.
Anyway, I think civil rights for people who do opt to live like the opposite gender is not a bad cause (everyone should be free to live as they please as long as they dont hurt others, etc), but surgery for children may be a step too far.
I am open to being converted, one way or the other :)