Features Australia

True selves

15 July 2017

9:00 AM

15 July 2017

9:00 AM

News of a world-first designation of a gender-free baby in Canada will come as no surprise, but should come with significant alarm. Canadian officials have issued an identification card with a U where an M or F should be, standing for unassigned.

Other government authorities are refusing to issue a birth certificate for the child, Searyl Alti, unless a gender is stated in the application, much to the ire of the transgender/non-binary mother, Kori Doty.

‘I want my kid to have all of the space to be the most whole and complete person that they can be,’ says Doty.

As a psychiatrist I have many patients who speak of being stuck in the wrong body. I have young men taking steroids assuring me their Herculean bodies are merely a step on the journey to their authentic selves. Other patients speak of finding their essence after I prescribe them anti-depressants. And there is the new epidemic of gender-confused patients like Doty determined to be something other than their biological sex.

On each occasion, the true self is that which is produced by medical science.

There is an unusual disorder known as apotemnophilia, which was first defined in the 1970s as an attraction to the idea of being an amputee. This is different to being turned on by amputees, a disorder known as ‘acrotomophilia’. Sufferers rarely present to mental health services, they have a significant Internet presence. One internet discussion group for people wanting to become amputees has several thousand subscribers.


In a 2004 BBC documentary, Complete Obsession, psychiatrists and surgeons involved with such patients spoke of how no amount of therapy made a scrap of difference to amputation desires.

What is striking is sufferers use of the language of identity and selfhood in communicating their desire to be an amputee, lines such as ‘I felt that this is who I really am’ or ‘It’s a desire to be “myself” as I feel myself to be’. There are technical debates about whether the disorder is one of body image or of misplaced desire. Surgeon Robert Smith believes the amputee wannabes have considerable overlap with the modern transgender movement. They are uncomfortable with their identities and and believe a change of sex will provide a solution. In my profession, the gender-confused used to be categorised by the term ‘gender identity disorder’, but this has since been changed to ‘gender dysphoria’ to reduce stigma. The transgender activists want to have their cake and eat it too. They don’t want to be labelled mentally ill, but still want access to health insurance subsidies for treatment.

Colleagues who help transition transgender patients to the opposite sex say they are merely relieving the distress of their patients. Meanwhile, the same colleagues are also sympathetic to activists who want to treat sex change much like having a baby, a normal life procedure that requires some medical input.

The strongest critics of this approach such as Paul McHugh, Professor of Psychiatry at John Hopkins University, have not changed their tune despite the cultural tide. McHugh was part of a team pioneering treatments for gender identity disorder in the 1970s. His views, strongly endorsed by the American College of Paediatrics, are that gender re-assignment surgery and the giving of cross-sex hormones for teens is a type of abuse.

Despite the subjective sense of relief many patients report, the much higher than normal suicide rates after surgery remain. Suicide is up to twenty times higher for gender changers.

The medical profession likes to radiate an air of omniscience but is not immune to cultural forces and the infiltration of activists. Alternative medicine is a great example; despite a lack of any scientific foundation, many inner city doctors have embraced the practice.

I would argue many of the fly in and out doctors who called our asylum seeker detention centres gulags of torture were also activists first and foremost, donning a trojan horse of science to prose-cute their political agenda. Likewise many psychiatric diagnoses have more to do with cultural trends than any new science, not least post-traumatic stress disorder which came about in the aftermath of the politics of the Vietnam war. False memories in the 1990s, fugue states in late nineteenth century France and multiple personalities in 1970s and 1980s also come to mind.

Brisbane psychiatrist Dr Stephen Stathis has witnessed the dramatic rise in presentations in his gender dysphoria clinic and sees its rise very much as a cultural fad, noting many teens adopt a ‘try out’ strategy as a way of being different. Over ninety per cent will grow out of it, usually becoming ordinary gay adults.

But there is a growing push to present the perfectly reasonable wait and see approach as ‘reparative’ therapy, likening it to conversion therapy for homosexuals.

A Toronto study of male sufferers by psychologists showed a subset were turned on by seeing themselves in the clothing of the opposite sex, while others were attracted to males. They were essentially homosexuals yet to integrate their identity. The pioneering centre which has researched gender confusion for decades, led by world expert Dr Kenneth Zucker, was shut down last year by lobbyist pressure for allegedly encouraging reparative therapy. This was a dramatic victory for the transgender movement, one that may encourage an international hubris.

While activists and colleagues working in the space, often past sufferers of gender and sexuality confusion themselves, argue that our cultural conditions are working to reveal transexuals, the evi-dence suggests they are primarily creating them. More people have started to conceptualise and interpret their experience in these terms, making sense of their lives in a way that wasn’t available to them before. This would be harmless if there weren’t growing forces determined to intervene on their behalf with life-altering medicine, the moral fervour fuelled by an image of themselves as the latest soldiers of civil rights. If allowed to continue, the rise of the transgender movement may represent one of the great victories of identity politics, that subjective truth and personal testimony is paramount, secondary to even biology.

Author’s note:
Medical philosopher Carl Elliot explores themes around apoptemophilia in his book “Better than Well” which is also explored in an Atlantic article.

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