6/3/15. Psychiatrist Paul McHugh says a drastic physical change doesn't address underlying psycho-social problems.
http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120
The following response is from Dr. Aaron Ceresnie (full disclosure: my nephew)
This
article seems to be drawing conclusions from a lack of perspective of a person
who identifies as transgender and from the perspective that being a transgender
person is itself a medical/psychiatric problem. I would suggest that "transgendered"
also isn't the correct language, and identifying as a different gender than
given at birth is not in and of itself is not a mental disorder, unless it
causes significant functional impairment and distress. The much larger
incidence of suicidal thoughts/attempts in that population should also take
into account (which this article does not) the proportional amount of
harassment and violence transgender people are subjected to on a regular basis
from as early as they begin identifying that way publicly, or even if trying to
pass discreetly. There are no anti-discrimination protections for
transgender people, and they are often victims of hate crimes. I didn't see any
discussion regarding the influence of constant bullying, a lack of social acceptance,
or recognition of their identity as legitimate. Also, people who are
transgender in one form or another have always existed and have been documented
in indigenous cultures. The 10 year follow-up study that found
an increased risk of suicide was comparing transgender individuals to
a non-transgender population. I'm wondering how that data compared to other
transgender individuals who wanted but could not get the surgery. The author's
statements also reflect an assumption that the transgender population is
homogenous, which isn't the case. A lot of people who are identify as the
opposing sex never want surgical interventions. There's just more nuance and
heterogeneity than suggested in the article.
Moreover, Bradley/Chelsea Manning isn't a good example and it seems
presumptuous to say he wanted to identify as female for a lesser punishment.
Military documents show he started questioning his gender and asking about
reassignment surgery in 2009 and he didn't provide WikiLeaks with any
information until 2010. I don't see a good connection there.
I'm also not aware of any research
showing success of psychiatrists or therapists "restoring natural gender
feelings to a transgender minor", which sounds a lot like conversion
therapy for people who are gay (which has also not been successful and
denounced by the American Psychological Association due to its coercive
nature).
Sexual reassignment surgery of
minors is a legitimate concern, and I would argue a consenting adult who has
really thought about it should be entitled to the surgery. This article seems
to be more concerned with how Medicaid allocates money than the legitimacy
of the surgery itself or the socio-cultural environment in which transgender
individuals exist. The article is making the case that surgical
intervention is never a good idea, and I'm not sure there's evidence to support
that claim either. More research is always a good idea. One could make a
similar argument about elective plastic surgery.
Aaron
Ceresnie, Psy.D.