“Male gender dysphorics, paedophiles, and fetishists:" How Ray Blanchard sees us

The quotation in the title above is from a 1993 paper by sexologist Ray Blanchard. [1] Blanchard is affiliated with Toronto’s Clarke Institute, long known as “Jurassic Clarke” among transsexual women for its outdated and draconian rules imposed upon women in our community seeking health services. In Blanchard's worldview, transsexual women are males whose condition is on a continuum with the other groups he studies.

Background: The Clarke Institute

The Clarke Institute is named after Charles Kirk Clarke (1857-1924). Clarke oversaw the two largest Canadian mental hospitals before accepting a government mental-health post. In addition to his desire “to keep this young country sane,” he sought to advance the psychiatric profession’s influence in making medical and political decisions.

Typical of “professionals” who are unable to see (or worse) unconcerned about larger systems which influence their realm of expertise or narrow interests, Clarke was an early proponent of eugenics, emphasizing the importance of restrictive laws that would limit the immigration and marriage of the“ defective.” [2] During his tenure, foreign-born patients made up more than 50 percent of the institutionalized population in Canada. [3]

As Katherine Wilson notes:

Psychiatric diagnosis on the basis of social, cultural or political affiliation evokes the darkest memories of medical abuse in American history. For example, women suffragettes who demanded the right to vote in the early 1900s were diagnosed and institutionalized with a label of "hysteria" (Mayor, 1974). Immigrants, Bolsheviks and labor organizers of the same era were labeled as socially deviant and mentally defective by prominent psychiatric eugenicists, such as Dr. Charles Kirk Clarke. [4]

Christened with his name, the Clarke Institute of Psychiatry opened for business in 1966. A young staff member recalls those early days:

My first impression of psychiatry in Toronto was that it was rather parochial in outlook and had a distinct British socio-biological emphasis and little interest and much scepticism about psychoanalysis. […] The Clarke, instead of being an ivory tower, seemed more like a cold cement fortress. [5]

Enter Ray Blanchard

Ray Blanchard came to "The Clarke" after studying sexual behavior in criminal men, pedophilia in particular. He began his work with Kurt Freund, who brought Blanchard into Clarke, and who himself is an expert in the area of "phallometric testing," a "psychophysiological method for assessment of erotic preferences in males" -- strap a "strain gauge" around a guy's penis, show him pictures of whatever, and draw your own conclusions. Indeed, the Clarke Institute's own literature states,

The Clarke Division Phallometric Laboratory was established by Kurt Freund, M.D., D.Sc., the first clinical sexologist to use penile plethysmography to assess erotic preferences in men. It is the oldest laboratory in North America for the phallometric assessment of sex offenders and paraphilics, and its instrumentation for the collection and processing of phallometric data is still the most sophisticated in North America, or indeed, in the world. [6]

The problem with penile plethysmographs (PPGs) is that they are like lie detectors (polygraphs): they measure a body response, but the data is open to interpretation. For this reason, they are often challenged as evidence in court, as with lie detectors. As the Skeptic's Dictionary notes:

A man or woman may be aroused by the sight of animals copulating or be aroused by a film of a woman eating a banana and a man eating a fig in particularly provocative ways. Still, they may have no desire to engage in bestiality or have sex with a bowl of fruit. A heterosexual man or woman may be aroused by the sight of lesbians engaging in oral sex, but have no desire to have sex with lesbians or in the presence of lesbians.

Strong arousal need not imply strong desire for what causes the arousal; and weak arousal need not imply weak desire. Furthermore, no test can determine whether a person will act on his feelings and desires. [7]

This is the major controversy in Blanchard's work: interpretation of data, and issues of his subjectivity, based on his assumption that transition is about erotic preference. While this may describe someone like Anne Lawrence, who considers her sex drive "that which moves us most," many of us feel this is not an accurate or even correct description of our motivation for transition. Cause and effect may be difficult to distinguish.

Blanchard has headed both the department for sex offenders and the department for gender identity. In fact, patients have told me that in the past The Clarke was set up so sex offenders and transsexual women shared a hallway, offices, waiting room, and even staff, who would essentially just "change hats" whether they were seeing a transsexual woman or a sexual predator. Imagine the dynamic that created. It was under these conditions that Blanchard made many of his observations regarding people presenting with gender issues.

A reader writes:

Blanchard, like many researchers of his day (and sadly today as well) take their base assumptions from their formal training and experience. Homosexuality may be out of the DSM, but it was not that long ago that it was considered itself a psychopathology. The psychological community's exposure to "things trans" was for many, many decades the paraphilia and festishism that spring from transvestism. Erotic preference is, I think, an important key to understanding all the "taxonomy" of Blanchard.

In his research approach (and many, many others'), their tacit assumption is the problem lies solely in the mind, be you a pedophile or paraphiliac or gender dysphoric (the "constructionist" approach versus "essentialist"). This naturally leads in the matter at hand to focusing on erotic preference as the "natural" dividing line.

Put yourself in Blanchard's shoes (or Bailey's for that matter). They genuinely and honestly do not believe the claims of people like ourselves that we are who we are. To them, we're men, and it's just that simple. They take that stance not even as a conscious effort -- it's just where they came from as psychologists. The fact they might use the pronouns we prefer is just a way of humoring the patient, but in no way implies or lends credulity in their minds to the legitimacy of their use.

Not only do they see us as men, but they also consider transsexual women to be liars, guilty of "systematic distortion." Below is an abstract from a Blanchard paper (when Blanchard says "heterosexual" and uses male pronouns, he means transsexual women attracted to women):

The tendency for a heterosexual subject to describe himself in terms of moral excellence or admirable personal qualities was significantly correlated with scores in the 'transsexual' direction on all eight sexological measures; for the homosexual subjects, only one correlation was significant. [... It] is possible that the differences in the histories produced by transvestites and heterosexual transsexuals are exaggerated to an unknown degree by the motivation of the latter to obtain approval for this operation. The findings do not diminish the important distinction between these groups, but they do suggest caution in interpreting the self-report data that have been used in comparing them. [8]

We find ourselves in a no-win situation in changing their viewpoint. We are males to them, and when we try to explain why we feel this is not accurate, we are unreliable reporters who can't be trusted.

Karen Gurney writes:

The problems I see, with the Blanchard position is that:

(a) it falls into the fundamental trap of trying to put overarching labels (either/or) on a group which is the epitome of diversity itself;

(b) it fails to recognise the physical intersexual nature of transsexualism - the incongruence between the phenotypical and neurological sexes;

(c) it seeks to attribute the psychological manifestations of neurological sex solely to "sexual desire" and does not reflect the John/Joan evidence which was so revealing of the shortcomings of psychological thought in regard to then accepted notions that gender is constructed;

(d) it is inherently disrespectful of the experiences of the majority of us who live with transsexualism, and especially those who pioneered the way by undergoing essentially primitive surgeries (as the transsexual men forgotten by Blanchard and Bailey still do) which did not produce wholly functional genitals, sacrificed all sexual sensation for the sake of harmonising "mind" and body, and were carried out in often ill-equipped clinics in faraway places (I have a friend who had her surgery in Casablanca in the early 1960's);

(e) it is predicated on the notion that sex assignment at birth is immutable and hence is opposite the medical rationale applied to many thousands of intersex individuals each year that, where sex is atypical or ambiguous, a medical construction is a valid response, and the legal position that such a constructed sex is valid (I do not seek to justify the ethics of such assignments where they are carried out shortly after birth but point to the many XY females who are happy in their opposite gender role and are accepted as females for all purposes); and

(f) it fails to account for the experiences of a significant number of intersex individuals who do not fit into a theory which is based on the dichotomy of both sex and gender and whose gender, like their sex, is ambiguous.

In 1998, the Clarke merged with three other mental health and addiction facilities: the Queen Street Mental Health Centre, the Addiction Research Foundation, and the Donwood Institute. Collectively, they are now known as the Centre for Addiction and Mental Health (CAMH) [9]

Perhaps we should think of The Clarke the way they think of transsexual women. They can change their name and act like a mental health facility, but deep down they are still the same fossilized institution that pathologized homosexuality and continues to pathologize those who do not fit society's standards for male and female.

From Blanchard to Bailey

From Blanchard's work comes Bailey' popularization of Blanchard's observations and theories, where we become exotic or pathetic males driven by sexual urges to drastic ends. As Katherine Wilson notes:

Much psychiatric literature about transgender people is shockingly similar to that published about homosexuality before it was depathologized. It is based on a presumption that cross-gender identity/expression is by definition pathological, is focused on unsubstantiated theories of psychodynamic (mother-blame) cause and anecdotal case studies of institutionalized subjects, denies the existence of healthy productive TG people in society, and ignores anthropological evidence of accepted cross-cultural TG roles. These tired old myths were debunked for sexual orientation 25 years ago and have been recycled to target transgender individuals. [4] (emphasis mine)

As we continue to see more work into the field of biologic and genetic investigations of sex and sexuality, it is very important to do what we can to help those undertaking this work to understand the larger systems in place, outside their realms of expertise. To ignore the historical context and the important ethical and political issues involved in this type of research has shown to be disastrous throughout history.

These people may consider themselves above criticism, especially critical comments by those from whom they make their livings, but they do so at their own peril, and at the peril of society.

It's impossible to separate ideological commitment from the highly specific historical contingencies bearing upon psychology and medicine in this time and place. This can certainly be demonstrated in Clarke's work on eugenics, which diffused through society and later accreted around fascism and Nazism. Those of us outside psychiatry, and those of us directly affected by the profession, must raise these important issues and maintain a rigorous critical viewpoint. In that way, we can hope to avoid having what appear to be "facts" misinterpreted, by both researchers and the public.

Bailey's interest in biological and genetic causes of sexuality and transsexualism does not occur in a vacuum, and he is not as "objective" as he'd like to think. As occasional Bailey co-author Richard Pillard notes:

No scientific knowledge is risk-free, and this must surely include genetic investigations of sexual orientation. One might take a sort of perverse comfort in knowing that homophobia, like racism (and all the xenophobias), exists regardless of whatever might be considered "the facts" of the moment. Research on human sexuality will, by its nature, evoke resistance and fear, to some extent legitimately. [10]

Draft version. Many thanks to those who contributed materials. Please contact me with comments.


1. Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. Freund K, Blanchard R, Br J Psychiatry 1993 Apr;162:558-63

2. Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940. Ian Robert Dowbiggin. Cornell University Press, 1997.

3. www.americanscientist.org/bookshelf/Leads98/benjamin.html

4. http://www.transgender.org/tg/gidr/tf3023.html (citing Dowbiggin, 1997, pp. 133-177).

5. http://www.psychoanalysis.ca/clients/cps/essays/tps%20history.html

6. Clarke website.

7. http://skepdic.com/penilep.html

7. Social desirability response set and systematic distortion in the self-report of adult male gender patients. Blanchard R, Clemmensen LH, Steiner BW, Arch Sex Behav 1985 Dec;14(6):505-16

8. www.gicofcolo.org/gd/writings/faqpsy.html

9. http://www.camh.net/

10. "The Genetic Theory of Sexual Orientation" in the Harvard Gay and Lesbian Review, Winter 1997, pp. 61-67.