Paul McHugh vs. transgender people

Paul Rodney McHugh (born 1931) is an American psychiatrist who is a key historical figure in the academic pathologization of sex and gender minorities. McHugh published many works on behavior and bioethics. Many of his works and appearances in the media are critical of sex and gender minorities, especially transgender people.

A noted Catholic conservative, McHugh infamously shut down the gender identity clinic at Johns Hopkins in 1979, based on a follow-up study by Jon Meyer that claimed there was no real benefit to these services. McHugh argues that gender variance is essentially a lifestyle choice or an ideology, and that offering trans health services is effectively collaborating in a patient’s delusion. He describes it as akin to giving liposuction to an anorexic person.

paul-mchugh-fox

Background

McHugh was born in Lowell, Massachusetts. His father was a high school teacher and his mother was a homemaker. According to the New York Times, “McHugh describes himself as religiously orthodox, politically liberal (he is a Democrat) and culturally conservative — a believer in marriage and the Marines, a supporter of institutions and family values.” (Goode (2002).

McHugh received his undergraduate degree from Harvard in 1952 and his medical degree at Harvard Medical School in 1956. He served as head of the department of psychiatry at the University of Oregon Medical School in the early 1970s, at the time when progressive psychiatrist Ira Pauly was also there. In 1975 he was appointed Henry Phipps Professor of Psychiatry and Director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, and Psychiatrist-in-Chief of the Johns Hopkins Hospital.

A member of the Institute of Medicine of the National Academy of Sciences, McHugh served as co-chairman of the Ethics Committee at the American College of Neuropsychopharmacology. He has also served on the board of The American Scholar until resigning in objection to an article.

Views on trans people

In the 1992 article “Psychiatric Misadventures,” McHugh outlines his distaste for three “fashions” — the anti-psychiatry movement, “sex-change surgery” and the theory of multiple-personality disorder. None, in his view, addresses what really ails patients; the result has been prolonged treatment with dubious results.

McHugh is a proponent of the concept of “autogynephilia,” a paraphilia created by Ray Blanchard in 1989:

The “transgender” activists (now often allied with gay liberation movements) still argue that their members are entitled to whatever surgery they want, and they still claim that their sexual dysphoria represents a true conception of their sexual identity. They have made some protests against the diagnosis of autogynephilia as a mechanism to generate demands for sex-change operations, but they have offered little evidence to refute the diagnosis. Psychiatrists are taking better sexual histories from those requesting sex-change surgery and are discovering more examples of this strange male exhibitionist proclivity. [3]

Conservative commentary

McHugh is a frequent guest for conservative media outlets, often sharing his views on

  • the transgender rights movement
  • paraphilia
  • the anti-psychiatry movement
  • multiple-personality disorder
  • schizophrenia
  • recovered memories
  • assisted suicide
  • abortion
  • clergy sexual abuse
  • terrorism

McHugh has been a proponent of the concept of schizophrenia, another controversial diagnosis, since the 1970s. He has been involved in work seeking genetic markers for the behavior. In this work, he has published with Malgorzata Lamacz, a former John Money collaborator on paraphilia at Johns Hopkins.

McHugh attacks anything he dislikes with the zeal of a fanatic. In 2007 he was ordered by Kansas Attorney General Paul Morrison to stop making public statements about physician George Tiller’s work. McHugh disapproved of Tiller’s work providing abortion services. Tiller was later murdered by a fanatic who was influenced by public statements made about Tiller.

McHugh is also known for his work defending Catholic priests against sex abuse charges. He was a founder and board member of the False Memory Syndrome Foundation, and he was named to a lay panel assembled by the Roman Catholic Church in 2002 to look into sexual abuse by priests, which led to protests from victims’ rights groups.

“McHugh, after all, is the man whose report to the court in one case stated that a defendant’s harassing phone calls were not obscene — including the call that detailed a fantasy of a 4-year-old sex slave locked in a dog cage and fed human waste. At least eight men have been convicted of sexually abusing Maryland children while under treatment at the “sex disorders” clinic McHugh runs at Johns Hopkins University School of Medicine — abuse the doctors did not report, citing client confidentiality. When Maryland law was changed to require that doctors report child molestation, the clinic fought it and advised patients on how to get around the law. [4]

McHugh added:

”What did surprise me was the response of the world out there: that they somehow thought Catholics wouldn’t be infuriated by this and do their best to stop it,” he said. ”I mean, I grew up in a little Catholic ghetto up in Massachusetts back in the 30’s. If there’d been anything like that there, there would’ve been broken heads amongst the priests.”

The New York Times adds, “Of course, it did happen in Massachusetts. A growing number of Catholics in that state are calling for the resignation of Cardinal Bernard F. Law, after disclosures in The Boston Globe that the Archdiocese of Boston had moved a priest, accused of being a child molester, from parish to parish.” [5]

It’s worth noting that in his defense of obscene phone calls made by American University President Richard Berendzen in 1992, McHugh oversaw recovering memories with the use of sodium amytal, and said that Berendzen suffered from “a kind of post-traumatic disorder,” [6] two concepts McHugh has questioned in other cases.

paul-mchugh
McHugh attacking physician George Tiller in 2007 before McHugh was threatened with legal action by the Kansas Attorney General. Tiller was later murdered.

McHugh has spent his career imposing his religious beliefs on the bodies of others and on the practices of peers. One Tiller patient was a 10-year-old girl, 28 weeks pregnant, who had been raped by an adult relative. McHugh said that while the girl’s case was “terrible,” it did not change his assessment: “She did not have something irreversible that abortion could correct.” [7]

Neoconservative/Catholic links

McHugh penned a piece for First Things, the neoconservative publication from The Institute on Religion and Public Life, “an interreligious, nonpartisan research and education institute whose purpose is to advance a religiously informed public philosophy for the ordering of society.”

Excerpts from Right Web on IRPL:

Both the institute and its journal function, in large part, as the institutional vehicles for the conservative religious philosophy of Richard John Neuhaus, a Catholic priest and neocon stalwart. In the early 1970s Richard John Neuhaus was a liberal, antiwar Lutheran minister, who became associated with the neoconservative camp by the end of the decade.

The Institute for Public Policy and Religion quickly established itself as staunchly neoconservative and recruited Midge Decter to serve on its board at about the same time that she was invited to join the board of the Heritage Foundation. In 1991 Neuhaus became a Roman Catholic priest.

The rise of the Institute on Religion and Public Life (and the absence of similar institutes controlled by traditional conservatives) illustrates the declining fortunes and influence of the Old Guard and demonstrates the neoconservative ability to integrate a traditional rightist position–the centrality of religion and ethics in politics and society–into the neoconservative ideological agenda.

In December 2004, McHugh wrote a rather revisionist history of transsexualism:

http://www.firstthings.com/ftissues/ft0411/articles/mchugh.htm

As with the “Psychiatric Misadventures” piece, McHugh takes credit for dismantling the gender program at Johns Hopkins, and for creating the idea of differential diagnosis. The article cites work done by Ray Blanchard at Toronto’s notorious Clarke Institute. The Johns Hopkins people under McHugh were advocating a differential diagnosis many years before Blanchard gave it his name. JHU proposed for those who weren’t “classic” or “primary” that they were “transvestitic applicants for sex reassignment” [1] who are “aging” [2] and “distressed,” [3] suffering from “pseudotranssexualism,” [4] or a “non-transsexual” variant of “gender identity disorder” (GIDAANT). [5]

This letter was published in response:

http://www.firstthings.com/ftissues/ft0502/correspondence.html

Transsexual Truths?

In “Surgical Sex” (November 2004) Paul McHugh is certainly right to assert that sexual identity (or, as I prefer, gender) is not subject to change; it is most certainly inherent. About nearly everything else, however, Dr. McHugh is quite wrong. To begin with, I honestly have to wonder how many transsexuals Dr. McHugh has encountered, either before or after surgery. While some do match his descriptions, most of those I know have actually been quite successful in their transformation and are indistinguishable from other women.
Contrary to Dr. McHugh’s claims, many transsexual women show considerable interest in children and many mourn the fact that they will never be able to bear a child. I myself have cried bitter tears over this. And yes, some transsexual women do identify as lesbian—just like women who are not transsexual. Likewise, many transsexual men identify as gay. Such is to be expected if transsexualism is more than just a choice.

The report published by Jon Meyer (and cited authoritatively by Dr. McHugh) was met with considerable skepticism at the time it was published. It was widely criticized for methodological flaws, while other studies have shown that Meyer’s study was incorrect in its conclusions. Nevertheless, it was used by Johns Hopkins as an excuse to shut down its gender identity clinic. I also note that Dr. McHugh mentions the Clarke Institute. The fact is that this agency has a notorious reputation for mistreating transsexual patients, forcing them to meet unreasonable standards, and denying them the hormones needed to modify their bodies.

One wonders why Dr. McHugh would choose such a cruel approach to the treatment of transsexuals. Sex- reassignment surgery has proven to be the only successful treatment for these patients, and yet for some reason he wishes to deny this. He makes a rather clumsy attempt to justify his position by comparing the treatment of adults who are transsexual with the treatment of children who are intersexed. Ironically, the arguments for one contradict the arguments for the other. Children who are intersexed have traditionally been surgically altered in whatever manner is simplest. This has often resulted in a child who has a male brain being given a female body. As Dr. McHugh points out, such a child is tormented by the attempt to force him to live at odds with his natural inclinations. And yet, he cannot find the compassion to provide treatment to those who, for whatever reason, were born male but whose brains were not sexualized as male in the womb. Even though both groups face the same set of problems, Dr. McHugh sets out to protect one group while effectively punishing the other.

Jennifer Usher
San Francisco, California

References:

1. Wise TN, Meyer JK (1980). The border area between transvestism and gender dysphoria: transvestic applicants for sex reassignment. Archives of Sexual Behavior . 1980 Aug;9(4):327-42.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7416946

2. Lothstein LM (1979). Psychological treatment of transsexualism and sexual identity disorders: some recent attempts. Archives of Sexual Behavior . 1979 Sep;8(5):431-44
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=496624

3. Wise TN, Dupkin C, Meyer JK (1981). Partners of distressed transvestites. American Journal of Psychiatry . 1981 Sep;138(9):1221-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7270729

4. Wise TN, Lucas J (1981). Pseudotranssexualism: iatrogenic gender dysphoria. Journal of Homosexuality . 1981 Spring;6(3):61-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7341667

5. American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (DSM III-R).
http://www.amazon.com/exec/obidos/tg/detail/-/0871400499/qid=1094416834/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s

Paul McHugh, M.D. is Henry Phipps Professor of Psychiatry and Director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, and Psychiatrist-in-Chief of the Johns Hopkins Hospital. A member of the Institute of Medicine of the National Academy of Sciences, McHugh is currently co-chairman of the Ethics Committee at the American College of Neuropsychopharmacology. He also serves on the board of The American Scholar. His writings include Genes, Brain, and Behavior (1991) and essays on assisted suicide and the misuse of psychiatry.

Psychiatric Misadventures by Paul R. McHugh

via http://www.lhup.edu/~dsimanek/mchugh.htm

This interrelationship of cultural antinomianism and a psychiatric misplaced emphasis is seen at its grimmest in the practice known as sex-reassignment surgery. I happen to know about this because Johns Hopkins was one of the places in the United States where this practice was given its start. It was part of my intention, when I arrived in Baltimore in 1975, to help end it.

Not uncommonly, a person comes to the clinic and says something like, “As long as I can remember, I’ve thought I was in the wrong body. True, I’ve married and had a couple of kids, and I’ve had a number of homosexual encounters, but always, in the back and now more often in the front of my mind, there’s this idea that actually I’m more a woman than a man.”

When we ask what he has done about this, the man often says, “I’ve tried dressing like a woman and feel quite comfortable. I’ve eve made myself up and gone out in public. I can get away with it because it’s all so natural to me. I’m here because all this male equipment is disgusting to me. I want medical help to change my body: hormone treatments, silicone implants, surgical amputation of my genitalia, and the construction of a vagina. Will you do it?” The patient claims it is a torture for him to live as a man, especially now that he has read in the newspapers about the possibility of switching surgically to womanhood. Upon examination it is not difficult to identify other mental and personality difficulties in him, but he is primarily disquieted because of his intrusive thoughts that his sex is not a settled issue in his life.

Experts say that “gender identity,” a sense of one’s own maleness or femaleness, is complicated. They believe that it will emerge through the step-like features of most complex developmental processes in which nature and nurture combine. They venture that, although their research on those born with genital and hormonal abnormalities may not apply to a person with normal bodily structures, something must have gone wrong in this patient’s early and formative life to cause him to feel as he does. Why not help him look more like what he says he feels? Our surgeons can do it. What the hell!

The skills of our plastic surgeons, particularly on the genito-urinary system, are impressive. They were obtained, however, not to treat the gender identity problem, but to repair congenital defects, injuries, and the effects of destructive diseases such as cancer in this region of the body.

That you can get something done doesn’t always mean that you should do it. In sex reassignment cases, there are so many problems right at the start. The patient’s claim that this has been a lifelong problem is seldom checked with others who have known him since childhood. It seems so intrusive and untrusting to discuss the problem with others, even though they might provide a better gage of the seriousness of the problem, how it emerged, its fluctuations of intensity over time, and its connection with other experiences. When you discuss what the patient means by “feeling like a woman,” you often get a sex stereotype in return–something that woman physicians note immediately is a male caricature of women’s attitudes and interests. One of our patients, for example, said that, as a woman, he would be more “invested with being than with doing.”

It is not obvious how this patient’s feeling that he is a woman trapped in a man’s body differs from the feeling of a patient with anorexia nervosa that she is obese despite her emaciated, cachectic state. We don’t do liposuction on anorexics. Why amputate the genitals of these poor men? Surely, the fault is in the mind not the member.

Yet, if you justify augmenting breasts for women who feel underendowed, why not do it and more for the man who wants to be a woman? A plastic surgeon at Johns Hopkins provided the voice of reality for me on this matter based on his practice and his natural awe at the mystery of the body. One day while we were talking about it, he said to me: “Imagine what it’s like to get up at dawn and think about spending the day slashing with a knife at perfectly well-formed organs, because you psychiatrists do not understand what is the problem here but hope surgery may do the poor wretch some good.”

The zeal for this sex-change surgery–perhaps, with the exception of frontal lobotomy, the most radical therapy ever encouraged by twentieth century psychiatrists–did not derive from critical reasoning or thoughtful assessments. These were so faulty that no one holds them up anymore as standards for launching any therapeutic exercise, let alone one so irretrievable as a sex-change operation. The energy came from the fashions of the seventies that invaded the clinic–if you can do it and he wants it, why not do it? It was all tied up with the spirit of doing your thing, following your bliss, an aesthetic that sees diversity as everything and can accept any idea, including that of permanent sex change, as interesting and that views resistance to such ideas as uptight if not oppressive. Moral matters should have some salience here. These include the waste of human resources; the confusions imposed on society where these men/women insist on acceptance, even in athletic competition, with women; the encouragement of the “illusion of technique,” which assumes that the body is like a suit of clothes to be hemmed and stitched to style; and, finally, the ghastliness of the mutilated anatomy. But lay these strong moral objections aside and consider only that this surgical practice has distracted effort from genuine investigations attempting to find out just what has gone wrong for these people–what has, by their testimony, given them years of torment and psychological distress and prompted them to accept these grim and disfiguring surgical procedures.

We need to know how to prevent such sadness, indeed horror. We have to learn how to manage this condition as a mental disorder when we fail to prevent it. If it depends on child rearing, then let’s hear about its inner dynamics so that parents can be taught to guide their children properly. If it is an aspect of confusion tied to homosexuality, we need to understand its nature and exactly how to manage it as a manifestation of serious mental disorder among homosexual individuals. But instead of attempting to learn enough to accomplish these worthy goals, psychiatrists collaborated in a exercise of folly with distressed people during a time when “do your own thing” had something akin to the force of a command. As physicians, psychiatrists, when they give in to this, abandon the role of protecting patients from their symptoms and become little more than technicians working on behalf of a cultural force.

Neoconservative/Catholic links

McHugh penned a piece for First Things, the neoconservative publication from The Institute on Religion and Public Life, “an interreligious, nonpartisan research and education institute whose purpose is to advance a religiously informed public philosophy for the ordering of society.”

Exerpts from Right Web on IRPL:

Both the institute and its journal function, in large part, as the institutional vehicles for the conservative religious philosophy of Richard John Neuhaus, a Catholic priest and neocon stalwart. In the early 1970s Richard John Neuhaus was a liberal, antiwar Lutheran minister, who became associated with the neoconservative camp by the end of the decade. 

The Institute for Public Policy and Religion quickly established itself as staunchly neoconservative and recruited Midge Decter to serve on its board at about the same time that she was invited to join the board of the Heritage Foundation. In 1991 Neuhaus became a Roman Catholic priest. 

The rise of the Institute on Religion and Public Life (and the absence of similar institutes controlled by traditional conservatives) illustrates the declining fortunes and influence of the Old Guard and demonstrates the neoconservative ability to integrate a traditional rightist position–the centrality of religion and ethics in politics and society–into the neoconservative ideological agenda.

In December 2004, McHugh wrote a rather revisionist history of transsexualism:

http://www.firstthings.com/ftissues/ft0411/articles/mchugh.htm

As with the “Psychiatric Misadventures” piece, McHugh takes credit for dismantling the gender program at Johns Hopkins, and for creating the idea of differential diagnosis. The article cites work done by Ray Blanchard at Toronto’s notorious Clarke Institute. The Johns Hopkins people under McHugh were advocating a differential diagnosis many years before Blanchard gave it his name. JHU proposed for those who weren’t “classic” or “primary” that they were “transvestitic applicants for sex reassignment” [1] who are “aging” [2] and “distressed,” [3] suffering from “pseudotranssexualism,” [4] or a “non-transsexual” variant of “gender identity disorder” (GIDAANT). [5]

This letter was published in response:

http://www.firstthings.com/ftissues/ft0502/correspondence.html

Transsexual Truths?

In “Surgical Sex” (November 2004) Paul McHugh is certainly right to assert that sexual identity (or, as I prefer, gender) is not subject to change; it is most certainly inherent. About nearly everything else, however, Dr. McHugh is quite wrong. To begin with, I honestly have to wonder how many transsexuals Dr. McHugh has encountered, either before or after surgery. While some do match his descriptions, most of those I know have actually been quite successful in their transformation and are indistinguishable from other women.
Contrary to Dr. McHugh’s claims, many transsexual women show considerable interest in children and many mourn the fact that they will never be able to bear a child. I myself have cried bitter tears over this. And yes, some transsexual women do identify as lesbian—just like women who are not transsexual. Likewise, many transsexual men identify as gay. Such is to be expected if transsexualism is more than just a choice.

The report published by Jon Meyer (and cited authoritatively by Dr. McHugh) was met with considerable skepticism at the time it was published. It was widely criticized for methodological flaws, while other studies have shown that Meyer’s study was incorrect in its conclusions. Nevertheless, it was used by Johns Hopkins as an excuse to shut down its gender identity clinic. I also note that Dr. McHugh mentions the Clarke Institute. The fact is that this agency has a notorious reputation for mistreating transsexual patients, forcing them to meet unreasonable standards, and denying them the hormones needed to modify their bodies.

One wonders why Dr. McHugh would choose such a cruel approach to the treatment of transsexuals. Sex- reassignment surgery has proven to be the only successful treatment for these patients, and yet for some reason he wishes to deny this. He makes a rather clumsy attempt to justify his position by comparing the treatment of adults who are transsexual with the treatment of children who are intersexed. Ironically, the arguments for one contradict the arguments for the other. Children who are intersexed have traditionally been surgically altered in whatever manner is simplest. This has often resulted in a child who has a male brain being given a female body. As Dr. McHugh points out, such a child is tormented by the attempt to force him to live at odds with his natural inclinations. And yet, he cannot find the compassion to provide treatment to those who, for whatever reason, were born male but whose brains were not sexualized as male in the womb. Even though both groups face the same set of problems, Dr. McHugh sets out to protect one group while effectively punishing the other.

Jennifer Usher
San Francisco, California

References

1. Wise TN, Meyer JK (1980). The border area between transvestism and gender dysphoria: transvestic applicants for sex reassignment. Archives of Sexual Behavior . 1980 Aug;9(4):327-42. 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7416946

2. Lothstein LM (1979). Psychological treatment of transsexualism and sexual identity disorders: some recent attempts. Archives of Sexual Behavior . 1979 Sep;8(5):431-44 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=496624

3. Wise TN, Dupkin C, Meyer JK (1981). Partners of distressed transvestites. American Journal of Psychiatry . 1981 Sep;138(9):1221-4. 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7270729

4. Wise TN, Lucas J (1981). Pseudotranssexualism: iatrogenic gender dysphoria. Journal of Homosexuality . 1981 Spring;6(3):61-6. 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7341667

5. American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (DSM III-R). 
http://www.amazon.com/exec/obidos/tg/detail/-/0871400499/qid=1094416834/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books

Resources

Paul McHugh bibliography

Paul McHugh media coverage

Lynn Conway (lynnconway.com)

President’s Council on Bioethics (2002-2009)

  • http://bioethics.gov/about/mchugh.html [archive]

Johns Hopkins Bloomberg School of Public Health

  • http://faculty.jhsph.edu/Default.cfm?faculty_id=462
  • Paul R. McHugh Chair in Motivated Behaviors
  • http://webapps.jhu.edu/namedprofessorships/professorshipdetail.cfm?professorshipID=181

Counterbalance (counterbalance.org)

  • http://www.counterbalance.org/bio/mchugh-frame.html

ProCon (procon.org)

  • http://euthanasia.procon.org/viewsource.asp?ID=000769

Internet Movie Database (imdb.com)

  • http://www.imdb.com/name/nm1573667/

Marshall Jon (2002) Reading Paul McHugh: Politics, Psychiatry and the Response to Terror Perspectives on Evil and Human Wickedness Vol. 1 No. 2 Page 92 ISSN: 1471-5597

  • http://www.wickedness.net/ejv1n2/ejv1n2_marshall.pdf