Ten Problems with that Article Comparing being Transgender to Getting a Lobotomy

So there is an article circulating the internet from the Federalist comparing the current “craze” of treating transgender youths to lobotomies. It draws ten parallels. Here is how they are all flawed.

First, a history lesson. The first identified sex reassignment surgery was Lily Elbe in 1930 in Germany. Her story is told, in a somewhat dramatic fashion, in the movie the Danish Girl.

She was not, it should be pointed out, the first transgender person by a long shot. History is filled with such people, dating back to the earliest known history. Every culture and every time period has not just individuals, but groups that identified in ways that defy our simplistic notion of male and female.

But the article conflates medical transition with being transgender, so we will focus on transition rather than being transgender. And the history of medical transition officially begins in 1930 with Lily Elbe. Or possibly with Dora Richter around the same time. (The short version: Then as now, transition is a process, not an event. Dora started her process earlier than Lily Elbe but finished it later.) Even before these surgeries there is anecdotal evidence of transgender people taking hormones and hormonal transition is likely older by a couple decades at least.

The end of the Weimar Republic and the rise of Nazi Germany stopped Magnus Hirschfeld and his early experiments with SRS surgery. But soon after the war other doctors picked up his mantle. In 1952 Christine Jorgensen, a decorated world war II veteran became infamous as America’s first “transsexual.”

Christine Jorgensen.

Meanwhile the first lobotomy was performed in 1930 as well.

Why is this important? Because the Federalist article paints lobotomies as the old medical craze and transgender surgery as the new one. But the two are actually contemporaneous. One of these became a craze and then was discredited. The other has been quietly performed for generations and is only now become more widely known.

With that in mind, let’s break down the ten parallels in the article.

1. A high level of desperation

The article compares two very different kinds of desperation. In the thirties and forties the medical field was desperate to make a break through with mental health. Doctors were grasping at straws and the early success of lobotomies at decreasing violent episodes in severe mental illness seemed to offer some hope.

There was a sense of desperation among early psychiatrist, who were watching other branches of medicine grow by leaps and bounds. There was desperation among government officials since many of the mentally ill were being housed in large state hospitals, which were chronically under funded, under staffed and a source of social and financial headaches for state officials. There was a sense of desperation among families of the mentally ill, who wanted something done for their loved ones.

When it comes to transgender people, the only group that seems desperate are the children themselves. And what they are desperate for is mostly some shred of acknowledgement and acceptance. They want their families, their doctors and society at large to recognize their feelings as real and valid.

The bottom line is that medical establishment is not desperate to “cure” transgender youths. If anything they face enormous pressure to not treat them.

2. Someone besides the patient authorizes treatment.

Technically true. Family members and doctors had to both sign off on lobotomies. To undergo medical transition as a minor, families and doctors have to sign off.

But there is an important distinction between authorization and consent. With lobotomies, the authorization of family was all that was needed. Then the procedure was done regardless of the patients consent.

Transition requires the full consent and participation of the patient. No children are being forced to have sex changes because the parents want it.

3. Highly variable results

Neurologist now know that the frontal cortex, the part of the brain that is removed in the lobotomy, is the seat of conscious thinking, planning and will. Lobotomy patients become more passive, less prone to outburst. They lose the ability to think ahead or plan for themselves. Lobotomized patients became passive robots that did what they were told. Only the most cynical researcher could find success in this.

Meanwhile lobotomies were mostly done in the forties and fifties. Given the state of surgery at the time and the conditions in which they were often performed, complications were common and many died.

Lobotomies had variable results, but they were invariably bad results.

What about transition? The article assertion that trans surgery has similarly bad results is supported by a couple of Tumblr posts and one article from a site of “A community of parents & friends skeptical of the “transgender child/teen” trend.” Hardly credible source material.

In fact there are a number of studies that show transition has generally positive results with few complications.

4. Treatment based on Theories, not Science

Is it true that we are treating transgender youth without any solid scientific evidence? Again the article refers back to the same webpage for skeptical parents and friends.

It’s a half truth. There haven’t been nearly as many studies of transgender people and transition as most researchers would like. I would love to see more serious scientific studies.

But to say there haven’t been any, or that transgender treatment isn’t grounded in science simply isn’t true. Here is one outcome study done in respected medical journals, from the European Journal of Endocrinology:

Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects

I could fill pages with the studies that have been done, but I will leave to the curious reader to do a google search, because we are not even halfway through the list.

5. The power of the press

The article points to the amount of positive press that lobotomies got in their early days. They use this to imply the same thing is happening with transgender care today, while ignoring the fact that there is more negative press about transgender people than positive. Case in point, their own article.

6. Embrace from Doctors

This is a dubious point at best. Yes, in the 1950’s the AMA supported lobotomies as an accepted procedure. Yes, today the AMA supports transition as the only medical treatment for transgender people that has shown any success in improving their lives.

The parallels end there. In the late forties and early fifties many in the medical community were skeptical of lobotomies. The doctor credited with developing the lobotomy, Dr. Moniz, never went past chimpanzee studies. Several of his colleagues did a handful before abandoning the idea as dangerous and unhelpful.

Thorazine, introduced in 1952 dramatically reduced the number of lobotomies performed and ushered in a new era of mental health treatment.

It was up to an American doctor, Harvey Freeman, to develop a new, simpler technique and to promote it himself. He spent years promoting his icepick method and doing the procedure himself. Even then the lobotomy craze died almost as soon as he left the field.

Meanwhile Harry Benjamin, an endocrinologist, was facing stiff skepticism for his claim that estrogen treatment helped transexual* patients.

By the mid sixties lobotomies were largely falling out of favor. Harry Benjamin was publishing The Transexual Phenomenon. A few hospitals and university began to open gender clinics, do preliminary research on Benjamin’s ideas.

Once again, one theory was studied, showed wanting and soon abandoned. The other was tested and has largely remained intact today.

7. Expanding Patient Base

The article compares Freeman’s public advocacy of the lobotomy procedure and his attempts to enrich himself with the procedure with…

High demand?

The graph shown in the article is highly misleading. The article claims there has been an explosion of gender clinics opening all over the UK and the US. The graph seems to support this, until you click through to the article it references. The numbers shown in the graph aren’t gender clinics. They are patient referrals to one clinic.

This graph is meaningless but it makes my article seem more scientific somehow. Funny how that works.

So there is an increasing demand from patients at one of the few clinics that exist. Where is the scrupulous doctor that is making a fortune by pushing his procedure? As far as I can tell the majority of the advocacy work for transgender people is coming from other transgender people, not from doctors.

8. Correcting Sexual Orientation

The Federalist goes on to assert that without treatment many gender non-confirming kids will go on to be happy, well adjusted homosexuals. We have this on the word of a celebrity and Sexology today! (Hint to academics; nothing screams credible source like an exclamation mark in your site name.)

I would like to pause a moment and congratulate the Federalist for evolving their position on LGB people. This is the first I’ve seen them actively support the community. There is something incredibly hypocritical about using this argument while your website also spews anti gay bigotry on a regular basis.

But there is another problem with this idea, gender identity and sexual identity are two different things. Trans men are not butch lesbians. Trans women are not drag queens. Denying them access to transition related health care will not make them accept themselves as gay people.

Besides, many trans people are also LGB after they transition. Our sexual identities are as diverse as that of cis gender people. So many of us already grow up to be well adjusted homosexuals in addition to being out and proud trans people.

What if I told you I was both Trans and Bi? Yes, it is possible.

Underlying this common myth is a basic misunderstanding of the difference between gender identity and gender presentation. Identity is how you identify, it is a deep core part of who you are. Presentation is how you wear your gender.

A tomboy girl is still a girl. An effeminate boy is still a boy. A trans person has a deep seated sense of themselves as being a gender that is different from the one they are assigned. A big part of why therapy is almost universally required before medical transition is to help patients and family with this very distinction. Gender non conforming children who do not have core identities that are transgender are quickly weeded out of the legitimate clinics.

Assertions that trans kids will outgrow these feelings is often based on older research that fails to make these distinctions. Tomboys will often outgrow being tomboys. But those with persistent male identities are not simply tomboy girls and will not outgrow the feelings.

9. Preventing future problems

Freeman, the man who promoted the lobotomy initially called it a procedure of last resort. Later he was quoted as saying its “safer to operate than to wait.”

By the same token, we are told, trans people are pushed to transition early because the results will be better.

There are two flaws with this. The first stems from the distinction between being transgender and undergoing medical transition. The second is a distinction between “being pushed” and “pushing.”

We haven’t made a lot about the distinction between being transgender and undergoing transition before now and we probably should have. Not all transgender people want or undergo medical procedures to make their bodies more congruent. It’s a very personal decision and there are many ways to be transgender.

But when the public hears about transgender people they assume that it involves hormones and surgery. Which leads to a lot of confusion about transgender kids and treatment.

Children are coming out as transgender earlier and earlier. Parents are increasingly allowing and supporting their children in this. This conjures images of doing sex change operations on little children, which is false. In reality accepting your six-year-old transgender child means letting them dress and wear their hair as they please, letting them use names and pronouns that are comfortable for them.

As puberty approaches some kids are allowed to take puberty blockers, medicine that prevents their bodies from going into puberty, until they are old enough make an informed decision about transition. If they outgrow those feelings, so be it. They can go off the puberty blockers and they will undergo puberty as the sex they were assigned. If they continue to have these feelings, they may transition.

The notion that young children are having their bodies permanently altered on the word of the child and some smarmy doctor are just sensationalism.

The other issue here is the idea of pushing or being pushed. Lobotomies were pushed by medical doctors as a cure for problematic behaviors.

Transgender people do not get pushed to transition. They push. They fight long and hard for it. Even in affirming families and with affirming doctors, the patient has to push. And the doctors push back.

Even in the most positive cases the protocols call for a period of therapy to “make sure the patient knows what they are getting into,” or “make sure they meet the criteria.” In many cases the push back is intense and unfriendly. “You don’t really know what you want.” “You’ll change your mind someday and regret this.”

Lobotomies weren’t just pushed by doctors. They were pushed by society. Society wanted certain problem behaviors and people to go away.

In the case of trans people the push back comes from society as well, for much the same reason. If they can prevent treatment, prevent schools and public facilities from accommodating transgender people, they can force us to go away, go back into the closet and hide.

It’s the same dynamic that pushed the lobotomy craze, but in the opposite direction. Let’s not forget that homosexuality and transsexuality were considered mental disorders and were sometimes treated with lobotomies. The critics have tried to “fix” our disorder for generations. Failing that, they’ve tried to shame us with moral teachings and now, as a last resort, to deny us any real effective treatment.

10. Ambitious Doctors

This article latches on Dr. Harvey Freeman as a tireless promoter of lobotomies. And he was, performing nearly 3,500 himself alone.

The lobotomy was a controversial procedure throughout it’s history. And it’s true that without Dr. Freeman’s “icepick” technique and his personal advocacy, it’s unlikely that the craze would have picked up steam on it’s own. Serious researchers abandoned the procedure after a few trials. Criticism emerged as early as the mid forties and while Freeman performed the procedure as late as 1967, it had fallen out of favor long before that.

So who is the transgender Freeman? Magnus Hirschfeld? Harry Benjamin? The article alludes to a Dr. Norman Spack, who runs a gender clinic in Boston. But who is the dubious doctor enriching himself at the expense of the trans community? I don’t see it.

The truth is that the history of transgender health care is nothing like the history of lobotomies. The growth in transgender care is driven by the growth in acceptance and in the number of people seeking care. While some doctors are advocating for their patients, none need to seek out new people to “become” transgender.

And the treatments they are providing aren’t particularly new or experimental either. Transgender people have been quietly for generations, and yes, even kids. Harry Benjamin began working with transgender people in 1948 after Alfred Kinsey asked him to see a child that “wanted to become a girl.” While we aren’t told the age of the child in question, minor transgender children seeking help goes back to at least 1948. And then, as now, its patient seeking out doctors not the other way around.

The true parallels between medical transition and lobotomies are as follows. Both were developed in the 1930’s. Both were met with initial resistance. Studies were done in both cases.

From their things diverge. Lobotomies were found to be cruel and ineffective. Despite this a hack named Dr. Freeman pushed his own version of the procedure for years, increasing his own riches and infamy.

Transition slowly evolved. Despite the controversies, studies have been done and have shown positive outcomes. Patient continue to seek treatment and doctors continue to offer it. The transgender community is currently experiencing a zeitgeist moment as the rest of the world discovers us. But we are not new, nor is our treatment. It is easier to be out as a trans person today, but I promise you, this is not a fad.

And parents, letting your child explore their gender identity is in no way like forcing them to have a lobotomy.

A wolf in another wolf’s clothing?

This article is written by Renee Gardner, a pseudonym. But the obsession with lobotomies as an analogy for medical transition reminds me a lot of another critic of gender transition, Walter Heyer. Walter underwent transition in his forties and soon detransitioned back to living as a man. Despite admitting that he was misdiagnosed and never transgender, he has gone on to push his claims that being transgender is a fad that many, if not all, trans people will eventually regret their transitions.

Perhaps his brand has become too tarnished and he’s now forced to use a pseudonym? It’s hard to tell. But the article contains another important hallmark of Heyer’s other writings, it’s based on flimsy rationals and flimsier research.

*Then the current term for transgender people. Not used much anymore.

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