Transsexualism as an Intersex Condition
Dr Z. Playdon
University of London, 2000.
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Dear Dr Whittle,
Further to your query about the arguments for and against understanding transsexualism as an intersex condition, may I advise as follows.
I would advise government to treat transsexualism “as if it were” an intersex condition. I advise this because, as they will know, there are two kinds of evidence used in scientific work: one is verification and the other is falsification. To cover familiar ground in order to illustrate this point, at the start of medical enquiry into transsexualism, two possible theories were advanced, that it was somatic and that it was psychiatric [we have to say psychiatric, of course, rather than psychological, since psychologists aren’t doctors: that is, they aren’t registered medical practitioners with all the legal status that carries], with its progenitor, Harry Benjamin, in 1954, holding to the first.
Evidence was sought to verify either of these theories but no conclusive evidence was found. However, it became clear that transsexualism was a different condition to transvestism or other paraphilias and in 1969 it received its own classification in Index Medicus, to separate it from that. Differential diagnosis continued to be carried out by psychiatrists, to verify that the individual wasn’t suffering from a paraphilia, and in 1984 the American Psychiatric Association gave diagnostic criteria. At that point, the circumstance might be described as a physiological condition which was subject to verification by psychiatric analysis – the analysis verified, or proved, that the individual was not mentally ill.
Since then, it has not been possible to falsify Benjamin’s original theory, that transsexualism is somatic. Thus, the theory of somatic origin continues to hold, and has held over almost fifty years.
As Popper points out, until a theory is falsified, it must be held to be true, and rather than falsification, the long-term evidence is that trans people are perfectly mentally stable, unless they have another mental disorder as well as being transsexual, as, for example, a diabetic might be acutely depressed. Indeed, the growth of liaison psychiatry in recent years – the practice whereby psychiatrists deal with the mental effects of physical problems [such as mastectomy, for example, which many women find deeply distressing] – supports the notion that the psychiatric intervention is to support the patient in dealing with a physiological problem.
Further, the recent Department of Health document, A Healthier Nation, allows evidence from sociological spheres to be brought into play in dealing with medicine – indeed, it requires that they are – and that work, such as surveys by Dave King of Liverpool University, or individual biography by Mark Rees, clearly demonstrates that trans people are not mentally ill.
Finally, psychiatrists specialising in this field have noted that their patients do much better since the P v S case meant that they can go through transition without losing their livelihoods, homes etc – which clearly suggests that mental stability is the norm.
Thus, I am obliged to advise that if a legal action were taken by the transsexual community, to assert their right to transsexualism being considered to be an intersex condition, then it would undoubtedly win. There is zero evidence that psychiatric intervention can ‘cure’ transsexualism, just as there is zero evidence that psychiatry can ‘cure’ homosexuality.
Such a legal action might, at present, be taken against, for example, the American Psychiatric Association, or the Royal College of Psychiatry, or, if government should be seen not to treat transsexualism as if it were an intersex condition, against the UK government. Hence my advice, which I am content should be passed to the Working Party either informally or formally.
I hope that this clarifies what has undoubtedly been rather a confused picture in the past.
DR Zoe-Jane Playdon
University of London
14 January 2000
Citation: Dr Zoe-Jane Playdon, University of London, 14 Jan 2000 – Correspondence with Prof. Stephen Whittle