It is Time to Break the Vicious Circle of Transphobia

A look at how transphobia and homophobia cause male to female crossdreamers and transgender people to behave in ways that  confirm the prejudices of the narrow minded. It is time to break the vicious circle of transphobia.

The circle of transphobia is a circle, so you might start anywhere along it's curve, but let us for simplicity's sake start with childhood. In this presentation I will present a male to female crossdreamer and someone who has a clear female gender core (to use Felix Conrad's term). Much of the same applies to female to male crossdreamers and those who are somewhere in the non-binary and gender fluid parts of the gender continuum.

1. Childhood gender dissonance

A young male assigned gender variant child, will -- as the surrounding culture increasingly demands adherence to the expected roles of gender -- start to feel some kind of dissonance between what feels right and what parents, peers and friends expect.

As the kid learns the ins and outs of language, they may try to express this unease, buy telling their parents that they are not "really a boy" or by trying to express their dreams by other means, most likely through play. Preferring Barbies to toy guns has become a bit of a cliché in transgender narratives, but there is something to it.

Why we need a new narrative for transgender sexuality and crossdreaming

I have been reading Felix Conrad's new ebook on crossdreaming and sexology. Well written, interesting and provocative, as always. This post will not be so much a review of the book as a commentary on what it covers. We agree that we need a new narrative that makes sense of the sexuality of crossdreamers and other trans people.

Felix' main point in Quantum Desire: A Sexological Analysis of Crossdreaming is that we need a new sexology for crossdreaming and transgender thinking.

We need a new model, a new narrative, a new way of thinking about sexual desire and gender variance, because right now we are far too busy reacting to the belief systems of old:

You know, the ones that sort gender variant people into categories like "effeminate gay men" and "autogynephiliacs", "real trans women" and "fetishists", people "trapped in the wrong bodies" and "sexual perverts".

We are lacking a new synthesis

The fact that we are arguing against the old is inevitable. This is how human thought evolves. To use the vocabulary of Hegel: We start out with one way of looking at the world (thesis), which is then challenged by another (antithesis) until the world moves on to a third position (synthesis).

What we are lacking is the synthesis. Felix does not provide us with that new model in the book, or at least not fully, but he gives as a pretty good idea about where we have to go.

If I understand him correctly we have to get to the point where we discuss the sexuality and sexual desires of queer and gender variant people freely and openly. We have to get to a point where we are able to make those fantasies an integrated part of transgender identities of all kinds (and I use the word transgender here as an umbrella term for all types of gender variance here).

Right now sexual fantasies of the crossdreamer kind are considered invalidating not only for transsexual women and men -- who have transitioned or who want to do so -- but also for non-transitioning transgender people (including those genderqueer, crossdressing, drag  and more).

What Dr. Zhana Vrangalova Taught Me About Transphobia in Science

This is the story about how science can be used to persecute transgender people, and on how some seemingly well-intended LGBT-allies can contribute to transphobia.

Zhana Vrangalova
Photo by Enid Alvarez, New York Daily News

In this post I will give you the story about Dr. Zhana Vrangalova's support for the transphobic autogynephilia theory.

The Vrangalova story is interesting because it is such a clear an example of how scientific theories can be used to recruit even  the most well-meaning helpers to the oppression of trans people.

And yes, in this post I will prove, beyond any reasonable doubt, that the autogynephilia theory is transphobic.

Context

Those of you who do not know the ins and outs of this stagnant backwater of transgender research, may make note of the following:

1. The auogynephilia/AGP theory, created by Dr. Ray Blanchard of Toronto, says that there is a separate category of trans women who are motivated by a sexual paraphilia (perversion) that drives them towards transitioning.  They are, according to Blanchard, sexually attracted to the idea of themselves as a woman. The word is also used to describe male to female crossdressers and crossdreamers who do not transition.

2. Dr J. Michael Bailey is a supporter of Dr. Blanchard, and the author of The Man Who Would be Queen, a book that popularizes Blanchard's theory, dividing the world of trans women into two: "autogynephile transsexuals" (non-homosexual perverted men, according to Blanchard & Bailey) and homosexual transsexuals (extremely effeminate gay men).

3. Zhana Vrangalova is a sexologist; she has PhD in Developmental Psychology from Cornell and is currently an adjunct professor at the NYU Psychology department.

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SIDEBAR This is not a blog post about the scientific value of the autogynephilia theory. This is a post about how it is used to harm MTF crossdreamers and trans women. I have elsewhere documented that  the science is bad, and that it has been thoroughly falsified by other researchers. You will find links to papers and blog posts showing this here. I have also written several blog posts on the scientific defects of the autogynephilia theory.

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LGBT-support and autogynephilia do not mix

On June 13 Vrangalova tweeted a link to an interview the religious site Patheos had made with Bailey, adding the statement "There are 2 types of trans women".

I have been following Vrangalova since she often tweets interesting links to all things sexology. She has become an active spokesperson for the polyamorous amongst us. I also knew her as a supporter of LGBT (lesbian, gay, bisexual and transgender) rights, so her promoting Bailey in this way surprised me.

After all, the autogynephilia model is considered to be one of the most invalidating and stigmatizing theories around right now. It is routinely used by right wing religious  fundamentalists and left wing trans-exclusionary "radical" feminists to harass and invalidate trans women. It has been dismissed by transgender activists as toxic and unfounded, and has very little support among front line health professionals in the field.

The Vrangalova Dialogue

I responded in accordance with this, hoping I had been mistaken about the dear Doctor's intentions:

The Two Traditions of Thinking about Transgender

There are two major strands in modern sexology, both going back to the late 19th century. One is binary, gender conservative and interprets gender variation as mental illness; the other is liberal, trans-positive and understands sex and gender as complex continuums.

I have read a lot of transgender history. Too much, probably. This also applies to the science of transgender and the philosophy of transgender.

In her book Sex and Temperament from 1935, Margaret
Mead presented an amazing variation in gender roles
and expressions in different cultures, debunking one
and for all the idea that all masculine and feminine
behavior is inborn.
(Cover of 1950 Mentor paperback edition).

There is one important lesson I have learned from all of this: Every single original idea  had been presented before 1915.

The binary, pathologizing, tradition

100 years ago you would find it all:

The binary theory of two completely separate sexes, male and female, was already there. So was the idea that gender variations are perversions threatening society's "evolutionary fitness".

As now, many researchers argued that transgender conditions was caused by variations in the presence of hormones in the womb. This applied to sexual orientation too; many researchers had some difficulty keeping the two apart, then as now.

Others argued that it had to do with bad upbringing, blaming -- for instance -- strong mothers and weak fathers. Feminists, homosexuals and "primitive", non-white, people could also be blamed for spreading these "diseases".

Then, as now, the main fear was of the feminization of boys. Society needed strong, masculine, rational boys to fight wars, colonize the world and govern society, and because of this the emotional, feminine sissies -- gay or trans -- were a threat to the system.

(Tomboys and FTM transgender were also a problem, but did not constitute the same threat to the social order. After all, the fact that women wanted to be men made sense; the MTFs, on the other hand, had to be mad to desire the life of a woman.)

This binary tradition can be traced from Richard Freiherr von Krafft-Ebing and his book Psychopathia Sexualis in 1886. via the Freudian psychoanalysts and John Money of the 20th century, up to the current autogynephilia theory of Ray Blanchard.

What unifies this tradition is not the explanation for what causes gender dysphoria or gender identity conflicts. The researchers will blame it on inherited degeneracy, hormones or feminist mothers, all depending on the researcher's natural inclinations and cultural context. What unites them is the need to present gender variation as something unnatural and unacceptable.

On evolution, autogynephilia and Anne Lawrence 2

I my previous post I presented Anne Lawrence's argument for why male to female trans women who are attracted to women  (referred to as "autogynephiliacs") must be classified as mentally ill.

Or, to be more precise, she asked if the desire for sex reassignment in some men is  to be understood as a mental disorder in terms of a particular classification system of psychiatric conditions.

Her answer is yes; mine is no.

Lawrence's comment,  "Do Some Men Who Desire Sex Reassignment Have a Mental Disorder?", was originally a response to a paper by Dr. Heino F. L. Meyer-Bahlburg of Columbia University.

Dr. Meyer-Bahlburg was kind enough to give me a copy of his own response to Anne Lawrence's text, and I am going to give you a summary of his main arguments here.

A summary of Lawrence

Meyer-Bahlburg gives the following summary of Lawrence's paper (the  text in  brackets [...]  are my comments):

"1. In line with the original sex assignment on the basis of genital appearance at birth, the young child forms a core gender identity (as ‘‘biologically male’’)."

[Actually: Basically both Blanchard, Bailey and Lawrence say that a man is a man if he has a penis. Period.]

"2. Later development includes the activation of erotic heterosexual interest, which involves a mental mechanism responsible for locating erotic targets (females) in the environment external to the self (Freund & Blanchard, 1993). This mechanism is 'natural,' i.e., was developed by way of evolutionary selection. However, in the particular men under discussion, this mechanism fails its natural function; these men become autogynephilic instead of gynephilic, or both, and, thereby, experience a powerful erotic interest in turning their own bodies into facsimiles of their preferred erotic targets (females), thus generating the desire for sex reassignment. This desire to transform the body is an epiphenomenon to the primary mental dysfunction, namely the malfunctioning erotic-target location mechanism."

[In other words: Autogynephilia is the result of a masculine sexuality, not a feminine sex identity.]

On evolution, autogynephilia and Anne Lawrence 1

Dr. Anne Lawrence tells us that "autogynephiliacs" must be considered mentally for evolutionary reasons. I argue that this make no sense.

Some how you have wondered why I keep writing on "gay" and "transgender" animals, arguing that these phenomena are of little relevance to a discussion of crossdreaming or "autogynephilia" (sexual arousal from the idea of having the body of the opposite physical sex).

I have argued that the presentation of "autogynephilia" (AGP) as a mental illness in the autogynephilia theory of Ray Blanchard, J. Michaels Bailey and Anne Lawrence is at least partially based on evolutionary biology and evolutionary psychology. 

This means that the categorization of crossdreaming as a paraphilia (perversion) is ultimately based on the idea that it represents a trait that hinders procreation. 

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Note that the use of the term "autogynephilia" in this article must not be understood as an endorsement of Ray Blanchard's two-type model of male to female transgender people. Moreover, when I refer to erotic cross-gender fantasies, I normally use the much wider term "crossdreaming", a term that is not dependent on Blanchard's theory.

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The sanctity of sexual selection

According to this type of thinking sexual selection provides organisms with adaptations related to mating. For male mammals, this theory holds, sexual selection leads to adaptations that help them compete for females. A behavioral adaptation that does not lead to them breeding with females is therefore harmful, and an illness.

They argue that "heterosexual transsexual men" (which is an impolite  reference to people I would call lesbian or gynephilic -- woman loving -- trans women), are mentally ill.  The underlying argument is that "autogynephilia" represent a maladaptation. The natural heterosexual longing for a woman out there has been internalized  as a "erotic target location error".

I believe this explanation for crossdreaming is the end result of reductionistic evolutionary thinking. Their basic model cannot encompass the idea of gynephilic male bodied person wanting to be women, for the simple reason that in this theory sexual orientation equals sex identity. It cannot be otherwise in a theory that argues that sexual selection, and sexual selection  only, explains the survival of the genes of the individual and -- ultimately -- of a species. 

Nature disagrees

I have presented alternative research on the sexuality and gendered behavior of animals to show you that this basic understanding is wrong. A lot of the sexual behavior found among animals (and humans) does not have procreation as a goal. It is, for instance, used as a tool for socialization or for comfort.

None of these alternative theories dismisses the concept of evolution – far from it – but they argue that the survival of a genetic line relies on much more than mere sexual selection.

This research also shows that the social and sexual dynamics of  animals does not  necessarily adhere to the simplistic strong, aggressive, male conquers coy and passive female paradigm. And if the basis for the paradigm is wrong, the conclusions based on this basis are also most likely to be wrong.

Anne Lawrence presents the evolutionary argument

The reason some of you have questioned my interpretation of the basis of the "autogynephilia" theory is that Blanchard, Bailey and Lawrence rarely make such evolutionary arguments. The most important exception has been Blanchard's sibling theory on homosexuality, and that one is not about "autogynephilia" at all, but adaptive advantages to homosexuality.

Well,  Anne Lawrence has let the cat out of the bag. She has written a paper, "Do Some Men Who Desire Sex Reassignment Have a Mental Disorder? Comment on Meyer-Bahlburg (2010)," where the argument is solely based on an evolutionary argument. "Autogynephiliacs" are mentally ill, because their condition does not lead to procreation:

Gender and sexuality diversity is not a disease!

Imagine there was no social stigma attached to crossdreaming, crossdressing or being transgender.

Imagine you were allowed to talk about it without risking your job, you family and your circle of friends.

Imagine you could find friends with the same interest as yourself, not only online, but in the physical world. Imagine you could find a lover who, based on is or her own life experience, gets who you are.

As long as conditions like these are considered paraphilias and mental illnesses, that is going to be hard. As long as the medical authorities, the priesthood of the Church of Science, label you as a pervert, there will always be doubts.

For the gay movement, the removal of homosexuality from medical manuals in the 1970s was an important step towards social acceptance.

I am perfectly aware of the homophobia found in parts of the Western world (cp. the American Tea Party movement), but the fact that a majority of Amercians now support gay marriage tells me that the decisive battle has been won. It is clear to most sensible persons that the psychological suffering of gays and lesbians are not caused by their homosexuality, but by the way the surrounding society has treated them.

While I have -- partly for personal reasons -- focused on the gender dysphoria of crossdreaming and crossdressing, others have focused on the fact that such interests may just as well be harmless expressions of the diversity of natural sexuality.

Take away the stigma and "paraphiliacs", and crossdressers and crossdreamers are no more likely to be maladjusted, unhappy or mentally ill than other people. If society could accept, and maybe even embrace this diversity, there would be no mental illness of this sort.

In Europe these insights have led to the establishment of an alliance between homosexuals, BDSM enthusiasts and crossdressers aiming at the removal of "fetishes" from the WHO manual.

Among the leaders we find Svein Skeid, the leader of Revise F65, who has been working with gay and BDSM human rights for 30 years.  Another influential activist is  Odd Reiersøl, a well known psychologist in my country, from the University of Oslo and the Solverv Psychotherapy Institute. 

I must admit I cringe a little at their use of the word "fetish". I am still not convinced that the term may be salvaged from the stigmatizing use of the medical community. The term is also  often used to belittle those that suffer from a clear sex identity misalignment, and it is -- in may opinion -- hard to categorize non-crossdressing crossdreamers as fetishists. 

Still, their main message makes perfect sense to me:

"The fetish/BDSM group is an equal contributor to the society and scores on the level with most people on psychosocial features and democratic values such as self control, empathy, responsibility, love, equality, and non-discrimination. Because the ICD fetish and SM diagnoses are superfluous, outdated, non scientific and stigmatizing to the fetish/BDSM minority, these diagnoses have been removed in nearly all of the Nordic countries. The diagnoses are so seldom in use, that neither care, statistics, nor research are affected by their abolition."

Revise F65 has now presented a report to the Word Health Organisation where they explain why the diagnoses as mental illnesses have to go.

On grammar, paraphilia and the DSM-5

Sloppy language and loose use of terminology cause a lot of confusion in the transgender debate. This especially applies to the idea that many (if not all) transgender conditions are mental illnesses or perversions.

In this post I take a look at Andrew Hinterliter's discussion of the paraphilia term.

Cause and effect

In the debate on transgender conditions there is a mix up of observed behavior and what causes this behavior (correlation vs. causation).

To give the crossdreamer example:

If a man gets turned on by imagening himself having a woman's body, this is what he is. His very being is defined by being an "autogynephiliac" (a man in love with himself as a woman).

Moreover, the condition is caused by "autogynephilia". It is, according to Blanchard, an intrinsic part of his nature. It is innate.

The alternative would be to look at crossdreaming as an effect of another underlying condition.

To give an obvous example: Let us say that some male bodied persons are biologically wired for a "female" sexual instinct. This instict, which due to the surrounding culture is suppressed and cannot find an expression in everyday life, finds its outlet through feminization fantasies.

The observed "facts" are the same, but the story used to explain them is completely different. In the first the man is a pervert, in the other -- maybe -- a sexually frustrated woman or a person living outside existing gender norms.

Another example: "Autogynephiliacs" are considered self-obsessed narcissist unable to connect in normal love relationships. They are narcissists. (This isn't true, by the way, but this is what some of the experts say).

The alternative would be to look for an explanation for such behaviour outside the observed phenomenon itself:

Some crossdreamers may appear to be self-obsessed because (1) their lack of emotional and sexual fulfillment is traumatic and extremely frustrating and (2) they have found that it is hard to integrate their own sexual needs in a traditional heterosexual relationship or they have been rejected because of them.

In other words: They are afraid of yet another rejection and have given up love alltogether.

They are not pathological narcissists, lacking the ability to connect per se. They have just come to the conclusion that their "handicap" is too severe, and that there will be noone there that could love them. (I am convinced they are wrong about this, but it is not an irrational assumption).

Again: The context changes everything.

Normal

The second fallacy is the tendency of interpreting "normal" as what the majority of people is doing. Hence abnormal is what a minority of people is doing.

A 19th century example would be the argument that since women have never been great scientists or political leaders they must in fact be biologically incapable of becoming so. (Queen Elisabeth I and Victoria would be ignored or explained away as as abnormal exeptions to the rule).

At that time you could also argue that women do not masturbate. Women who do masturbate must therefore be sexually deviant. This argument was commonly heard among doctors and scientists all the way up to the 1970's.

The alternative use of the word "normal" -- if we stick to biology -- would be "that which appears as a result of natural diverisity". According to this understanding homosexuality would be natural, even if a minority of the population understand themselves as being gay.

Understanding perversions

These distinctions are extremely important, because if you label someone as a pervert or a paraphiliac, you have -- in effect -- denied them their dignity and their humanity.

However, some people have a strong need to sort people into the clean and the unclean, the normal and the abnormal. We have seen this since the time the priests and the prophets of the Old Testament wrote their laws and regulation. They took great pleasure in telling the people what was kosher and what was unacceptable in the eyes of the Lord.

Andrew Hinderliter and Ray Blanchard

Andrew Hinderliter has published an interesting paper called "Defining Paraphilia: Do not disregard grammar" published in the Journal of Sex and Marital Therapy.

On crossdreaming and autogynephilia as a fetish

Is autogynephilia a fetish? And is that why so many would rather not be associated with the term?

Autogynephilia (AGP) means to love oneself as a woman, and the researcher that coined the term, Ray Blanchard, argued that "autogynephiliacs" had internalized their external love object, so instead of loving a flesh and blood woman out there, they love the idea of themselves as a woman. He called it a paraphilia.

In the online debate about autogynephilia (or crossdreaming, which is the term I prefer) the most common used term for the condition is, however, that it is a fetish.

It was Blanchard's mentor Kurt Freund that called this condition for "cross-gender fetishism".

A note on terminology

Since this blog post was written, I have stopped using the term "autogynephiliac" to refer to MTF crossdreamers. The term is simply to closely associated with Ray Blanchard's misleading and transphobic explanation of transgender identities.

WHO on fetishistic transvestites

In modern medicine, crossdreaming is often classified as a fetishism. The World Health Organisation manual ICD-10, fives the following definition of crossdressing as a "disorder of sexual preference":

"Fetishistic transvestism: The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. It can occur as an earlier phase in the development of transsexualism." (F65.1)

Under the category "gender identity orders" there is another type of crossdressers, unsullied by impure desires (F64.1):

"Dual-role transvestism: The wearing of clothes of the opposite sex for part of the individual's existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing. Gender identity disorder of adolescence or adulthood, nontranssexual type. Excludes: fetishistic transvestism ( F65.1 ) "

This is an attempt to make sense of the group of crossdressers who do not report sexual arousal, but who nevertheless do not want to transition.

You can see that the authors have had a hard time distinguishing between crossdressers who crossdress for sexual purposes and the rest. To be honest with you: I think this distinction is completely bogus.

In this classification the experts use sexual desire as the most important factor for defining the two groups. This could make sense in a time when sexuality was considered impure and of the Devil. These days sexuality is considered a natural and good part of human existence. Heck, even fetishes are now normally considered an acceptable variation of human sexuality.

To argue that crossdressers who get aroused by crossdressing are fundamentally different from those that do not, must imply that "the fetishistic transvestites" (the crossdreamers) do not share the dreams of the asexual "dual-role transvestites ", i.e. the dream of temporary or permanently being members of the opposite sex. From what I see, many -- if not most of them -- do.

This becomes even more paradoxical when it argues that fetishistic transvestitism can be an earlier phase of transsexualism:

"Transsexualism: A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex."

(The WHO definitions are clearly based on Harry Benjamin's sex orientation scale. Benjamin solved the paradoxes presented above by arguing that there were no clear boundaries between the different types of fetishists and transsexuals.)

What is a fetish?

There are many definitions of sexual fetishism, but at the core of most of them is the notion that something nonsexual, such as an object or a part of the body, arouses sexual desire or is necessary for one to reach full sexual satisfaction. Since a lot of "autogynephiliacs" crossdress, it is easy to conclude that female clothing is this object.

HBS 3: What Harry Benjamin really meant

In this post I will take a look at what one of the giants of trans research, Harry Benjamin, really meant about what he called "transvestites" and "transsexuals".

The discussion of Rose White's book on the Harry Benjamin Syndrome and the idea that "true trans women" and crossdreamers belong to different species continues.

Read parts 1 and 2 first!

What about Harry Benjamin?

"So who are these HBS people that hold themselves clear and distinct from all other people on the planet?" Rose White asks. (Yes, that was a direct quote!)

"Put simply an HBS is a person who from first memory feels to be trapped in the wrong body just as Harry Benjamin described back in 1966."

But would Harry Benjamin have embraced White's book if he was alive today?

I can with great certainty say that he would have hated it!

Harry Benjamin

Harry Benjamin (1885-1986) was a German endocrinologist who late in life, in the US, started treating and doing research on trans women. His patient Christine Jorgensen made transexuals known in the US. His pioneering work remains very influential.

Benjamin was a man of his time and his use of language reflects that period, but all in all he was a very tolerant and loving man who embraced all trans women, including the crossdreamers, who he -- using the lingo of the day -- called transvestites.

Beyond the binary

In his book the Transsexual Phenomenon from 1966 Benjamin observes that:

"For the simple man in the street, there are only two sexes. A person is either male or female, Adam or Eve. With more learning comes more doubt. The more sophisticated realize that every Adam contains elements of Eve and every Eve harbors traces of Adam, physically as well as psychologically."

Because of this Benjamin does not operate with a binary system as the one of White (or Ray Blanchard for that matter):

"Coming back to the differences between transvestism and transsexualism, another simpler and more unifying concept and a corresponding definition may have to be considered. That is, that transvestites with their more or less pronounced sex and gender indecision may actually all be transsexuals, but in varying degrees of intensity.

"A low degree of largely unconscious transsexualism can be appeased through cross-dressing and demands no other therapy for emotional comfort. These are transvestites (Group 1).

A medium degree of transsexualism makes greater demands in order to restore or maintain an emotional balance. The identification with the female cannot be satisfied by wearing her clothes alone. Some physical changes, especially breast development, are requirements for easing the emotional tension. Some of these patients waver between transvestitic indulgences and transsexual demands for transformation (Group 2).

"For patients of a high degree of transsexualism (the 'true and full-fledged transsexual'), a conversion operation is the all-consuming urge, as mentioned earlier and as a later chapter will show still more fully. Cross-dressing is an insufficient help, as aspirin for a brain tumor headache would be (Group 3)."

Harry Benjamin was a "transgenderist"

So, according to Benjamin crossdressers and "true" transsexuals are different positions on a scale. Their "transsexuality" is the same (at least for some "transvestites" and transsexuals), while the degree of transsexuality differs.

He also refers to crossdressers who gradually move towards transitioning, exactly the kind of development White cannot accept.

"Nature does not abide by rigid systems," Benjamin says. "The vicissitudes

of life and love cause ebbs and flows in the emotions so that fixed boundaries cannot be drawn."

The Benjamin model

So how has it been possible for White to misinterpret Benjamin in this way? Well, she is probably projecting her own prejudices onto the book, reading what she wants to read.

Benjamin developed an interesting typology of the trans phenomena. Click on the image below to see his table.

Benjamin explicitly and repeatedly says that there are no clear boundaries between the columns, but White and others like her read it this way, because it gives them the order and exclusivity they so desperately need.

Benjamin does not deny the sexual slant to crossdressing. He also upholds the traditional theory that there are fetishistic transvestites, i.e. where the main focus of interest is on feminine garments. This he considers a sexual deviation. But at the same time he has a category of transvestites with a latent transsexual trend, where there is a "gender disharmony":

<- Harry Benjamin

"The second inception of transvestism is not fetishistic but in all probability the result of an inborn or early acquired transsexual trend of 'latent' character. (S.O.S. III). Those patients (like true transsexuals), invariably date the beginning of their deviation to earliest childhood. 'As long as I can remember, I wanted to be a girl' is a frequent part of their history.

"While it is quite possible that such statements may merely express the wish that it may be so, most evidence gained not only from patients but also from relatives points to the fact that transvestitic tendencies, in the great majority of all cases, were noted in the first five or six years of the child's life."

Benjamin is clearly confused about the cause of the different types of "transvestites". At the same time as he upholds a difference in etiology (cause) for the two types, fetishists vs. latent transsexual, he also opens up for biological men developing from fetishists to transsexuals:

"A sharp differentiation between a fetishistic and a latent transsexual inception of transvestism is not always possible. The fetishistic can gradually develop into the (basically) transsexual variety, as case histories have repeatedly shown me. The former, however, may well contain elements of the latter from the very beginning. Otherwise the initial morbid interest in one or several articles of female wardrobe would hardly have evolved into the desire for total 'dressing.' The basic transsexualism may therefore explain an occasional and, seemingly, progressive nature of transvestism."

How a fetishist can develop into a transsexual is not explained, but this is clearly what he says.

Closeted gay men

White repeatedly talks about crossdressers as being homosexuals. They are not, Benjamin says:

"The idea that transvestism may be a latent or masked form of homosexuality was expressed by several writers but particularly by the Viennese psychoanalyst, Wilhelm Stekel, and is still favored by some of his followers.

"The explanation seems simple enough, but to the unprejudiced clinical observer it does not ring true. Kinsey and his collaborators also consider it incorrect. There are too many clearly heterosexual transvestites and it could do no good to saddle them with another (the homosexual) emotional burden, a deviation that they often greatly resent and reject."

Benjamin does not conclude on the general etiology (cause) of all these phenomena, but it is clear that he is supportive of an "inborn, organic, but not necessarily hereditary origin."

The only conclusion I can draw from this is that White has not read Benjamin, she has not understood him or she is deliberately misusing his name for political purposes. I, a much detested "autogyne", am much closer to Benjamin's real position than White. Crossdreaming is definitely a Harry Benjamin Syndrome.

The Controversy

White's book is born out of an alliance of HBS trans women who aggressively fight crossdressers and crossdreamers, and who uphold the dogma that only they can be considered real women.

The Harry Benjamin Syndrome site is down at the moment. I have not been able to find out what has happened to it. "The Original Harry Benjamin Syndrome" site is up and running, though.

The group has been strongly criticized by people from the transgender community:

Laura of Laura's Playground originally sat up a site in support of HBS. She later turned it into a site against the HBS. She explains why:

"With such an impressive name you must be wondering how many medical doctors invented this medical syndrome? The answer is none. The inventor of this syndrome is a non-medical lay person. Charlotte Goiar claims to own the originating web site. Does this give her authorship? In addition permission was never obtained from Dr Benjamin's heirs to use his name. Can a layperson invent a Medical Syndrome? NO! Can A layperson write Medical Standards of Care for anyone? No! Can a layman change terms and definitions established for Transsexuals by Medical Doctors? NO!"

She says that in order to learn more she joined the Official Yahoo HBS Support Group, and found it to be an anti-GLBT group:

"People who asked simple questions and needed support, were diagnosed by militant members as being transgendered, perverts and fetishists. Gays and lesbians were also denigrated with frequent slurs. In fact those who did support GLBT [gay, lesbian, bisexual and transgender] rights were banned simply for supporting them. "

Is this important?

Why do I bother writing about this? Well, like all transgendered persons many crossdressers and crossdreamers struggle with guilt, shame, confusion, depression and grief. The growth of the Internet have given them a new arena where they can reach out and get in touch with other transgender people -- a place to get help.

Too often their cries for help are met with hateful and derogatory comments from HBS trans women. These comments seem to confirm the prejudices found in the rest of society. I have been in touch with crossdreaming teenagers who have considered suicide after meeting such an aggressive lack of compassion. It is important that crossdreamers and crossdressers realize that this group does not represent trans women in general.

The HSB/CT position can be defended

My point is not that it is wrong to uphold the belief that "HBS women" or "classical transsexuals" are completely different from crossdreamers. I disagree with this approach, but the position remains a valid point of view. It is this hateful way of communicating I cannot stand.

Ironically it is actually easier to defend such a standpoint using a more complex approach (gender identity as the combined result of a large number of biological variables) rather than the essentialist position of the HBS group and the "classic transsexuals".

They need to find one and only one part of the brain that makes them female, which puts them completely at the mercy of a handful of researchers. One thing is certain: science constantly develops and what is considered the truth today may very well be considered to be old prejudices tomorrow.

Using the much hated "transgender" approach you can argue that a female gender identity appears when a sufficient number of "feminine" traits are present in a sufficiently strong degree. You could say that a biological male is female when the combination of traits have reached critical mass. If you pass that tipping point the gender dysphoria becomes acute, and it is impossible for that person to live a harmonious life in her male body. Using this approach it becomes perfectly clear that a trans woman is very different from your average crossdresser, even if they share the same etiology (cause).

The reason the HBS group is not following this approach is probably because it cannot be used to stigmatize crossdressers, crossdreamers and feminine gay men as perverts. Their fear of being associated with these groups stops them from taking the obvious route, even if this is the route Harry Benjamin took in the real world, and not in the fantasy world of White.

For them it is important to be understood as stereotypical women, so that there can be no doubt as regards their right to call themselves women. The very existence of crossdressers and transsexual prostitutes means that they may be associated with people they believe are perverts and degenerates. Regular men and women may suspect that they too are "perverts" of this kind, which is why they so desperately try to keep a distance from them.

They take this as far as trying to change the meaning of words in order to achieve this goal. To White the word "transsexual" has become tainted because of all the crossdreamer trans women. Hence the need for the HBS term. For "classical transsexuals" using the word "transgender" as an umbrella term embracing all types of gender variation is offensive, because the word indicates that they have something in common with people like me. The fact that they offend me by finding me so toxic, does not seem to bother them. The goal apparently justifies the means.

I would love to see a constructive and fruitful discussion on the various forms of transgender lives, what causes them and how you can learn to live with them, but that means that the HBS group will have to find a way of communicating that is more constructive than the one of White.

Further reading:

Charlotte Goiar, the founder of the HSB movement, has written a knol that describes the syndrome.

For a a more serious defense of the "classical transsexual" position, see Anonymous T Girl. She is also highly critical of the HBS culture.

Harry Benjamin Syndrome Revealed: The naked bigotry of some transwomen against others (Hontas Farmer).

I'm Glad I'm Not Like You (TransGriot)

Harry Benjamin Derangement Syndrome (Below the Belt)

Rose White’s Harry Benjamin Syndrome Review – a review (Zagria)

Harry Benjamin Syndrome - Transgender-haters putting the BS in HBS (Transboutique)

Three models of transsexuality (Mercedes Allen)

HBS 2: The science behind the Harry Benjamin Syndrome

In this post I continue to the discussion of Rose White's book HBS The Harry Benjamin Syndrome Comes of Age.

Continues from part 1.

She blinded me with science

Rose White argues that crossdressers and real trans women (who she calls HBS) have nothing in common. The origins of the two conditions are completely different. While HBS trans women have a natural brain based femininity, the crossdressers have not, she argues.

So what about the science White is pointing to? Does science really prove that HBS trans women belong to a different race than crossdreamers who choose to transition?

Misquoting

White quotes an article by Zhou, Hofman, Gooren and Swaab from Nature 1997 (my emphasis):

"HBSS Harry Benjamin Syndrome Sufferers have strong feeling, often from childhood onwards, of having been born the wrong sex. - A female-sized BSTc was found in male-to-female HBS's -- the size was not influenced by sex hormones in adulthood and was independent of sexual orientation. - Investigation of genetics, gonads, genitalia or hormone levels have so far produced any results that explain HBS."

Those of you who have followed this blog know about this research already. It does indeed indicate that gender dysphoria may be connected to a biological male having a female sized BSTc - a brain region reckoned to be associated withgender identity. However, I could not remember that the four authors had mentioned the Harry Benjamin Syndrome explicitly.

I checked. This is what the paper actually says (and it is from 1995, not 1997, my emphasis):

"Transsexuals have a strong feeling, often from childhood onwards, of having been born the wrong sex. The possible psychogenetic or biological aetiology of transsexuality has been the subject of debate for many years. Here we show that the volume of the central subdivision of the bed nucleus of the stria terminalis (BSTc), a brain area that is essential for sexual behaviour, is larger in men than in women. A female-sized BSTc was found in male-to-female transsexuals. The size of the BSTc was not influenced by sex hormones in adulthood and was independent of sexual orientation. Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones."

(Zhou, Hofman, Gooren, Swaab: "A sex difference in the human brain and its relation to transsexuality." Nature 378, 68-70, 1995)

HBS 1: The Harry Benjamin Syndrome Part 1

Some of you may have heard about the so-called Harry Benjamin Syndrome. It is a term developed by trans women who vehemently oppose any association between them and what I have called crossdreamers, among them crossdressers.

The argument is that science has proved that this particular group of trans women, the HBS women, are real women brain wise, and that transitioning crossdreamers and crossdressers are not.

In three posts I will take a look at a new book from the Harry Benjamin Syndrome camp, and see if their arguments hold water.

Please note that these blog posts refer to a use of language that many crossdreamers might find offensive.

Not in the Wikipedia

Fleur Black tried to get the following paragraphs into the Wikipedia:

"Harry Benjamin Syndrome is not the same as transsexualism or transsexuality but is the medical correct term for the very small group of people who genuinely feel to be trapped in bodies that do not match their brain.

"All who claims to be similar, but refuse to to accept the logic, tests, evidence and accuracy of HBS - Harry Benjamin Syndrome are bigots, fools, transgenders, transvestites, crossdressers or autocunniphilics."

(I love the word "autocunniphilics", a great pun on Blanchard's "autogynephilia".)

Violet Grey quotes this Wikipedia entry in her introduction to the book HBS Harry Benjamin Syndrome Comes of Age, a book written by Rose White.

"Unfortunately," Grey writes, "the Wiki board (...) allowed HBS to be lumped in with the transexualism label that many non-HBS crossdressing men claim in order to legitimise their autogynism and homosexual urges."

Harry Benjamin Part 2

Rose White is explicitly considering her book a continuation of Harry Benjamin's enormously important work The Transsexual Phenomenon. Benjamin had indeed argued that there were biological men who felt themselves trapped in a man's body.

White goes on explain why there is a natural continuation from his book, to the idea that the HBS syndrome is completely different from what people like me call other types of transgender conditions:

"Harry advanced the study of truly transexed people and codified diagnostic criteria that has still not been improved on despite the protestations of generations of transgenders and it is only fitting that the condition should actually be known as Harry Benjamin Syndrome - or HBS - to separate its sufferers from all the gay, lesbian, bisexual, crossdressers, transvestites, transgenders, genderqueers, autogynes, non-ops and others who claim to be afflicted with exactly the same condition that Harry found when in fact they have nothing but various degrees of mis-nurturing to account for their weird urges."

Not transsexual

One major point in the book is the need for a term that does not associate the HBS trans women with "transgenders". You may already have met classical transsexual activists that redefine the word "transgender" to mean autogynephiliacs and effeminate gay men only. White takes this line of argument to the next level, by arguing that the word "transsexual" has become tainted as well.

"In practices HBS do not like to have the word 'transsexual' applied to them as it has been adopted by a vast number of people who are not but not merely give the impression of being of opposite sex and/or gender to that they really are. Thus crossdressers, transvestites, genderqueers and similar claim the label 'transsexual' when in fact they are perfectly happy with their bodies and genitals and would not accept genital surgery if offered to them."

Naturally feminine

White argues that only HBS (and, I presume, XX women) are naturally feminine. All other transgender, wannabies, crossdressers, maningas (men how have SRS just for sex), non-ops are not.

The proof is that HBS' have a second puberty when taking female hormones, argues White:

"The MtF HBS shows it by behaving like stereotypical late teenage girls in taking delight in the changes brought to their bodies and faces by the estrogen regime and indulging in the love of shopping for fashions, makeup and accessories that so mark the teenage girls. (...)

"Now that we know about BSTc [a brain section that is thought to indicate a female gender identity] it is easy to realise that the truly-HBS brain will respond to the estrogen regime exactly as does the pubescent girl. If a wannabe transsexual does not show this adolescence to any great extent with an estrogen regime then the truth of the matter is simply that they do not have a female brain trapped i their male body!"

White goes on to say that watching a group of HBS women will be like watching a group of non-transgender girls:

"..the body and face language, ways of sitting, holding glasses or cups, and socially interacting will be totally female without any of the effeminacy displayed by gay men or the TGs. In comparison the TGs will sit and look exactly like blokes in frocks..."

The HBS girls are exactly the same as a non-transgender woman, White says. They even share their enthusiasm for high heels, colorful makeup, and bright jewelery. The book has a separate chapter on why HBS women love shopping.

(Seriously! I am not making this up!)

Painted nails

There is also a sales site for the book called The Harry Benjamin Syndrome Review. The site has a picture of a HBS woman's hand with painted fingernails. The ad explains that the picture was chosen to show that

"(...) to a HBS women finding time to do her nails and the money for pretty rings is important - those who claim to be HBS women but angrily assert they should not 'have to' follow such female pastimes are not really HBS or else they would 'want to' - this conundrum is explained in Chapter 14."

It isn't really. Explained in Chapter 14, I mean. Exactly how this test is supposed to exclude transitioning crossdressers is unclear to me. One thing is certain: trans women who find "pretty rings" less important are not real women, according to White.

What this means for non-transgender XX women with no interest in such female pastimes is not explained, either.

Crossdreamers are gay men in denial

White argues that her theory is corroborated by TGs [trangender people] being predominantly late transitioners with homosexual proclivities:

"I know one person like this who was the effeminate little boy and is now a unhappy unconvincing homosexual post-op who sits legs gaping and has zero femaleness -- not even a handbag! Others I have had short contact with dress as male as possible and hate women's shops!"

Th HBS women may "goodhumouredly" make fun of a real HBS woman's bad choice of an outfit, White says, but...

"...they will not sneer and snigger as they do over the simple crossdresser who they can see and sense has zero femaleness and only dresses for masturbation or to invade the woman's camp for some reason. These older women are all well aware that most men (sic!) get sexual thrills from dressing and that they look ridiculous with their lack of femaleness perfectly obvious in the ill-chosen finery."

HBS FTM transmen, on the other hand, will find that transitioning with hormones bring an increased enjoyment in drinks, cars, girls, and sports, according to White.

The bad and the ugly

White has a complex list of categories that helps her sort out the bad seeds: transgenders, maningas, amazons, fetishists, amputation fetishists, autogyne (a variant of autogynephile; she truly hates Blanchard but find his terms useful when it comes to dismiss fake trans women), malignant bisexual, homosexual, lesbian, pseudo-transsexual, regretters, drag kings, perverts, hermaphrodites, dual-moders, and so on and so forth.

The reason she makes this long list is to make sure that people know the difference between a real woman and the pseudo-trans women. In spite of her second puberty theory, White admits that it can be difficult to see the difference between a HBS and another person who has had surgery. I guess some of the "perverts" even have hand bags.

Her test of sorting out male perverts who want to look like women, by checking if they want to keep their male genitalia, is not fool proof either, as there are "autogynes" who go for the full surgery package.

"When these patients are healed and emerge they may be perfectly passable as the opposite sex or they may conceal their body modifications under the exactly the same styles of clothing they have wore all their mature life. Thus it can be impossible to know without direct confrontation and intrusive questioning if the person leaving the clinic is a HBS waiting to disappear into stealth, a lesbian too long on vaginal estorgen who now feels a flat chest better sums her up or just a man who got a vagina because he has seen the porn queens writhing and moaning in constant climax and thinks that if he had a vagina he would be able to have the same endless orgasms."

However, elsewhere she argues that a HSB person can easily spot another HBS among all the transgenders jostling under the transgender umbrella and instantly feel an affinity with them that is different from the feelings all the others engender: "How they do it is a mystery known only to HBS, " White says. She is right about that.

No homos please, we are British

I have tried to find out whether White allows for homosexual HBS', i.e. gynephilic trans women. I think not:

"Obviously everyone varies but by and large a HBS will have an internal image of themselves with a man and that man will be as idealised as any other woman's. This is in itself a marker of the difference between HBS and all other people under the TG umbrella who get sex change and choose same sex partners or get the genital surgery with sex in mind."

The HBS have many enemies:

"The enemies are Fouratist homos, the public, the press, bigots and fools, ignorant medics, penny pinching political manipulators, BRSS dykes, religious pedophiles, closet homos and unfortunately the unaccepting homos a.k.a. Manginas who themselves try to become HBS in the vain hope that masquerading as a woman will help them refuse to confess that they are just homos and not HBS."

Blanchard is Belzebub

White, who is British, wants the EU to get out of the clutches of the American psychiatric manual, the DSM, as this one is dominated by arch enemy number 1: Ray Blanchard. (The fact that the Europeans do not follow the DSM is apparently of no importance).

She often refers to Blanchard and his followers as BLZB (for Blanchard, Lawrence, Zucker and Bailey = Belzebub):

"He [Blanchard] is personally fixated on dreaming up all sorts of silly names for what are basically natural human conditions and persuasions and by doing so ensures that vasts numbers of people with simple desire to cross gender lines or go as far as sex change are labelled perverts, queers and freaks -- or has he has it peedoheebeejeebies, autogynes etc."

White is of course doing exactly the same as Blanchard does in her book -- i.e. labeling all non-HSB's as perverts -- but that is all right, I guess.

What does this all mean for crossdreamers?

White's use of language and complete lack of serious argumentation tell much of the story. I find it very hard to respond to this book as if it was a scientific, philosophical or political work. It is more like a piece of hateful extremist propaganda. It is homophobic, sexist and -- who would have believed it possible? -- even transphobic. It definitely undermines any serious attempts at turning the Harry Benjamin Syndrome into an alternative to the transgender narrative that presently dominate research and health care.

It is hard to imagine what could have possibly made White write this book. It could be that she has been urged on by others taking part in HSB discussion forums. But that does not explain why she ended up in those circles in the first place.

I have no problem understanding the existence of gay-bashers, racists, sexists and transphobic persons. Such people are normally driven by a deep sense of insecurity and a need to sort everything into neat and clean categories of good and bad, the clean and the tainted. Normally such persons project their own dark sides out on others, especially on people that do not follow the norm and they do not understand. By doing this they are able to generate a feeling of superiority and they get an easy target for their own frustration and anger.

But White is a transsexual woman. She has most likely been the victim of prejudice and bigotry herself. Like many transpeople she has probably been called a sissy, a fag, and a pervert, and she should therefore know better than copying the practices of her own tormentors.

But maybe this is the explanation. Maybe the crossdressers and the crossdreamers remind her of her own past, and the very fact that she once had the body and maybe even the mannerisms of a man. She therefore constructs this strange tale about this ultra-feminine stereotype of a second puberty, to keep the distance from a part of herself she would like to forget. If that is the case, we are witnessing a personal tragedy of gigantic proportions. Unfortunately that does not excuse what she is doing.

The classic transsexuals

There are some more serious activists out there who share White's contempt for "the trangendered" and who agrees with her idea that crossdreamers have nothing in common with what they call "classic transsexuals" (CT), even if they are angered by the bigotry of the HBSers.

So even if White's book cannot be taken seriously, some of the arguments require a serious discussion.

In the next two parts I will look into the basis for White's arguments:

1. Does the research she refers do really prove that there is a difference between HBS and what she calls "pseudo-transsexuals?
   
   
2. Would Harry Benjamin have supported her?

Postscript

Zagria believes the colors of Black, Grey and White are all names for the same "flower" woman, which sounds plausible to me.

DSM-V: What others say

I just wanted to draw your attention to a few other blog posts covering autogynephilia and the DSM-V manual (see my previous post).

Cheryl over at Cheryl's Mewsings makes a point similar to mine regarding the fact that crossdressing men are considered perverts, while crossdressing women are not:

"Let’s backtrack a little to talk about Transvestic Fetishism. This is what we used to call Transvestism, and is used to be an 'illness' only if it caused distress. Under the draft of DSM-V it is now an illness regardless of whether the patient is distressed or not. It is also gender-specific. Only men can be diagnosed with it. So if a woman wears clothes that the psychiatrist deems appropriate to a man that’s fine, but if a man wears clothes that the psychiatrist deems appropriate for a woman then he’s automatically diagnosed as crazy, even if he exhibits no other symptoms."

The DSM-V does give transsexual autogynephiliacs the chance of having sex reassignment surgery, but the price is high. Cheryl puts it this way:

"I should note that Blanchard & Zucker are prepared to allow people that they diagnose with Autogynephilia to go forward for surgery. However, that is at the price of having been labeled a narcissistic sex pervert, and with no option for being declared 'cured' as there is with Gender Incongruity."

Over at Wrestling Emily Dickinson Adam Fish follows up on Chery's musings, discussing the "reality" of autogynephilia. He points out, correctly as I see it, that psychological disorders are not the same as illness caused by viruses and bacteria. Mental disorders are "nebulous collections of symptoms":

"But the labels we apply to these collections of symptoms are always subject to change, as are the symptoms which fall under a certain label. For example, schizophrenia as we know it has developed over a curious course of diagnostic evolution from its original classification as 'dementia praecox' to the clinical definition we know today. Currently, moves are afoot to eliminate Asperger's Syndrome as a separate condition and merge it with the other Autism Spectrum Disorders, on the grounds that it fits in better on that spectrum than as a separate entity. All this is as it should be: research modifies our understanding of a condition, which in turn modifies the way we categorise it, which in turn leads to improvements in the ways we treat or help people deal with these conditions. "

Exactly! Good science is always changing, challenging its own preconceptions. This requires humility in the face of complex phenomena like crossdressing and autogynephilia. As far as I am concerned Blanchard and his friends have the right to do the research they do and make the claims they do. But they and everybody else should keep in mind the following:

Blanchard and his friends have not presented the objective truth of anything. They have no real proof for their statements. That does not mean that theirs is bad science. It isn't. It just means that we have to read it for what it is: Another argument in a never ending scientific discussion.

Blanchard and his friends (as well as all scientists) are not disinterested observers of the world. They carry their own baggage and their own prejudices, and in this case it seems that what their mama told them ("Real men don't dress up in skirts, but women can wear trousers!") forces them to interpret their observations in one way only.

These ideas about what is normal and abnormal sex has been reinforced by their scientific training. Traditional evolutionary biology can only interpret hetero sex normal, as that is the only sex that can lead to offspring. This is why Blanchard & Co spends so much time on trying to explain homosexuality and why they cannot accept that heterosexual men would like to be women.

Fish again:

"I mentioned in my previous piece that, for a long time, homosexuality was considered a psychiatric 'disorder' because it was regarded as 'abnormal.' Thankfully, these days it is accepted that this isn't the case. But psychiatry persists in categorising some sexualities as normal and others as not so. The device used for this purpose is the idea of 'paraphilia' or, in layman's terms, sexual fetishism. "

But something doesn't have to be causing anyone harm to be considered a paraphilia. Fish argues gender incongruence becomes a disorder because it conflicts with the social expectations a society places on someone because of their birth gender, and failing to meet those expectations causes feelings of trauma and guilt:

"Most sexual fetishes only become disorders when the treatment of people who happen to enjoy such fetishes leads to their experiencing feelings of marginalisation and low self-worth. "

The purpose of medicine is to heal those who are hurting, without harming them further, Fish says.

"So, to return to Autogynephilia, here we have a definition of something which could easily be classed as Gender Incongruence, but isn't because some cis male psychologists have decided that the only real gender incongruence is heterosexual in nature. If you're a [male to female] trans woman and you want to fuck men, Roberta's your auntie. But if you're male assigned at birth, feel gender incongruence, but want to get it on with other ladies...that's not real Gender Incongruence. That's just a paraphilia. That's just sexual deviancy (don't worry if you're a [female to male] trans man who wants to fuck other fellas, though. Ray Blanchard doesn't consider gay trans men in his definition of Autogynephilia. Perhaps, like Queen Victoria on lesbians, he doesn't think they really exist)."

Fish's advice to the DSM is simple: Focus on gender incongruence and drop autogynephilia.

See also comments by

• Kelly Winters
• Aethelread
• Pam's House Blend
• For a second opinion, see Alice Dreger's post over at the Bioethics Forum