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.
Yours sincerely
DR Zoe-Jane Playdon
University of London
14 January 2000
