Transgender and Delusion

When I was 10 years old and travelling the old time Vaudeville circuits with my ‘Song ’n Dance’ parents, there was often “on the bill” a gig (act) called the “Female Impersonator”.

By definition this meant that a male was so cleverly adorned that the casual observer would assume he was a woman. He came on stage heavily “made up” with creams and blushes and facial paint. Usually wearing an enormous wig, he was dressed in formal ‘Queen of the May’ female clothing, affected a high vocal singing pitch, and pranced around in carefully studied behaviors meant to ape what he thought were female movements. He told gender-based jokes and swirled his skirts as if he were in a ‘Gilbert and Sullivan’ operetta. Everything about him shrieked “Exaggeration” but, somehow, he was entertaining.

Julian Eltinge, a famous female impersonator of the Vaudevillian era.

Audiences “to a man” knew beyond doubt that they were watching a man in a dress. The card announcing the act said “Impersonator” - clearly announcing a public and planned illusion, not delusion. No one believed this to be a woman trapped in a male body. All the masquerade could do was to call attention to itself, evoking the various emotions one experiences upon viewing such an unusual situation. That one of the descriptive words (in that era) was “Queer”, is not surprising.

As a gregarious kid I used to enjoy talking to the actors and actresses backstage, but my faint recollection of the “Impersonators” was their unfriendliness (or remoteness) - not just to me but to all. They wanted to be ‘alone.’ Without understanding anything psychological about such a “mismatch”, I sensed that something wasn’t working correctly and I avoided these guys assiduously.  

What goes on in the interiority of such people? How do people get so basically confused with their identity? Or, do people really believe that they are trapped in the wrong body? To wish to be someone other than self, is intrinsically different from believing that one actually is someone else. 

Before consulting personal knowledge, see Dr. Paul McHugh's work¹ as a Chief of Psychiatry at Johns Hopkins in Baltimore. Dr. McHugh treated many cases of transgenderism, surgical as well as medical, as a clinician. The then rule was to try to fit the soma (body) to the psyche, rather than the reverse.

Patients would complain of “gender dysphoria”, which was some form of deep unhappiness. They would be convinced that this was due to their owning the sex imprisoned in a disparate body form. Only by changing the body (soma) to coincide with the interior psyche could this unhappiness be managed. Using puberty blockers, hormones, and sometimes surgical intervention, science tried to relieve the misery of their patients who often were perfectly normal - anatomically, physiologically and biologically. McHugh’s team followed such a course.

There was sometimes an immediate positive “affective” return following treatment “…but it proved too often to be transitory in nature, leaving the patient ultimately with the underlying dysphoria intact.” The “re-assigned” patients had an alarming record of dissatisfaction with their new lives. ‘Alarming’ to include even suicides. Dr. McHugh abandoned his previous type of practice and suggested that “…we spent too much time on the soma and not enough on the psyche…”

There was no question for him that the old method of medicine has failed: “…too many failures to replicate with an easy conscience. The occasional patient who, over a long period of time is delighted with his/her new external moulding might represent the ‘exception’…”

The further question of involving children in such a questionable procedure darkens the picture considerably. The charge of Child Abuse has surfaced when youngsters have been placed into such programs. We know how susceptible children are to adult influences. We also know the fluid and rapid affective changes that occur dramatically in the teen years, where absolutes change on a daily basis. To allow a 10-year-old to make such a choice has been rightfully challenged as possible “child abuse”.

There is no question, I think, that patients seeking “re-assignment” do have real pain and suffering. There is no delusion with their unhappiness. That is clearly factual. They are really unhappy - fancily called ‘gender dysphoric’. Studies also indicate that the percentage among them of poor self-esteem, poor socialization, poor peer interaction, and family dysfunction is too high for proper mental health and happiness. McHugh’s point of more focused psychological assistance might — in the long run — be far more helpful than the chancy route so quickly pursued by modern Activists.

So, the question is not with available data of unhappiness but with its imagined causation. When one begins the fascinating study of Psychology, Psych 101 would define Delusion roughly as ‘out of touch with reality’. A false belief. For a patient to break with the external world and function in the world of fantasy, would lead any therapist to include some calibrated reference to delusional thinking in the initial intake. The range is wide, sometime obvious, sometimes subtle.

The female impersonator of Vaudeville dealt with illusion. The modern activist is dealing with delusion. Watching a magician saw a woman in half on stage is an illusion. To believe that it actually happened is delusion.

Human beings as a species have two sexes, male and female, within which there are multiple calibrations and shadings. But only two sexes: male/female, and one genus: Human. The street kid of my day would accurately say ‘Bananas’ to the list of categories proposed today with a straight face.

Responsible studies have shown that some sensitive young boys have the “girl wish” because they believe that girls have it easier in life. The rough and tumble kids of any era have been difficult for boys who were insensitively called “sissies…” with their poor eye/hand control for sports. So, they feel more comfortable and safer with girls.

A public picture of a trans woman swimmer standing alongside three real females, shows the enormous difference nature provides. The guy, dressed in a female swim suit, seems enormous compared to the girls with their narrower shoulders and wider hip area. Another picture shows a world-famous trans woman athlete, now dressed in female garb alongside natural women with obvious differences. As one simple observer said to me: “You can always tell…” If not always, certainly usually. There is some “gestalt” clue.

The facile dismissal of obvious empirical data should cause concern with even the least scientific among us. 

Now, after 45 years of State-licensed psychological experience, I am (at 101 years of age) confronted with what looks on the surface as Delusion and not Illusion. I have dealt professionally with what was called trans sexual patients, today called transgendered.

Three, specifically, I recall with some frustration and sadness. All from my personal practice.

The undergrad co-ed. Unattractive girl, ultimately “trans gender” to boy. Became a baker’s assistant. Dysphoria remained.

Physician. Tiny. Fine features. Married to passive woman. Contacted Thailand for surgical process. Intelligent. Religious. Clung to “pat” reasons. Deep dysphoria.

The ex-military who joined the Service seeking “cure.” Lived as a “lesbian” with his wife. With two children who had vapid and zombie-like movements.

My curiosity, professional and personal, pushed me to seek basic dynamics. Besides the overt dysphoria, was there something else? I did hear utterances approximately like this:

“I want to look pretty. I think girls are prettier than boys.”

“I want  attention. Girls are waited on…”

“Boys are too rough. I can’t be like them.”

“I can’t compete in sports. I like reading better…”

“I can talk better among girls….”

“Girls have it easier than boys….”

It was always the variations on the theme of feeling somehow unloved, inferior and ignored. A theme of poor self-esteem.

As a therapist, I had to respect my client’s feelings, but knowing the data of outcome I was depressed. They were all sad and unhappy. They were going headlong into the difficult and usually depressing experience of living out the fantasy in the real world. Or, in effect, living the life of delusion.

Even the clear notion of the Faith helped little…. In Deut. 22:5 it is stated that “in God’s eyes, one who seriously counterfeits as the opposite sex, is TOEVAH” (Big Time Sin). God decides one’s sex. A refusal to accept His Will on such a basic level becomes - potentially, at least - objective serious sin. Prayer and sacraments help little, once delusion takes over.    

Deep depression trumped everything. Perhaps there was some unintended chemical discharge in utero. Perhaps there was something of which we know little. Nevertheless we do know much of the outcome presently. To permit this delusion, even if merely potential, to be foisted on children is monstrously wrong.

Children are malleable and undergo enormous changes of view as they progress into their twenties. To put them into a situation of such possible sadness would be a crime veritably crying out to heaven for vengeance. Teaching respect and proper tolerance is wonderful, but quite different from senseless and brutal agenda-driven indoctrination.

Good family functioning and sensible “normalcy” would be more loving than hormones, blockers and insane indoctrination. Let us put resources in that area rather than into dead-end fantasies.

It is sheer delusion to teach that one sex can produce a child all by himself/herself by creating a zygote — even with a bizarre analogy from the single-cell amoeba world.

Hollywood can joke, but that is all it is - a joke. And delusion.

*Editor’s note: Readers may be interested in the following works by Dr. Paul R. McHugh: The Mind has Mountains: Reflections on Society and Psychiatry and The New Atlantis Special Report - Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences (co-author Dr. Lawrence S. Mayer).