Psychological Tests: The Uninvited Guest

Several extrinsic factors may also influence the diagnostic process. The initial reports of psychotherapy failures (without the parameters of "success" ever being operationalized) may have reinforced the idea among some clinicians that any form of psychotherapeutic approach to the transsexual was at best naive. There is also a cadre of gender clinicians who espoused a transsexual ideology which implied that anyone who refused to treat transsexuals medically surgically was prolonging their suffering and persecuting them. The Hippocratic Oath has seldom been so willfully stretched and injudiciously applied as by the medical practitioner who used it to rationalize his/her justification for intervening in a medically aggressive way (so as not to prolong suffering) in the treatment of female transsexuals. I am not suggesting that a small number of select patients may not benefit from SRS; rather the rationale for medical surgical intervention had been stretched far beyond its scientific basis and was in need of a new support system. It seemed, to turn on a Kierkegaardian phrase, that I was witnessing a "teleological suspension of the clinical" even among sophisticated clinicians.

Proposition 2: Tomboyism And Transsexualism

The second proposition stated in the DSM III criteria for female transsexualism was that evidence of "childhood masculinity in a girl child increases the likelihood of transsexualism." While this proposition was being supported as a viable hypothesis by DSM III clinicians, one might well ask what the evidence was for such a claim. Are there "masculine" girls who grow up to be transsexual? What exactly is meant by "childhood masculinity" in a girl child "increases the likelihood of transsexualism"? How much "masculinity" makes adult transsexualism predictable? These are not moot questions since parents and pediatricians need to be informed about the nature of risks in childhood if appropriate interventions and referrals for treatment are to be made.

Although no serious minded clinician would take issue with the idea that adult behavior has childhood antecedents, it was quite another matter to argue ex post facto that a disorder present in adulthood must also have been present in childhood (in the same way). Rekers et al. (1977) cite no fewer than eight studies in which "clinical and research evidence indicates that gender identity problems in childhood are strongly predictive of sexual orientation disturbance in adulthood and transsexualism in particular." A review of these studies revealed that none of the children were followed into adolescence (no less adulthood). The researchers assumed that these children were experiencing exactly what adult transsexuals had described; that is, adult transsexuals reported that as young children they had experienced severe gender identity and role conflicts. None of the researchers seemed to entertain the possibility that the childhood and adult disorders might be two separate diagnostic entities. It appeared, therefore, that almost all the evidence for proposition 2 came from two sources: studies of children with gender identity and role disturbances, and studies of adult transsexuals who recalled that as children they had exhibited gender identity and role disturbances. Until recently there have been no longitudinal studies following children with gender identity and role disturbances through adulthood. It seemed that evidence for the second proposition was not based on empirical data but on a speculative hypothesis. A review of the literature was quite sobering. (see PROPOSITION 1: THE SO CALLED "STABLE" COURSE OF FEMALE TRANSSEXUALISM PART XIII)