Watching "The Lobotomist" on the "American Experience" series I was stunned by the parallels between what occurred in the 1930-1960 period with respect to the advent and dissemination of lobotomy for "mental disorders" and what we are seeing now in "Transgender Medicine" clinics.
Film footage of mental institutions with horrifying images of patients who no doubt ranged from schizophrenic, to depressed, to severe developmental disorders to traumatic brain injuries, lying naked against the fecal smeared walls in warehouses then called, "Insane Assylums" were enough to establish that desperate times called for desperate measures.
Before the advent of drugs like Thorazine, which could sedate screaming, howling, hyperactive patients and prevent them from jumping out of windows or attacking fellow patients and staff, prefrontal lobotomy, in which an ice pick was rammed through the orbital bone above the eye and swished around like a windshield wiper, severing connections of the frontal lobe to brain structures posterior to it,lobotomy seemed like an answer to horrible suffering.
The problem with lobotomy was it was not systematically, i.e. scientifically evaluated for almost ten years after it came into widespread use.
Clearly, from the film, it was applied to a wide variety of disparate "mental disturbances" which included schizophrenia (where patients hear voices) to depression (where patients become inert or very anxious) to war veterans with traumatic brain injuries, to unruly children we might now call hyperactive or attention deficit. Predictably, it failed whole categories of patients, but it did make many patients more manageable: They no longer shrieked or ran away, but sat placidly and lumpish, and were now tractable.
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| Walter Freeman, MD |
"The Lobotomist" introduces the purveyor of the lobotomy procedure not from the origins of the procedure but from the point where the procedure had been discredited and it's main advocate, Walter Freeman, MD, was portrayed as a medical monster who reduced hundreds to thousands of patients to vegetables, hulking remnants of the human beings they had once been.
The documentary then goes back to examine how Dr. Freeman came to advocate for such a procedure, now thought to be akin to medieval torture.
How could he have come to this dreadful decision and advocated for this frightful procedure?
The failure to critically evaluate the risks as well as the benefits of lobotomy was not the failure of Dr. Freeman alone; the medical profession and the government failed to act decisively. When he presented his first results at a medical conference, there were plenty of physicians who were appalled and who demanded prospective, controlled studies, but the mechanism for such things were not in place in the first half of the 20th century.
Dr. Freeman was motivated by a desire to help patients and their families, but also clearly driven by another set of motivations, to succeed and to be celebrated.
Ultimately, when the harm caused by the procedure became more widely known, Dr. Freeman was chased from the medical community, and spent the remainder of his life traveling in search of former patients who he had lobotomized to see what had happened to them in the long run, seeking vindication in success stories. Of course, following carefully what became of these patients should have been baked into advocating for the procedure in the first place. This man was no scientist.
One wonders whether the directors of "transgender clinics" may meet a similar fate.
And one wonders whether the story of the 21st century clinics will not be in days to come, seen as horrific as Dr. Freeman was ultimately viewed.
Anyone who has seen "One Flew Over the Cuckoo's Nest" knows the argument against lobotomy. The day may arrive when a version of Cuckoo's Nest may gain currency, portraying the Nurse Wratched's of the transgender clinics.
Today, we have another intractable problem: Patients with "gender dysphoria."
The patients afflicted today with this new disease are not as disturbing in their suffering: These patients are nowhere nearly as wild and disruptive to others, and pose nothing like the social disruption of scale.
They are treated with methods which, like lobotomy before, shock physicians who look at the treatments: castration of testicles and penises, industrial doses of testosterone or estrogen with outcomes which are not systematically reported other than one: suicide rates, and that rate is not encouraging.
At a recent Endocrine Society meeting the Phantom heard an expert on a panel of heads of "Transgender Clinics" answer a question about the suicide rate in his clinic as, "Somewhere just above 40%" as if he were talking about the chance of rain that afternoon.
When Paul McHugh, who has now become a focus for attack by "transgender activists," assumed the chairmanship of the department of psychiatry at Johns Hopkins, he was asked to cooperate with the transgender program being developed there. The clinic was run as an inter departmental effort by Psychiatry, Urology, Gynecology and Internal Medicine/ Endocrinology. McHugh took his time, collecting data, but when he confirmed the suicide rate among clinic patients was just north of 30% he cancelled psychiatry's participation. Ultimately, the clinic closed, although it has recently re opened.
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| Paul McHugh, MD |
The response from those in the transgender medicine trade is the suicide rate is not their fault, not the result of any failure on their part. Suicide, they argue is not a reasonable end point to evaluate the success or failure of a transgender clinic. Suicide is the result of the rejection of transgender patients by society, of the degradation and hostility faced by transgender patients.
Defining a transgender patient is not always easy. In general, it is defined as a person who feels he/she/they have been given the wrong gender assignment by parents, society. "I am a woman in a man's body."
McHugh has argued that transgender patients are very much like patients with anorexia nervosa: they are obsessed with a single wrong idea.
In the case of the patient with anorexia nervosa that wrong idea is they are too fat. They look in the mirror and see an 80 pound person who is 5'9" inches tall and they think, "If only I could lose weight, I would not hate myself so much."
Most people, physicians or not, can see this is a wrong idea.
But in the case of people with gender dysphoria, not the same.
These patients believe if only they can be transformed into a different gender, they will find happiness. But when the promise fails, when their testicles have been removed, and their penises removed, they are not happy, and in fact fall into despair and some commit suicide.
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| The campaign against Dr. McHugh; He cannot be wrong; he must be hateful |
Then there are those patients who do not feel totally committed, who want to keep testes or penises and have sex with their penises but want a lot more estrogen to reduce male hair growth. Or there are XX individuals who want testosterone in industrial doses to lower their voices and grow hair on their lips, but they still have penis in vagina sex.
Transgenders are not in the same box as homosexuals. Both groups suffer humiliation, sometimes violence, mistreatment, intimidation because of who they are and in the case of homosexuality, clearly, this is not something the individual can change about himself or herself. In the case of the transgender patient, there has been no effort to dissuade or change, only to accommodate to the demand of "change me." It's not clear if any amount of persuasion would be effective or even desirable. Any effort to dissuade a transgender is immediately placed in the same category as just another attempt by authority figures to "reprogram" patients as homosexuals were subjected to this travesty in the past.
The problem, which never gets explored is the revenue stream "Transgender Clinics" represent for the centers which run them. Like Walter Freeman, whose motivations are explored in "The Lobotomist" the motivations of the doctors who have built careers and incomes on transgender medicine are relevant.
McHugh, much reviled by Johns Hopkins medical students who accuse him of acting out of hate rather than concern for patients with gender dysphoria, has retired. He says he lives with a clean conscience but he is not sure others who have pushed transgender medicine have clean consciences.
Alarm bells should go off whenever a condition requiring treatment by doctors, using drugs or surgery becomes a cause, activist driven, rather than dispassionately examined by doctors with no skin in the game, who are interested only in the academic questions. When book royalties or jobs or TV appearances are involved, oh, we ought to have our antennae up high and they should be twitching.
Someday, the Phantom suspects, they'll be making documentaries about transgender medicine doctors which will look a lot like "The Lobotomist."
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