Is Transgender Surgery the New Lobotomy?

Since the end of the Second World War, there have been several fads for unnecessary, and sometimes even harmful, surgery. One remembers the medical enthusiasm for the circumcision of newborn babies in the late 1940s and the large number of tonsillectomies performed in the 1950s. Prefrontal lobotomies were also popular at around that time, although all three operations have now fallen out of favour. In recent years, another type of surgery has enjoyed something of vogue: the amputation of healthy body parts, so that the patient’s physical appearance more closely matches the mental image they have of it. Such procedures were at one time known as ‘sex-change operations’, but today, we usually refer to it as ‘transgender surgery’.

For those who are not part of this fashionable movement for what is really an extreme form of cosmetic surgery, there seems something slightly bizarre about the whole business. A man claims he is in some way a woman, so a surgeon castrates him; a woman believes she is a man and has a double mastectomy to appear less female. For those not initiated into this ideology, it appears as if surgery is being used to treat a psychological condition. After all, if a man claimed to be Admiral Nelson, we wouldn't arrange for him to have his arm amputated and be blinded in one eye, simply to make his body more in line with his mental idea of himself. Is this an absurd and offensive comparison? 

It sounds like the sort of debating point designed to trivialise the whole question of gender identity problems. Except, of course, it is actually a reality in this country. The same psychiatrists who refer people to surgeons for gender identity problems have also helped organise the amputation of healthy legs of those with the delusion that they are men with wooden legs.

Before he retired, Dr. Russell Reid was one of Britain’s greatest experts on body dysmorphia, which refers to dissatisfaction with one's body. He specialised in people with gender identity problems, referring many of them to surgeons for castration or breast removal. He also arranged for people with the obsessive belief that they should only have one leg to have their legs amputated by a surgeon in Scotland. In a BBC programme, Dr Reid said, “I thought well, I see transsexuals and transsexuals want healthy parts of their body removed in order to adjust to their idealised body image and so I think that was the connection for me. I saw that people wanted to have their limbs off with equally as much degree of obsession and need and urgency and it was a powerful emotion.” The idea of a man who thinks he is Admiral Nelson being treated by having his arm amputated is not, in fact, as grotesque as it sounds. In the United States, a woman who thought her essential identity was that of a blind person found a psychologist who helped her pour drain cleaner in her eyes to blind her.

When a man or woman feels that, despite all evidence to the contrary, their core identity is that of someone with one leg, a blind person, or a castrated male, they have a psychiatric disorder that must be treated as such. Using surgery to treat psychiatric disorders of this kind has not been met with much approval in the past. We are reminded of the procedure known as a prefrontal lobotomy, which was claimed to be beneficial for certain psychiatric conditions. Those who pioneered this form of treatment, and those who used instruments such as ice picks to damage the brains of many people, have not been looked upon favourably by history. There is no reason to think that resorting to surgery to treat people who have bizarre obsessions will, in the long term, be viewed with any more enthusiasm in the future.

There can be little doubt that most of us would regard someone who wishes to be blinded with drain cleaner as needing professional psychiatric help, just as we would a man with two legs who wishes to have one removed so he can have a wooden leg instead. The fact that the same doctor was involved in arranging surgery for many men who desired to have their testicles removed suggests that this irrational desire belongs in the same category as elective amputation of limbs. One feels that sensitive counselling and therapy might be more appropriate, rather than surgery.

There is another disturbing aspect to the current craze for transgender surgery: in at least one country, it is being used as a form of gay conversion therapy. There is reason to believe that this is also happening in Britain. Readers may be aware that there are currently efforts to make conversion therapy, which is designed to change the sexual orientation of homosexuals and turn them into heterosexuals, illegal. The awful example of Alan Turing, a gay computer expert who was given hormones in a process known as ‘chemical castration’ to suppress his sex drive, is remembered with great distaste.

In the Islamic Republic of Iran, transgender surgery is, surprisingly, even more popular than it is in this country. Homosexuality carries the death penalty there, but it is accepted that a woman's spirit can inhabit a man's body in accordance with Muslim theology. Consequently, male homosexuals are urged to change their gender via surgery in order to have sexual relations with men without the threat of legal repercussions. The surgery is available freely and the process is quicker and simpler than in Britain. As a result, hundreds of gay men are castrated each year in an effort to change them from homosexual men into heterosexual women. It is the ultimate conversion therapy, and there is evidence that many of those subjected to the surgery only do so because they realise that the ultimate alternative will be execution.

In Britain, there are anxieties that something similar might be happening with lesbians. Until a few years ago, the vast majority of transgender surgery was carried out on men, but there has been a very strong surge of young women now being referred for this treatment. Some people find this worrying. Many of these girls and young women are what would once have been described as ‘Tomboys’; they favour masculine clothing and often prefer activities traditionally associated with men. An awful lot of those who are diagnosed as transgender and thus directed onto the route of hormones and surgery, would in the past probably have either grown out of such a phase or become masculine lesbians when older. Instead, they are now being persuaded that they are not really women at all, but men. Just as in Iran, the end result of this is the elimination of homosexuals and their replacement by heterosexuals.

Something particularly disturbing is that autism is five to six times more common in people who have undergone transgender surgery, which does suggest that many of them feel out of place in society and are easily convinced that their problems stem from presenting as the wrong gender. Only fixing that, they are led to believe, will make them fit in like everyone else—a cruel deception.

All signs point to the current spate of operations being performed in Britain to change one's outward gender presentation being viewed in the future with the same astonishment as we now view lobotomies. Treating what is essentially a psychological or psychiatric problem surgically sounds objectively like a terrible idea. It is only because we are currently in the midst of this particular fashionable medical trend that we lack the perspective to see the situation for what it is. Removing legs, eyes, testicles and breasts to satisfy the delusional wishes of patients who are in desperate need of appropriate counselling and advice is unlikely to end well and it might be best for all if we call a temporary halt to the practice. Such things tend to run their course, and it may be decades before we realise what we have done.