Guest Blogger

The Gender Gulag: Voices of the Asylum

Filed By Guest Blogger | December 04, 2008 2:00 PM | comments

Filed in: Living, Transgender & Intersex
Tags: gender transition, kidnapping, medical malpractice, mental health, transgender

Editors' note: Kelley Winters, Ph.D. is a writer on issues of transgender medical policy, founder of GID Reform Advocates and an Advisory Board Member for the Matthew Shepard Foundation and TransYouth Family Advocates. She has presented papers on the psychiatric classification of gender diversity at the annual conventions of the American Psychiatric Association, the American Counseling Association and the Association of Women in Psychology.

kelley winters.jpgIn 1860, abolitionist and suffrage leader Susan B. Anthony risked arrest to help a battered wife who had been committed by her husband to an insane asylum for over a year. Mrs. Phoebe Phelps, a school principal and accomplished author, was imprisoned and allowed no contact with her children, friends or family for nonconformity to the submissive role expected of women. It was remarkably easy to incarcerate women of that time with a diagnosis of "delusions" or in later years "hysteria." After her release by writ of habeas corpus, she asked Ms. Anthony to help her flee the grasp of her abusive husband, a Massachusetts Senator. On Christmas night, Anthony took Mrs. Phelps and her daughter by train to New York City and a chance for freedom.

aware of how often her friends of the Underground Railroad had defied the Fugitive Slave Law and hidden and transported fugitive slaves, Susan decided she would do the same for this cultured intelligent woman, a slave to her husband under the law.

A century and a half later, so much and yet so little have changed. Our country has abolished the atrocity of slavery, enacted civil liberties for people of color and just this month elected our first African American President of the United States. Yet, gender variant Americans are still incarcerated in mental institutions and physically and emotionally assaulted with drugs and "aversion therapies" for failing to comport to the roles of their assigned birth-sex.

In 1995, Dr. Deidre McCloskey, a renowned professor of economics at the University of Illinois, Chicago, was taken from her home by sheriff's deputies with "a warrant for arrest for mental examination." Dr. McCloskey was a transsexual woman who had come out of the closet to her family prior to social transition, Deidre's sister, a psychologist, held intolerant views of gender diversity and, like Mrs. Phelps' nineteenth-century husband, was easily able to procure a civil commitment to a psychiatric ward.

Dr. McCloskey was incarcerated not once but twice at her sister's insistence. In Crossing, a Memoir, McCloskey described the "treatment protocols" for those seized for gender transgression:

the victim has no civil rights, especially if poor and unable to hire a vigorous lawyer; nothing he says is to be credited; no penalty of perjury or civil liability or even court costs attaches to the people initiating the seizure if their testimony proves to be false; and the psychiatrists do everything to avoid the liability from letting the victim free, are cowardly about taking the responsibility to do so and in effect are exempted from liability for the consequences of a false seizure and an unreasonable detention.

Deidre was interrogated by psychiatrists who displayed utter ignorance about gender dysphoria and the transition process. She was labeled as "manic," resulting from "latent homosexuality," decades after the American Psychiatric Association had removed same-sex orientation from the classification of mental illnesses. One psychiatrist demanded, "Are you a homosexual?" "Do you wish to become one?" When Deidre responded "no," that she was attracted to women, the doctor was incredulous. Reflecting old stereotypes confusing sexual orientation with gender identity, he responded, "Well, then, why are you doing this?"

To regain her freedom, Dr. McCloskey was forced to pay $8000 in legal fees and, astonishingly, was billed $3000 by the hospitals that falsely imprisoned her. She wondered, "What if I were poor?"

Susan Anthony would be disappointed at how little we have progressed.

The extraordinary narrative of Ms. April Ashley, a British transwoman and fashion model, illustrates the cruelty inflicted on gender variant individuals in mental institutions in the 1950s and beyond. Attempting suicide at eighteen-years-old, Ashley was rescued by her long hair from the Mersey River and delivered to the Ormskirk Mental Hospital near Liverpool. She agreed to a regimen of gender-reparative therapy at nearby Walton Hospital, intending to change her feminine identity. April's "treatments" included drugging her with ether while doctors exacted, "Why do you want to be a woman?" Later, the interrogations were punctuated with sodium pentathol injections. Ashley was given massive doses of male hormones. Finally, she was placed in a public ward and administered electroconvulsive therapy:

These blitzed souls returned from the convulsion chamber like zombies, their eyes blinking and heavily bloodshot, with an attendant supporting them on each side. A few hours later they awoke in their beds with murderous headaches in comparison to which an aspirin overdose is like a day at the seaside. When it comes to medical matters I'm usually very brave but on these occasions was not.

Ashley's treatment illustrated a recurring theme in gender incarceration: obsessed with attempts to change her gender identity, they neglected the depression and despair that led to her original hospitalization. In spite of her abuse, Ms. Ashley persevered to live her truth.

No matter what you do, you'll never be able to change my mind. I said with a knowledge I didn't know I had.

Ashley prevailed as a remarkable pioneer in the transcommunity. She was one of the first patients for corrective genital surgery with Dr. Georges Burou in Morocco, and she appeared in Vogue and the movie, The Road to Hong Kong, starring Bing Crosby and Bob Hope.

Phyllis Burke, author of Gender Shock: Exploding the Myths of Male and Female, told the heartbreaking story of Jamie, a transsexual woman who survived fifteen years of hospitalization from age six. "Jamie did not do boy things, and would not lie about it," Burke explains. Admitted in the late 1950s, Jamie was drugged and given numerous electroconvulsive shock treatments over the span of her imprisonment:

The treatments never became less painful, and there was nothing more painful than the shock, not even the rapes by the male patients, not even Mother and Father never returning.

At twenty-years-old, following an extremely painful ECT treatment, Jamie escaped the institution and made her way to San Francisco and transition to an affirmed life. Jamie asked Ms. Burke to find as many children like her as she could and write about their stories,

No one is talking about them, ... but there are still kids in the hospitals.

Burke noted that attitudes about childhood gender nonconformity within American psychiatry were influenced by Dr. Martha MacDonald and her 1938 study of eight birth-assigned males at Michael Reese Hospital on the South Side of Chicago. In a paper entitled "Criminally Aggressive Behavior in Passive-Effeminate Boys," MacDonald associated feminine expression with violent aggression. Contrary to this stereotype, she observed that these youth were "model playmates" in the company of girls, and she did not clearly distinguish them as perpetrators of violence in the presence of boys or as victims. Nevertheless, MacDonald advocated psychiatric hospitalization of gender-variant youth -- a role that her own institution would play, decades later, in one of the best known and most tragic stories of the gender gulag.

In his seminal autobiography, The Last Time I Wore a Dress: A Memoir, Dylan Scholinski recalls high school years incarcerated in a series of mental institutions with a diagnosis of Gender Identity Disorder. The first of these was Michael Reese Hospital, where the fifteen-year-old was termed by doctors "an inappropriate female."

"Can you tell me," Scholinski's father had asked at a prior clinic, "why she won't wear a dress?"

At Michael Reese, the award-winning author describes being pressed to the floor under the boot of a guard who ordered, "Shut up, you f***ing crazy-ass queer" - a phrase apparently synonymous with a diagnosis of Gender Identity Disorder; being injected with thorazine; being locked in seclusion; being tied to a bed while touched, assaulted, by a male patient on the ward. The attending psychiatrist would ask, "Why don't you put on a dress instead of those crummy jeans?"

At Forest Hospital in Des Plaines, Illinois, Scholinski was told that, "if I appeared more feminine I would be better adjusted." This was followed by daily humiliation with "girly lessons," and make-up sessions:

If I didn't emerge from my room with foundation, lip gloss, blush, mascara, eyeliner, eye shadow and feathered hair, I lost points. Without points, I couldn't go to the dining room. I couldn't go anywhere.[...]

Ever lied to save yourself? [...] Ever been so false your own skin is your enemy?"

After three years of incarceration in three institutions at a cost of one million dollars, Scholinski was finally released when insurance benefits ran out. Today, Dylan is an accomplished artist, author and community advocate in Denver, Colorado. He recently founded the Sent(a)Mental Project, a memorial to GLBTIQ suicides.

Trey Polesky, a counselor and GID reform advocate received very similar mistreatment at Forest Hospital in 1990. He tells how a psychiatrist diagnosed him with Gender Identity Disorder at age 9 and recommended incarceration to "help me become more in touch with my feminine side." In a program of gender-reparative therapy, he was forced to wear pink and purple dresses and skirts, grow out his hair and read teen fashion magazines to learn to behave "like a girl."

Trey recalls,

I finally learned to fake my way out in order to be released, though the reparative therapy did nothing but shatter my sense of self-confidence in who I was. Essentially, they taught me to hate who I was.

Harsh punishment of gender variant youth occurs in outpatient as well as residential settings. Dr. Arianna Davis today is an advocate for trans and intersex communities and GID reform. Though born with an intersex condition and expressing a strong female identity at a very early age, she was assigned male and later diagnosed as mentally ill for not comporting to that assignment. Arianna was subjected to a gender-reparative therapy regimen at UCLA in the 1980s:

I was subjected to forced testosterone injections and used as a study subject against my wishes. These things happened (under the physical beatings and punishment -recommended by a therapist of a reparative mindset- the urging of my father and the all too eager compliance of UCLA doctors and researchers).

Dr. Davis' story raises the point, a painful memory to so many of us, of how physical violence from parents of gender variant children is encouraged by intolerance from the mental health professions - what has been called, "the sissy-whupping method." I have often remarked in my own diversity lectures that if it were possible to beat, shame or coerce the gender identity out of a child, I would not exist and my audience would not be having this conversation with me. Playwright Eve Ensler termed this violence toward young transwomen, "They Beat the Girl Out of My Boy... Or So They Tried," in a 2004 Los Angeles production of The Vagina Monologues.

In Aldous Huxley's Brave New World, psychiatric aversion therapies were used to condition the lower classes to hate books. In our real world, aversion therapies have long been the cornerstone of reparative therapies intended to "cure" both gender variance and same-sex orientation. However, the American Psychiatric Association issued position statements in 1998 and 2000 opposing these "conversion" treatments that attempt to change sexual orientation:

APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to "First, do no harm."

Sadly, the APA never discouraged analogous gender-reparative therapies attempting to change gender identity or suppress gender expression. Indeed, the dictum of "First, do no harm" does not seem to apply to the treatment of gender variant people within American psychiatry. Nor do the bounds of human compassion and decency, when it comes to enforcing conformity to assigned birth sex. For example, Dr. Ron Langevin of the University of Toronto Clarke Institute of Psychiatry (today known as the Centre for Addiction and Mental Health) promoted inhumane aversion treatment of cross-dressing individuals assigned male at birth in his 1983 book, Sexual Strands: Understanding and Treating Sexual Anomalies in Men.

Reminiscent of a scene from Anthony Burgess' A Clockwork Orange, Langevin described chemical aversion therapy to "cure" cross-dressing,

In chemical aversion therapy, the patient is first administered nausea-inducing drugs. When he indicates that he feels sick, his favorite female clothes used for crossdressing are presented. He should touch them and look at them as best he can. Then he is overwhelmed by the need to vomit. The clothes are withdrawn and the procedure repeated several hours later.

Next, he noted the advantages of "electrical aversion" in offering greater "control" over timing. He described the treatment of a patient:

The conditioning stimuli were pictures of women wearing panties which were followed by the unconditioned stimulus, electric shock. The shock level was set so the patient found it so uncomfortable, he wanted it stopped. In addition to seeing pictures, he was instructed to handle panties and to imagine himself wearing them. After 41 sessions, he said he was no longer troubled by the "fetish" but a month later, it spontaneously recovered.

Finally, Dr. Langevin introduced a newer form of "shame aversion therapy" used on a "transvestite:"

the patient was required to crossdress before a disinterested group of men and women who watched him without reaction or comment. ... In this case, shame replaces electric shock... the patient was evidently experiencing shame. He was in tears as he crossdressed and had a look of anguish on his face. He attempted suicide the following day according to the investigator.

This unconscionable treatment brings to mind a quote by Nurse Ratched of Ken Kesey's One Flew Over the Cuckoo's Nest. "Aren't you ashamed?" she demanded.

Ashamed of what, though? Where exactly is the shame in being different? Author Dylan Scholinski perhaps said it best:

But I've proven the doctors wrong. I don't feel disgust in myself or in love.

They are the ones who should be ashamed.

Psychiatric incarceration and abuse of gender variant youth and adults has for generations been facilitated by diagnostic nomenclature that equates difference with disease: nonconformity to assigned birth-sex with mental disorder and sexual deviance. It is time for the American Psychiatric Association and other mental health organizations to repudiate the practice of gender-reparative therapies, as they have renounced reparative therapies for sexual orientation. It is time for the APA and the mental health professions to extend an apology to all who have been imprisoned or traumatized in the course of these treatments. In drafting the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder, it is time for the APA to remove the classification of Transvestic Fetishism and revise that of Gender Identity Disorder to serve constructive rather than destructive purposes. It is time for new diagnostic nomenclature consistent with the medical principle of "First, do no harm."

For full citations, please check out the original version of this blog post at Kelley's site. For more information about her project, visit GID Reform Advocates.

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For point of discussion, this does continue in some hospitals today. It's extrememly difficult to find someone willing to talk about these experiences, because of the emotions and memories they dredge up, not to mention fear of things like legal reprisals or whether people would be willing to believe someone who spent time in a psych ward. So I guess, all I can do is relate a bit of the surface of things, and it's up to you what you believe.

We have a few target hospitals that we keep watch on when we know someone in our community is there for psych treatment, although knowing about it before the fact is rare. Psychiatrists at these facilities have a history of disregarding diagnoses of GID and instead picking out either Dissociative Identity Disorder or Borderline Personality Disorder as favorite alternatives (in Alberta, at least -- the diagnoses may vary by region).

This summer, we had someone in one of these hospitals for a non-trans issue, they ignored the issue and diagnosed her with BPD. And all of a sudden, well, "we noticed an unusual heart rhythm and have to do some tests." She's young, no history of heart ailments in her or her family's past... they were testing her suitability for ECT. At that point, we had friends visit the hospital every day, were phoning every day, talking also with the care staff and the doctors, bringing up GID... and they did an about-face and released her.

I say this so that if anyone ever encounters this pattern, BPD or DID diagnoses and heart tests, then make sure you get on them. Stay on the doctors and with the patient like a dirty shirt. That's not a guarantee, but if they know they're going to be held accountable, chances are good that you could spare somebody that.

This is horrible! These things shouldn't go on, anywhere. This is supposed to be a civilized country.

We forget that others in the GLBT community aren't aware of this. To us, it seems just the natural order of things, something we are trying to get changed. We take it for granted, just as we do the murder and suicide rates.

I get the feeling that most GLB people have no idea about us, nor what we go through. And if we tell them, there's a credibility issue, they can't believe that this kind of thing goes on in this day and age.

This article hit me kind of hard. I am familiar with several of the Chicago area institutions that are mentioned. I have had family members treated at Michael Reese and Forest Hospital over the years. It's worth noting that both of these institutions are now closed.

My cousin, who is also possibly trans like me, was committed to the Forest Hospital in the 1980s. Goodness knows what he endured during his stay. He is schizophrenic, but we really don't know if this is a result of a disorder or the 'treatments' that were administered to him.

People wonder why I didn't come out until I was well into my 40s. This article provides those reasons in graphic detail.


Dr. Winters,

Thank you for an excellent, informative article.

Mercedes and Zoe are right, too. This is just another of the many issues that must be intelligently presented and discussed with others, while fiercely monitored and fought by us.

I guess in some ways I am lucky that I don't have insurance and my brother won't have anything to do with me. Otherwise, I might be getting "repaired".

"In drafting the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder, it is time for the APA to remove the classification of Transvestic Fetishism and revise that of Gender Identity Disorder to serve constructive rather than destructive purposes."

That will never happen so long as "Drs." Kenneth Zucker and Ray Blanchard continue to be on the team to rewrite the DSM. Those bastards should be removed at once!

I don't know that delisting is necessarily the cure-all, at least not without a parallel biomedical model / process. The trouble is with alternate diagnoses, like BPD, DID... I also assume that because there is not as much drive to delist TF that it would remain longer and be a potential alternate diagnosis.