In the late 1970s, McHugh halted sex-change operations at Hopkins, calling them "perhaps, with the exception of frontal lobotomy, the most radical therapy ever encouraged by 20th-century psychiatrists." His conclusion was that reputable surgeons should not be in the business of carving up a healthy body to satisfy a feeling about what that body should be.
At the time, it looked as though the Hopkins decision might discourge and help stop sex-change surgery. But it didn't. One reason is that no medical way of relieving the pain and torment of the transgendered has appeared. The cultural acceptance of body modification -- everything from breast enlargement to tattooing, scarring and branding -- made drastic surgery on healthy organs seem routine. The rise of radical gender studies on the campuses played a role, too, spreading the argument that gender (as opposed to sex) is socially constructed or at least very malleable.
Now a new argument is forming against sex-change operations because of a peculiar demand for a different kind of surgery: People are asking to have one or more healthy limbs cut off because they say they don't feel whole or happy with both arms and both legs attached. This is a psychiatric condition known as apotemnophilia. Last year a surgeon in Scotland drew heavy publicity for amputating the healthy legs of two patients. His hospital stopped him before he could amputate the leg of a third patient, a New Yorker.
In the December 2000 issue of the Atlantic Monthly, University of Minnesota bioethicist Carl Elliott notes that "clinicians and patients alike often suggest that apotemnophilia is like gender-identity disorder and that amputation is like sex-reassignment surgery." This has the effect of undermining the uniqueness of sex-change surgery and challenging the social value attributed to it.
Elliott suggests that unpredictable psychopathologies rise in certain societies "seemingly out of nowhere ... and then disappear just as suddenly." In 19th-century France, young men commonly lapsed into a "fugue state," often coming to in a foreign country with no idea of how they got there. In the 1970s and 1980s, thousands of Americans came to believe they had multiple personalities as a result of childhood trauma.
Fifty years ago, Elliott says, nobody suspected that tens of thousands of people would want to have their genitals surgically altered as a way of relieving suffering. He thinks transgender activism and many social cues may have resulted in a temporary boom for sex-change surgery. It's a tentative analysis, and maybe he's wrong. But at least he is pushing the discussion back into the right arena -- psychiatry and medicine, not politics.