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Book Review - The Man Who Would Be Queen

The Psychology of Gender Bending and Transsexualism.

J. Michael Bailey, New York: Joseph Henry Press

Also on line at: http://www.nap.edu/books/0309084180/html/

Jed Bland, Trustee of the Beaumont Trust

 
GENDYS JOURNAL

Issue 22
Summer 2003

 
This book is mainly a platform for a mass readership of Blanchard's theory of autogynephilia. His position seems to be that, what he calls, "homosexual transsexuals" are a subset of gay men, while "autogynephilic" transsexuals and transvestites are heterosexual men with a misdirected erotic target. The author writes: "If a current textbook discussed the basis of my intuitions - which many people share - it would do so in the context of stereotypes. It would neglect to explain that my intuitions are probably correct, and it wouldn't discuss why."

I found myself having to approach the book at two levels - on the one hand as typical of its psychiatric genre. On the other, assessing it as it relates to my own personal intuitions and insights.

Transsexual and transvesite people have traditionally refused to acknowledge a link beteeen themselves, and with homosexuality and eroticism. Bailey's essentialism cannot, of course, account for sociological abstractions such as, for instance, gender identity. The eroticism he describes may be a symptom, rather than a cause, of transsexualism.

It is therefore at the intuitive level that this book is of value, rather than for its scientific credibility, particularly its insight into children's lives and their progress into adulthood. How do children grow up to be gay men, or transsexual people?

Danny

The book begins with the story of Danny, who, from the earliest age, set out to be like his mother and sister. Danny's story is no doubt a composite of a number of children that Bailey has known. However, it is by no means atypical, as the parents in various support groups will testify. He writes with great empathy, not only about the child, but the bewilderment and concern of his mother. Experimenting with dressing up is common enough among small children, but this was persistent from the moment he could walk and found his mother's shoes. While the family continued in an uneasy relationship, other children at school, particularly the boys, made their opinion of Danny's behaviour abundantly clear. Meanwhile, Danny's mother began a round of counsellors and psychologists, without finding much help.

Feminine boys.

Psychiatry has long associated childhood femininity with homosexuality, but is it more than a psychiatric stereotype? As the author points out, Richard Green's study of feminine boys(1)) was the first, and still the definitive one. It predicted that the majority of feminine boys will become homosexual, but very few will be transsexual. His subject population was the very small population of children whose behaviour was sufficiently worrying to their parents that they took them to a clinic. His control group was a selection of "typically masculine" boys.

As Bailey points out "These were clearly two different groups of boys and the feminine group was on the extreme side" How many intermediate boys were there? In other words, how many marginally feminine boys become heterosexual? The group was unrepresentative of the male population as a whole, indeed Green did not intend it to be. He was simply contrasting two groups of behaviours and predicting their outcomes, but he was saying nothing about gay men in general. It seems reasonable that feminine children will become sexually attracted to men, but are all homosexual men invariably feminine? Bailey thinks so.

Feminine men.

Questionnaires regarding retrospective memories of childhood have well-known problems. More compelling are Bailey's studies of subtle differences in speech and body language, of which they may not have been aware, where different men are perceived as masculine or feminine, which turned out to correlate with their sexual orientation. He points out that there still some unanswered questions. Do they acquire certain mannerisms as an assertion of group identity in a social minority? Or are they an extension of the mannerisms they grew up with. Are gay men exhibiting traces of the feminine behaviour they identified with before they learned that such behaviour was not acceptable? If there is a 'gay accent', is it actually feminine? The gay community has long accused transsexual people of escaping the taboo of homosexuality. It is intriguing to think of gay men as denying their inherent femininity.

It is not my intention here to debate the validity of these studies as they apply to gay men. However, it is less clear how they relate to those transsexuals that speak of their femininity, yet remain attracted to women.

In one study quoted by Bailey, subjects were rated on their speech, using a scale from 'gay-sounding' to 'heterosexual sounding' and "only" ten per cent of the latter were rated as 'gay-sounding', while 25% of the gay men were rated as straight.

Other studies focused on body language. One viewed videotapes of various subjects and predicted whether they were homosexual or heterosexual, the results being better than would have occurred by chance. In other words, there were cases where the predictions were wrong. In the other study, subjects were scored according to a predetermined list of masculine and feminine traits. Bailey records that "40 percent of the gay men were rated as more feminine than the most feminine heterosexual men" So there were feminine-tending heterosexual men. In fact he admits that one of the thirty heterosexual exhibited marked feminine movements - 3 per cent.

Remember that, in spite of their public visibility in recent years, transsexuals account for less than 0.001% of the population, far less, for instance, than people diagnosed as intersexed. It seems likely, then, that those sufficiently feminine to be transsexual, yet remaining heterosexual, that Bailey later describes as autogynephilic, would be lost as experimental error.

Heredity.

It turned that Danny's uncle was gay. On the face of it, that personalities run in families comes as no surprise. They may be inherited genetically, or through family associations - academic, practically inclined, outgoing or introspective, and so on. As Bailey points out, nobody suggests that there is a gene for being Catholic. He discusses the many studies of biological predictors, from the 'gay gene', through hormone effects in the womb, to various brain structures.

Psychiatrists are desperately looking for biological, specifically neurological, reasons for human behaviour, to find a way through their confusion. Humans are the ultimate opportunists, able to move into almost any environment and adapt it to their needs. Not only do they invent technology, but adapt their behaviour and cultural systems, unencumbered by rigid genetically based behaviours. Such genetic influences on behaviour as may be found are likely to be very subtle. It seems to me that, in a species that has to learn courtship and the most fundamental behaviour - the act of sex itself - it seems unlikely to me that any complex behaviours will be found to be predetermined, except perhaps in the very young.

Born or made?

The early part of the twentieth century was the heyday of the behaviourist movement. From this came social learning theory, which feminists saw as liberating them from biological theories that sought (with little evidence) to prove their inferior status. Money's assertion that babies are psychosexually neutral at birth appeared in a political climate that was all too ready to accept it. While others, such as Diamond, insisted that there were still biological biases to overcome, their voices were unheard.

Bailey describes a study by Money, which took a prominent place in every high-school psychology text book, where a boy baby that had lost its penis in a clinical accident was reassigned as a girl.(2) Throughout its childhood, its progress was publicised as an unqualified success. By the time the child entered school, Money had already begun considering biological influences, but still insisted they could be overcome by rearing. In a sense, having publicised his case so widely, he had burnt his bridges, but, in the ninety's, a researcher for the BBC Horizon series found that things were not as they seemed. It turned out that, as a child, she, as he was then, was gawky and aggressive, and called "the gorilla" by the other children. In time, the boy, who we now know as David Reimer, began to live as a man.(3)

A common criticism is that David's story is just one case history, possibly untypical. I am more concerned about the many unanswered questions. Bailey convinces me more with his citing of a larger scale study by Reiner of boys who had been born with a condition called cloacal extrophy. Although they had been brought up as girls, they, in time, reverted to living as boys.(4)

From this and other studies, it is increasingly clear that there is "something" though we don't know what it is. Somehow a child is predestined to develop in a, more or less, masculine or feminine way. After decades of argument, I would submit that we still have no real idea of the complexities of development, of which this predestination is a substrate. In other words, we cannot truly predict whether a child will develop as a male or female person. This is particularly so if the child is intersexual, like the baby recently featured in Footballers' Wives on British television. Thus there has recently been a strong reaction against the tendency of clinicians to 'tidy up' babies with ambiguous genitalia, or even artificially assign them to one role or the other.(5)

Other times, other places.

Bailey summarises a number of periods that social historians have highlighted for their acceptance of homosexual activity. What about the Greeks? He cites Boswell's The Marriage of Likeness, but the situation that Boswell describes is much more subtle than Bailey implies.(6) Moreover, Boswell addresses the idea of homosexuality as a form of male-bonding. However, whether or not homosexuality was tolerated or institutionalised at different times, gender deviant behaviour was deplored. Soranus, a second century AD. Greek physician, wrote of 'molles'- soft unmasculine men, and women called 'tribades' "who pursue women with an almost masculine jealousy."(7)

If gender roles are cultural constructions, why can we not have three or four - or seven degrees of masculinity and femininity like the Chukchi of Siberia?(8) This is where I feel Bailey should have asked more questions. He writes about the katoey prostitutes of Thailand, but ignores the masculine homosexual rent boys. He does his subject material a disservice by not looking at the history of other cultures, instead of their modern Westernised manifestations.

Intermediate gender categories occur in many traditional cultures around the world. Roscoe(9) lists over a hundred and fifty Native American tribes in which they occur. Most also have categories for man-like women, such as the fa'tama of the Pacific Islands.

Traditionally feminine males did not dress as women - or as men. While the Xanith of Oman had their own specific clothing, among many cultures, they dressed in a mixture. Among the Zunis, for ceremonial occasions, the llamana wore their hair up on one side in the warrior fashion, and down on the other in women's fashion.(9) The fa'afafine of the Pacific Islands wear their lava-lavas covering their chests, female fashion, rather than around their waists, and the older generation among the islanders is expressing concern that they are, more and more, dressing like Western women.(10)

In most accounts, the native correspondents describe them as "gentle" or "soft" men - non-warrior or nonaggressive males. Their work was around the home base, often craftwork, but also domestic duties where their strength might be helpful. They helped care for the young and sometimes adopted orphans. In that they learned the tribal lore and performed at tribal functions, they were invested with a certain spirituality. However, they were not necessarily shamans, nor were shamans necessarily intermediate gendered.

Some might argue that these were social roles, not sex roles. But there was a liminality inherent in such cultures, and the native names for them often indicated a perceived position between men - hunters or warriors - and women.

They, therefore, performed a social role in which their sexual behaviour was a natural extension, but it was not the primary aspect of their identity. By definition, it was not homosexuality as we think of it, and invariably their role was receiver rather than initiator. Indeed, in some such cultures, homosexuals were recognised as a distinct category meriting disapproval.

A short history of sex.

The reader might find this part of my response a little difficult. However, Bailey is insisting that some transsexuals "are males who fantasize sexually about wearing women's clothes, having female anatomy, and doing feminine things. Some of them want to become women so badly that they do so."(11) It is something, therefore, we have to address.

The author may be dismissive of social constructionism, but the study of different sexual behaviours cannot be divorced from the social environments in which they arise. In past ages, magic and the spiritual and the sexual were intrinsic to daily life. Rituals included the fetishistic adoption of cross-sex roles. The difference between 'acting out' and 'belonging to' particular roles could be said to parallel the modern transvestite and transsexual. Archaeologists have noted the references to the female sexual organs, even in the layout of ancient tombs, which, in time, gave way to an emphasis on phallic symbols. Erotic artefacts from the earliest times have been discovered, often tucked away in museum storerooms away from the public view. What human males find sexually attractive is extremely flexible. Nowadays the emphasis is on youthful women, almost prepubescent. In Neolithic times, postpubertal women may have been more able to produce children safely, with the energy reserves from increased body fat. The famous Venus figurines, which have been found in great numbers all over Europe, were once thought of as female fertility symbols. Some now suggest that they represent the first signs of male objectification of the female body.(12)

The last few thousand years have seen increasing inhibitions about sexuality, and in second millennium BCE Europe the spiritual experience inherent in sex was co-opted by religion, the former being retained as an unwelcome necessity for procreation, sanctioned by the sacrament of Holy Matrimony. By Victorian times, proscription of non-procreative sex had reached the point where ingenious appliances were invented to prevent night-time emissions by boys, which probably only served to encourage masochism. Science reinforced cultural perceptions in the introduction of degeneracy theory. The medical profession proved to its own satisfaction that masturbation produced feeble mindedness, and introduced cold baths and breakfast cereals.(13) We have a legacy of shame and negativity about sexuality, which is reflected in the media, and in diffidence about conducting meaningful scientific research.

John Money has long been an advocate of sex rehearsal among the very young. I don't wish to get involved in moral and sociological arguments at this point, but merely suggest that, undirected, an individual's primary erotic target may develop unpredictably as gynephilic, androphilic or paraphilic. We still have no idea how people acquire it, whether female, male, inanimate or simply an idea. Thus, for instance, someone may be nominally heterosexual, yet only be able to function effectively when almost totally encased in rubber.

Humans are endlessly inventive in every area, including that of sexual expression. Perhaps they are the only species that thinks about sex as opposed to simply doing it. Sexual fantasies are the penalty we pay for having a large cerebral cortex and an imagination. What, actually, is the difference between clothing fetishism and haute couture? But erotic fantasies have cognitive scripts. They don't appear from nowhere, but are based on present issues and past experiences. This clearly is the domain of psychodynamics rather than medicine.

Sometimes a transvestite will extend the role by having an encounter with a male partner, imagined or real. Another paraphilia? Or does he discover he's "really gay after all"? Only he can tease out the reality behind the fantasy. If someone can only have sex with a woman as a man, and with a man as a woman, are they truly bisexual? Is this what transsexuality is all about? Yet, it is one thing to have sex with someone, quite another to have an emotional relationship.

Sex and transsexuals.

If someone is a woman, they will be attracted to men, right? Certainly it seems to be central to psychiatric theory.

Bailey introduces two very different characters into his story, both transsexual people. Terese, who as a child was very like Danny and, in teenage, experienced crushes on other boys, and on some of the male teachers. She met other gay crossdressers and went around with them, with occasional male sexual partners. Cher, on the other hand, was never obviously feminine, (though the author does not say whether she was obviously masculine). She had boyhood friends and participated in sports and, in time, developed a sexual interest in women. Unlike Terese, from teenage, she had crossdressed in secret.

At this point the author introduces the idea, first proposed by Blanchard, of autogynephilia, defining it as "a male's propensity to be aroused by the thought of himself as a female." Many rejected the erotic implications, feeling that it obscured the emphasis on identity. Others saw political implications, feeling it provided ammunition for the right wing. Would the authorities be as sympathetic in producing legislation and changing paperwork if it was seen as an erotic fetish rather than as a psychological conundrum? About a year ago, the local newspaper published a two page article about me, with a large photograph, at a time when I was working on a building site. Would I have received such a friendly response from my work-mates if they had known the attitude of a high profile psychiatrist? This book is not only wrong-headed, it is unbelievably dangerous.

Transsexuals have long sought to distance themselves politically from transvestites. Many found the idea personally threatening, but others found it liberating, acknowledging an important part of themselves that they'd felt they should keep hidden. Mostly, however, there is a refusal to admitting any relationship with eroticism. It shouldn't take long on the internet to convince them they cannot bury their heads in the sand. Autogynephilia exists - it is an open secret and we have to confront it.

If you wanted to be an amateur tranny-spotter or a barrack-room psychiatrist, how would you go about it? You could start with the checklist entitled "Autogynephilic and Homosexual Transsexuals: How to Tell Them Apart." This chapter adds nothing to the book and seems to have been inserted unnecessarily as a sop to the author's vanity.

Bailey then introduces Stephanie Braverman, a heterosexual male crossdresser. On the surface, her story seems much like Cher's. Although the Diagnostic and Statistical Manual would regard Stephanie as a fetishistic transvestite, Bailey makes it clear that he groups her among the several subtypes of transsexual.

He uses a conceptual process, commonly used in science, called 'lumping' and 'splitting.' Previous writers have been splitting their subjects into an increasing number of categories. Blanchard observed that they could all be lumped into one group with a behaviour in common - autogynephilia - in which they differed from homosexual transsexuals.

Bailey suggests that, somehow, misdirected gynephilic preference locates the erotic target inside the self rather than on an external woman (In other words, Freudian incorporation).(14) He writes "autogynephiles are not women trapped in men's bodies. They are men who desperately want to become women. "However, he goes on: "regarding the fundamental question of whether autogynephiles are born or made, my intuitions are with 'born'" - in common, he suugests, with other paraphilias.

What then allows Stephanie to live in two different roles, while Cher can only progress in the female role? Blanchard's Eureka moment seems to have come when he met Philip, who had no wish to live in the female role, whose sexual experiences with women had been unsatisfactory, but imagined having features of the female body on himself in his sexual fantasies. In time he had begun to fantasise himself having intercourse with a man as a woman. Bailey writes: "to many autogynephiles, the act of being penetrated by a penis is the ultimate statement that one is a woman." Blanchard suggests that those who fantasise about being nude women, and particularly about having a vagina, would feel the strongest desire to change their sex.

However, it must be remembered that 'lumping' is simply a conceptual process by which phenomena with characteristics in common are grouped together. It does not of itself say anything about cause and effect. The question is still why these people want to become women.

Transsexuals have long known that, to make progress through a gender clinic, they have to assert two things - that they have a partner preference for men, but that they are not actually very interested in sex. They may feel that, otherwise, they will be rejected out of hand.

Certainly the erotic component complicates matters, which renders one aspect of his clinical practice difficult to understand. Bailey describes the effect of hormone medication, which varies considerably from one individual to another. One of these - the most immediate and consistent, I would submit - is the reduction of libido. If the eroticism was an important aspect for a particular individual, the hormones would be expected to lead to a loss of appetite, leaving the individual able to gain a clearer understanding of his cognitive motivations. By delaying their administration until after a year of changing role, the individual has already damaged his relationship with his wife, family, friends and work colleagues, and probably lost his job - changing his mind is not an option.

Hormones are not immediately prescribed for women, for they would increase, rather than decrease libido, and the effects are not reversible, as they are, to an extent, for men. I had always understood the reluctance to prescribe them was due to their perceived dangers, however small, or to an androcentric antipathy to the idea of a male wanting to lose his virility. Apparently, however, "Blanchard does not want to risk accusations of gender bias." It seems, then, that a humane, and potentially powerful, diagnostic tool is denied on a point of political correctness that, incidentally, seems very patronising to female to male transsexual people.

Gay Men or women?

One might expect that homosexual people might also have fantasies associated with crossdressing, perhaps before they become old enough to find partners. Bailey suggests that homosexual fantasies concern a fancy for a particular man and of having sex with him, while autogynephilic fantasies seem to concern the person herself being made love to by a, usually anonymous, male. This is also true, of course, for heterosexual males who cannot credibly visualise a female partner, hence the provision of girlie magazines that provide surrogates, usually focusing on a particular feature of an, otherwise anonymous, woman.

Putting it another way, it will be remembered that there may be masculine homosexuals and feminine heterosexuals that disappear from Bailey's studies. From Bailey's own account of heterosexual and homosexual relationships, while the former may well attract partners, the latter are unlikely to. Autogynephilia is then, quite reasonably, their only erotic outlet.

Thus, for Bailey, autogynephiles aspire to be women, but homosexual transsexuals aspire to be attractive to men - indeed objects of heterosexual male desire. The message seems to be that they become women because they can't make it as gay men. In other words, it seems that, for Bailey, their changing sex is a pragmatic decision based on partner likelihood.

Transsexuals have acquired an image of glamour from those who hit the headlines, from April Ashley and Tula, to Dana International, who won a recent Eurovision song contest. Certainly those people that Bailey writes about are, to say the least, exotic. In fact most transsexual people disappear unremarked back into the community they came from, as teachers, doctors, priests, accountants, lawyers and lorry drivers. As Purnell puts it: "Exceptional People: Whose greatest aspiration is to be seen as ordinary."(15)

The objections of some writers to surgery are discussed. As Bailey puts it "we simply have no idea how to make gender dysphoria go away", and the object of all therapy is the improvement of quality of life. In this, Bailey does not exclude people because they are autogynephilic.

The author concludes with the regimen at the Clarke Institute, which includes a two-year Real Life Experience with no ifs or buts. I have, in the past, been taken to task for suggesting that pre-op people should spend some time as transvestites first. It seems to me that it would be a useful part of the reality check before the person has revealed himself to too many people. No study as far as I know has looked at the relative success of those who have spent some time as transvestites going out and about to clubs, compared to those who jump straight into the clinic from the closet. As Bailey points out, most homosexual transsexuals spend some time on the gay scene beforehand, gaining feedback from other transsexuals - and straight men.

When it comes to clinical practice the theory is not, in fact, very helpful. Like it or not, people do not behave in predictably neat ways. There are transsexuals who remain attracted to women, while others adopt an intermediate path and call themselves 'transgendered' (Bailey suggests they are almost all autogynephilic.) There are homosexual transvestites, who attend transvestite meetings, strictly social occasions, but dress as men and go to gay clubs when they want sexual partners.

There must be something else. Bailey suggests that it is not primarily a disorder of gender identity, yet the people we are writing about are exactly as defined in the Diagnostic and Statistical Manual.

As to cause, Bailey suggests he is betting on biology, which seems something of a cop-out. Humans are, after all, biological organisms - ones that react in a myriad of different complex ways to a myriad of different complex social environments. There are many years of development between birth and the beginnings of sexual awareness. In order to understand transsexuals, we are forced to consider the way they have juggled their individual biology and environment, to construct, often subliminally and irreversibly, their social worlds.

Conclusion.

Bailey admits to being an essentialist. Essentialism, like most reductionist paradigms, ignores phenomena that it cannot account for. Nevertheless, he injects a refreshing note of realism into a literature often imbued with wishful thinking. What, after all is masculinity and femininity?

He seems, however, to have great empathy with and compassion for the people he describes, though this is belied by a recent news article,(16) and immense enthusiasm for his subject. If I have added comments of my own it is because I feel that, though flawed in its claimed scientific basis, it is a book that should generate a great deal of valuable discussion. In particular, he does not make it clear enough that autogynephilia may be an effect of transexuality, rather than a cause. I would encourage all transsexual people to read it, if they dare, but I would suggest that health professionals should not expect the book to offer any great insights.

Bibliography

  1. Green, R., (1987) The 'Sissy Boy Syndrome' and the Development of Homosexuality Yale University Press
  2. Money, J., (1975) Ablatio Penis: Normal Male Infant Sex-Reassigned as a Girl. Archives of Sexual Behaviour, Vol 4, No. 1 pp65-71
  3. Diamond, M., Sigmundson, H.K., (1997) Sex Reassignment at birth: A Long Term Review and Clinical Implications, Archives of Pediatric and Adolescent Medicine, 151, 298-304
  4. Reiner, William G., Meyer-Bahlburg, H.F.L., Gearheart, J.P. Realization of Male Gender Identity in Spite of Neonatal Sex-Assignment as Female in 46, XY Patients With Cloacal Exstrophy. Submitted for publication 9-01
  5. Diamond, M., Sigmundson, H.K., (2000) Management of Intersexuality: Guidelines for dealing with individuals with ambiguous genitalia. Archives of Pediatrics and Adolescent Medicine.
  6. Boswell, J., (1995) The Marriage of Likeness: Same-sex unions in pre-modern Europe, London: Harper Collins
  7. Halperin, D.M., Sex Before Sexuality: Pederasty, politics and power in classical Athens. in Duberman, M., Vicinus, M., Chauncey, G., (eds) (1990)Hidden from History: Reclaiming the gay and lesbian past, London: Penguin Books
  8. Jacobs, S.E., Cromwell, J., (1992) Visions and Revisions of Reality: Reflections on Sex, Sexuality, Gender and Gender Variance, Journal of Homosexuality, 23(4) 43-69
  9. Roscoe, W., (1991) The Zuni Man-Woman, Albuquerque: University of New Mexico Press
  10. Paradise Bent: Boys will be girls in Samoa, Channel 4 television (UK) 15.02.2002
  11. From the Amazon.com website.
  12. Taylor, T., (1996) The Prehistory of Sex: Four Million Years of Sexual Culture. London: Fourth Estate
  13. Money, J., Lamacz, M., (1989) Vandalised Lovemaps, Paraphilic Outcome of Seven Cases in Pediatric Sexology, New York: Prometheus Books
  14. Incorporation is where the person takes on the attributes of an admired other. (not necessarily an object of fear as in the Oedipus Complex) Its importance is that, to the extent that the biological temperament, or whatever, of the person leads to internalisation of attributes, identification follows. That Bailey, in a medically essentialist theory, resorts to a psychoanalytic model, is testament to the power of Freud's conception of human psychological dynamics.
  15. Purnell, A., (1998)Exceptional People: Whose Greatest Aspiration is to Be Seen As Ordinary. A Counsellors view. Gendys Journal, Number 1, February 1998, London: Gendys Network. http://www.gender.org.uk/gendys/1998/01alice.htm
  16. Roughgarden, J., (2003) Psychology lecture lacks sensitivity to sexual orientation Stanford Daily Online edition, April 25, 2003, http://ai.eecs.umich.edu/people/conway/TS/BaileyStanfordLectureReport.html
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