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27 October 2022

The 1953 symposium at the New York Academy of Medicine

Emil Gutheil (1889-1959) was born in Czerlany close to Lviv, which was originally in Poland, but then part of Austria-Hungary and now is in the Ukraine. He was educated at the University of Vienna. He became a neuro-psychiatrist at the university Psychiatric Clinic, and was mentored by psychoanalyst Wilhelm Stekel (1868-1940), who is credited with coining the term ‘paraphilia”.

We met him previously in the early 1920s when a trans man then 34-years old, whom Gutheil refers to only as ‘Elsa B’ came to Gutheil, seeking help to gain a transvestitenschein. He subjected B to 33 sessions of psychotherapy during which he continued to refer to B as ‘she’ and as a ‘woman’.

Gutheil became director of the Active-analytic Clinic in Vienna, but emigrated with his wife to the United States in the late 1930s in anticipation of the the Anschluß Österreichs, the Nazi takeover of Austria.

In 1939 in New York he founded the Association for the Advancement of Psychotherapy and in 1947 the AAP started publishing the American Journal of Psychotherapy. Gutheil remained loyal to the ideas of his deceased mentor Wilhelm Stekel (and, working with Stekel’s widow, edited his autobiography), in particular the idea that trans conditions had an environmental cause and successful therapy would dissuade patients from the pursuit of medical options. This of course would require many sessions of psychoanalysis. Gutheil had no examples of patients successfully ‘cured’.

Harry Benjamin wrote in The Transsexual Phenomenon (p29-30 in the Warner edition; p12-3 in the PDF version):

“Following the sensational Jorgensen publicity in 1952, I was asked to write an article on the subject for the now no longer existing International Journal of Sexology. In this article, which appeared in August 1953, 1 chose the term transsexualism for this almost unknown syndrome. I did the same in a lecture (as part of a symposium) at the New York Academy of Medicine, before the Association for the Advancement of Psychotherapy in December, 1953, discussing male transsexualism” [i.e. trans women] “only. … In the years following the Hamburger et al. publication in the A.M.A. Journal and my own in the American Journal of Psychotherapy in 1954 (constituting the lecture of the previous year) there were hardly any references to transsexualism, in the American medical literature. ”

The symposium had been suggested by Gutheil and was held 18 December 1953. Benjamin read his paper, "Transsexualism and transvestism as psychosomatic and somatopsychic syndromes", and Gutheil and two others responded from their respective experiences and standpoints. This was the second time that Benjamin used the term ‘transsexual’.

All four papers were published in Gutheil’s American Journal of Psychotherapy, 8,2, 1954 without any editorial comment, but with “Transsexualism and Transvestism” added to each title.

  • Harry Benjamin. “Transsexualism and Transvestism as Psycho-Somatic and Somato-Psychic Syndromes”.

This is twelve years before Benjamin's The Transsexual Phenomenon.  It shows how his ideas were developing.   Some but not all of what he says here will be retained in the later book.

Benjamin reviewed the various terms proposed by his predecessors. Then he writes:

“Naturally not every act of ‘cross-dressing’ is transvestitic. Only if it occurs in an atmosphere of emotional pressure, sometimes to the point of compulsion and is accompanied by a more or less distinct sexual satisfaction can the term be applied . Otherwise it would be simple masquerading of a non-affective nature .”

[Editorial comment: this is in line with Hirschfeld’s Die Transvestiten but not his later works such as Sexualpathologie, 1919. ]

“While the male transvestite, enacts the role of a woman, the transsexualist wants to be one and function as one, wishing to assume as many of her characteristics as possible, physical, mental and sexual.”

“Transsexualism as well as transvestism are decidedly more frequent among men than women, like most other sexual deviations. Due to the more permissive fashions in women, female transvestism is less conspicuous, but naturally can involve for the individual the same frustrations and often tragic situations as in men.”

[Editorial comment: In 1953 the evidence did point to this conclusion. However the relative proportions are quite different in the 21st century - as also they were in Weimar Germany.]

“The transsexualist is always a transvestite but not vice-versa. In fact, most transvestites would be horrified at the idea of being operated.”


[Transsexuals] “consider the fact that they are attracted to men natural because they feel as women and consider themselves of the female sex. … Transvestites on the other hand are in the majority heterosexual, although their principal sexual outlet seems to be auto-erotic.”

[Editorial comment: This is retained in The Transsexual Phenomenon of 12 years later when Benjamin assigns Kinsey scale numbers to each of his types. The Transvestites are Kinsey 0-2; The True Transsexuals are Kinsey 4-6. The erasure of gay transvestites is in this early paper. Benjamin had been introduced to Virginia Prince by Louise Lawrence a few years earlier. Certainly he accepted some of her ideas. Hirschfeld had also erased gay transvestites in his 1910 work Die Transvestiten, but reversed this in Sexualpathologie, 1919 - the former but not the latter in the bibliography at the end of the paper.]

On etiology, Benjamin writes:

“The effeminate male may look and behave as he does on a purely psychosomatic or psychological basis (imitating his mother, for instance) but he may also be the product of a somato-psychic mechanism originating in his chromosomes. It is often impossible to distinguish between the two.

Havelock Ellis has this to say in regard to etiology : "Early environmental influences assist but can scarcely originate Eonism. The normal child soon reacts powerfully against them. 'We must in the end seek a deeper organic foundation for Eonism.' "

Benjamin proposed three types:

  1. The principally psychogenic transvestite. “He is miserable when dressed as a man and immediately comfortable and relaxed in the clothes of a female. He has become an expert in cosmetic make-up, yet is occasionally in social or legal difficulties. He assumes a female first name and wants to be referred to as 'she.' … In fighting his peculiarity he sometimes over-emphazises masculinity and becomes known as a ‘tough guy.’ ”

  2. The intermediate type. “ .. he inclines at times toward transsexualism, but is at other times content with merely dressing and acting as a woman. He wavers between homo- and heterosexual desires usually according to chance meetings.”

  3. The somatopsychic transsexualist. “Feminine appearance and orientation is often striking in these people but masculine features are compatible with full transsexualism. The conviction of these endocrine males that they are really females with faulty sex organs is profound and passionate.”

Benjamin retained this 3-part typology in his The Transsexual Phenomenon of 12 years later where his six Types were still sorted into three Groups:

Type 2 here became Group 2 and thus Type IV on Benjamin’s scale, 'Nonsurgical Transsexual, Kinsey 1-4'. Just what this is became confused: sometimes a Virginia Prince ‘transgenderist’ ( a term which would also include Sylvia Rivera); sometimes a true transsexual who chose or had to put up with being non-op; but also a waverer such as Benjamin’s one example, Peter/Irene, a rather well-known musician from Oregon, married for twenty-five years, who apparently never did transition.

He comments on psychotherapy.

“All therapy, in cases of transsexualism—to the best of my knowledge—has proved useless as far as any cure is concerned. I know of no case where even intensive and prolonged psychoanalysis had any success. If we are dealing with a constitutional deviation, we can hardly expect to influence it .”
And then again 2 pages later: 
“In my opinion, psychotherapy for the purpose of curing the condition is a waste of time . A basic conflict would be too firmly anchored in the constitution. All that the psychiatrist can possibly do is to relax tension, to develop and reinforce realistic thinking, and to supply guidance. That, of course, is not a cure.”


  • Emil Gutheil. “The Psychologic Background of Transsexualism and Transvestism”.

Gutheil accepts Benjamin’s proposed use of the term ‘transsexual’.

Like Benjamin he refers to Hirschfeld’s Die Transvestiten, but not his later Sexualpathologie, 1919, and includes the former but not the latter in the bibliography at the end of his paper. He does not erase gay transvestites in the way that Benjamin does, but in the very different way of insisting that all transvestism is a type of homosexuality, even though this is unknown to and denied by the patients themselves. He cites one of Hirschfeld’s patients: “I never felt attracted to men. However, dressed as a woman, I liked to flirt and joke with them. I felt flattered to be mistaken for a woman.” A behaviour that Virginia Prince also admitted in her sessions with Robert Stoller.

He rejects Benjamin’s etiology:

“The neurosis of the transvestite is frequently considered as a sequel of the existing "biologic error. " Since the biologic component cannot be established satisfactorily , such a concept must be accepted only as a hypothesis. However, closer psychiatric exploration of the transvestite reveals to all who are familiar with the methods of psychiatric investigation that the patient's neurosis is due to specific pathogenic factors, most of which are accessible to scientific inquiry . The most important finding of the psychiatric investigation is that the patient's desire to be a woman is a symptom of this neurosis and is imbedded in a setting of other neurotic mechanisms of contributing value.”

He continues:

“In my opinion, transvestism is the result of six psychopathologic factors. They are : (1) latent (or manifest) homosexuality with an unresolved castration complex; (2 ) the sadomasochistic component ; (3 ) the narcissistic component; (4 ) the scoptophilic; (5 ) the exhibitionistic , and (6) the fetishistic component. In every case all six tributaries are represented in varying degrees. In some cases, the homosexual component is conscious and manifest; in others the fetishistic, or sadomasochistic features predominate.”

He concludes:

“What about psychotherapy? Hasn't psychotherapy been unsuccessful in so many of these cases! My answer is—that as far as the evaluation of the pathogenesis of transsexualism is concerned, it does not matter. Poor therapeutic results do not necessarily prove that the etiologic concept is wrong. If our therapy does not succeed, we must investigate the causes of our failure, learn from our mistakes and improve our approach. In most of the unsuccessful cases the patients' uncooperative attitude may be considered as the main source of failure . … I think, however, that to do justice to the transvestites we must also educate the patients themselves. We must show them how, while fantasying a future physical metamorphosis, they are, in reality, harking back to their neurotic past, to their infantile fears and pleasures, and point out to them how futile it is to try solving one's sexual problems—in effigy.”

  • Danica Deutsch. “A Case of Transvestism”.

Deutsch from the Alfred Adler Consultation Center in New York presented a single case study which was regarded as a ‘cure’.

A patient is referred to as “O.R.” and is a man in his early 30s, married four years who had dabbled as a child and after marriage in cross-dressing. He had tried a psychiatrist, but stopped because of the cost. He went to the Center. They interviewed O.R. and then his wife, who then worked on his lack of self-confidence and even shared cross-dressing with him. Deutsch, of the Center, concludes:

“This case represents a classical example of the Adlerian concept of 'masculine protest.' Interesting is also that the patient compensated for his organ inferiority (bad eyesight) by scoptophilia and fetishism.

The favorable outcome after such a short period of treatment can be attributed to the positive aspects of the client's personality. According to Benjamin's categories, this case can be classified as a 'simple male heterosexual psychogenic transvestite.' Though he was self-centered, he was not so completely discouraged as to deviate into manifest homosexuality. His fantasies were always of heterosexual character; though in feminine clothing, he assumed the role of the male.

Moreover, the cooperation of his wife cannot be overlooked. She refrained from everything that might feed his neurosis, his feeling of inferiority and incompetence; she avoided overindulgence, or a critical or domineering attitude . She rather helped him to apply his newly gained insight to obtain a positive relationship based on equality.”

  • Robert Veit Sherwin. “The Legal Problem In Transvestism”.

This is the first consideration of the legality or otherwise of transvesting and or having genital surgery in the US.

“… in the strict sense of the word, there are no laws concerning either transvestism or the various medical aspects concerned with sex transformation. But this fact in no way prevents or nullifies the popular conception that everything connected with this subject is illegal in this country. … Legislators are seldom willing to tackle problems involving sex head-on. The result is that law enforcers are therefore forced to utilize whatever laws they have at their disposal, and whether these laws actually fit the problem often seems of little consequence.”

He then discussed the mis-application of the Disorderly Conduct and the Mayhem laws.

[Editorial comment: Sherwin did not discuss the many cities in the US starting with Columbus, Ohio in 1848 that passed municipal laws against cross-dressing.]

See also the 1967 symposium at the New York Academy of Sciences.

  • Emil Gutheil. “XVI. Analyse eines Falles von Transvestitismus,” in Wilhelm Stekel. Der Fetischismus, vol. 7, Störungen des Trieb- und Affektlebens. Urban & Schwarzenberg, 1923: 534-570. Translated by S Parker: “Analysis of a Case of Transvestism” in Sexual Aberrations: The Phenomena of Fetishism in Relation to Sex. John Lane The Bodley Head Ltd, 1930: 281-318.

  • Harry Benjamin. The Transsexual Phenomenon. Warner Books reprint Edition 1977: 29-30.

  • Werner H Engel, Frederic Wertham, Paul H Hoch, William Wolf, Lewis R Wolberg & Hilda Stekel. “In Memoriam: Emil A Gutheil, M.D., 1899-1959”. The American Journal of Psychiatry, 13,4, 1959. Online.

  • Linda Heidenreich. “A Historical Perspective of Christine Jorgensen and the Development of an Identity” in Bonnie Bullough, Vern Bullough & James Elias (eds). Gender Blending. Prometheus Books, 1997: 274-5,

  • Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, 2002:105-7.

  • Rainer Herrn. Schnittmuster des Geschlechts. Transvestismus und Transsexualität in der frühen Sexualwissenschaft. Giessen, 2005: 76n6

1 comment:

  1. Gut heil (German for good healing) is a great name for a doctor.

    However a good doctor does not blame the patient when healing fails: "In most of the unsuccessful cases the patients' uncooperative attitude may be considered as the main source of failure",


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