Harry Benjamin in the press 6 April 1924

San Bernardino Sun.  6 April 1924 p 8. 

Elmer Belt (1893 - 1980 ) urologist, pioneer sex-change surgeon.

++Original version April 2009; revised March 2019, and again February 2021.
                                                                             
Originally from Chicago, Elmer Belt moved to Los Angeles with his family at age 9. He did a bachelors, 1916, and a masters, 1917 at University of California Berkeley.  He married his high-school girlfriend in 1918. He qualified as M.D. in 1920 at the University of California Medical School in San Francisco. As his first son had been in a serious motor accident, and as he was not satisfied with the orthopedic treatment at the UCLA, he  applied for a residency in General Surgery at Peter Bent Brigham Hospital in Boston, where his son could be treated by Dr Lovett. Afterwards they returned to and lived in Los Angeles for the rest of their lives. Belt opened a private practice. 

Belt had collected the works of novelist Upton Sinclair since he was a student. In 1934 he was part of Sinclair’s campaign to become governor of California. By then he had established the Elmer Belt Urologic Group, a group practice which moved to its own building on Wilshire Blvd. in 1936; the second floor of this structure housed his ever-expanding library.

From 1939 through 1954 Belt served as the President of the State Board of Public Health, having been first appointed by California Governor Culbert Olsen and then reappointed by Governor Earl Warren for each of Warren's three terms in office. While treating Warren, Belt was able to put the case for a medical school at UCLA, which opened in 1946. He was not only instrumental in the founding of the UCLA School of Medicine, he found its first dean, and continued to support it for his whole life. Dr. Belt had privileges as a staff, attending, or consulting urologist at many hospitals around Los Angeles County and taught as Clinical Professor of Surgery (Urology) in the UCLA School of Medicine. He was acknowledged as a specialist for prostate problems.

In 1950, when he was 57, Belt was contacted by Harry Benjamin who was starting to accept transsexual patients, and was looking for competent and willing surgeons.   At some point after that Belt became the first surgeon in the US to do sex change operations on a regular basis, many on patients referred by Harry Benjamin. While he was associated with the UCLA School of Medicine, he did not perform his operations there.  They were usually done at the Good Samaritan Hospital.   He predated the team led by Poul Fogh-Andersen in Copenhagen, and he was doing vaginoplasty using skin grafts from the thigh, buttocks or back while the Fogh-Andersen team was doing only orchiectomy and penectomy. While most surgeons would not do a castration because of the mayhem laws in effect in California and most other states, Belt got around this by preserving the testicles, pushing them into the abdomen, to preserve the hormones that they produced and to avoid charges of mayhem. He regarded this as good practice. As he explained to a colleague: “It is not necessary to disturb the patient’s endocrine balance to maintain his condition as a transsexual since the faulty tissues lay within the substance of the testis in the first place.” 

Belt's nephew, Willard Elmer Goodwin (1915-98) was in 1951 the founding chair of the Division of Urology in the Department of Surgery at the UCLA School of Medicine.  Belt had trained him in the techniques of sex-change surgery, and he did several such operations at UCLA.  Belt's second son, Bruce (1926-2012) also became a urologist and practiced with his father for 20 years or so. 

Belt was also interested in doing surgery for trans men. He corresponded with Harry Benjamin about how to do this. Benjamin mentioned the flap techniques that Harold Gillies had done for Michael Dillon, but was unsure that such a procedure was worth following. Belt did have a trans man client who had had breast reduction from another Los Angeles surgeon, and as he had a cystic ovary, hysterectomy was medically justified anyway. Phalloplasty was considered, but in the end was not done.

Willard E Goodwin asked Rollin Perkins, a professor of law, about the mayhem statutes in 1954. Perkins acknowledged that there was a “want of judicial decision on the point” and advised caution given the uncertainty and the prejudice.  A committee of doctors at UCLA, including Goodwin and psychiatrist Frederick Worden, decided against the practice, and Goodwin ceased doing so.  Belt also ceased although as he never did the operations at UCLA he was not affected by the decision.   Annette Dolan, who did her own auto-orchiectomy, was one of his last patients.  

In 1956, Dixie MacLane was arrested in Los Angeles by a vindictive policeman, and although she had had her surgery in Mexico, Dr Lyman Stewart from Belt’s practice provided supportive written testimony as did Harry Benjamin.

Both Belt and Goodwin had restarted quietly. As Belt wrote to Benjamin, he considered himself a softie who found it hard to turn away such desperate patients. In 1956, he did completion surgery on Barbara Wilcox, who was one of the first trans women to receive female-hormone injections and who in 1941 had successfully petitioned the Superior Court of California to change her name and to legally become a woman. 

In 1958 there was a fire in Belt's office and most of his records were lost. 

A notable patient was Agnes who approached UCLA psychiatrist Robert Stoller also in 1958. Stoller convinced himself that she was intersex rather than transsexual, and referred her to Belt for surgery. Also that year, Belt saw an 18-year-old trans woman “who is trans-sexual and earnestly desires an operative procedure for the change of his sex”, but as he explained to Benjamin, he turned her away for being under the age of medical consent. 

Patricia Morgan, from New York came in 1961, but it took four months before a bed could be found in a hospital for Belt’s type of surgery. Then she had to wait another two months for the second phase, the vaginoplasty. And then she developed urinary problems and Belt had to do a third operation.

Aleshia Brevard, who like Annette Dolan had done an auto-orchiectomy, came in 1962, one of Belt’s last trans patients.  Hedy Jo Star had also been referred to Belt and accepted.  She was saving up for this just before Belt discontinued doing genital surgery, however a friend referred her to a doctor in Chicago who arranged surgery elsewhere.

He discontinued finally in 1962 under family pressure after he heard about the growing practice of Georges Burou. He had continual problems finding hospitals where he could do the work; he feared that a dissatisfied patient would ruin his practice by suing; he had a number of patients who did not pay their bills. There were also complaints about the way that he treated some patients. He was by then 69 and ready for retirement.

He was not part of the UCLA Gender Identity Research Clinic (GIRC) that was founded the same year, led by Robert Stoller and Richard Green, although he had more experience of transsexual patients than the entire GIRC team together.

Elmer Belt was a collector of artefacts by or about Leonardo de Vinci for over 60 years. He gave the collection to the UCLA in 1966.

Willard Goodwin was a member of the GIRC and was the urological surgeon for the operation on Beverly-Barbara in 1968, the GIRC’s first transgender operation.

Bruce Belt left medicine in 1977 and became a high-school teacher.

Elmer Belt died in 1980 at age 87.

• Elmer Belt. Surgical teaching through motion pictures, A. R. Fleming co, 1937.
• Elmer Belt. Leonardo the anatomist. Logan Clendening lectures on the history and philosophy of medicine, Ser. 4, Univ. of Kansas Press, 1955.
• Patricia Morgan as told to Paul Hoffman. The Man-maid Doll. Lyle Stuart, Inc, 1973: 51-3, 56-64, 68-9.
• Willard E Goodwin, MD.  "A Chat with Elmer Belt".  Urology, 10, 4, 1977.  
• Akleshia Brevard. The Woman I Was Not Born to Be. Temple University Press, 2001: 81-7.
• Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States . Harvard University Press. 363 pp 2002: 142, 146, 147-8, 160, 162-3, 164,192, 242.
• Jules Gill-Peterson. Histories of the Transgender Child. University of Minnesota Press, 2018: 137, 171-2, 244n25n26n28, 251n27.
• Victoria Steele.  Emails to Zagria, February 2021. 

LA Conservancy   Elmer Belt Papers   Vidensbanken om konsidentiten     Google Scholar     EN.Wikipedia   

---------

When Belt was interviewed by Goodwin in 1976, he said that after the car accident that injured his son, "I wasn’t satisfied with the orthopedic care he was getting at the University of California" and so did a residency in Boston.  I think that was 1922.  Virginia Prince's father was Charles Lowman, an orthopedic physician trained in Boston with the same Dr Lovett that Belt was taking his son to see.  As I wrote "The owner of the building where Charles Lowman had his clinic made an offer that if Lowman could establish a functioning hospital within 15 years, he would donate clear title to the building and its gardens. This was done and further expansion of the Los Angeles Orthopedic Hospital was being discussed when the 15 years had passed in 1922".   So one does wonder why Belt did not take his son there.

The Harry Benjamin Foundation in the mid 1960s

In 1963 Benjamin was invited by Dr Robert Hotchkiss, the urologist, to read a paper at New York's Bellevue Hospital. He also read a paper at the Society for the Scientific Study of Sex (of which he was a charter member). That year Reed Erickson became a Benjamin patient and almost completed transition. He then founded the Erickson Educational Foundation (EEF), financed entirely by himself.

Through his foundation Erickson agreed to finance the newly created Harry Benjamin Foundation (HBF) for three years at a minimum of $1,500 a month. The money from Erickson enabled a move to a larger office at 86th St and Park Avenue. The foundation sought to enhance Benjamin’s professional status. Robert Stoller at the University of California Los Angeles (UCLA) had disparaged Benjamin in that he was not psychiatrically trained, and did not publish in the most reputable journals. Stoller politely declined to serve on the Foundation’s advisory board. Nevertheless Benjamin was able to use the Foundation to enhance his working relationship with other doctors and researchers in the field.

Meetings of the foundation were held in the office, mainly on Saturday evenings. The members conducted psychological, endocrinological and neurological tests on transsexual patients, and interviewed them before and after surgery, looking to prove or disprove any genetic, hormonal or neurological basis for the condition.

Those in regular attendance

Harry Benjamin

Of course. GVWW

John Money

Money had become head of the Psychohormonal Research Unit at Johns Hopkins Hospital in Baltimore in 1962, and was keen on opening a Gender Identity Clinic.

Richard Green

In addition to attending meetings of the Foundation, Green also spent time in Benjamin’s office writing approval letters for his clients, and writing what became two appendices to Benjamin’s 1966 book. GVWW

Leo Wollman

Gynecologist and hypnotist, Wollman claimed to have seen more transsexual patients than Benjamin had. At this time they shared the practice, and worked from the same office. Wollman also ran a group session, the first Sunday of every month, near his other office at Coney Island. GVWW.

Henry Guze

Guze was a professor at the American Academy of Psychotherapies which he co-founded. He was also a co-founder of the Society for the Scientific Study of Sex, where he was president 1964-6. He specialized in psychosomatic illness, schizophrenia and disorders of sexual behaviour, and was a hypnotist. He proposed a 4-part typology of transsexuals: 1) effeminate in structural appearance 2) trained early to adopt a cross-gender role, as among some Native American tribes 3) problems of self-identification, perhaps as a result of a psychotic process 4) latent or expressed homosexuals. He found fantasies of sex change and cross-dressing common among ‘so-called normal’ people but regarded the expression of such desires as markedly fetishistic. Guze died in 1970, age 51, of cardiac arrest. Obituary.

Ruth Rae Doorbar

Doorbar had published on sex offenders and sex within marriage in the 1950s. Her major work with the HBF was “Psychological Testing of Transsexuals” (Online), which found more trans woman than expected with high IQs. At a time when inter-racial couples were still illegal in some US states, her boyfriend was Jamaican, and she moved to Jamaica with him and became a pioneer in Jamaican psychotherapy.

Robert Veit Sherwin

Sherwin was a lawyer and co-founder of the Society for the Scientific Study of Sex. He was the author of Sex and the Statutory Law, 1949. He advised Benjamin and others on mayhem and other legal aspects of what they were doing. He published “The Legal Problem in Transvestism” in 1954, and a revised version “Legal Aspects of Male Transsexualism” was included in Green and Money, 1969. He died in 1979.

Herbert Kupperman

Kupperman authored Human Endocrinology, 3 volumes, 1963, and was known for his work on hormones in women. He was a pioneer in identifying the chromosomal sex of intersex infants.

Wardell Pomeroy

Trained as clinical psychologist, Pomeroy had been a major colleague of Alfred Kinsey, and they and Clyde Martin were co-authors of the landmark books Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953). He moved to New York in 1963 and went into private practice as a sex therapist. He was known for his prodigious sexual appetite; while primarily gynephilic, he also went with men for balance. Later he wrote popular books on adolescent sexuality, that those who would ban books kept putting on their lists. He died in 2001 at age 87. EN.Wikipedia. Obituary.

And when they were in New York

Christian Hamburger

The Danish endocrinologist who had overseen Christine Jorgensen’s transition. EN.Wikipedia.

Walter Alverez

Alverez (1884-1978) was a prominent physician at the Mayo Clinic in Minnesota. After retiring in 1951 he began writing a medical column which soon became syndicated across North America. He was noted for his enlightened attitude to homosexuality. EN.Wikipedia.

-------

Benjamin met monthly with John Money and Richard Green and the idea was raised of applying the kind of surgery being done on intersex patients to transsexuals as well. Money took three post-operative patients of Harry Benjamin to meet his colleagues at Johns Hopkins. As the Gender Identity Clinic there began to coalesce, it was integrated into the work of the Foundation, which provided them with patient referrals. Reed Erickson’s EEF donated $85,000 to the Gender Identity Clinic over a few years, and Reed became quite friendly with John Money. He went to Johns Hopkins for a double mastectomy repair in 1965.

The Harry Benjamin Foundation similarly endorsed the gender clinic at Stanford University. The Minnesota Medical School in Minneapolis was considering opening a Gender Identity Clinic led by Donald Hastings. Two members went to New York, met with the HBF and were able to examine patients of Benjamin and Wollman who had had surgery abroad. Their surgeon, John Blum, went to Johns Hopkins to observe transgender surgery.

Harry Benjamin's The Transsexual Phenomenon came out in 1966. Guze gave it a very positive review in The Journal of Sex Research. Also in 1966, Benjamin referred Phyllis Wilson who was the subject of the first sex-change operation by Howard Jones at the Johns Hopkins Hospital in Baltimore. He also witnessed an operation performed by Jones. By now Stoller had come round, and after meeting with Benjamin described him to Green as “not only a good heart but plenty of good clinical data’.

The Harry Benjamin Foundation presented eight separate papers at a meeting at the prestigious New York Academy of Sciences on January 16, 1967, mainly considering etiology based on pre and post examinations of Benjamin's patients. Stoller flew in from Los Angeles and presented the first paper. Green returned from London. Stoller and Green presented papers based on research at UCLA. Kupperman, Pomeroy, Money, Doorbar, Wollman and Guze also presented papers, based on their work with the HBF.

Benjamin and Erickson had been having disputes, sometimes quite petty, about how the money was spent. In the spring of 1967 the EEF grant was reduced to $1,200, and in the fall – after the promised three years expired-- stopped entirely. Shortly afterwards, the Erickson Educational Foundation asked Benjamin to vacate the office that it was subsidizing.

There had been discussion that a book should emerge to embody the findings of the Foundation, but this was felt to be too narrow. In particular that would exclude the important work being done in Europe. The book, financed again by the EEF, eventually came out in 1969 as Transsexualism and Sex Reassignment edited by Richard Green and John Money.

Publications by members of the Foundation

• Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. With a bibliography and appendix by Richard Green.  A close reading.
• Transactions of the New York Academy of Sciences, 29,4II, January 16, 1967.

Robert Stoller. “Etiological Factors in Male Transsexualism”. p431-3.
Herbert S Kupperman, “The Endocrine Status of the Transsexual Patient”. p434-9.
Richard Green. “Physician Emotionalism in the Treatment of the Transsexual”. p440-3.
Wardell B Pomeroy. “A report on the Sexual Histories of Twenty-Five Transsexuals”.p444-7..
John Money & Ralph Epstein. “Verbal Aptitude in Eonism and Prepubertal Effeminacy – A Feminine Trait”. p448-54.
Ruth Rae Doorbar. “Psychological Testing of Transsexuals: A Brief Report of Results from the Wechsler Adult Intelligence Scale, the Thematic Apperception Test and the House-Tree-Person Test”. p455-62.
Leo Wollman. “Transsexualism: Gynecological Aspects. p463.
Henry Guze. “The Transsexual Patient: A problem in Self Perception”. p464-7.

• Henry Guze. “Review of The Transsexual Phenomenon by Harry Benjamin”. The Journal of Sex Research, 3,2, May 1967: 183-5.
• Richard Green & John Money. Transsexualism and Sex Reassignment. The Johns Hopkins Press, 1969. With contribution by Benjamin, Erickson, Money, Green, Stoller, Guze, Pomeroy, Doorbar, Hamburger, Wollman, Sherwin.

Other

• Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, 2002: 214-5, 219, 222, 223.
• Richard Green. Gay Rights, Trans Rights: A psychiatrist/lawyer’s 50-year battle. 2018: chp 16.
• Julian Gill-Peterson. Histories of the Transgender Child. University of Minnesota Press, 2018: 139-140.

Ethel Person (1934-2012) psychoanalyst: Part I Life

Part I: Life
Part II: theory

Unless otherwise noted, page references are to The Sexual Century.

Ethel Jane Spector was raised in Louisville, Kentucky. Her mother was a mathematician, and her father owned a bar. He died when she was twelve. She completed a first degree at the University of Chicago in 1956, and then a medical degree at the New York University College of Medicine four years later. She became Mrs Person when she wed an engineer. The marriage ended after ten years, although she kept his name for her professional life. She married her second husband, a psychiatrist, in 1968, and became Mrs Sherman.

Soon after joining the Columbia University Center for Psychoanalytic Training and Research, Person was invited to work with Lionel Ovesey (1915-1995), the author of The Mark of Oppression: A Psychosocial Study of the American Negro, 1951, and Homosexuality and pseudohomosexuality, 1969. His concept of ‘pseudohomosexuality’ concerned `homosexual anxieties' in heterosexual males who were concerned about dependency and lack of power. Ovesey was one of the psychiatrists strongly opposed to the delisting of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973.

Ovesey’s proposal was that he and Person would write a textbook on sex and gender. They quickly realized that neither of them had any experience with transvestites or transsexuals. An acquaintance in the psychoanalytical world was Harold Greenwald, the founder of the Professional School for Humanistic Studies (where Anne Vitale qualified as a psychologist). Greenwald introduced Person to the then 88-year-old Harry Benjamin and his assistant Charles Ihlenfeld in 1972. She spent time in Benjamin’s office interviewing some of his patients.

“The work that I did with Lionel would have been well nigh impossible without the cooperation of Harry Benjamin, who was hospitable to me despite his major bias against psychoanalysts. In fact we became great friends.” (p xiii)

Indeed Benjamin asked her to write a biographical portrait of him to be published after his death. She formally interviewed him to this end a dozen times.

One person that Person met at Benjamin’s offices was Ed/Edna, 60, a retired tugboat captain who had become the superintendent of a rental building. He fell in love with Clair, one of his tenants, a completed transsexual. He detransitioned to become her lover, and was devastated when she left him for a truck driver. To cope with the resulting depression, Edna restarted hormones and dressing full-time. Again he rented to a completed trans woman, Janet. Again he reverted to male, and became her lover. After Ed’s original wife died, he married Janet, and lived happily with her until she also died ten years later. He was then 85. (By Force of Fantasy p 131-4)

Edna subscribed to Transvestia magazine, and through that discovered transvestite social groups. Edna introduced Person to these socials: “it was at these events that I gained some of my deeper insights into the subjective meaning to transvestites of their participation in that world”. Person and Ovesey also sought confirmation for their work by visiting pornography shops and reading trans publications.

Person and Ovesey proposed a typology of trans persons assuming that a child's separation-individuation anxiety produced a fantasy of symbiotic fusion with the mother which the transsexual tries to resolve by surgically becoming her mother.  Papers to this effect were published 1973-85. (See part II for details).

One of the transsexuals included in the Person-Ovesey study was Elizabeth – author of the Notes from the T Side blog. She writes:

Harry Benjamin “in 1970 -71 asked me to talk to a Dr. Ethel Person as part of a study and I agreed although I am inherently distrustful of shrinks but I found her pleasant and quite nice and we became friendly. When the study was published I was stunned to be honest. I was part of the study and I knew two others who were part of it and friends of mine. We never talked about anything mentioned in the study directly. We talked about our lives as children until the current time and at the time I was 24 and had close to enough money for surgery. In point of fact Harry might have been more upset by the study than anyone. I am posting this to refute what they found because as one of the participants in the study I walked into her office and asked her where I fit in late 1974 and she said Secondary because I liked boys so I was a homosexual transsexual where by Harry's definition I was a Type VI high intensity transsexual and according to Harry the study was bogus.”

Ethel Person’s second husband died in 1976. She married a lawyer in 1978 and became Mrs Diamond. 

Person was director of the Columbia University Center for Psychoanalytic Training and Research 1981-91. She did an “epidemiological study of sexual fantasy” which she contrasted to Alfred Kinsey’s study of sexual acts.

Her best known book is By Force of Fantasy: How We Make Our Lives, 1995, where she argues that we shape our lives by trying consciously or otherwise to live out our fantasies.

In 1987 Person had paired the film critic Molly Haskell with an appropriate analyst, and became a friend. In 2005 when Haskell’s sibling was starting transition, she spoke to Person about the situation. Apparently Person said nothing to her about primary or secondary or separation anxiety. Only: “Transsexuals are the best, the kindest people I know, maybe because they have to learn compassion the hard way” and “He longs for validation,” Ethel spoke of transsexualism as being “a passion of the soul”. Later in Haskell’s book, Person is quoted: “The worst thing about it is you discover you don’t know the person you thought you knew.”

In 1997 Person gave a presentation to the International Psychoanalytic Association Congress in Barcelona on her life of Harry Benjamin, and used it to illustrate the origin of shared cultural fantasy. In 1999 she collected her works on sex and gender, including her biography of Harry Benjamin, and published them as The Sexual Century.

Person’s third husband died in 2009. Ethel Jane Spector Person Sherman Diamond, her final name, incorporating the surnames of all three husbands, died at age 77 of complications from Alzheimer’s disease.

Leah Cahan (Schaefer) (1920 – 2013) singer, psychologist

Leah Cahan was born in Milwaukee, and raised in Chicago. She was the daughter of an Orthodox rabbi who had escaped the pogroms in Lithuania.

Intending to be a music teacher, she started singing at age 15 at Central College (now Roosevelt University). After college she was in The Barries, a female trio. They lasted five years, sang on NBC radio in New York, were among the first artists to record for what became Capitol Records, and had a hit record with the Johnny Mercer, “San Fernando Valley”.

She lived in California and learned folk songs. Back in New York she was part of The Wayfarers, and became the first wife of jazz legend Hal Schaefer who was then in the group, and became known as Lee Schaefer.

After her second divorce Leah tried analysis, but after her father died, she slipped into a period of depression while living on unemployment pay.

A second session of analysis in 1953 led to her accepting the suggestion that she herself become an analyst. She was accepted at Columbia Teachers College, and then Columbia University, where she earned an MA and then a doctorate.

A third marriage at this time resulted in a daughter.

For her doctoral thesis she chose the topic of female orgasm. It was then 1961, and the ongoing work by Masters and Johnson had not yet been published. She was given permission by Ernest G. Osborne(1903-63), the head of her department who supervised her thesis until his early death. Leah was also advised by Margaret Mead. She quickly realized that understanding orgasm required understanding a whole life. She interviewed 30 white, middle-class women who were unaffected by the then just-beginning women’s movement. They talked about their first reactions to menstruation, their adolescent sexual encounters, their first sexual act, and how they feel about orgasm and adult sexuality. One finding was how each woman in the study had a negative reaction in childhood to the idea that her parents had sex. Many of the women had never talked to anyone in such detail before.

Leah 1974

The thesis was completed in 1964, and Columbia suggested that a commercial publisher would be appropriate, but it took until 1973 until one was willing.

After graduation, Leah was credentialed as a psychotherapist. After she had built a practice using the name Leah Schaefer, and had established a reputation in the field, she was contacted by Wardell Pomeroy, a co-author of the Kinsey Reports. Pomeroy had been working with Harry Benjamin as a therapist to assess ‘true’ transsexualism. Schaefer was chosen because of her ability to be non-judgmental. Pomeroy was preparing to move to San Francisco, and wanted her to take over his work with transsexuals, which she did. She continued to work with transsexuals for the rest of her life, progressing from evaluation to general therapy.
 
She was the first women president of Society for the Scientific Study of Sexuality (SSSS), 1978-1979. She worked with Connie Christine Wheeler. They interviewed Harry Benjamin in 1979 about the history of the SSSS, he took to them and trusted them with his files. They read all the 1500 or so files, and started meeting regularly with him to discuss what they found.

In 1983 they presented a paper “The Non-Surgical True Transsexual: A Theoretical Rationale”, an elaboration of Harry Benjamin’s Type IV, the person who cross-lives but does not desire gender confirmation surgery. After Benjamin’s death in 1986, Wheeler and Schaefer became the custodians of Harry Benjamin’s professional archives.

Schaefer was president of HBIDGA 1991-5 (before it was renamed WPATH), and was involved in the writing of several editions of its Standards of Care. In 1995 Schaefer and Wheeler published their seminal work, “Harry Benjamin's first ten cases (1938-1953): a clinical historical note”.

Schaefer donated the Benjamin archives and her own archives to the Kinsey Institute in 2007.

Leah 2007

Nancy Gonzales, who met Schaefer in 2008, summarized her work with transsexuals:

“She takes issue with the terms ‘gender dysphoria’ or ‘gender identity disorder’ in referring to these individuals' circumstances.  She feels that it's pejorative and inaccurate to classify this condition as a pathology.  In her professional opinion, most of the presenting problems they have stem from the stigmatization they suffer.  She believes that transsexualism is a birth anomaly and maintains, as do a growing number of scientists, that transsexualism is a naturally-occurring variation in humans and is part of a person's inborn psyche.” 

Leah Scheafer died aged 92.

• The Barries & Johnny Mercer. “Someone’s in the kitchen with Dinah”. 1944
• Paul Weston & his Orchestra, The Barries & Johnny Mercer. “San Fernando Valley”. 1944. Lyrics
• The Wayfarers (Hal Schaefer; Elka Sylvern; Lee Schaefer; Paul Bain). Wandering with the Wayfarers, LP RCA Victor, 1957.
• Lee Schaefer & Jim Hall. A Girl and a Guitar. LP United Artists, 1958.
• Lee & Hal Schaefer. Finian’s Rainbow and Brigadoon Remembered. LP United Artists, 1959.
• Leah Cahan Schaefer. Sexual Experiences and Reactions of a Group of 30 Women As Told to a Female Psychotherapist. Ed D Thesis, Columbia University 1965. Revised as Women and Sex; Sexual Experiences and Reactions of a Group of Thirty Women As Told to a Female Psychotherapist. Pantheon Books, 1973.
• Leah C Schaefer . "Frigidity." Modern woman.  Charles C Thomas, 1969: 165-177.
• Edward M Brecher.  "Leah Cahan Schaefer".  The Sex Researchers.  a Signet Book, 1971: 184-202.  
• Lindsay Miller. “Woman in the News: Dr. Leah Schaefer: A Lot More Than Just Sex”. Washington Post, 7/28/1973. Online.
• Suzanne Lowry. “Come as you are”. The Guardian, July 5 1974. Online.
• Leah C. Schaefer & Connie C. Wheeler. “The Non-Surgical True Transsexual: A Theoretical Rationale”. Eighth International Symposium on Gender Dysphoria, Bordeau, September 16-19, 1983. Abstract Revised as "The nonsurgery true transsexual (Benjamin's category IV): A theoretical rationale." International Research in Sexology (Sexual Medicine) 1 (1984).
• Leah Schaefer. “TV Relationships”. The tv-ts Tapestry, 43, 1984: 30-3. Online.
• Connie Christine Wheeler & Leah Cahan Schaefer. "Historical overview of Harry Benjamin's first 1500 cases." Harry Benjamin International Gender Dysphoria Association, Tenth International Symposium on Gender Dysphoria, Amsterdam, The Netherlands, 1987.
• Connie Christine Wheeler & Leah Cahan Schaefer “Harry Benjamin's first ten cases (1938-1953): a clinical historical note”. Archives of Sexual Behavior 24:1 Feb 1995. Online at www.helen-hill.com/pdf/hbfirst10cases.pdf. Revised as the Afterword to Randi Ettner. Confessions of a Gender Defender: A Psychologist's Reflections on Life Among the Transgendered. Evanston, IL: Chicago Spectrum Press, 1996.
• Jamil Rehman, Simcha Lazer, Alexandru E. Benet, Leah C. Schaefer, and Arnold Melman. "The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients." Archives of sexual behavior 28, no. 1 (1999): 71-89.
• Stephen B Levine, George R. Brown, Eli Coleman, Peggy T. Cohen-Kettenis, J. Joris Hage, Judy Van Maasdam, Maxine Petersen, Friedemann Pfaefflin, and Leah C. Schaefer. "The standards of care for gender identity disorders." Journal of Psychology & Human Sexuality 11, no. 2 (1999): 1-34.
• Anne Lawrence, Yvon Menard, Stan Monstrey, Jude Patton, Leah Schaefer, Alice Webb & Connie Christine Wheeler. "The Harry Benjamin International Gender Dysphoria Association′ s Standards Of Care For Gender Identity Disorders, Sixth Version." World Professional Association For Transgender Health, 2001.
• Leah Cahan Schaefer & Connie Christine Wheeler. "Guilt in cross gender identity conditions: Presentations and treatment." Journal of Gay & Lesbian Psychotherapy 8, 1-2 (2004): 117-127.
• Ellen Michel. “A Season of Recognition for KI Donor Dr Leah Schaefer”. Kinsey Today, November 2007. www.indiana.edu/~kinsey/about/images/schaefer-newsletter.jpg.
• Nancy Gonzales. “When October Goes: My Day with Leah Schaefer”. NCFR, 2008, www.ncfr.org/members-stories/when-october-goes-my-day-leah-schaefer.
• Dana Beyer. “Remembering Dr. Leah Schaefer, the Sweet Singer-Turned-Psychiatrist Who Healed a Generation of Trans Women”. The Huffington Post, 01/30/2013. www.huffingtonpost.com/dana-beyer/leah-schaefer-trans-women_b_2569123.html.

Discogs
____________________________________________________________

I don’t know why there is no mention at all of Leah Schaefer in Joanne Meyerowitz’ How Sex Changed: A History of Transsexuality in the United States.

Leaf Schaefer started her career as a psychologist while married to her third husband, but using her first husband’s surname.

Schaefer and Wheeler discuss Benjamin’s Type IV as it is usually taken to be, that is as a cross-living, non-op person. However in Benjamin’s 1966 book, as I have discussed, a Type IV is defined as “’Dresses’ as often as possible with insufficient relief of his gender discomfort. May live as a man or a woman; sometimes alternating.” Benjamin’s typology actually erases full-time non-ops, as well as gay and female transvestites and gynephilic High Intensity Type VIs.

Randi Ettner, psychologist and author of Confessions of a Gender Defender, 1996, is Leah’s niece. The book has, as an Afterword, a rewrite of “Harry Benjamin's first ten cases”.

The backing singers here are The Barries
 

Ira B Pauly (1930–) psychiatrist, sex-change doctor

(All quotations from Anderson 2015, unless otherwise specified).

Ira’s father was a successful bookmaker who raised his three sons and a daughter in Beverly Hills, Los Angeles. Ira was the youngest, and the first in the family to go to university. He graduated from the University of California, Los Angeles in 1953. He was a noted rugby and US football player. In the latter, he was on the UCLA winning team of 1953, and Pauly was the B’nai B’rith 1953 Los Angeles Jewish Collegiate Athlete of the Year.

 “I applied to medical school. And even though my, I had a pretty good GPA, probably 3.4, 3.5. But the guys that were getting in had 3.8 and 4.0s. But you know, because by then I had become known as a football player, I was the first one to get accepted at UCLA, I was told. So that didn’t hurt. They were looking for people who were so-called well-rounded.“ (p2)

He graduated from the UCLA School of Medicine in 1958. After doing a surgical internship at UCLA, he was accepted for a psychiatric residency at Cornell Medical Center in New York. He married in 1960, and he and his wife had four sons.

In 1961 he was doing a rotation in the consultation service when he was called to urology to counsel a trans man who was in for a hysterectomy. He attempted research in the hospital library but found material on transsexualism only in French and German. He had patients who were willing to do longhand translations for him.

He then discovered a paper by Cauldwell.

“And then there was a brief article by someone named Harry Benjamin. And in those days, it was in a somewhat obscure journal. I don’t quite remember which journal it was. But it had his address. And it was an address that was about five blocks away from the hospital that I was working at. So I looked up his name in the phone book and told him that I was a psychiatry resident, and I had a little experience with a transgender, transsexual patient. And was there any way I could come over and talk to him, because I had read—he was an endocrinologist. And a lot of these folks, the first step in the physical transition is taking the contrary hormone.” (p6)

For much of that year, he attended Benjamin's Wednesday afternoon clinic.

 “So every Wednesday afternoon, through the generosity and mentorship of Harry Benjamin, I was able to see probably more transsexual patients than any psychiatrist in North America. … As I got to know the patients, they uniformly described being happier into the gender role that they felt they were in from the very beginning. And that the only thing that needed to be done as far as treatment was concerned was to get the body on board with the gender of their choice.“ (p6)

Pauly set out to aggregate 100 cases from the literature and from among Benjamin’s patients.

He had been in the Reserve Officers’ Training Corps (ROTC) at UCLA and would normally have done military service at the end of his education, but he had developed glaucoma, and the army no longer wanted him. In 1962 he obtained a position at the University of Oregon Medical School.

He completed "Male Psychosexual Inversion: Transsexualism. A Review of 100 Cases" in 1963, but it was not published until 1965. He concluded that that gender surgery had positive results and that trans patients should be supported by medical professionals in their quest to live as the gender of their identity. He then received a thousand requests from doctors around the world for offprints of his article. It also resulted in a job interview at Johns Hopkins, but Oregon doubled his salary to keep him.

++His presentation at the American Psychiatric Association in 1964 led to a sensationalized article in the National Insider that while quoting him that the desire to change is found in childhood, it then blames alcoholic fathers who punished their children, and that "It apparently gave them a reason to escape from responsibility and from being a man".

However, Harry Benjamin, in his 1966 The Transsexual Phenomenon, quotes Pauly as saying:

“Because of his isolation, the transsexual has not developed interpersonal skills, and frequently presents the picture of a schizoid or inadequate personality.” (p71-2/33).

Speaking to the American Psychiatric Association in May 1964, Pauly said:

“The transsexual attempts to deny and reverse his biological sex and pass into and maintain the opposite gender role identification. Claims of organic or genetic etiology have not been substantiated. … Although psychosis is not frequent in the schizophrenic sense, in its most extreme form, transsexualism can be interpreted as an unusual paranoid state, characterized by a well-circumscribed delusional system in which the individual attempts to deny the physical reality of his body. The term Paranoia Transsexualis has been suggested as an appropriate descriptive term for this syndrome. Psychosexual inversion is seen as a spectrum of disorders, from mild effeminacy to homosexuality, transvestism, and finally transsexualism, each representing a more extreme form, and often including the previous manifestation.” (quoted in Benjamin, 162-3/76)

He proposed the term ‘pseudotranssexual’ for those who sought transition to justify their

homosexuality.

He was one of the first doctors to point out that transsexuals tell the doctor what he wants to hear. He called them “unreliable historians”. (Benjamin, 164/76)

Pauly also saw private patients.

“But these folks were, among other things, very grateful because they had great difficulty getting a physician to empathize with their situation, let alone treat them. And prescribe hormones and refer them to the surgeon for surgery. So the word got around. So I probably treated everybody in the Portland area on a one-to-one basis.” (p12)

Oregon had no surgeon performing transgender surgery, so at first patients were referred to San Francisco, and then to Dr Biber in Trinidad, Colorado. Pauly did his own endocrinology prescriptions. In that period he also attempted to treat gay persons wishing to become heterosexual.

“And there was the occasional transgender person that wanted to go back to accept himself in the gender role that was consistent with what his body said. And some of us tried to help out in that regard. But I personally tried to do that with a couple of patients. And the only thing I really accomplished was to kind of push them into a psychosis. So that, by trial and error, I learned that I certainly didn’t have the ability to help them with that problem.” (p19)

In 1969 he contributed two papers to Green & Money’s Transsexualism and Sex-Reassignment, one on trans women, one on trans men; each includes four case studies, and an overview.

Paul McHugh, who would close down the gender identity clinic at Johns Hopkins after 1975, was dean of the University of Oregon Medical School until 1975.

In 1975 Pauly’s student Thomas Lindgren, wanting something more objective than a patient’s self-history, developed a body-image scale where patient’s rated how they felt about different parts of their body. Not surprisingly pre-op transsexuals rated their genitals worse than their arms or legs. However it was also used for anorexia and other conditions, including those wanting homeogender surgery.

In 1978 Pauly became chair of the University of Nevada Medical School. He was a founding member of the Harry Benjamin International Gender Dysphoria Association, (now WPATH) in 1979, and served as president of the Harry Benjamin International Gender Dysphoria Association from 1985 to 1987.

In the late 1980s, Louis Sullivan was lobbying the American Psychiatric Association and the Harry Benjamin International Gender Dysphoria Association and the gender identity clinics to recognize the existence of gay trans men. Pauly was one of the few psychiatrists to respond, and made a three-hour video interview with him.

Pauly retired in 1995, did sabbatical work in New Zealand, and returned to work in the state hospital in Reno, Nevada and became medical director for the Northern Nevada Adult Mental Health Service.

In 2004, Pauly was inducted into the Southern California Jewish Sports Hall of Fame.

He retired again in 2010.

• Ira B Pauly. "Female Psychosexual Inversion: Transsexualism. Read before the American Psychiatric Ass., St. Louis, May 1963.
• Arnold Wells. “Exclusive! MD Reveals The Fourth Sex! Not Male, Not Female, And Not Homosexual”. The National Insider, 5, 3, July 19, 1964. Online.
• Ira B Pauly. "Male Psychosexual Inversion: Transsexualism. A Review of 100 Cases". Archives of General Psychology, 13, 1965:172-181.
  
• Ira B Pauly. “The current status of the change of sex operation”. Journal of Nervous and Mental Disease, Nov;147, 5, 1968:460-71.
  
• Ira B Pauly. “Female Transsexualism”. Archives of Sexual Behavior,3, 1974:487-526.
  
• Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977, with a bibliography and appendix by Richard Green.  PDF (with different pagination): 71-2/33, 162-3/76, 164/76, 179/84, 181/84.
  
• Ira B Pauly. “Adult Manifestations of Male Transsexualism” and “Adult Manifestations of Female Transsexualism”. In Richard Green & John Money (ed). Transsexualism and Sex-Reassignment. Baltimore: The Johns Hopkins Press, 1969: 37-87.
  
• Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Cambridge, Ma, London: Harvard University Press, 2002: 123, 124, 125, 174.
• Amy Bloom. Normal: Transsexual CEO's, Cross-Dressing Cops, Hermaphrodites with Attitude, and More. Vintage, 2014: 18-22.
  
• Maija Anderson. Interview with Ira B. Pauly, MD. Oregon Health & Science University, Oral History program, Februray 18, 2015. Online

TSRoadmap
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For some reason Harry Benjamin calls Pauly “Ira S Pauly”. 

The EN.Wikipedia article is almost the same as the TSRoadmap article.

At the end of Maija Anderson’s interview, Pauly is asked what he thinks about Alan Hart, the famous trans doctor from Portland, Oregon, who transitioned in 1917. Despite having lived in Portland for 16 years where Hart is remembered, he replies: “No. I wish I had seen that. Where was it published again”, and then “And as far as I knew, the first published female to male, as we referred to it, was the patient I described in the New York Hospital”. Obviously he does not spend much time reading trans history.

Benjamin’s TS Phenomenon – comments

Harry Benjamin's book is now 50 years old.

• Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977, with a bibliography and appendix by Richard Green.  PDF (with different pagination). 

Part I:  intro and the Scale
Betty (?1938 - ?) female impersonator, salesgirl, model. --- 2nd entry, Appendix D, autobiographies
Part II:  transvestites
Clara Miller (1899 - ?) fur merchant, office worker ---  3rd entry, Appendix D, autobiographies
Part III: trans women
Joe (1920 - ?) cattle breader, art dealer ---  4th entry, Appendix D, autobiographies
Part IV: photos, legal, trans men, conclusions
Comments


See also my biography of Harry Benjamin:
Part 1 - beginings
Part 2 - rejuvenation.
Part 3 - transsexualism to 1966.
Part 4 - transsexualism since 1966
Harry Benjamin's other books
The other Harry Benjamin

 
 
When I wrote my 4-part biography of Harry Benjamin in October 2012, I had intended to finish with a review of his major book. However it turned out to be a bigger task than I had realized, and I put it aside until now. As this year is the 50^th anniversary of the book's publication, this is certainly a good time to reread it.

A close reading reveals that the book is composed of segments that were written at different times. Sometimes this is openly admitted. Such that chapter 1 was published in Sexology in 1961, and part of chapter 7 in Sexology in 1963. Sometimes this is deduced such as at the beginning of chapter 6 where Benjamin writes: “Although this volume does not deal with transvestism specifically, a few remarks as to the therapy of this less serious deviation, in comparison with TSism, may be in order” as if chapters 2 and 3 do not exist. The grumpy bits at the beginning and end of chapter 4 were probably written at a different time from the rest of the book, including the middle parts of the same chapter.

Textual analysis as a tool well developed in literature and Bible studies (e.g. we know the text of TS Eliot’s Waste Land before Ezra Pound edited it, and gave us the version that is best known; The Epistle to the Philippians contains a kenotic hymn at 2:5-11 whose theology is quite at odds with the rest of the document). The tool is only just beginning to be used in transgender studies. The obvious document for such analysis is Neils Hoyer’s autobiography of Lili Elvenes (Elbe), where Sabine Meyer has made a good start.

The Harry Benjamin Archives at the Kinsey Institute, Indiana (a US State where trans persons are not allowed to use the toilets) is quite vast. Does it contain the initial drafts that became The Transsexual Phenomenon? A comparison with the published version would be a useful PhD thesis for somebody to write.

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Some parts of the book do not seem to know about Benjamin’s Scale, suggesting that it was developed after the book was partly written. The big problem in the scale is the assignment of Kinsey Scale numbers which led inevitably to erasures, of gay transvestites and gynephilic transsexuals. In a couple of cases Benjamin attempts to get around this by declaring a person to be a Kinsey 3 or 4 while being a husband and father, but a 6 after deciding to transition. As Kinsey and his team based positions on the scale on a person’s sexual history this would be an innovation by Benjamin.  In Kinsey's usage a person who was 3 or 4, and then became exclusively androphilic, would have become a 5, not a 6.   Your previous history becomes part of your current history.

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Other problems with the scale are the lack of real difference between Type III and Type IV and the lack of a type for full-time non-ops. This would seem to have grown out of Benjamin’s previous three-part typology 1) those who merely want to ‘dress’ and be accepted as women. 2) those who waver, who want breast development but shy away from surgery. 3) ‘fully developed’ transsexuals. Hence he mainly sees a Type IV more as wavering, rather than choosing to live without surgery (despite the name).

Type I (pseudo-transvestites) is not really thought through. Three subtypes are quickly mentioned:

1. “Nonaffective dressing” is Type 0 (cis) doing drag for non-existential ends.
   
2. Those who cross-dress when young and then desist.
   
3. Those who never actually cross-dress, but enjoy transvestic films and literature.

_______________________

Type II is quite muddied by being labeled ‘fetishistic’ while not understanding fetishism, a practice performed by a few transvestites, a few transsexuals, and mainly cis persons. Type III is ‘true transvestite’, implying that type II is sort of ‘false transvestite’. In what way false? This is not addressed, other than talking about ‘fetishism’. Some trans women who are into fetishism, or go through a period of fetishism, appear otherwise to be true transvestites (Johnny Science, Kim Christy),  and some complete the transsexual journey (Lana Wachowski). In this, as in much else, Benjamin paid too much attention to Virginia Prince who was obsessed that her femmephilics not be regarded as fetishistic.

As I wrote: “Two years after Benjamin’s book, Transvestia columnist Sheila Niles popularized the concept ‘whole girl fetishist (WGF)’ for FPE members who did not pass well enough, particularly if it were for lack of trying. Over the next few years it came to be that those who failed or didn’t bother to fashion themselves as truly feminine were ‘fetishistic’. Susanna Valenti even estimated that the majority of members were WGFs”. I think that here we have the key to what Type II should have been: those who don’t attempt to pass, especially those who get off on being read. Those who want to pass are often uncomfortable around those who don’t care to. This division, into true=wants to pass and false=doesn’t want to pass, can also be applied to female impersonators, as they were then called - as long as we do not insist that they are Kinsey 0-2.  Some female impersonators were women offstage (the pre-op Coccinelle, April Ashley etc) but others were definitely men offstage.

Those who relish attention, on or off stage, are sometimes called drag queens (of whatever sexual orientation) or attention whores. But only a small percentage of them may reasonably be called ‘fetishistic’. So would genderqueer and non-binary be false transvestites in this meaning? Mixing up 1960s questions and ways of thinking with 21st century concepts is an interesting game, but of limited validity.   Nobody in 1966 was  genderqueer or non-binary, and so we need not pursue the question. Today very few people want to declare any one group ‘true’, and another ‘false’. That does not get us anywhere.

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The HBS crowd made a big deal of being followers of Benjamin while execrating Virginia Prince. This is intellectually nonviable as Prince and Benjamin were long time associates and Prince is repeatedly mentioned in The Transsexual Phenomenon. She is mentioned 5 times in the first three chapters, and in addition Benjamin also repeats opinions that we know had earlier been expressed by Prince. From chapter 4 onwards, transvestism has been left behind, and perhaps you hope that Prince is also left behind. However she is mentioned another three times.

Prince also deformed the work of Richard Docter and Vern Bullough. I certainly think that Benjamin should have been advised to pay her less attention, and more attention to Louise Lawrence and Patricia Morgan. He should perhaps have also paid more attention to those trans women who could not afford his fees and went to Leo Wollman, Benito Rish or David Wesser instead.

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So is a change of sex possible? The Warner Books cover promises: “All the facts about the changing of sex”. Chapter 1 (written 1961) affirms that chromosomes are only one of seven aspects of what is sex. I think that most of us go with this. It is really disconcerting that Benjamin reneges in chapter 3 and declares that “No actual change of sex is ever possible”. And then again in chapter 7 (written 1963): “Furthermore, the operation, even if successful, does not change you into a woman”.

Editor Brooking Tatum did not feel that this inconsistency was something that should be resolved.

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Benjamin lists four motives for the conversion operation (p140-2/65-6):

1. Sexual. “It concerns particularly the younger transsexuals. Their sex drive is not that of a homosexual man but that of a woman who is strongly attracted to normal heterosexual men.”
   
2. Gender. “Especially for the older transsexuals, the urgent need to relieve their gender unhappiness can be powerful and impressive”.
   
3. Legal. “The constant fear of discovery, arrest, and prosecution when ‘dressing’ or living as women is a nightmare for many. They want to be women legitimately and have a legal change of their sex status.”
   
4. Social. “applies only if the transsexual patient happens to have a conspicuous feminine physique, appearance, and manners” [while still presenting as male] 

I will leave (2) until last.

1. This became a standard criticism that androphilic trans women were really gay men in denial.  This, of course, is not so, not only because many 'gay transsexuals' first explored the gay scene, but found that they were something different from gay men.

Furthermore there are  men who do want to have sex as a woman, but without being a woman, who seek to acquire a vagina, but otherwise continue living as men. They are rarely discussed. They are not what Benjamin meant here.
3. Fortunately – in most of Europe and North America – it is no longer a crime to dress or live as a woman without surgery. However in many parts of Asia, Africa and South America it still is. And in many of these countries, a conversion operation is not recognised. However even where such legal hassles are present, is the fear of discovery really a greater motivator than the desire to be fully a woman?
4. As it happened there were three outstanding transsexuals in the 1960s who were frequently taken to be women even when dressing as male: Coccinelle, April Ashley, Rachel Harlow. Most of us are not so beautiful. However surely all three became women because they wanted to be women, not that they became women involuntarily to avoid hassles. In the 1990s we had the example of Jaye Davidson who was cast as Dil in The Crying Game because of his beauty. However he is not transsexual, and continued living as a man.
2. “Especially for the older transsexuals, the urgent need to relieve their gender unhappiness can be powerful and impressive”. This sounds like Anne Vitale’s G3 with Gender Deprivation Anxiety Disorder (GEDAD). Should we assume that Vitale’s G1 has been split between 1 and 4?

What is missing is that persons want the conversion operation for existential reasons, in that they want to be women, have always felt that they are women, being a woman is what feels right, being a woman is who they are. There are other ways of saying it. But the overwhelmingly dominant reason for wanting a conversion operation is not mentioned by Benjamin.

One could use this section on the four reasons to argue that Benjamin did not understand at all why trans women asked for and sometimes got the conversion operation.   You could otherwise argue that his support and empathy showed that he did understand, or at least sympathised.   Speaking as a writer I know that sometimes I write something that seems quite dumb on rereading.    A good writer does reread and takes out what jars with the overall theme of the book.   This was not done re the four reasons, but should have been.

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Benjamin states clearly that, except for the frequency of hypogonadism, pre-op, pre-hormone trans women are physiologically indistinguishable from cis males - except for their assertion that they are/want to be women.   And likewise for trans men and cis females.    But what about intersex persons who likewise seek a sex/gender change? 

Benjamin worked with John Money and must have been aware of the work that he was involved in with those who at that time were referred to as 'hermaphrodites'.   He would have been aware that most intersex stick with the gender of rearing, but that a few do not.  And some transsexuals discover that they have xxy or mosaic DNA and then announce that they are not therefore transsexual, even though e.g. the vast majority of xxy boys grow up to be xxy men.

It is perhaps a pity that Benjamin did not comment on this.

___________________

Female-to-male persons get pretty short shrift. Not only are trans men confined to one chapter, but female transvestites, and implicitly female fetishists, are erased.

There are four autobiographical accounts in Appendix D. Only the first Ava/Harriet is properly discussed in Benjamin’s text, there is also a very quick mention of the fourth, Joe.

A rereading of Benjamin: Part 4: photos, legal, trans men, conclusion

• Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977, with a bibliography and appendix by Richard Green.  PDF (with different pagination).  Page references eg p32/13 mean p32 in the 1977 Warner edition and p13 in the PDF. 

Part I:  intro and the Scale
Betty (?1938 - ?) female impersonator, salesgirl, model. --- 2nd entry, Appendix D, autobiographies
Part II:  transvestites
Clara Miller (1899 - ?) fur merchant, office worker ---  3rd entry, Appendix D, autobiographies
Part III: trans women
Joe (1920 - ?) cattle breader, art dealer ---  4th entry, Appendix D, autobiographies
Part IV: photos, legal, trans men, conclusions
Comments

Photographs

In the center of the Warner edition are 23 pages of photographs: some before and after contrasts, and then close-ups of surgical results. The photographs are not identified in any way, not by a letter, not by a number, not by a pseudonym. Thus it is difficult to refer to any specific photograph. In the PDF of the book, only a few of the photographs are included.

The 6^th and 7^th pages (not in the PDF) are the before and after of an actor, both in a stereotyped pose more typical of silent films, than of the 1960s. This actor has never been named. How an actor can transition in stealth and keep working is intriguing. The US trans actors of the 1960s were non-op e.g. Candy Darling (however, of course, several of the stars of Le Carrousel in Paris were in films in the 1960s). The first US trans actor known to have surgically transitioned was Ajita Wilson who did so in the mid-1970s. The unnamed actor in the photograph is the true pioneer in her field, and we know nothing of her.











Pages 22-4, the last 3 pages, of the photographs (not in the PDF) are of a tattooed woman who had conversion surgery in 1953 at age 45. Benjamin discusses her on p137/63: “One patient who is now, several years after the operation, a decidedly masculine-looking ‘woman,’ with tattoos all over her body, is getting along well in an active business and is unrecognized as a former male. She is merely considered eccentric by her associates. Under no circumstances, she assured me repeatedly, would she ever go back to living as a man. ‘This way I am at least myself and can relax,’ were her own words. A couple of times she was arrested under the suspicion of ‘impersonating.’ When she was taken to a police station, examined and declared to be a woman, the arresting officers apologized and in one instance, bought her a dinner.”

She is named Janet in Wheeler & Cahan Schaefer “Harry Benjamin's first ten cases (1938-1953): a clinical historical note".

9. Legal Aspects in Transvestism and Transsexualism

“There is actually no law anywhere that expressly forbids a man to dress as a woman; but the New York State Code of Criminal Procedure, Section 887, Subdivision 7, is being used against transvestites, and other states have similar statutes. This law says that a person (designated as a 'vagrant') must not appear with 'a face painted, discolored, or covered or concealed or being otherwise disguised in a manner calculated to prevent his being identified.' This applies to persons 'on a road or public highway, or in a field, lot, wood or enclosure.' This law had been passed more than one hundred years ago for an entirely different purpose. It was directed against farmers who disguised themselves as Indians and sometimes attacked law officers when they tried to enforce an unpopular rent law.” p167/78

Benjamin, advised by attorney Richard Levidow, was right about New York State, but municipalities across the US had passed laws against cross-dressing. See here.

The first case discussed is “A middle-aged man, an airline pilot for many years, of high standing in the community, a recent widower and a father, whom I knew well and for whom I have the highest regard, was arrested last year in the street near his home, wearing a wig, female clothing, and so on.” Readers of this encyclopedia will immediately recognize Felicity Chandelle.

The second case is of a woman, “Back from abroad after the conversion operation, and no longer a male anatomically” who was arrested for impersonation. An examination at the police station told the detectives that they had made a mistake, but unlike what had happened to the woman with tattoos, they changed the charge to ‘soliciting’. Fortunately she drew a sensible judge who dismissed the case.

“E, a transvestite who for years had lived as a woman and whom I knew through frequent contacts to be a respected and responsible person, wanted to travel in Europe as a woman although the birth certificate and the given name were that of a man. I wrote the Passport Bureau, State Department, Washington, presenting fully all the facts in support of E's application for a passport to be issued in her female name and identity. Without comment, E's request was granted and she received the desired passport. Someone in the respective department was big enough to override technicalities and, in this instance, common sense won out over possible ‘rules and regulations’." p169/79 This could well be Virginia Prince who somehow managed to get a passport as a woman, and in the late 1960s visited the UK and Australia.

An ancient law threatens surgeons. This is of course the concept of Mayhem, originally a crime against the king in that it rendered a man less able to fight, but by the 20^th century it had become a crime of removing a functioning body part. Because of this almost no US doctor was willing to do conversion surgery. Benjamin seems to regard Mayhem as a residual piece of English law in US law codes, but no US surgeon was ever charged, unlike Argentina where Ricardo San Martin was charged in 1961, and Francisco Sefazio in 1969.

After Benjamin’s book was published, Mauricio Archibald was on his way home in April 1967 from a masquerade party when he also was arrested and convicted under Section 887, Subdivision 7. Unlike Felicity, he appealed, but Per Curium the conviction stood as “the wording of subdivision 7 does not require that the State must establish either a lack of means of support or an intention to commit an illegal act”. However Section 887 was repealed that year, but with the caveat that the “newly enacted sections were not to apply or govern the prosecution for any offense committed prior to the effective date of the act".

10. The Female Transsexual

As we said re the title of Chapter 4, the usage, referring to trans men as ‘female transsexuals’ does grate.

Frequency of female transsexualism.
“It is probably very unfair to devote only one chapter in this volume to the female transsexual: unfair because her emotional problem is in every way as serious as that of her male counterpart. However, the frequency of female transsexualism is considerably less than that of the male. While the clinical experiences described in the preceding pages are based on 152 cases of male transsexualism, the female transsexuals here reported number only twenty (by the end of 1964). Even so, sometime in the future she may merit a book devoted to her alone.” p178/84

Such a book never did emerge.

“If a female transsexual, after having been changed into a male, should receive the same publicity as Christine Jorgensen, it is possible that a greater number of female patients might apply for treatment. How many of them might do so merely as a passing mood, and would then not be acceptable for treatment, is conjectural.” p179/84

There was a press brou-ha-ha when Michael Dillon was outed in 1958, but he disappeared to India rather than stay around and continue the attention.

Why the second sentence? Why suppose that trans men are more likely to apply for treatment “merely as a passing mood”. This phenomenon was not discussed for trans women.

“It is interesting to mention in this connection that in our culture about twelve times more women would have liked to have been born as men than vice-versa. They said so when they were questioned in a Gallup-type poll.” p179/84

This was so in the 1960s and earlier. Benjamin’s explanation is: “The more intimate, maternal relationship, however (with its exposure to the mother's female hormones during the nine months of gestation), may offer a possible explanation.” p180/85 Personally I would suggest the strong social restrictions applied to women before second-wave feminism began to gain ground. Far fewer women in the 21^st century say that they would have preferred to have been men. Of course today those, that say that they would rather be a man, are likely to be advised that they can indeed change.

Symptomology.

“The female transsexual has many symptoms in common with the male and much that was said in the previous chapters could apply equally to her. The female transsexual's conviction that she ‘was meant to be a man’ is as strong as the reverse is in our male patients. She resents her female form, especially the bulging breasts, and frequently binds them with adhesive tape until a plastic surgeon can be found who would reduce the breasts to masculine proportions. Transsexual women fall deeply in love with normal or homosexual girls, often those of a soft, feminine type. Besides wanting to be lovers, they want to be husbands and fathers.” p180/85

Before Louis Sullivan in the 1980s, the trans man who wanted to be a gay male, was pretty much invisible. Ray Blanchard kept on maintaining that such trans men did not exist even despite communications from Sullivan.

Benjamin gives a case study but without his usual empathy:

“One of my patients so much desired to be a father that she allowed one particular man to have sex relations with her until he could impregnate her, but this man then had to relinquish all claims on her and on the child. She reared the child, a boy, as a father would and wanted him to consider her his father, although the child, when old enough, was informed of the fact that 'father' was really his mother, but his 'natural parent.' The psychological impact on the child's mind of this confusing situation is worth studying. The persistent demand of this patient to be treated, operated upon, and 'made' a man, and her hostile reactions to the refusals by doctors, have brought her several times into mental institutions with the diagnosis of schizophrenic reaction. For patients of this type, Pauly coined the term 'paranoia transsexualis,' an apt label but naturally only a label. Whether the patient 'reacted' with a psychosis to her transsexual problem with its frustrations, or whether the TS problem should be considered part of her psychosis, is still an unsolved question. This patient, in spite of a short course of androgen treatment, is still in and out of hospitals, and the question whether to allow her (him?) custody of the child is undecided at this writing. Further studies of her case may deserve publication at some later date.” p180-1/85

Benjamin concludes this section with: “Menstruation constitutes a psychological trauma to the female TS. Its suppression under androgen therapy affords enormous emotional relief. Interests, attitudes, and fantasies take a masculine direction. Typically masculine occupations such as those of soldier, policeman, truck driver, would be their ideal, but only too often they have to be practical and settle for office work. Just like some of their male counterparts, they frequently show much ability in their work, can be highly successful in business or profession, profiting perhaps by the combination of male and female traits in their constitutional makeup and in their psychological development.” p181/85

Sex Life.

“Sexually, female transsexuals can be ardent lovers, wooing their women as men do, but not as lesbians, whom they often dislike intensely. They long for a penis, yet mostly understand realistically that the plastic operation of creating a useful organ would be a complicated, difficult, highly uncertain, and most expensive procedure.” p181-2/85

However only one of Benjamin’s patients had had phalloplasty at that time. “ the operation performed in several stages, but the final result is still questionable. The first surgical attempt, as his doctor explained to me, was ruined because the patient went horseback riding too soon!” p182/86

“I have had extensive correspondence with another intelligent female transsexual whom I never met personally. He described 33 plastic operations, but the male organ, although serviceable, still does not seem fully satisfactory. The technique of creating a penis varies greatly with the various surgeons who have attempted it. The textbook by Gillies and Millard goes into considerable detail. The Russians are said to have more extensive experience with this type of operation than anybody else.“ p182/86

“Of the twenty patients, five had been married as women before I ever saw them. These marriages were entered into either in the hope that it might reverse the psychological trend, or under pressure from the family, or to escape family supervision. All these marriages failed, ending in annulment or divorce, or, in one instance, in a reversal of roles with the wife becoming the husband and the former husband becoming the wife. Some were never consummated and were highly unpleasant experiences, probably for both partners. There were four pregnancies in three patients with one abortion, one miscarriage, and one ending in normal birth twice. This person, living as a male (whether married as a male is unknown) now has two children to which ‘he’ is the mother.” p182/86

Etiology.
 
“Much that has been said on etiological speculation for the male transsexual applies equally to the female, especially as far as conditioning is concerned. Definite conditioning could be proved in only two cases, and not at all in eleven. The remaining seven were considered doubtful.” p183/86

Again no theory of etiology is convincing.

Physical Data.

“The physical examination of the female transsexual usually reveals a normal girl except that, as in the male, hypogonadism seems to be more frequent than one would expect. Among my twenty patients, it was more or less distinctly evident in nine. There was no sign of hypogonadism in ten, and in one case it is unknown.”

“One case was that of a female pseudo-hermaphrodite who underwent corrective surgery late in life and had been happily married as a man for five years when he was widowed.” p184/87

Social Position.
Artist 2
Entertainer 1
Librarian 1
Engineer 2
Selling 1
Ranching, farming 3
Office work 6
Factory work 2
Restaurant 2
p185/87

Surgery.

“A total hysterectomy, including the removal of the ovaries, is often as ardently desired by the female transsexual as the male desires his conversion operation. It is almost as difficult to obtain because surgeons, quite naturally, are reluctant to remove healthy organs. After a more or less extended period of androgen treatment, a physical state resembling pseudohermaphroditism (enlarged clitoris, body hair, etc.) develops, so that some surgeons at times felt justified in operating, especially if the social status (male) of the patient is already well established. In several instances, the patient was not fortunate enough to find a surgeon in the United States and had to go abroad or to Mexico for the operation. Of the twenty female transsexuals here reported, nine had a hysterectomy performed. In eight it was total and in one the ovaries were retained. The average age of the nine patients at the time of the operation was 35.5. Four patients were in their twenties, two in their thirties, two in their forties and one in the fifties, at the time of operation. The corresponding average age in male patients was 33.2.” p187-8/89

Results of therapy.

“Psychotherapy with the purpose of having the patient accept herself as a woman is as useless in female transsexualism as it is in male. Psychotherapy can be helpful only as guidance and to relieve tension, provided there is a permissive attitude on the part of the doctor regarding masculinization. If the patient is of age, not acutely psychotic, and reasonably intelligent, the doctor might best say: ‘as to masculinization and your future life, you have to make your own decision’." p189 /89

“With one doubtful exception (to be mentioned later), all patients under my observation (and I know the fates of fifteen of the twenty fairly well) were benefited. They still have problems. There still can be spells of depression (mostly reactive) and more or less distinct neurotic or psychoneurotic traits. They were unhappy, disturbed persons before any treatment and they are not boundlessly happy and free of disturbance afterward. Who is? But they are better off; better able to find a satisfactory niche in life, perhaps in a job or profession as a bachelor or as a married man.” p189/89-90

Some examples:

“The aforementioned young lady, a student and musician, who seems to have had a doubtful result from her treatment and operations (hysterectomy with the ovaries retained, and mastectomy), was seen about ten years ago. She had been married and divorced, had several years of psychoanalysis, but still wanted to change. After the operation she tried living as a man, then changed her mind and returned to her female role. She even had the shape of her breasts restored by plastic surgery. But she is not unhappy and has no regrets. Her ‘double sex’ may give her a feeling of satisfaction.  Unfortunately I have had no opportunity to see her in recent years, but I know from correspondence and from her physician that she feels her therapeutic attempts ‘basically have worked’." p190/90

“One twenty-six-year-old, disturbed, unhappy girl is now, four years later, a busy, handsome, bearded young man, proud husband of a beautiful wife and father of two legally adopted children.” p190/90

“One confused, unhappy girl, after two disastrous marriages, an attempted suicide, years of futile psychoanalysis is now, seven years later, a man in his early forties, of some importance in the art world, married to a highly intelligent woman and living in an environment where very few of the numerous friends of this couple have any idea of the husband's past.” p190/90  [This is Joe in Appendix D]

“Bobby, formerly Mary ... When first seen ten years ago at the age of thirty-seven, he was living and working as a man. He had been successful in obtaining a complete hysterectomy as well as a mastectomy and his greatest problem was a legal change of sex status. Red tape offered formidable obstacles. After waiting several years, and with the help of various medical certificates, a new birth certificate was finally issued with strikingly good results on the emotional life and his job prospects. Bobby is now reasonably successful as an architect, gets along with people much better than in years past, and his only regret is that his aged mother never became reconciled to the change, although an older sister had readily done so. Bobby has some flair for writing. He is doing his autobiography now, the first one written by a female transsexual for possible publication as a book.” p191/90”

“More cases could be related, almost equally satisfying. There are those for whom an operation is not yet attainable, but androgen treatment is at least a partial substitute. A great and deeply disturbing handicap for some is their inability to secure for themselves the legal change of sex status.” p192/91

Appendix A: Concluding Remarks and Outlook

(December 15, 1965)

Benjamin updates his statistics: “The collection of statistical data in the preceding pages was closed at the end of 1964. Toward the end of 1965, a total Of 307 cases of the transvestite-transsexual phenomenon were observed. Among them were 193 males (S.O.S. IV, V, and VI); 62 of them were operated upon. Besides, there were 27 female transsexuals; 11 of them had either hysterectomies or mastectomies or both performed. The rest of the males were transvestites.” p195/92

He looks to the future: “The etiology of the transsexual state is still largely obscure, but a light seems to blink here and there in publications from the laboratories of brain physiologists.” p195/92 He considers possible future developments in conditioning and imprinting, in genetics, in psychology and in endocrinology.

“From the therapeutic end, it cannot be doubted or denied that surgery and hormone treatment can change a miserable and maladjusted person of one sex into a happier and more adequate, although by no means neurosis-free, personality of the opposite sex. The degree of such a change depends upon constitutional factors, as well as upon the environment in which the individual's new life pattern will develop.” p196-7/92

He is most pessimistic about legal changes of identity: “As far as the legal change of sex after a conversion operation is concerned, the respective patient in the United States in 1965 has to be lucky. He has to have been born in a state that proceeds from good will, cuts through red tape, and issues a new birth certificate on application accompanied by medical testimony. If he is not lucky and has been born. in a state like the one mentioned above, he has to have money, swallow his sugar-coated pill of disappointment, entrust his fate to a judge, and hope for the best.” p199/93

Appendix B: Complementarity of Human Sexes by Gobind Behari Lal

The Science Editor Emeritus of the Hearst newspapers combines science and religion, regrets the difference between the sexes, and concludes: “The less we think of the 'opposite sexes,' of the 'war of sexes,' and the more we think of 'human beings – with dual sexes, in varying proportions,' the greater might be the hope of success of a more acceptable civilization than that of today. Not ashamed of their 'female nature,' men of power might become tamed down, so that the nuclear weapons will not go off, as the guns went off in August, 1914, starting the First World War, the epoch of horrors still not past.”

Appendix C: Transsexualism: Mythological, Historical, and Cross-Cultural Aspects by Richard Green

Richard Green repeats the common tales found in Bulliet’s Venus Castina and Gilbert’s
Men in Women’s Guise, plus an early account of gender variance among the North American aboriginals.

Appendix D: Transsexual´s Lives by R. E. L. Masters

R. E. L. Masters was Benjamin’s co-author of Prostitution and Morality, of two years earlier, 1964.

As Masters writes: “As a research worker and author in the field of sexology I have had occasion to come to know a great many sex deviates and other persons whose sexual behavior sets them at odds with society.” One suspects that he had not read the earlier parts of the book.  He also refers to trans women as 'he' even after surgery.

This Appendix consists of four selections from unpublished autobiographies, by Ava, Betty, Clara and Joe, and three clinical profiles, C, H and K presumably written by Masters.

Ava is also Harriet, whom Benjamin had discussed as his example of a Type VI High Intensity. p83-5/38-9

Betty is also K.

Clara is also C.

Joe was discussed by Benjamin p190/90.

H was discussed by Benjamin p106-7/49, was Benjamin's first transsexual patient, and is known as Sally Barry.

Bibliography by Richard Green

This bibliography contains the complete publications of Richard Green up to 1965. It contains many books and articles never mentioned by Benjamin. It does not contain some publications mentioned by Benjamin.