A Single Wrong Idea

 

Watching the Netflix Australian melodrama/saga "A Place to Call Home,"  Mad Dog has been swept along by the characters in a way he hasn't felt since "Downton Abbey" but the experience is the flip side of the Downton coin: In Downton the Earl of Grantham is constantly pulled back toward doing the kind and just thing rather than what the requirements and expectations of class and orthodoxy demand. 

In Call Home, we see no such concession to the humane, as the members of this particular upper crust family are slowly eaten alive by the strictures and misapprehensions imposed by class and virulent disdain for the underclass and the reviled minorities.

The central plot follows Bridget Sarah Adams, a woman born to a Catholic mother devout unto Hellfire and her gradual entanglement with the Bligh family at their estate suitably named Ash Park, and it is a place deep in the ashes of a world of the walking dead, cremated but unaware of it.

Of all the conflicts explored, the most raw and explosive is the homosexuality of the much beloved son, James, on whom the continuance of the dynasty depends. This is 1955, and the idea shared by virtually all the males of that era is that homosexuality is:

1. Disgusting

2. A perversion 

3. A disease in need of cure.

The women are, on the whole, much more open to the idea that male homosexuals should be accepted for their "nature," but various among them are appalled, scandalized, until at some point James' wife realizes there is more to the man than his sexual predilection and she embraces the soul of her husband rather than rejecting the problem his sexuality presents.

But this is not a blog post about "A Place  To Call Home." It's about the idea that  "single wrong idea" can drive the  prolonged, excruciating, wrong headed effort  to "cure" James of his homosexuality.

As has been said before by homosexuals: "Who would want to be born this way?" James emphatically wants to be attracted not to men but to women. He agrees, initially to undergo any treatment which can change him. 

The doctors who are very sure of the correctness of their approach, using first electroshock/convulsive (ECT) therapy and then proposing frontal lobotomy. The physician in charge makes Nurse Ratched of "One Flew Over the Cukoo's Nest" look like Mary Poppins. 

James' father reacts viscerally to the revelation his son is a homosexual. He has only recently learned James tried to commit suicide and now he knows why, and the father says, "Perhaps it would have bene better for everyone if you had succeeded." But father is brought to his senses by Sarah and James' wife, Livvy. 

Father has signed James into the clinic and only father can liberate James from it, but he does not know exactly what goes on in the efforts to exorcise James' demons, although Sarah is able to identify some clues: the bruises from the restraints on wrists and legs, the burn marks on the temples from the ECT.  

As viewers, we are spared no details as James is "treated' and suffers under the "care" of the doctor and the staff. This is some of the most excruciating TV ever screened.

Watching all this unfold in 2021, now that most people accept the notion homosexuality is not a "disease" which demands "therapy" we cringe, and we are outraged at the doctors who are so officious, so sure, so wrong.

But I saw something more, something I know others do not see. I saw this as a representation of what we are seeing in 2021 in another sort of clinic, where a single wrong idea drives suffering and despair: The Transgender Clinic.

The "single wrong idea" hypothesis about gender dysphoria is that this is a condition in which the basic nature of the problem is very much like that of the homosexual, an inexplicable root nature which causes some people to feel they were assigned the wrong gender by their parents, their doctors, their society. "I'm a girl trapped in the body of a boy." 

The argument is made that like homosexuality, "gender dysphoria" is simply a matter of "nature" and like homosexuality, this unalterable fact should be accepted, embraced and nurtured, and of course, something everyone would agree with: the person suffering should not be made to suffer more, but should be helped in whatever way we can. 

The "single wrong idea" concept was actually first explored not about gender dysphoria or homosexuality but about another type of person altogether:  It is the operative mode for the treatment of anorexia nervosa. Few would argue that the 18 year old woman, who is five feet six inches tall and weighs 85 pounds, and looks at herself standing naked before the mirror and says, "I am so fat!" perceives her situation correctly. She suffers from what the psychiatrist Paul McHugh calls, a "wrong idea" which dominates her life and frequently leads to death.

McHugh notes that few people would argue with the doctor who tells the anorexia nervosa patient she has a wrong idea about what is wrong with her. 

Paul McHugh, MD

McHugh arrived at Johns Hopkins Hospital years ago to chair the department of Psychiatry and was asked to coordinate the psychiatric services for the Hopkins Transgender Medicine Clinic and he discovered that roughly 40% of its patients committed suicide within three years of being enrolled in the clinic. He promptly put a hold on the Department of Psychiatry's participation until he could explore just what was happening in the Transgender Clinic. The more he investigated, the more disturbed he became.

Patients at Hopkins who believe themselves to be female but  born male underwent surgery to remove the penis, testicles and to construct a cavity which could function as a workable vagina by the Department of Urology. General surgery augmented breast size. Endocrinology provided estrogen and progesterone hormones. Psychiatry spoke with the patients and learned about their reactions to what had been done and to support their "transition."

McHugh became the focus of intense fury for questioning the program and ultimately opposing it. He was accused of homophobia, transgender-o-phobia, a hate monger and of being an agent of the Pope determined to undermine liberating therapy.

Medical students at Hopkins shunned him, refused to speak to him. The internet went wild making him a pariah, as if he wished to harm the patients who sought care at the Transgender Clinic. 

McHugh bore all this recrimination with a sigh, and responded that he was pretty sure, in the end, as time passed he was the one who would be sleeping well at night, not his critics and certainly not the doctors who ran these clinics.

In "A Place to Call Home" he would have been helping James limp out of the sexual deviance treatment clinic, a place ruled by a wrong idea.

Mad Dog sees that people who believe they have a transgender problem are different from homosexuals in one crucial way: Homosexuals do not need therapy to achieve a life of happiness--all they need is to be left alone, not tormented by others. But the transgender patient cannot achieve his/her goal alone; he/she needs hormones, sometimes surgery, in short he/she needs the cooperation of a physician and is, therefore, a patient.

And the "single wrong idea" concept is inverted in the case of the transgender clinic and the conversion therapy clinic for homosexuals: In the case of the conversion clinic the medical authorities were trying to destroy something in the patient; in the case of the transgender clinic, the medical authorities are trying to "affirm" the patient is correct. But each clinic got it wrong. And each clinic committed substantial harm to those who sought help there. 

Mad Dog knows he does not understand what drives the problem in transgender patients. He does not know if it is a single cause or a final common pathway coming from many directions. He does know there are certain well studied cases of patients who have certain biochemical abnormalities which makes them unable to make adequate levels of male hormone while in utero, during "the first puberty" and these folks wind up playing with toy guns and chasing boys around the playground as "tomboys" who never really felt like girls. And there are the 5 alpha reductase deficient people who "grow a penis" at puberty. So there are some known biochemical reasons for gender confusion.  But patients at Transgender Clinics can be screened for all that. And the vast majority have no identifiable biochemical abnormality.

At the most recent conference Mad Dog attended on Transgender Medicine the head of one of the largest clinics was asked about his clinic's suicide rate. "About 40%," he said, with a shrug, "Pretty much what every other clinic sees."

"My God!" thought Mad Dog. What other form of therapy would be allowed to go forward with a number like that?  If clinics for coronary artery bypass surgery or gastric bypass surgery had a 40% mortality rate, would they be allowed to continue?

Mad Dog has no answers. He only knows McHugh is not wrong. He sees this is a topic which even at an Endocrine Society meeting, that ultimate shrine of dispassionate analysis, academia all rational discussion is blown out of the water and emotions from the transgender clinic doctors, nurses, patient advocates stamp out all other questions and discussion. We have, pretty much, what you see in the clinic to treat the "depravity and perversion" in "A Place Called Home."

McHugh would say the person suffering from the feeling he/she has been assigned the wrong gender is suffering from a single wrong idea, just as a patient with anorexia nervosa is.  Thus, he would resist the request to cut off penises, to institute hormone therapy.  Is he correct? Mad Dog does not know. 

But one thing Mad Dog does know is that Clinics can be shops of horror.