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The Know-it-all Men Of The APA: Ray Blanchard Print E-mail
Opinion - Global Warning
Lisa Jain Thompson   
Friday, 16 May 2008 17:00
Left hand with suspect fingers.
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Washington, DC, USA. Ray Blanchard is a specialist in Gender Identity Disorder (GID), his particular flavor is the self-coined autogynephilia: an unproven, unevidenced, self-projecting soft science psychotheory defined as a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman. [1] In Blanchard’s mind, Harry Benjamin women (HBS, fna transsexuality) are men turned on by the thought of themselves as a woman who then carry that erotic fantasy to the extreme by having surgery.
 
Blanchard is a member of the workgroup on sexual and GID disorders that will develop the guidelines for the fifth edition of the American Psychiatric Association (APA), a revision to the APA Diagnostic and Statistical Manual of Mental Disorders (DSM). [2] The final result, DSM-V is planned for completion in 2012.
 
To date there are no scientifically rigorous outcome studies that support Blanchard’s theory of autogynephilia, only soft science exploitations using purposefully culled samples chosen specifically to further a repressive sociosexual agenda.
 
In Blanchard’s mind, HBS is does not exist, sex assignment is what society designates at birth, and most HBS women are deeply closeted homosexuals. What personal revelations he used to come to his conclusions are unknown: his proposed theory was born fully formed, then “supported” by cherry picked examples that do not reflect the HBS population as a whole. His conclusions are facile, ignore the real life experiences of successful post-op HBS women, and do not scale up as a meaningful, useful tool.
 
Any theory of HBS must address both men and women. It is unlikely that men and women differ in the root causes of HBS. Blanchard’s critically flawed conjecture does not address female to male HBS and, as such, is intrinsically inadequate as a scientific explanation for HBS.
 
HBS is a medical condition that originates during fetal development inside the womb. (The genitals of an HBS man or woman are misaligned with the brain’s sex identity that was set before birth long before development of the other sexual organs. Sex Realignment Surgery (SRS) brings the outward genitals into agreement with the actual sex of the HBS man or woman. The end result is that the body’s genitals finally match the configuration of their brain and they are HBS no more.
 
Blanchard, however, apparently has no interest in women and focused only on a group of gay men who met the base assumptions of his personal conjectures. Determination of the underlying causes of this psycho-sexual study bias requires lengthy analysis of Blanchard’s psyche and motivations, and, at this point, serves no purpose. The APA, in their godly wisdom, has appointed Blanchard to the workgroup on sexual and GID disorders, declaring him an unbiased clinician, a shrink of great wisdom and personal insight, a highly regarded professional following the foot steps of Sigmund Freud.
 
But the good doctor is not unbiased and has a very visible dog in the fight, a very male gender clinician who enters the ring with dogmatic preconceptions of HBS and HBS women, one who believes that what sex reassignment achieves nothing:
This is not waving a magic wand and a man becomes a woman and vice versa. It's something that has to be taken very seriously. A man without a penis has certain disadvantages in this world, and this is in reality what you're creating.
 
          — 2004 article on Transsexuality by Ray Blanchard.
Once again we encounter a man who cannot conceive that any sane person, given the choice, would not want a penis, a penis like the one he presumably was born with, a man slouching with his brother with cigar, Kenneth Zucker, towards DSM-V. 
 
Let’s dialogue with Dr. Blanchard. I would rather let you hear him in his own words. All Blanchard quotations are from Origins of the Concept of Autogynephilia by Ray Blanchard. [3, download below] 
In 1989 I coined the term “autogynephilia” from Greek roots meaning “love of oneself as a woman” and defined it as a male’s propensity to be erotically aroused by the thought or image of himself as a woman. My identification of this erotic orientation was not the result of any advance in imaging technologies, laboratory assays, or computationally intensive statistical procedures. It was the result of a perceptual shift — a shift in the way I saw, heard, and understood statements that patients had been making to clinicians for decades.
Fair enough, but realize that Blanchard’s great discovery was not as the result of scientific investigation and research. It came to him whole fabric as a personal perceptual shift reminiscent of Saul of Tarsus’s vision of the resurrected Jesus on the way to Damascus and his conversion into the person who became Paul the Apostle — a perpetual shift directly received from God himself (as opposed to Saul studying the early Christians, analyzing their philosophy, and coming to a logically supportable decision to convert). The shift just seems to have happened and since then Saint Blanchard has become the Apostle of Autogynephilia with his own band of converted acolytes.
Epigrammatic allusions to autogynephilia maybe found in the writings of Magnus Hirschfeld (1868–1935). Hirschfeld was the brilliant German physician who coined the term transvestism. He is generally credited with being the first clinician to distinguish homosexuality per se from transvestism and other cross-gender phenomena. He identified the erotic idea of being a woman in a subgroup of cross-dressing males … [4]
Autogynephilia was originally identified within a group of male crossdressers, notably not in HBS men or women. We need to keep that distinction clear. HBS men and women are not crossdressers, nor has their gender ever been in doubt.
There is evidence that other writers, in contrast, were aware of the difference between true homosexual attraction and autogynephilically mediated attraction — the difference between sexual interest in men for their bodies and sexual interest in men for their symbolic value as accoutrements of femininity.
This is not new news. One of the first things my therapist told me early in transition was that there were “heterosexual” men who were excited about the idea of having sex with a pre-op male to female transsexual, who get sexually turned on by the thought of making love to a woman who still has a penis. He warned me, for my own safety, to be on the look out for them.
 
But these were straight, closeted males who were the predators, not the transvestites or the crossdressers, not the transgenders. Straight men who grew physically aroused when pursuing a pre-op HBS woman.
 
HBS women were the prey, not the predators.
The clinical literature at that time included a confusing array of classification schemes for gender identity disorders in biological males.
HBS men and women do not have a gender disorder. HBS sex identity (gender) was set in the brain long before birth. The genitals are mismatched with the true HBS sex.
 
Biological males may be subject to gender identity disorder (GID), HBS men and women are not. If it were is Blanchard’s intention to apply his Autogynephilia conjecture to homosexual or heterosexual males, there would be no objections. When he attempts to extend the Autogynephilia diagnosis to HBS women, he does so without sound evidence or a basis for his conclusions.
The research strategy that I used for this question was to start by distinguishing a larger number of groups and then reduce this to a smaller number by combining groups that seem to be merely superficially different variants.
This is called culling the sample to arrive at the data group that best supports the desired conclusion. In everyday terms, Blanchard was cooking the books to confirm his previous, personal revelation.
My conclusion from this taxonomic research was that heterosexual, asexual, and bisexual transsexuals are more similar to each other — and to transvestism — than any of them is to the homosexual type. Asexual and bisexual transsexualism seemed to be variant forms of heterosexual transsexualism, and transvestism to be a not-too-distant cousin. This left me to answer the question: What is it that transvestites and the three types of non-homosexual transsexuals have in common? It was clear to me, by this point, that the common feature is a history of erotic arousal in association with the thought or image of oneself as a woman. 
Assertion. Unsupported by the evidence.
 
I am a post-op, bi-sexual HBS woman as is my partner. We both have had sex with men and women. Neither of us has ever been erotically aroused by the image of ourselves as women. I know of no HBS woman who has been.
 
We all know, however, of men who get erotically aroused by dressing up and pretending they are women. This is a well known, widely occurring male fetish (evident chiefly among male heterosexuals) that is unrelated to HBS. 
 
Blanchard’s confusion of fetish crossdressers and homosexual queens with HBS women is a complete misunderstanding of HBS, the same misunderstanding that is present, perhaps consciously, in fundamental religions who wrongly conflate HBS men and women with homosexuality. I will give Blanchard benefit of the doubt for being obviously confused by what for him may be a difficult subject to understand.
I was strengthened in this conviction by the following patient, whom I described at length in one report and more briefly as below:

Philip was a 38 year old professional man referred to the author’s clinic for assessment. His presenting complaint was chronic gender dysphoria, which had led, on occasion, to episodes of depression severe enough to disrupt his professional life. Philip began masturbating at puberty, which occurred at age 12 or 13. The earliest sexual fantasy he could recall was that of having a woman’s body. When he masturbated, he would imagine that he was a nude woman lying alone in her bed. His mental imagery would focus on his breasts, his vagina, the softness of his skin, and so on — all the characteristic features of the female physique. This remained his favorite sexual fantasy throughout life. Philip cross dressed only once in his life, at the age of 6. This consisted of trying on a dress belonging to an older cousin. When questioned why he did not cross dress at present—he lived alone and there was nothing to prevent him — he indicated that he simply did not feel strongly impelled to do so. 
This single cherry-picked case was sufficient for Blanchard to be totally convinced of his autogynephilic revelation. This use of a meager, self-fulfilling case study is reminiscent of the Bush administration’s selective data use to support the already determined intention of invading Iraq. Blanchard does not seem to have been looking very hard for data that would contradict his assumptions and preconceptions.
This patient had not the slightest motivation that I could detect for distorting his self-report in this particular way, and his presentation seemed to me the final evidence that the erotic idea of being a woman could exist in the complete absence of any interest in women’s clothing or any other fetish-object.
Did Blanchard ever think that, as far as society goes, there is much less baggage attached to Autogynephilia than to fetish transvestism? — much in the same way that crossdressers have been calling themselves transsexual rather than crossdresser (which was rather than transvestite) — so much so that transsexuality has come to mean anyone who says they have a gender disorder, e.g., they like to dress up in women’s clothes (so much so that transsexuality has become a uselessly vague term necessitating the establishment of HBS).
I therefore reluctantly concluded that I had no alternative but to invent a new word. My colleagues and I at the Clarke Institute were accustomed — again, under the influence of Kurt Freund — to referring to the erotic preference for adult women as gynephilia rather than heterosexuality, because the former denotes both the gender and the age of an individual’s preferred partners, whereas the latter denotes only the gender. It was thus a small step for me to prefix gynephilia with auto to produce autogynephilia. [1]
And thus was born a new philia and Blanchard was its prophet.
The existence of autogynephilia as a distinguishable form of sexual behavior is scarcely in doubt.
Agreed, but it’s not a new behavior. Men have been getting off on their fantasies since Adam. All that is new is the medicalization of what appears to be a fairly frequent behavior pattern into pathology. 
During the past 15 years, numerous individuals have come forward, outside of clinical contexts, to say that, yes, indeed, the published descriptions of autogynephilic behavior and feelings closely match their own histories. Their testimonials are sometimes accompanied by expressions of comfort and relief at learning of the existence of fellow travelers, sometimes by expressions of grief and anger at the confirmation that their feelings represent a distinct paraphilia and by moving requests for help. Unless all these individuals have been motivated by obscure and perverse desires to claim emotions they have never really felt, their statements constitute further evidence that autogynephilia exists and that it is not extraordinarily rare.
This is Blanchard’s great proof: he threw a rationalization against the wall and it stuck. People would rather be identified as autogynephilic than as a fetish crossdressers. Some people believe they have been abducted by aliens. Some believe they are aliens.
 
So what?
All gender-dysphoric biological males who are not homosexual (erotically aroused by other males) are instead autogynephilic (erotically aroused by the thought or image of themselves as females).
Please note, HBS women are not biologically male — they are, to various degrees, an intersexed variant with female brains within a body that has male genitalia. The brain is part of the body. The mind is a product of the brain. This insistence that the mind exists outside of the physical body is scientifically unsound and presupposes something closer to a religious belief than a physical, verifiable reality.
 
Psychiatrists and psychologists are predisposed to believing in the meta-reality of a mind above and apart from the body’s physical existence. That preconception and unconscious prejudice colors and distorts their discussion of HBS.
 
HBS women do meet any of the criteria for Autogynephilia.
Autogynephilia does not occur in women, that is, biological females are not sexually aroused by the simple thought of possessing breasts or vulvas.
Blanchard’s own statement confirms that Autogynephilia does not describe Harry Benjamin Syndrome. His great “theory” does not account for female to male HBS men, or perhaps he denies the existence of HBS men. In any event, from this statement we can infer that Blanchard does not intend to include HBS men and women in his conjectures (or else he would offer an explanation for the existence of HBS men).
The desire of some autogynephilic males for sex reassignment surgery represents a form of bonding to the love-object and is analogous to the desire of heterosexual men to marry wives and the desire of homosexual men to establish permanent relationships with male partners.
We can only assume that Blanchard has encountered confused transvestites and crossdressers who mistakenly think they want sex reassignment surgery. This is why Doctor Harry Benjamin developed the protocols to sort them out of the mix. HBS men and women, by definition, are not and can not be autogynephilic. 
Autogynephilia is simply one example of a larger class of sexual variations that result from developmental errors of erotic target localization.
Perhaps. Again, however, this says nothing relevant to HBS men and women.
All or none of the foregoing propositions may be true, false, or something in between. Their accuracy is an empirical question that can be resolved only by further research.
Ah yes, exactly — but nobody is doing scientific research into the actual physical causes of Autogynephilia, or transvestism, crossdressing, or transgender for that matter. Everything is case studies, opinion, and conjecture. The only relevant physical laboratory research being done is relative to Harry Benjamin Syndrome.
 
What follows is the final piece of information needed to once and for all de-conflict and eliminate HBS from the Autogynephilia descriptive diagnosis.
The primary evidence that Autogynephilia exists is the self-report of biological males who say “I am sexually excited by the idea of having breasts,” “I am sexually excited by the idea of having a vagina,” “I am sexually excited by the idea of being a woman.”
No HBS woman has ever expressed feelings such as these. The declaration that the patient was sexually excited about the idea of living as a woman categorically would eliminate a diagnosis of Harry Benjamin Syndrome. No woman is sexually excited by the idea of having a vagina, having breasts — breasts and vagina are the commonplace facts of life of being female.
 
I do not doubt that Blanchard has meet biological males who are sexually excited by their female bodied fantasies. The variety of male fetishism would seem to be endless: painted toenails, panties, breasts, lips ….
 
But the people Blanchard has seen are not HBS men or women. 
Thus, even a skeptical view of the data provides little reason for doubting that Autogynephilia exists as a discriminable erotic interest — either a superordinate category including transvestism or a correlate of it.
Blanchard would appear to agree with TS-Si. Autogynephilia, as described by Blanchard, is an extreme manifestation of transvestism that exists separate and distinct from Harry Benjamin Syndrome. Where Blanchard grows confused is when he mistakes the crossdressers and transgenders on which he bases his diagnosis with women who were born with HBS (who he does not seem to have ever met). 
 
To pretend that HBS women do not exist would be a manifestation of male arrogance, a continuation of the Freudian obsession that only a penis matters. When stripped of its jargon, Blanchard’s world view neatly divides into heterosexual and homosexual males. Nothing else matters. Women exist only as piecemeal objects of fetish and fantasy.
 
For Blanchard to maintain his philosophy intact, he must ignore the existence of female to male HBS men and insist male to female HBS women are autogynephilic despite the body of evidence to the contrary that successful post-operative HBS women present — or he must admit that his definition of Autogynephilia does not include or describe those men and women born with Harry Benjamin Syndrome.
 
He should choose the latter course, as should the APA in DSM V.
 


[1] Ray Blanchard is a Canadian sexologist and the head of Clinical Sexology Services at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. CAMH is the result of the 1998 merger of the Clarke Institute of Psychiatry, the Addiction Research Foundation, the Donwood Institute and Queen Street Mental Health Centre.

Blanchard conducted research into the biological origins of male sexual orientation and promoted the fraternal birth order effect as a discovery. That is, the more older brothers a man has, the greater the probability is that he will have a homosexual sexual orientation. The fraternal birth order effect is considered by many as the strongest known predictor of sexual orientation; each older brother increases a man's chances of being gay by about 33%.

Autogynephilia is Blanchard's coined term for men with an erotic desire to be women. He proposed a theory that all transsexual women could be usefully classified as either autogynephiles or extremely effeminate gay men who needed to become female to express their sexuality. He termed the latter group homosexual transsexuals.

[2] APA Names DSM-V Work Group Members: Experts to Revise Manual for Diagnosis of Mental Disorders. News Release No. 08-27. American Psychiatric Association (APA). May 1, 2008. [ Download PDF ]

The APA release has the names and personnel rosters for all of the working groups named so far (eff. 1 May 2008).

[3] All quotations in the text are from Origins of the Concept of Autogynephilia by Ray Blanchard (February 2004).  [ Download PDF ]

[4] Magnus Hirschfeld (14 May 1868 - 14 May 1935) was a German physician, sexologist and gay rights advocate. Hirschfeld developed his theory of a third, or intermediate, sex between men and women around 1900. He studied of a wide variety of sexual and erotic urges at a time when the early taxonomy of sexual identity labels was still being formed. His scientific work extended that of Karl Heinrich Ulrichs and influenced both Havelock Ellis and Edward Carpenter.

 
Ms. Lisa Jain ThompsonMs. Lisa Jain Thompson is the Co-Founder & President of TS-Si, Inc. She also serves as a Contributing Editor and columnist for the TS-Si website. Ms. Thompson's signed articles contain her own opinions and do not necessarily convey an official position of TS-Si, its partners, or affiliates.
 
Lisa welcomes your comments. You can use the public form below or send private correspondence via her TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.
 

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The Know-it-all Men Of The APA: Ray Blanchard
Friday, 16 May 2008

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Another take, Autogynephilia sounds to me like just anot
17 May 2008     
Want vs. Need, and how the DSM confuses the issue..., Ve
19 May 2008     
..., Re: People would rather be identified as autogyneph
06 September 2009     
If ANON would like to contact us at TS-Si, We would like
06 September 2009     
..., Bit too busy to do any serious writing at present,
07 September 2009     

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Last Updated on Saturday, 17 May 2008 17:44