Springfield, VA, USA. Harry Benjamin Syndrome (HBS) is a physical medical condition that originates during fetal development inside the womb [1]. Since Freud, psychology has grown into a soft science [2] whose major American medical organization, the American Psychiatric Association (APA) relies almost exclusively on isolated case studies, personal observations, and conjectures rather than undertaking the hard scientific research required to determine the underlying physical causes for behavior within the human brain itself.

 

The APA is still caught up in ancient philosophies and excited undergraduate discussions about a mind-body dichotomy. We know that the brain is part of the body and now we know that what we call the mind is a physical byproduct of the human brain’s neurobiology. Because of what we are we are who we are.

 

Although the APA still acts like the mind exists outside the body — a thing apart — neuroscience is using functional Magnetic Resonance Imaging (fMRI) to identify regions of the brain where blood vessels are expanding, chemical changes are taking place, and extra oxygen is being delivered — all indications that a particular part of the brain is processing information and giving commands to the body [3]. Through fMRI the hard sciences are exploring the physical structure of the mind while the APA is still using notepads, tape recorders, and rapidly scribbled personal observations.

 

As a patient performs a particular task, scientists using fMRI have discovered increased metabolic physical changes in the brain area responsible for that task, changing the signal in the MRI image. By performing specific tasks that correspond to different functions, scientists locate the parts of the brain that govern that function.

 

The APA, however, clings to Freud like flies on a decaying donkey, stuck in last millennium discussions of the unconscious, infantile sexuality, repression, and the tri-partite nature of the structure of the mind. All of these beliefs were radical and new when Freud expressed them early in the last century and proposed using them as a conceptual therapeutic framework for the understanding of human psychological development and the treatment of “abnormal” mental conditions.

 

Freud, and the APA, depends on the assumption that the mind is a non-extended, non physical substance — a “soul” perhaps — subject to direct investigation by psychiatrists and psychologists trained in the magic art of psychotherapy. While this belief may appeal to our commonsense intuition that we — the ones who reside inside behind our eyes — exist apart and distinct from our body, there is no evidence, no scientific proof that consciousness is any more than the inevitable result of gathering a sufficient number of neurons and synapses into one processing organism, the human brain. Self-awareness may be nothing more than a primate’s desperate pride hoping to make the universe something more than it is.

 

The APA’s 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. This same insistence makes the APA judgment singularly unsound when making medical determinations and recommendations on conditions that find their cause in the physical structures of the human body.

 

As currently constituted, the APA is unqualified to sit in judgment on Harry Benjamin Syndrome (HBS) and present itself as the gatekeeper for the treatment of HBS men and women. As previously stated, 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.

 

But instead of the APA conducting research into the physical causes of HBS, they prefer to really on case studies that are little more than minimal observations of limited data sets passing through their offices and clinics. In the world of hard science, these observations would call for further study to determine if what is true in the limited data source is also present in the physical world at large. Does the specific, localized observation scale up to the universe as a whole or is it the product of a skewed sample or a faulty observation? 

 

None of this happens in the APA. Freud says that women have penis envy and suddenly the good doctors are diagnosing women everywhere as having penis envy. Someone using a handful of observations invents Autogynephilia and a dozen acolytes start writing publish or perish research papers on the subject, unwilling to miss the latest psychological bandwagon and their chance in the academic spotlight. Someone grows keen on the reparative treatment of homosexuality and gender identity disorder and the APA nods their collective head at the announcement, comfortable in anything that supports their unspoken belief that the mind exists apart from the body and all problems can be resolved through psychotherapy conducted by APA approved doctors and therapists.

 

Where are the neuroscientists on the APA working groups? [4]

 

— They are all in the labs conducting hard science research.

 

Where are the neuropsychologists?

 

— Disdained by the APA as nonproductive to psychoanalytical theory.

 

Where are the neurobiologists?

 

— Ignored by a 17th Century APA philosophy that insists that body and mind have radically different properties.

 

Where is the hard science on which to base decisions and determine the efficacy of the diagnostic treatments recommended by the APA?

 

— Non-existence within the roving bands of APA theorists fighting for recognition of their pet theory in the Diagnostic and Statistical Manual of Mental Disorders (DSM) so that insurance will pay for their patient’s therapy sessions.

 

Harry Benjamin Syndrome does not belong in a manual describing non-physical theoretical disorders. The APA, as presently constituted, is unqualified to sit in judgment on HBS men and women.

 

Until such time as the neuroscientists and neurobiologists are equally represented in the APA and on the working groups that make up the DSM, the APA remains a product of an age when the best science available was watching an apple fall from a tree. The old order needs to get out of the doorway and let the real scientists in. 

 

[1] 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.

[2] In formal terms, research within the natural sciences is considered hard because it depends upon hypotheses, quantitative data abnalysis, and reproducible experimental results.

Soft science is a colloquial term often used by physical scientists deriding those types of research that depend upon conjecture, qualitative data analysis, and/or uncertain experimental results.

The term soft science is usually used as a pejorative, mainly due to the term's association with social science.

The general issue is important to the philosophy of science, history of science studies, and the sociology of science (which study scientists' implicit perceptions of research and methods).

[3] functional Magnetic Resonance Imaging (fMRI) uses radio waves and a strong magnetic field rather than X-rays to take clear and detailed pictures of internal organs and tissues.

Scientists use this technology to identify regions of the brain where blood vessels are expanding, chemical changes are taking place, or extra oxygen is being delivered. These are indications that a particular part of the brain is processing information and giving commands to the body.

As a patient performs a particular task, the metabolism will increase in the brain area responsible for that task, changing the signal in the MRI image. So by performing specific tasks that correspond to different functions, scientists can locate the part of the brain that governs that function.

[4] 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).

 

 

 

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