Box Turtle Bulletin

A George Rekers Case History: Where Is “Carl”?

When Kirk Murphy’s sister Maris contacted me last October via this comment, it was the first step on a long road of discovery. Until just a few days earlier, she had no idea that anyone had written about her brother. And while Kirk knew that UCLA researcher Dr. Richard Green had written a book in 1987 which included his treatment, it appears that neither he nor anyone else in his family knew that Rekers written about him — not just that, but had built his career on Kirk’s case history under the pseudonym of “Kraig.”

In one of the epilogues to our original investigation of Kirk Murphy’s treatment by George Rekers, I explored the weakest link in the mental health profession, the point where doctors are entrusted to accurately and truthfully present their case histories in the published literature. The discrepancies between Rekers’s descriptions of “Kraig” and what Kirk was really like as his family remembered him turned out to be pretty wide. Those discrepancies were continuing theme in the conversations that I had with Kirk’s mother, brother and sister.

Rekers wrote several case histories, featuring about a dozen young children in his career. Kirk was Rekers’s most famous and most widely published case history, but he was far from the only one. Today’s case history is that of “Carl”, an eight-year-old boy who Rekers treated at the Gender Identity Clinic at UCLA’s Neuropsychiatric Institute, about the same time as Kirk’s treatment in 1970. “Carl” appeared in Rekers’s 1972 doctoral dissertation alongside “Kraig,” and he first appeared in the professional literature in the summer of 1974, at about the same time as “Kraig’s” case appeared in the Journal of Applied Behavior Analysis. And like Kirk’s treatment, “Carl’s” treatment was paid for by grants to UCLA from the National Institute of Mental Health.

“Carl’s” case was presented in a paper by Rekers, his mentor Dr. O. Ivar Lovaas, and fellow UCLA researcher Benson Low, titled “The Behavioral Treatment of a ‘Transsexual’ Preadolescent Boy,” published in the June 1974 issue of the Journal of Abnormal Child Psychology. Carl was the title’s “transsexual” — the authors put the term in quotes in recognition of the fact that they had no idea whether “Carl” would actually grow up to the transgender, gay or straight. But that wouldn’t stop them from treating him. They introduced “Carl” this way:

Our client, Carl, was referred to us for treatment at the age of 8 years, 8 months. The referring physician had found Carl to be physically normal in terms of currently available methods of biomedical testing. Prior to referral to our clinic, Carl had been evaluated by two separate psychiatric agencies as having a severe cross-gender identity problem. In one clinic, Carl had been treated in family therapy for a period of 8 months in a largely unsuccessful attempt to alleviate his transsexual problem, his low self-esteem, and his major difficulties in peer and family relationships. He came from a broken family in which his mother had had 4 marriages in Carl’s lifetime. Carl had a brother 7 years old and a sister 6 years old, both of whom were without apparent psychiatric difficulties.

Carl reportedly had a “pronounced feminine inflection and content of speech” since the age of four, according to case material they quoted from earlier therapists:

He had several recurring exclamatory feminine remarks, such as “goodness gracious,” and “Oh, dear me.” His feminine gestures were exaggerations of an effeminate swishy gait and arm movements. He would typically sit with his legs crossed very effeminately and his arms folded like a female model. At home, he would frequently use towels after a bath to simulate female garments and long hair. …Not only was Carl labeled by his peers as effeminate, but he referred to himself as a “sissy” and “fag”, and his speech regularly implied that he preferred to be considered a girl.

As we learned when we delved into Kirk’s childhood, Rekers’s descriptions may be as far off the mark with Carl in important respects as they were with Kirk. So some caution is in order.

Carl entered a treatment regimen very similar to Kirk’s — the same playrooms in the clinic, and the same red chip/blue chip program in the home. If Kirk’s case is any guide, it is possible that “Carl’s” younger brother and sister may have also been placed on the chip program. There was one element in “Carl’s” treatment program however that different from Kirk’s. Being eight years old and in school, “Carl’s” treatment program was extended to the classroom with his teacher instructed on implementing a “cost-response contingency.” “Carl” was given ten points at the start of each day, and with each act of effeminacy, the teacher would call out “one point!” and deduct a point from the score. At the end of the school day, Carl received two minutes of free time for each point remaining.

The school program extended over three semesters and three classroom teachers (spring, summer, and fall). “Carl” evidently learned to suppress his feminine behaviors with the first teacher, but every time he entered a new classroom and a new teacher, he would express himself naturally again. As each teacher implemented the point system, “Carl” would suppress his effeminate mannerisms, but the process would start over again at square one with the next classroom and teacher. But after fifteen months, the program was ended, and “Carl’s” treatment was proclaimed a success:

Undoubtedly, treatment produced marked changes in Carl’s behavior and his interest patterns. His mother, school teachers, and neighbors all agreed that he changed in a rather basic or comprehensive way from a feminine to a masculine boy. Perhaps due to his late age at the onset of treatment, however, occasional remnants of certain feminine behaviors have been observed. These feminine behaviors have reappeared, in a diminished strength, on occasions when Carl is extremely anxious, angry, or confronting frustrating circumstances. It is possible that Carl has maintained this discriminative behavior because he had not been specifically taught (in treatment) to behave masculinely in all situations in which he becomes emotionally distressed.

“Carl” wasn’t presented as the unqualified success that “Kraig” was, but Rekers and associates concluded that “his sex-role development may have become normalized.” They continued,

Our treatment results for Carl suggest that we may have isolated an effective treatment for boyhood cross-gender identity problems. … Only followup data will allow us to claim a cure for (or prevention of) the severe adult sexual pathologies of transvestism and transsexualism or some forms of homosexuality. At this time, however, we have facilitated Carl’s current social and emotional adjustment, which should have positive effects on his future adult adjustment, independent of the issue of future sexual orientation.

In 1978, Rekers published this brief update of “Carl’s” case in the Journal of the Florida Medical Association:

Case #4 — Treatment Example: Eight-year-old Carl was treated for his severe cross-gender identity by a comprehensive set of treatment procedures including clinic behavior therapy, token economy behavioral management by parent, consultation with school teachers, athletic training, companionship therapy, family counseling, and counseling of the parent. The detailed treatment procedures, published elsewhere, resulted in a normal gender identity, better emotional and social adjustment, and a reversal from depression to reasonable happiness at the one-year and six-year follow-ups. At age 16 years, Carl is now within normal ranges of sexual identity and emotional development.

“Carl’s” case, like Kirk’s, was widely cited in the professional literature, although his case didn’t quite reach the same level of notoriety as Kirk’s. But there was one particular area where “Carl’s” case found an audience: because “Carl’s” treatment was extended into the schools, his case made occasional appearances in books and journals focused on guidance counseling and school behavioral issues. It’s doubtful that “Carl” or his family knows that his case history has been published, let alone published widely. But as with “Joan” whose case history we presented yesterday, the same questions remain: who was “Carl”? Where is he? And most importantly, how is he?

“Carl,” if you think you recognize yourself in these reports, please let us know how you’re doing.

See Also:
“Carl,” age 8½
“Joan,” age 14
“Paul,” age 8
“Wayne,” age 7
And, of course, “Kraig” (Kirk Murphy), age 4