The Daily Agenda for Tuesday, August 20
August 20th, 2013
THIS MONTH IN HISTORY:
Letter to a Probation Officer: 1965. Throughout much of the twentieth century, the mental health professions were exceptionally slow to come to grips with the distinction between sexual orientation (defined according to the gender one is attracted to) and gender identity (defined according to the gender in which one views oneself). Until relatively recently, it was broadly believed that every man who “wanted” to be a woman was gay, and that every gay man secretly wanted to be a woman. The magnitude of suffering inflicted on gay and transgender people due to this ignorance is incalculable; it is also illustrated by a letter that one psychiatrist, Rodolfo M. Bramanti, of the New Mexico State Hospital in Las Vegas, New Mexico, wrote to a probation officer. Bramanti published the letter in the August, 1965 edition of the journal Southwestern Medicine to discuss “some of the medical, legal and social problems that homosexuality creates.” Bramanti doesn’t say how it is that “Mr. Peter M.” came into the state mental hospital system. The letter begins:
Dear Mr. M …… .
This letter is in reference to Mr. Peter M., a previous patient in this Unit, who was released on ….. , I have been quite concerned ever since in trying to secure the best solution to his problem, and, as I promised you in our telephone conversation, in the following I will try to discuss this case and summarize the conclusions at which I have arrived.
…Although the diagnosis in this specific case is more an academic matter, I would like to express my opinion that Peter is not suffering from a true psychotic disorder. I know that he was diagnosed before as a schizophrenic; however, in my interviews, as well as in the observation of his behavior during his stay in the hospital, no symptoms or signs on which to base such a diagnosis were found.
I think he belongs to the group that modern psychiatry knows as sociopathic personality, sexual deviation (also called sexual perversion), in whom the only manifestations of the disorder are in the sexual sphere. The pervert suffers from an anomaly of the sexual drive and gets satisfaction either in some other activity than that of complete heterosexual intercourse, or, in some deviant activity, acts that are not accepted bv our morals, customs or laws.
Peter, as the generality of homosexuals, has a tendency to be immature in his reactions, is easily depressed and discouraged, frequently frustrated, emotionally unstable, dependent and self-indulgent, and involved in love affairs with other men which end in disappointments, frustrations and suicidal thoughts. These could have the appearance of psychotic symptoms, but, altogether, do not constitute the well-defined picture that characterizes the schizophrenic.
…The problem, as I see it from a practical standpoint, is that we are dealing with a youngster, who at the present time shows all the emotional feelings of a female, even though he has the complete appearance of a male. Due to his abnormal urges he has been indulging in homosexual relations and creating a difficult problem in his community.
Bramenti then launched into a long and wide-ranging dissertation on the attitudes of society towards homosexuality and transgender people, a dissertation that cites the Judeo-Christian tradition, the 19th century Napoleonic code (which dropped all sanctions against homosexuality), and, surprisingly, the rigidity of gender binaries, leading Bramanti to conclude that “our laws and the community attitudes in this respect are not only unscientific but unjust.”
Bramanti then discussed the range of therapeutic options available to Peter, and it is here that it becomes rather obvious to anyone reading it today that Peter’s problem wasn’t so much that he was a gay man in a homophobic society, but that she was a transgender person among professionals who hadn’t the slightest clue about what that distinction meant:
Peter came to this hospital with the idea that an operation could be performed to make him apparently, at least, more female_ In other words, he completely refused the idea to become a male: even more, he was disgusted, disappointed because his physical appearance did not fit with his female mind and he thought that medical science could convert him into what he has been longing to be.
Bramanti briefly describes the case of Christine Jorgensen (who Bramanti insists on calling “Chris Jorgenson”), the first celebrity transgender person to be written about in the popular press (see May 30). Bramanti considered the option of gender reassignment for Peter:
Can we advise such an operation in the case of Peter M … ? There are many factors to be considered. In fact, could we legally sanction such an operation? Should a surgeon agree to perform it? Is it justified from the religious point of view to try to transform what God decided? In the event that the operation is performed, should he be considered as a man or as a woman in spite of the fact that he will be lacking the male sexual characteristics as well as those of a female.
I feel that with all these drawbacks. we can hardly advise such a porcedure and, p;actically, we rule it out as a prospective solution of this problem.
Investigating the option of gender reassignment, in hindsight, appears to be the most logical course of action based on what we know today. Had Peter been under the care of a mental health professional who was knowledgable about gender identity issues, there may well have been a more positive outcome. But just when Bramanti brought up the most logical option, he retreated from a scientifically-valid position to an entirely religious-based one.
Bramanti then considered other therapeutic options for Peter: hormone treatments to “accentuate the masculine characteristics,” electroconvulsive therapy, and psychoanalysis, all of which he rejected because he believed they would fail to provided the hoped-for outcomes. Convinced as Bramanti was that he is dealing with a homosexual problem, he even quoted, in its entirety, Sigmund Freud’s famous letter to an American mother (see Apr 9), the very letter in which Freud said that homosexuality was “nothing to be ashamed of, no vice, no degradation.” That, apparently, didn’t phase Bramanti, who then considered an institution in California “that takes care of sexual perverts,” only to discover that they only handled people who were genuinely psychotic. He also considered “Labortherapy,” which, he said, “may also be, as you very well pointed out, good.” Bramanti contacted the head of the Vocational Rehabilitation Department, who told him that Peter “could have good chances for such a program, provided that he wear clothes according to his sex, which, as you know, the patient refuses to do.”
After considering that there is nothing that can be done clinically to “change Peter’s condition,” Bramanti made the following six recommendations, which, given the tortuous journey he took to getting to them, turned out to be somewhat-for-1965 enlightened:
1) Take an understanding attitude toward his sexual behavior by explaining to his family, his relatives and members of the community that Peter M. should be accepted the way that he is.
2) Alleviate his emotional tensions, his frustrations, anxieties and periods of depression. In this sense, psychotherapy, adjusting him to his inversion, is the type of therapy recommended, if financially feasible. Some psychopharmacologic agents could also help him in achieving this end.
3) Punishment is by no means indicated. The best thing one can do is treat him as politely as one would anyone else. He, on his part, of course, should be expected to abide by the ordinary rules of decency such as applied to relationship between men and women, namely, he should not seduce others nor force himself on people who are not interested in his company. He should not flaunt his desires in public by dressing in clothes of the opposite sex or otherwise and he should not embarrass those around him by making love or about it in public.
If he behaves himself and controls himself as discreetly as people with heterosexual desires are expected to do, his private life should be of no more concern to anyone else than should a normal person’s. Putting him in jail or in a hospital results only in providing him and the other inmates or patients with added opportunities for abnormal sexual activity.
4) Due to the tendencies of being immature in his reactions, easily depressed, discouraged and frequently frustrated, he could be a suicidal risk: therefore, close supervision by the Probation Officer is in order.
5) The tentative idea of placing him in Vocational Program for the purpose of training him as a beautician should be encouraged, if he would agree to dress as a man during the training period.
6) It is also felt that a priest could help by providing him with support.
[Source: Rodolfo M. Bramanti. "Letter to a probation officer on a case of homosexuality." Southwestern Medicine 46, no. 8 (August 1965): 253-257.]
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