Interview with Dr. R. Bruce Ritchie
Q: Who becomes a Transsexual?
Dr. Ritchie: That would be a person who is not comfortable with their basic sexual identity — that being whichever they were born with, genetically and physically.
Q: What are some factors that contribute to that discomfort?
Dr. Ritchie: There are individuals who believe for various reasons that they are a person of the opposite gender caught in the body of someone of the same gender — or vice versa.
Q: Are they?
Dr. Ritchie: That’s what they believe they are. It’s very difficult to make a scientific assessment as to whether they are or not because it’s a subjective factor. I mean, masculinity and femininity, from a Jungian perspective, fall on a continuum. We have a sort of a core sense of gender. We define ourselves either one way or the other — and we also have the opposite component. It’s like the yin and yang thing; to be masculine is to have that little dot of feminine and to be feminine is to have that little dot of masculine so that we can understand each other. So, there’s sort of an inherent bisexuality — but then there’s the reality of genes, the way the genes lined up. Whether you’re an XX or XY — there’s no getting around the rigorousness of that test. You’re either one or the other. There’re some anomalies involved here, but it’s gonna be X’s and it’s gonna be Y’s and if you have two X’s you’re a female and if you have an X and a Y, you’re a male. That’s just the way it goes.
Q: Doesn’t saying that an identity is trapped in the wrong body kinda suggest the metaphysical and the spiritual — and ghosts?
Dr. Ritchie: Well, it could — but the question is, where’s the ghost? Where’s the influence? Over the years, I’ve worked with more than a few women who had actively hoped their sons would be girls instead of boys and that they’d be Gay if they were male. Now, what kind of ghost is that? I mean, that’s one of these entities that works its way into your head when you’re a kid because mom’s dressing you up in little frocks and stuff and giving you all sorts of attention when you act girlish. Is that indicative of an outside force or is that something that’s functioning from within? Where do you draw the line? It’s difficult.
Q: I see. Well, maybe that tells us that all kinds of things can combine to influence one’s sexual identity.
Dr. Ritchie: Yes, that’s right — and it’s on a continuum. There are males who are more female than male, but not necessarily homosexual — and for them perhaps becoming a woman would give them a socially normal path to being involved with men without actually being homosexuals from their own internal perspective, relatively.
Q: So there’s a difference between homosexuality and Transgenderism.
Dr. Ritchie: Absolutely, absolutely. They can function on completely different planes altogether. They need not be related at all. There are individuals who are homosexual who are attracted male to male, or female to female. There can be other individuals who, because of their own internal sexual orientation or self-perception, perceive themselves as being emotionally a member of the opposite sex. So, therefore having sex with a member of their same sex would be equivalent to being not homosexual — or it being like an A-B relationship, as opposed to an A-A or B-B. In the final analysis, you have to go with the genes. You have to go with the way that the genes lined up.
Q: That’s contrary to much of what’s in the legal pronouncements on these issues —
Dr. Ritchie: I think that if you have to make a decision, you need to make your decision based on some kind of scientific function, as opposed to a subjective function — and if an individual has an XY profile, they are a male and if they have an XX profile they are a female. Now, they may choose or select to identify themselves as being a member of the opposite gender, but when it comes down to scientific rigor, you ultimately have to go with that which will give you a reproducible result — and that comes down to genes.
Q: This brings up the issue of how we document Transgendered people. When one undergoes gender reassignment in New York, the gender on their birth certificate is changed from male to female or vice versa. Now there’s an attempt to make it so that one doesn’t need to get the surgery, that one’s feelings about their identity should be adequate for them to decide whether they’re a boy or a girl. I was hoping you could comment on that.
Dr. Ritchie: Well, I’d be more interested in the way that law enforcement would look at that situation because I think that’s really where the crunch is gonna come.
Q: Should we be altering historical documents to reflect current perceived realities?
Dr. Ritchie: That gets into a lot of subjective factors, of course. If you choose to do that, you have to decide whether or not you’re going to base it on one person’s point of view. There’s a growing sense over the years that Michelangelo was homosexual and sometimes a cross-dresser. I don’t know whether it’s true or not because I don’t know how legitimate the evidence is. There’s a lobby that would like to see him as being homosexual or Transgendered. It doesn’t matter. But on the other hand, what is the evidence that we have sitting in front of us right now? It’s all subjective. When you’re looking at something historically, you’re basing whatever gender assignments you choose to lay on an individual on intelligence which may be inadequate or that may be skewed.
Q: What I’m asking you here is directly in regard to birth certificates. If we change them, is that a bad precedent?
Dr. Ritchie: It depends on whether you want scientific rigor in descriptors in your society. If it’s all going to be subjective, than a person could describe themselves as being a god or an alien. I mean, there’s a point where you have to look at this thing and decide how rigorous you wish to be — and I think there are very few factors that are less rigorous than gender. I mean, male or female — when you’re out there in the field working as an anthropologist and you find a body, the first thing you do is you look at the body and you try to sex it. You say, “This was a female,” or “This was a male.” From an anthropological perspective, there’s very little that’s more prominent in the way that you deal with human beings than gender. An individual may say, “Well, I was born one way and I feel like another —” and if you decide to change the record to reflect that, that’s a social statement. That is not truly a scientific way of looking at it — and science is all we have to make decisions.
Q: What kind of a person identifies themselves as a Transsexual, and goes through some of the processes involved in becoming one — like hormonal therapies and cosmetic surgeries — but hasn’t had reassignment surgery?
Dr. Ritchie: It comes down to that situation where they talk about involvement and commitment. An individual who undergoes nonsurgical means to cause themselves to appear to be a member of the opposite sex — they are involved in a process. And, they are involved in a process of defining, redefining, denying their genetic gender identity. The ones who have the surgery are committed.
Q: Tell us what the profile might be of folks who are Transgendered by self-identification —
Dr. Ritchie: Being Transgendered, either surgically or by choice, is a means of not being homosexual. There’s one category of individuals who, in the literal sense of the term — genetically — are homosexual but who alternately have found a means to not be homosexual while doing the same behavior without any change to their gender. Another category is the people out there whose sense of gender identity is just not really screwed on real tight. They may not feel completely one way or the other. I mean, there’s a certain androgyny in their perspective — and for individuals who are androgynous, it can kinda scuttle back and forth, in terms of which gender identity feels the most comfortable, because it’s on a continuum. In the prison environment, as an example, there’s a certain level of male aggression — and if it dips below a certain level, the individual in that society becomes like a female, whether they wish to be so or not. They are identified as being a female because of what is perceived, socially, as being an inadequate number of male characteristics — including aggression, including the means to defend themselves. If they drop below that threshold, they become women, in that culture. On the street, they might be considered perfectly normal males. So, a lot of it is based on what’s going on then and there. What environment are we in?
Q: So a prison sentence isn’t only about incarceration, it’s about a change of sexual identity. The judge might as well say as much when he sentences you: “X number of years, and slide so far along the scale of the sexual continuum.”
Dr. Ritchie: There is a line on that scale under which the individual ceases to be a male. Alternately, in the female penal institutions, the women tend to form families and the women who are the dominant females of the family are the ones who are the most masculine. They are the fathers. There are other individuals, generally their lovers, who are the mothers, and then there are other young women who are attracted to them and they are a family and they function as a family. You know — mom, dad and the kids.
Q: Do some people get gender reassignment procedures in prison?
Dr. Ritchie: In certain situations, individuals who entered prison having been pre-op, in terms of gender reassignment, have been able to get the State to pay for the continuation of their hormone treatment, for example. But that has more to do with medical standards, because the MD prescribed it and has allowed it to happen. It becomes medical; whether it’s health-inducing or not is secondary.
Q: I see. Speaking of medical matters, how did the psychiatric community view Transgendered behaviors in days gone by, vis a vis how such things are described today?
Dr. Ritchie: Until relatively recently it was considered a perversion. And it was assigned to certain environmental factors or predispositions that would cause an individual to do that. It was considered a pathological state.
Q: And what led to the shift in attitude?
Dr. Ritchie: The interest of individuals and organizations that were publicly sensitive to their plight. There was a change in the social attitude that was being led by advocacy groups.
Q: I see. There was a change in society at large. There was more tolerance towards homosexuality—
Dr. Ritchie: Within the psychiatric community, yes. Within the psychiatric and psychological community there was a shift in the perspective of how one should look at individuals who were homosexual, Transgendered, bisexual — whatever. At that point in time the labeling of these individuals as pathological was replaced by their being lifestyle choices, for all intents and purposes.
Q: So how would Freud have diagnosed a person who expressed a Transsexual impulse?
Dr. Ritchie: That’s hard to say, because of his own homosexual impulses, but I would say that he would perceive it in terms of being a domineering mother and a weak father — which would have been the classic psychoanalytic profile of a male homosexual.
Q: How does the Jungian and the Freudian perspective differ?
Dr. Ritchie: The Jungian perspective is more inclined to see gender issues as being on a continuum without there being necessarily a pathological drive behind it. That yin-yang symbol — sometimes that little dot in there is a little bigger in one individual than another. But yet they are either yin or they are yang. They are male or they are female.
Q: So in the Freudian model, it’s a —
Dr. Ritchie: Pathological state.
Q: A pathological state, and then in the Jungian model —
Dr. Ritchie: It’s on a continuum. I mean, of course from a Jungian perspective, homosexuality is considered a manifestation of arrested development because the homosexual phase goes through a certain level of your development and if you’re stuck in it, that’s indicative of there being an arresting of your emotional and sexual development. But alternately, for everyone else who falls on the continuum it’s all part of a band of normalcy. There’s no pathological situations like repressed homosexuality or that sort of thing which you’d find with the Freudian perspective.
Q: Okay. In days gone by, from what you know, when this condition was considered pathological, what treatment might have been recommended or how would the problem have been addressed?
Dr. Ritchie: If you’re going to address it from a psychoanalytic perspective then there’d be a period of many, many years of psychotherapy — and even Jung said, when they asked him what his success ratio was, he said, “Well, a third get better and a third get worse and a third stay the same.” So whenever you have an intervention of that sort, you’re kinda working on the law of thirds.
Q: I see. What might have been prescribed? Was this institutionalization-worthy?
Dr. Ritchie: Institutionalization was not out of the picture. In extreme cases, I’m sure people had frontal lobotomies or were given medication that would pretty much shut them down from an emotional perspective. It depends very much on who you’re dealing with. If you’re dealing with a Christian counselor, you know, it could be a whole thing of sitting around and praying. It would depend very much on what kind of a counselor — but from the classic Freudian position, from the DSM [Diagnostic and Statistical Manual of Mental Disorders] I, II and III, maybe even up to IV, it was considered a pathological state. Only recently has that changed.
Q: Let’s talk about how things are today in the psychological community. Say a young person comes to a psychologist and wants to discuss the fact that they feel Transgendered or they have questions about it — how are they handled? They say, “Doc, I think I’m a Transsexual —”
Dr. Ritchie: Again, it depends where you go. My own personal perspective might be different than the norm. I’m sure that many people would support them in pursuing their gender identity. From the perspective of following the Socratic oath, first to do no harm, I would have to have a more conservative perspective. I’d wish to speak to the person about it, and find out why that happened to be, or what they wish to do with it, and to consider the various options available in defining one’s own gender identity.
Q: Let’s say — I hate to use this term — a ladyboy-type of guy comes into your office. Later on a guy comes in who’s a very masculine type, and they both express the same issue. Are they handled differently or does one size fit all?
Dr. Ritchie: Well, every individual would have to be handled differently, but if an individual came in and their basic presentation is more female than male, the way that I would interpret their social presentation would be different based completely on what you describe. If a guy came in and was ultra-butch and he said that deep down inside he felt like he was a woman, I’d have to deal with the fact there was a significant gap between his social presentation and his stated gender identity perspective.
Q: What part does bullying play in all this?
Dr. Ritchie: Well, that’s the same as in prison, I would say. The way that male hierarchies function — from childhood to the military to prisons to single-sex school situations — you get the same sort of a function by which there are males whose masculinity is gonna be defined as their ability to involve themselves in, or resist, aggression. There are going to be boys who fall beneath the line, in the same way that you’re going to find females whose aggression orientation, sports interest — the tomboys of the group — are going to be more inclined towards engaging in behaviors that are typical of the members of the opposite gender.
Q: There’s the matter of defining gender for participation in sports —
Dr. Ritchie: Well, that’s one of the issues that I perceive as being best resolved by endocrinologists. If a person who identifies themselves as being one gender or the other has the hormonal advantage — or perhaps having had hormones in order to achieve that —
Q: The endocrinologists will sort it all out.
Dr. Ritchie: Well, if what you’re asking is, Does an individual have an edge or a deficit based on factors that are specifically genetically related — then that becomes an issue. You’ve had people cheating in the Tour De France based on the fact that they were being doped with androgens and testosterone and other drugs. If in a given sport an individual is getting hormones that would cause them to perform at a higher level, that would be the same. You would have to look at it from an endocrinological perspective.
Q: But the trend seems to be going toward a situation where the individual makes the decision about their identity and then a legal framework reinforces their perspective. Once people declare themselves Transgender, it’s up to the rest of us conform to their self-image, legally and ethically.
Dr. Ritchie: Well, some of that is a social trend. How rigorous do you wish to be with identity? One often hears this argument: If I say I’m Jesus Christ or Napoleon, how far do you have to take your acceptance of my subjective reality?
Q: What do you see in the future for the psychological community in relation to Transsexuality?
Dr. Ritchie: Modern institutional psychology sees it as separate and distinct from the way that the average American sees it. Those two perspectives could shift in either direction. I think at this point we are looking at what is approaching the apogee of acceptance of subjective gender identity.
Q: And when you hit the apogee, of course, the curve goes back down. Does that mean we’ll see a period of less tolerance, less acceptance in the future?
Dr. Ritchie: Inevitably. The conservative and the liberal ends of society are in a constant back-and-forth. The equilibrium is not stable, historically. As an example, I’m sure that in ancient Rome, gender identities were more flexible than they are today. So, you’re always going to find situations where acceptance or lack of acceptance is going to go back and forth. We happen to be going through a liberal phase right now.
Q: And we’ve gone through other liberal phases —
Dr. Ritchie: Yeah. And it’s not as if you can say that there was one glorious awakening in any given culture. There’s been a lot of back and forth over time. The smartest, the best and the brightest of the anthropologists at Harvard, in the 1920’s, were writing things that could get them locked up in Europe today — and these people were no less intelligent than the intelligentsia of today. In fact, I could make a case for saying that they were probably brighter. But the social and the political perspectives were simply different, and the intellectuals of the era were supporting the generally perceived notion of reality. I think that once you accept an individual’s subjective description of their gender identity as being the true reality, I think that is as far as one can go in terms of acceptance.
Q: When people have gender reassignment, do they ever revert to their original gender?
Dr. Ritchie: Well, in terms of individuals who have had their surgery, the overwhelming majority of them — after five or ten years — were not happy with the results. I don’t think that’s in terms of how slick the surgery was. They were not happy with being that heavily committed to the process of gender change.
Q: It’s just hard being a human being, no matter what gender you are —
Dr. Ritchie: When an individual is unhappy with their overall round of life, a lot of times they can latch onto various fantasies. In a lot of those cases, what you wind up with is not what you imagined. Be careful what you wish for, you know? Until you’ve had the operation, you can go backwards. It’s the involvement-versus-commitment continuum.
Q: If I were to go to a psychologist and say, “Doc, I don’t like these Transsexuals; they make me uncomfortable —” what could I expect to be told?
Dr. Ritchie: I think that a psychologist or a psychiatrist might take it from the perspective of how better to make you comfortable with your own identity to the extent that you would no longer feel threatened.
Q: So, in layman’s term, it would be my problem — not theirs.
Dr. Ritchie: Yes.