On May 5, 2020, the Johns Hopkins News-Letter—the student newspaper at Johns Hopkins University—published a lengthy story online about a recent medical-school postdoctoral fellow’s complaint against two psychiatrists in the university’s health service whom the fellow had seen for treatment. Since the university’s Office of Institutional Ethics (OIE) had by then resolved the case by finding there to be no reason to sustain the complaint—even by the most favorable standard of proof for a complainant, “preponderance of the evidence”—one would be entitled to wonder what interest the story commanded to merit such detailed treatment by the paper.
The answer is that this complaint was located at one of the most sensitive flashpoints of our contemporary culture wars—the controversy over transgenderism. The complainant in this case, identified only as “Henry” because the person is not entirely “out” to everyone, is a “transgender man,” i.e., a woman transitioning to the adoption of a masculine gender identity. (In the rest of this essay we will call “Henry” by feminine pronouns, in keeping with the reality that this is a biologically female person.) And the most curious thing about the story is that Henry clearly wanted her complaint—and still wants her story—to gather in a person she blames for her alleged mistreatment but whom she has never seen for psychiatric care, Dr. Paul McHugh.
The two psychiatrists who did treat Henry—who cannot speak on the record about a patient’s care—are themselves graduates of Johns Hopkins School of Medicine’s psychiatric training, where they had studied under McHugh, who was the head of the school’s psychiatry program, and chief of psychiatry at Johns Hopkins Hospital, from 1975 to 2001. McHugh, who is nearly 89, has not retired to emeritus status, but continues to serve as University Distinguished Service Professor of Psychiatry, and to treat patients at the hospital. (Full disclosure: I know McHugh well and consider him a friend, but he did not encourage me to write this article, nor did he see it before publication.)
Henry’s charge against her two university doctors—in which she attempted to implicate Dr. McHugh—is that they violated the university’s policy forbidding discrimination against transgender persons by not affirming her new gender identity to her satisfaction, and by prescribing medication inappropriate to her condition. Since the university resolved the complaint in the doctors’ favor, and since the News-Letter has understandably been able to publish only Henry’s side of the story, it would not be appropriate here to hash over all the details of her allegations.
But still the question lingers: Why should Henry attempt to make Dr. McHugh culpable for alleged mistreatment by other doctors who had once been his students? And why should the News-Letter take such an interest in airing her grievance, after the university’s investigating officers found it had no merit? The attempt to pillory McHugh makes for a fascinating glimpse of the politics of transgender ideology today.
The guilt imputed to Dr. McHugh is simply this: Henry says that the discrimination she allegedly suffered stemmed from an “implicit bias” her doctors learned from McHugh.
It is certainly true that Paul McHugh has a four-decade record of strong—and well-argued—skepticism regarding the increasingly accepted courses of treatment for gender dysphoria. In 1979 he oversaw the cessation of transgender surgeries at Johns Hopkins Hospital—which only resumed there in 2017—on grounds that there was no evidence that surgical removal or alteration of healthy tissue improved the psychological well-being of the patients who underwent it. More recently, in venues like First Things, The New Atlantis (here and here), and here at Public Discourse, he has published scientifically informed articles, accessible to general readers, showing that the growing acceptance of transgenderism rests on insubstantial claims for the priority of a purely psychological “gender identity” over the reality of bodily sex. Likening the claim that one is “a woman trapped in a man’s body” (or vice versa) to conditions like anorexia, McHugh argues that we should no more operate on the healthy bodies of persons with gender dysphoria, excising here and fabricating there, than we would perform liposuction on the underweight body of an anorexic woman who falsely believed she was fat.
In the pending Supreme Court case of Harris Funeral Homes v. Equal Employment Opportunity Commission, Dr. McHugh has filed an amicus brief that effectively explodes the claims of the American Medical Association and the American Psychiatric Association in their own respective briefs to the Court. At stake in the case is whether Title VII of the Civil Rights Act, when it forbids discrimination on the basis of sex, should be read to protect persons against discrimination on the basis of a gender identity they claim to have, apart from their biological sex. The AMA and APA, supporting such a creative rereading of our civil rights laws, advance the idea that we can have an authentic “gender” that is something other than our “sex assigned at birth,” and thus endorse the progressively more intrusive treatments of social transition, hormone therapy, and surgical intervention to conform the body to the idea of gender held by the patient’s mind.
But the truth is that human beings are all either biologically male or biologically female permanently, from our conceptions to our deaths. A conviction that one is “really” a person of the opposite sex—or gender—is a false belief. The most compassionate course of treatment for gender dysphoria (known until recently as gender-identity disorder), McHugh argues, is to help patients with this condition to realign their self-understanding with the unchangeable reality of their bodily sex. The evidence is simply lacking that “gender affirmation” and all that follows from it is actually good for the well-being of patients so treated.
These arguments of Dr. McHugh—perhaps the leading champion of evidence-based psychiatry in the U.S. over the last half century—are what prompted the postdoctoral fellow called “Henry” to aim her complaint at McHugh as much as at the doctors who treated her. And sadly, it appears that the investigators at Johns Hopkins University considered a “McHugh factor” in their inquiry into the complaint. Concerning one of Henry’s doctors, the university’s OIE found there was no preponderant evidence that (in the News-Letter’s words) “he shared McHugh’s views or that they affected the care he provided Henry.” Would it really be an offense against the university’s anti-discrimination policies for one of its attending psychiatrists to share the view of Paul McHugh that it is in the best interests of patients with gender dysphoria to come to terms with their bodily sex and accept it?
Dr. McHugh himself spoke with the News-Letter for its story, and while he professed that some patients he had seen “who claim to be transgender . . . can say whatever they want” about their gender identity, he observed that “many people are uncomfortable with opinions that doctors give them. The doctor’s job is to help them understand why the answer is for their benefit. . . . Lots of people hear bad news from doctors, and don’t hear what they’d like to hear. Doctors are not here just to make people feel good after every interaction.” If a psychiatrist’s considered opinion, in other words, is that a patient’s claim of gender identity should not be affirmed, but her bodily sex affirmed instead, he is obligated to tell the patient so—and he should be free to tell her.
Now we come to the real point of this little controversy on the Johns Hopkins campus—the reason for a “McHugh factor” in OIE’s complaint inquiry, and the reason for the student newspaper’s high level of continuing interest in the case after its resolution. The point is not to “get” Paul McHugh. At his age, and with his unassailable track record of achievement in his profession, he is not a “gettable” guy. The point is to signal to every other mental health and medical professional in the country—from psychiatrists to endocrinologists to surgeons to therapists and counselors—that the ideology of transgenderism will brook no dissent. Wherever “gender identity” becomes a forbidden ground of “discrimination,” their judgment of what is the soundest and most ethical medical or mental-health advice to patients presenting with gender dysphoria may carry the risk of their being charged with a violation of their patients’ civil rights.
To his credit, Dr. McHugh foresees this in his amicus brief in the Harris Funeral Homes case: “Unfortunately, ideology rather than science is driving the support” for the current trend of “gender affirmation,” “transitioning,” and the rest. “And since dissent is systematically eliminated and those who disagree are loudly condemned, the kind of research necessary to inform the public debate is not occurring.”
Should the Supreme Court decide, contrary to all norms of statutory interpretation as well as to the truth about human beings’ bodily sexual nature, that “sex” in our anti-discrimination laws encompasses self-declared “gender identity,” the result will not be a new birth of freedom but a new legal regime of repression and a forced affirmation of false beliefs. And in the name of solicitude for people who suffer from gender dysphoria—who deserve compassionate treatment—we will insist that medical and therapeutic practitioners who really want to provide such treatment not do so if it contradicts the ideological demand for “affirmation,” for fear of being branded as bigots and perhaps even hounded out of their professions. In universities that train health professionals, this danger will be particularly acute, as Title IX norms governing higher education will necessarily adopt any new misreading of Title VII.
Henry, the Hopkins complainant, seems to look forward to such a day. “Henry believes that Hopkins will need to reconcile a growing tension between academic freedom and identity,” writes the News-Letter, and there is no doubt how she would resolve that tension. However little we can really know about what she experienced in her university’s health care system, Henry deserves our compassion. She carries a double burden, not just of gender dysphoria but of being a warrior in a misbegotten ideological crusade—two grave mistakes, one about herself and one about justice. That she is a willing warrior should not deprive her of our sympathy. But that we owe her our compassion—even if she rejects it—does not mean we should surrender in the war we are in for good science, sound medicine, and just laws.