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patient "Doris"

Following yesterday’s post here is a second excerpt which describes Doris - one of Harry Benjamin's first 10 patients. Doris was a strong advocate of the socialization theory which opposed Benjamin’s biological theory. I identified with her more than with the other nine patients because of her decision not to have surgery (although she lived socially as a woman in later life) and because of the keen intellectual curiosity she held about her condition. Apparently, their exchanges helped Benjamin formulate many of his ideas on transsexualism.

Although it is not precisely stated in the text, Benjamin would have likely categorized her as a type IV non-surgical transsexual.

“Doris was an artist who married twice. The first wife, with whom there was one daughter, knew nothing of the condition until after marriage. The second spouse was informed of Doris's cross-gender desires and they lived happily together for 3 years; but the strain of keeping the secret eventually led the spouse to a nervous breakdown and subsequent divorce.

Doris concluded that it must be time to attempt to be in a life always dreamed of: to live full-time as a woman. Doris relocated to another city, managing a small apartment house, remodelling and decorating for young employed women ("working girls"), and continued successfully to sell her paintings.

Born in 1913, Doris considered her/himself a heterosexual transvestite with strong autoerotic tendencies (i.e., masturbation), and, like Otto (Benjamin’s first patient), reported "vicarious menstruation" that manifested itself in copious nose-bleeds lasting up to 3 days. Cross-dressing desires were always present, the intensity variable, and rationalizing them was endless and curbed only by Doris's imagination. Doris believed that the inception of the desire to dress occurred in childhood between ages 1 and 5 as a result of faulty, incomplete, or distorted sex identification. Doris felt that society's negative attitude toward crossdressing was responsible in large part for her developing two distinct personalities: one for the public to know, and the other, "her true self," which almost no one knew. (Doris felt this dynamic was responsible for the cross-dresser's paranoid tendencies.)

By the mid-1950s, Doris wrote: "I consider [Doris] to be my true identity even though the birth records say differently, and on this I will stand, for to me, as to most people who know me, I AM [Doris]. I maintain that people are personalities first and that the statistical facts are merely additional information."

In the struggle to listen to early voices that would shape understanding of the complexity of cross-gender identity conditions, Benjamin's correspondence with Doris was constant - Doris being his most intellectually developed patient about the issues of gender formation and expression and interpretation medicine, as well as the required unique adjustments to living.

Benjamin and Doris introduced each other to many of these first 10 patients and in the years to come, they met, among many others, all of the famous Kinsey researchers and also the flamboyant female impersonators from Paris' Carrousel Bar, Bambi and Coccinelle (Doris' letter to Benjamin, February 14, 1957).

Benjamin's letters to Doris were full of concern, advice, and instruction regarding terminology, genital surgery, hormones, gender as a learned role, and many other related issues. In the early 1950s, for instance, Benjamin wrote to Doris about the Christine Jorgenson case: "Christine's 'transvestism' was only a part, the external or symbolic part of her problem. The urge goes much deeper. We lack a proper scientific term for it. I would describe it as an 'obsessive urge to belong to the opposite sex.'"

The uniqueness of their correspondence was that Doris, as a patient and as an inner analytic inspiration to Benjamin, taught him much about the condition; and Benjamin, in turn, could use Doris as a sounding board for the development of many of his ideas. For instance, on the subject of surgery, Benjamin wrote: "The operation we've discussed so often is legal in Holland and could be performed there - naturally only with the proper medical and psychiatric indications. I am trying to make the necessary contact for those who may need it. Be happy that you don't" (italics added).

On hormone treatment, Benjamin both referred to endocrinological therapy as "chemical castration" and explained its effects:

“Breast development on hormones is nothing constant . . . it all depends on existing breast tissue that can be developed endocrinologically or not. Treatment with estrogen constitutes an irritation, and if constant and persistent it involves the danger of tumor formation later on. I consider it my duty to prevent such possible occurrence and suggest administering "irritation treatment" with interruptions. Distinctly feeling a retrogression after cessation of estrogen medication means you can resume taking the tablets - but remember the warning. Off and on, say every three months, make an interruption so that any undue irritation can subside for awhile. Now please use your own judgement”

On gender as a learned role, Benjamin wrote:

“Based on a medical journal report in the early 1940s of psychiatrists' observations of children ages 12-18, who had been reared from birth as the opposite sex, and who had been apprised of their true sex and given their choice of gender role, only 3/4 chose to revert to their physiological sex, the others remaining in the role in which they had been reared.”

Doris thought this to be conclusive "proof" that role is learned and conditioned. Benjamin responded:

"If the theory of a learned gender role satisfies you, fine, stick to it. I cannot believe in its exclusiveness because I am biologically oriented. A living brain has to exist to learn anything, to have any feeling, thought or emotion, and brains are very complicated instruments and very different in different people"

It is of worthy paradoxical interest to note that Doris, the creative artist with the condition, did not believe that it involved a prenatal phenomenon, but was, rather, a conditioned condition; whereas Benjamin, the scientist thinker, held the strong belief that the biology of the brain and therefore the possible etiology of the condition must emanate from other sources, or be an interplay of both biological and social effects.

Doris died in 1976 at age 63. Doris's collection of letters, research questionnaires, bibliographic citations, writings - including an article entitled, "Transvestism: An Empirical Study" (which contained no research data), published in The International Journal of Sexology, under the pen name of Janet Thompson (1951) - are permanently stored in the Kinsey Institute archives in Bloomington, Indiana”

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