Volume 1, Number 2, October - December 1997
Sex Reassignment, Harry Benjamin, and some European Roots
By Friedemann Pfaefflin, M.D.
Citation: Pfäfflin F., (1997) Sex Reassignment, Harry Benjamin, and some European Roots. IJT 1,2, http://www.symposion.com/ijt/ijtc0202.htm
This paper documents the author´s Presidential Address at the XV Harry Benjamin International Gender Dysphoria Symposium, Vancouver, Canada, 7.-18. Sept. 1997. It traces the roots of the term transsexualism far beyond the writings of Cauldwell who is generally believed to have coined the word. Benjamin, born in Berlin, had close connections to sex researchers in Europe where sex research blossomed at the beginning of the 20th century. His interests in endocrinology were inspired by the work of Steinach, Vienna. His involvement in transvestism and transsexualism was inspired by the work of Hirschfeld, Berlin. In contrast, his interests in psychoanalysis were spoiled at his first encounter with Freud. It was Hirschfeld who, in 1910, coined the term transvestism, and, in 1923, the term transsexualism. in 1918, Magnus Hirschfeld reported the first sex reassignment surgery having taken place in Berlin in 1912. The paper highlights some of the most important contributions of Hirschfeld to sexology. It traces the connections between Benjamin and Hirschfeld, and it discusses what may be learned from history for present controversies in the realm of transgenderism.
For a continental European it is a great pleasure to visit British Columbia and to watch the salmon climb the rivers and the salmon ladders to reach their spawning grounds where they fertilize and start their new journeys through the oceans. Just like the tides it seems to be an eternal circuit of being born and dying away. Every individual salmon contributes to it. It goes on and on, although not all salmons reach their places of origin and are able to procreate. Quite a few are caught by fishermen on their journey, and others are devoured by bigger fish or by the black bear. Some grow to an enormous size and if caught they are exhibited as trophies: the salmon king of a certain year or of an individual valley.
|It is this picture that came to my mind when I was pondering the prospective topic for
the Presidential Address at this Symposium. The journey of the salmons seemed to be a
metaphor for our scientific dreams and endeavors. They are born and they die away, and we
treat the names of selected individual scientists as trophies. We may call such a person a
king scientist, and we admire this person for his or her contribution to the progress in
the eternal quest of mankind to transcend its boundaries. The ideas of such a person may
fertilize the minds of many others. They also may be treated by the entourage of the king
salmon as if the truth had been found forever and as if the narrow stream of the
individual valley is just like paradise. The followers thus may never become aware of what
is going on in neighboring valleys. That may be one of the reasons why mankind has to
repeat itself over and over again, and why every new generation seems to have to invent
the same things that could have been known if one looked across the boundaries of one´s
It is the purpose of this presentation to demonstrate that some of the issues we are struggling with look like second or even third editions of problems our forefathers in the field had already tried to solve. I will use Harry Benjamin, Sigmund Freud and Magnus Hirschfeld, three of the most outstanding sexologists of the beginning of the century, who worked in the field, before the term sexology was known, to exemplify this.
Our Association carries Harry Benjamin´s name in its coat of arms as the name of the physician and scientist who paved the way to a better understanding of transsexualism, and above all, an easier access to cross gender living, cross sex hormonal treatment and sex reassignment surgery. Without his deep caring for far more than a thousand patients, without his engagement in academic and professional organizations, without his numerous talks and writings, these treatments might not have become as easily accessible as they are now. We owe him a lot, and his work has been acknowledged in previous presidential addresses, in the special issue of the Archives of Sexual Behavior in his memory, published about a year after his death (Ihlenfeld et al. 1988), and in the short portrait of him in the introduction to the abstracts of this conference (Schaefer & Wheeler 1997).
Before he turned to treating transsexual patients and responding to their concrete wishes, he had devoted much of his work to rejuvenating individual life or rather prolonging it. Both wishes, to transcend the time limitations of an individual life as well as to transcend individual boundaries of sex and gender most probably are as old as mankind itself - religious traditions of various backgrounds, myths, philosophies, pieces of art and literature giving testimony thereof.
We know quite a bit about his work and his life, but we are still missing a biography of him putting the roots of his research and clinical work into the perspective of contemporary scientific developments and investigating mutual influences between him and other king scientists and clinicians of his era, an epoque which witnessed an unprecedented development of sex research and sexual science. When he was a young man, the capitals of Austria and Germany, Vienna and Berlin, were the two very places to study sexology. Although he set off very early for the United States, he stayed in close contact with the leading researchers of those places, and he eagerly soaked up every new finding of sexual endocrinology and sexual psychology years before he met the first transsexual patient. Let me highlight just a few examples.
He was an ardent admirer of the work of Eugen Steinach (1940), Vienna, who, together with Magnus Hirschfeld (Steakley 1985, Baumgardt et al. 1985), Berlin, experimented with the transplantation of gonads to cure all kinds of what then was considered a sexual disorder, for instance homosexuality. Like Steinach, Benjamin believed in the beneficial effects of vasoligation or sterilization respectively, to postpone the process of aging and to cure - among other complaints - erectile dysfunctions. For the psychoanalysts among you it may be worth mentioning that even Sigmund Freud underwent such a sterilization operation in the hope to thus defeat his cancer disease and to slow down the process of aging (Schur 1972). This is worth mentioning because so many psychoanalytic colleagues are still reluctant to accept the overall beneficial results of somatic treatment measures in gender reassignment.
On one of his visits to Vienna, Benjamin met Freud and consulted him because of personal problems with sexual potency. Freud, at that time, was still rather inexperienced in his psychoanalytic technique - at least when judged from our knowledge of today - and he gave Benjamin a very primitive interpretation. He suggested Benjamin´s erectile dysfunction was due to his latent homosexuality, and you certainly can imagine that Benjamin did not appreciate this interpretation.
This short interaction between the two great men resulted in a permanent skepticism of Benjamin against psychoanalysis if not a thorough dislike which since then has been replicated in many encounters of transsexuals and their doctors. A prototypical example of it is found in the movie "I change my life" in which Vanessa Redgrave plays Renee Richards and in which the attempt of a psychoanalytic cure of the patient´s problem is profoundly ridiculed.
Certainly more important than his acquaintance with Freud was Benjamin´s acquaintance with Hirschfeld and his work in Berlin. Who was Hirschfeld? If, apart from Benjamin, there is any other single person with major influence on the understanding of transgender phenomena and of sex reassignment treatment it is without question Magnus Hirschfeld (Herzer 1992, Wolff 1986).
This Symposium hosts an exhibit which gives you a glimpse of parts of his extraordinary work. We got it courtesy of the Magnus-Hirschfeld-Society, Berlin, and I am happy that it can be shown here thanks to Ralf Dose, Berlin, and Oliver Robinow, Vancouver, who worked very hard to bring the exhibit to this place. Two days ago, at the welcome reception, it was on display in a separate room so that more than 60 tables could be studied easily. Now, with so many more attendants to this conference than expected according to the pre-registration, the hotel management has made a great mess by putting some of the tables aside, thus repeating what happened to Hirschfeld during his scientific career. His pathbraking work was often put aside by colleagues who held academic positions in universities and who did not want to get in touch with Hirschfeld´s social and political engagement.
Hirschfeld was born in 1868, 17 years before Harry Benjamin was born. Before he laid the corner stone of what is now known as the gay movement and before he became the best known sexologist of his time, he worked as a general practitioner, first in Magdeburg, then in Berlin. At age 28 he had published a booklet , entitled: "Sappho and Socrates, or how to explain the love of men and women for persons of their own sex"
In 1897, exactly one hundred years ago, he founded the "Scientific-humanitarian Committee", which was the first gay liberation activity of impressive political influence, initiated at a time when homosexual behavior among adult men still was criminalized and responded to by society with incarceration (Pfaefflin 1985). From 1899 to 1923 he edited the "Yearbook of Sexual Intermediate States" (Jahrbuch fuer sexuelle Zwischenstufen) which up till now is one of the most enlightening historical sources for all kinds of gay and transgender forms of living. There he published a petition to the German Parliament, signed by more than 800 writers, artists, lawyers and other people in public positions, to plead for the abolition of criminal law against homosexual behavior.
At the turn of the 19th to the 20th century, he performed the first empirical study on the prevalence of homosexuals among the students of Berlin´s Technical University, and he also developed a psycho-biological questionnaire exploring people´s sexual behavior more than a generation before Alfred Kinsey and co-workers started their work.
In 1908 he founded the first "Journal for Sexual Science" (Zeitschrift fuer Sexualwissenschaft), but he was not very successful with it and it appeared only for one year. Because he was gay, the academic world rather avoided him.
Five years later, in 1913, he co-founded the "Medical Association for Sexual Science and Eugenics" (Aerztliche Gesellschaft fuer Sexualwissenschaft und Eugenik) which, in the following year, started a new "Journal of Sexual Science" (Zeitschrift fuer Sexualwissenschaft), appearing until 1932 and being the leading journal of its time in the field worldwide.
It is hard to say whether it was his most important or whether it was just one more of his many important activities, when, in 1919, he established the "Institute for Sexual Science" (Institut füer Sexualwissenschaft) in Berlin, devoted to research, counseling and political campaigning. As a forth pillar, the much frequented Institute´s work was based on providing space for free meetings of clients, researchers and whoever else was interested in sexual politics, research or treatment. The Institute had a large collection of sexual items as well as archives of sexual writings and case material. There was a remarkable number of staff, most of them working on a voluntary basis, but some also as fully employed experts. The exhibit lists some of the names of the most important coworkers and shows their portraits if they were available.
Hirschfeld was one of the most well known persons in Germany. When he toured the country to give talks he easily attracted audiences of a thousand and more listeners. He was admired by many for his courage to openly address sexual politics, but he was also attacked and almost assassinated by right wing nationalistic students in Munich in 1920.
I do not intend to go into details of the history of the Institute which, in May 1933, was raided by storm trooper students of the Nazi party, most of the collections being destroyed and writings of "Jewish sexology" being publicly burnt. Hirschfeld had already left Berlin in 1930 for a trip around the world, and he happened to see the raid of his institute in the news in a cinema in Paris, reacting with a feeling of having attended his own funeral.
He never returned to Germany but died in exile in France in 1935 on May 14, his 67th birthday. He had suffered from malaria for a long time but he also died from a broken heart (Dannecker 1995/96).
Let me now come to three questions: (1) What has all this to do with Harry Benjamin?
(2) What has all this to do with transsexualism and transgenderism? (3) What can we learn
from Hirschfeld's work for our present discussions?
Harry Benjamin was fully informed about Hirschfeld's work. Personally they knew each
other at least since the twenties. When attending the 1st International Congress of Sex
Research in Berlin in 1926 (Benjamin 1928) he visited Hirschfeld´s institute. Shortly
after Hirschfeld and Norman Haire had founded the World League of Sex Research in 1928 in
Copenhagen, they planned the next congress in London in 1929. Benjamin became a member of
the English section of the World League and supported the London congress. They again met
the next year in Vienna. Benjamin prepared Hirschfeld´s journey to the United States in
1930 and provided him with an invitation from a New York medical society. In addition, he
allowed Hirschfeld to give lectures in his New York apartment. Benjamin attempted to
organize a congress of the World League of Sex Research in Chicago in 1933. Advised by
Havellock Ellis, he drafted a program for the World League (Haeberle 1983). This program,
however, was never adopted, as the World League broke apart due to the persecution of
sexologists in Europe, and the Chicago congress did not take place.
Hirschfeld coined the term transvestism when he wrote the first monograph about that phenomenon in 1910 (Hirschfeld 1910). This two volume book contains many biographies of persons which we would nowadays call transsexuals or transgendered people.
Hirschfeld (1923) also coined the word transsexualism and used it already in 1923, more than a quarter of a century before Cauldwell (1949) who is quoted in about 98 % of the literature as the first author to have used this word. First incomplete sex-reassignment surgeries in female-to-male patients were performed in Berlin in 1912 (Hirschfeld 1918, Muehsam 1926), and in male-to-female transsexuals in 1920 (Muehsam 1926). The patient had been referred by Hirschfeld to the surgeon. This is also true for the famous Danish patient Niels Hoyer alias Lilli Elbe (1932) who was operated in 1930 and who published her sensational and widely distributed autobiography in 1932.
The first complete male-to-female SRS was reported in 1931, and it was performed based on Hirschfeld´s recommendation by two of his co-workers in his institute, Dr. Levy-Lenz, and Dr. Felix Abraham. Portraits of these doctors as well as a portrait of their patient Rudolph, later living with the female first name Dorchen, will be found in the exhibit. Dorchen lived and worked in Hirschfeld´s institute for more than 10 years as a housemaid (Herrn 1995).
It is obvious that Harry Benjamin knew all this, and I think it is time that we should
publish the manuscript of his talk before the Association for the Advancement of
Psychotherapy in New York City in the early 30th, which, according to the preface of the
abstracts of this conference, was "the first scientific lecture on
transsexualism" (Schaefer & Wheeler 1997p.4). If this manuscript exists, it
should, so I would suspect, honor Magnus Hirschfeld as the pacemaker in the treatment of
There are many lessons from this history which cannot all be developed here considering the short time available. One may pick out the three most important ones:
(1) Hirschfeld´s motto "through science to justice" and his naive conception that science would reveal the true nature of things proved to be a boomerang. This is evidenced by the history of the persecution of homosexuals and transgendered people during Nazi-times. To refer to a biological or natural predisposition for certain sexual behaviors was not a safeguard against persecution. On the contrary, it turned out to be an invitation to apply the so-called hereditary health law which allowed sterilization and castration of homosexuals and other sexual deviant persons (Pfaefflin 1986). This is true even though there were exceptions allowing some individuals to have sex-reassignment surgery, name and legal sex change even during Nazi times (Huelke 1949, Pfaefflin 1992)
(2)It may not necessarily be true that transgendered and transsexual people suffer primarily because of the prejudices of the professionals, as the consumer group entering today's conference claimed. But rather, it seems to me, transgender people suffer from the prejudices and lack of tolerance among their own subgroups.
As Herrn (1995) pointed out in his historical research, Hirschfeld "invented" transvestism and wrote his two volume monograph on the phenomenon (Hirschfeld 1910) at a time when the gay liberation movement threatened to break up. Whereas Hirschfeld was interested into the full spectrum of gay lifestyles, including all so-called effeminate styles, the straighter gays, oriented towards an idealized Greek type, feared their engagement to abolish criminal sanctions against homosexuals might be in vain if homosexuals included also drag queens etc. To distinguish cross dressers and to call them transvestites was an attempt to secure the success of the political action against a antihomosexual legislation.
(3) There is obviously a continuum between femaleness and maleness according to the old Latin saying natura non facit saltus. The transsexual phenomenon covers only part of this continuum, and transsexualism is in itself not a homogeneous phenomenon. That is why we now offer The International Journal of Transgenderism covering a wider scope. Transgenderists and/or transsexuals, however, who want to have the costs covered by medical insurance when taking advantage of medical interventions, e. g. hormone and surgical treatment, will be well advised to stick to the rules of the medical model. The art of medicine includes malpractice, and Standards of Care are issued as a safeguard against malpractice. Prerequisite medical/legal standards for the proper application of sex-reassigment treatment serve the protection of the consumer as well as the provider. It is not intended to negatively discriminate "true" from "false" transsexuals because the personal conviction of one´s own gender identity deserves nothing but to be respected.
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