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Thursday, May 12, 2016

The Problems With Citing Dr. Paul McHugh

This is a black and white
picture of Dr. McHugh
Over the last few weeks (basically since the passage of North Carolina’s HB2) I have seen a particular 2015 Public Discourse Article by Dr. Paul McHugh passed around social media by folks who take the position that we as a society ought not recognized the gender identities of transgender individuals. While that is a position I ultimately disagree with and believe to be deeply harmful to a vulnerable population, I do recognize that there are scientific, philosophical, and theological arguments which can be marshaled in its defense--I think those arguments ultimately fail (I have put forward my own counter-argument to the theological in this series), but some of them are, at least, worth discussion in the abstract. However I think it is important to note that, regardless of your position on the topic, Dr. McHugh’s articles are not useful sources of information for the following reasons.

Credentials: I suspect that McHugh’s popularity on this subject comes from the fact that, on paper, his credentials are excellent on the subject of transgender psychology. Dr. McHugh is a Distinguished Professor of Psychiatry at Johns Hopkins University School of Medicine who holds his MD from Harvard Medical School, has published significantly in his field, and has a robust history of teaching and practice. So on the basis of his credentials, Dr. McHugh really does merit attention. However the fact is that Dr. McHugh stands practically alone on this topic against other credentialed experts and organizations in this field. Notably, as Mari Brighe points out in her comprehensive article critiquing McHugh, Dr. McHugh’s positions are in opposition to the findings of (among others) the American Medical Association, the American Psychological Association, the American College of Obstetrics and Gynecology, the American Academy of Pediatrics, and the World Professional Association for Transgender Health. In terms of constructive debate and conversation, this means that while it is valid to cite Dr. McHugh as an expert or authority on the subject, it is completely unwarranted to present him as some sort of final word (when dealing with science it is usually problematic to assume that there is a total consensus), and anyone who decides to reference Dr. McHugh in support of an argument or position they are defending should be aware that there are many well credentialed vices which oppose him. While he has a degree of authority on the subject, his expertise must be situated in the context of overwhelming dissent from the medical and psychological/psychiatric establishment. So don’t use Dr. McHugh in an appeal to authority, tactically it will backfire, and more importantly is it a misrepresentation of the overall “voice” of the collective experts in this field. Dr. McHugh is a single, albeit credentialed voice who is considered discredited on this subject by many other experts in the field, so long as he is presented that way, you will avoid misinformation on that count.

Argumentation: Because Dr. McHugh won’t work as a final authority on the subject, any use of his work depends on an analysis of the quality of the arguments Dr. McHugh actually makes. But it is this analysis which makes any use of his work deeply troubling. When writing on the subject, Dr. McHugh routinely cites two specific studies in defense of his conclusions and systematically ignores the many studies which undermine his statements. First, it needs to be said that Dr. McHugh’s failure to even acknowledge the growing body of medical and psychological literature which challenges his thesis causes his case to appear stronger than it actually is and calls his integrity into some question.
More troubling though is the fact that Dr. McHugh fundamentally misrepresents the conclusions of the study he primarily cites (a 2011 Swedish study) and refers to as “the most thorough follow-up of sex reassigned people”. He cites their findings that post-op transsexual people have significantly heightened suicide risks when compared to the general population, and uses that as support for his belief that sex reassignment surgery (SRS) is bad for transgender people. The problem with this use is that the study itself claims the exact opposite. Quoting from the study’s conclusion (emphasis mine): 
Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
In fact, the study concludes that sex reassignment surgery does indeed help transgender folk and is saying that after surgery, treatment providers should be careful to recognize that there are ongoing traumas and stresses that trans people will face and that SRS should be accompanied by ongoing care afterwards. This must be stated as clearly as possible The study Dr. McHugh cites as his primary evidence says exactly the opposite of what he claims it implies. Dr. McHugh is a sufficiently thorough and intelligent scientist that it is hard to see his misrepresentation of this study as anything but disingenuous, particularly given the fact that the study’s primary author, Dr. Cecilia Dhejne, stated in the paper itself that the study would not work as an analysis of the efficacy of SRS (here is an interview with Dr Dhejne where she expresses significant frustration at McHugh’s, as well as other people’s, misuse of her study).

The other study Dr. McHugh routinely references in his popular writing is a 1979 study which he encouraged, based on his already existing distrust of SRS. The problem here is that this study, by Dr. JK Meyer, predates many of the surgical techniques and refinements available today, the study consisted of only 50 individuals (all male-to-female transgender persons), and was seen as controversial and problematic from the outset. Even it its problems were overlooked though (and they shouldn’t be), this leaves Dr. McHugh with a single study in contrast with the conclusions of the collective medical and psychological/psychiatric establishment and a much larger body of work which has been thoroughly examined in a number of comprehensive literature reviews on the subject.

In conclusion, people who take a “conservative” position on questions relating to the gender identities of transgender persons need to stop citing the writing of Dr. Paul McHugh. He is not representative of the contemporary medical or psychological/psychiatric consensus and the support he provides for his argumentation ranges from misrepresentation, to disingenuous, to outright misinformation. In citing him you will only convince those who are not willing to research his claim and those who already agree with you and are merely looking for an “authority” to support what they have already decided to believe. This undermines your own credibility and, to the extent that you speak/write “as a Christian” harms your witness. Please take the time to build your arguments on well researched data, presented with appropriate caveats, limiting the degree of certainty you express to the quality and quantity of the data.
These are also adjectives

P.S. While I have your attention, please stop referring to trans people as “the transgendered” or “a transgender”. Transgender is an adjective (its counterpart is cisgender) used to specify something about an individual person. People aren’t adjectives and, in my experience, transgender people don’t like to be spoken about as though they were. So "Bob is a tall, transgender athlete."

P.P.S. If you find any factual errors in this piece please don't hesitate to point them out to me in comments (it will help if you provide links/citation) and I will evaluate and update this post.

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