OTI Online
Summer 1998

Designing Sex
Playing God, Have Doctors Gone Too Far?
by Mahin Hassibi, M.D.


My name is Michael Ross. I'm a condemned man on Connecticut's death row," began the unsolicited manuscript entitled "Reflections from Death Row" in On The Issues' mail. "I'm the worst of the worst, a serial killer and sexual sadist," it continued, "who is responsible for the rape and murder of eight women in three different states, who has assaulted several other women, and who has stalked and frightened many more. I have never denied what I did, and fully confessed to my crimes. The only issue in my case, from the beginning, has been my mental condition. For years I have been trying to prove that I am suffering from a mental illness that drove me to rape and kill, and that this mental illness made me physically unable to control my actions. I have met with little success."

Opinions were divided among the editorial staff at OTI who read the manuscript. There is something unusual, if not cynical, about a killer and sexual torturer of women expecting to be published in a feminist magazine. The publisher thought OTI readers should be allowed not only to share in the horror and brutality depicted in the story, but to witness the man's supposed redemptive striving. The editor was offended by the self-pitying tone of the manuscript, and considered his discussion of accepting "guilt" as convincing as Ted Bundy's, who said the same. She also questioned his meaning and intent. Was he arguing that he should not be executed, or receive a life sentence without possibility of parole, because he is "cured"?


Surgeons playing God also reassign the gender of infants born with ambiguous genitals, that is intersexual or hermaphroditic youngsters, without considering their underlying biological sex.


From his writing, Ross comes across as a manipulative, self-centered, and grandiose individual. There is no sign of those emotions which characterize a socialized human being, or of an ability to grasp the depth of horror that his crimes engender. He writes: "I was plagued by repeated thoughts, urges, and fantasies of the degradation, rape, and murder of women. Having those unwanted thoughts, urges, and fantasies is a lot like living with an obnoxious roommate." Ostensibly, Ross's reason for submitting the article to OTI was to describe for an audience of women the "treatment" he is receiving while on the death row. He claims that monthly injections of Depo-Lupron, which blocks the production of testosterone, have diminished the "suffering" caused by his urges and thoughts. "One of the most difficult things for me to deal with today is knowing that, had I begun receiving an injection of just 1 cc of Depo-Lupron once a month 20 years ago, those eight women would be alive today.

"For some reason, be it because of some abnormal biological hook-up in my brain, or some sort of chemical imbalance, testosterone affects my mind differently than it affects the mind of the average male. . . ."

In 1994, in Texas, Larry Don McQuay, a convicted child molester who was applying for parole after serving six of his eight-year sentence, demanded to be castrated, at the expense of taxpayers. The news media reported that he claimed he needed help in curbing his sexual appetite for small children, because, while he had not as yet killed any of his victims, he might do so in the future in order to prevent them from identifying him. The media, running with the story, enthused about castration as a new strategy for fighting sex crimes. The result was a rush by legislators across the country to introduce bills mandating chemical and/or surgical castration for a variety of repeat sex offenders as a condition of parole. In many states, the bills passed, and castration before parole is now law.

Criminologists, however, are extremely concerned by the fact that legislators apparently assumed that the problems of sex offenders strictly reside in their genitals, rather than their personality, and hence constitute an illness that is treatable. These experts point out that it is the rage and the emotional imbalance characterizing sex offenders that need to be suppressed, rather than their sexual drive per se. Testosterone, the so-called male sex hormone, which is produced in the testes, is only one (although a major one) of several hormones known to be involved, along with other chemical messengers essential to the body's functioning, in normal sexual drive, sexual arousal, and sexual performance. To name just two: the "brain chemicals" dopamine and phenulethulamine, which are neurotransmitters (substances that "carry" information from one nerve cell to another), play a role in sexual gratification. It is not yet known whether sex offenders produce more of any of these substances, including testosterone, than the rest of us.

Even more worrisome than this lack of scientific evidence: The effects of the two drugs commonly used in chemical castration, Depo-Lupron and Depo-Provera, can be neutralized by other hormones, such as steroids, which are easy to obtain. Like athletes and body-builders, sex offenders are able to buy them on the street without a prescription.

Nor have follow-up studies shown that castrated sex offenders have a lower recidivism rate than those who have not been "treated." (It should be noted that the "recidivism rate" for a class of offenders is not the true rate at which they resume committing crimes after their release, but the rate at which they are rearrested. And that is subject to a multitude of factors, including the crime-fighting ability of a given police department.)

In fact, this is not surprising. Experts in all disciplines dealing with sex offenders agree that these individuals show defects and deficiencies in their emotional, psychological, and moral make-up. Hence mere castration, whether chemical or surgical, will not "cure" them. Indeed, it may make them more violent. In a number of cases, chemical castration has been shown to increase sex offenders' anger and aggression. There is also ample evidence demonstrating that the violence associated with sexual battery is not treatable by any form of castration.

Michael Ross writes: "The monster within [me] is still present, but the medication has rendered him impotent and banished him to the back of my mind." Fortunately, Ross is not free to roam the streets; but the fact that he has no contact with women also means that there is no way to assess how tightly this particular monster is bound.

Castration of sex offenders is a medical or surgical manipulation of sexuality in order to achieve society's ends. Such manipulation, and the medical profession's complicity in it, whether eagerly or reluctantly, is not new. Physicians of the Byzantine era were compelled by the rulers of the day to castrate male children of defeated enemies, thus ending any hope that their de-scendants might attempt to regain the power that was lost. During the Greco-Roman period, ambitious parents frequently had their sons castrated in childhood in an effort to prepare them for higher office. Eunuchs of the day held senior administrative positions in both the military and in government, because it was assumed that, unable to begin their own dynasty or blood line, they would have less motivation to betray their superiors.

In some societies, castration was the punishment for those who had acted against the code of conduct or the implicit expectations of the community. Abelard, the 11th-century French intellectual and teacher, was castrated at the behest of the angry relatives of Heloise, his student, for having wed her in secret. In 18th-century Italy, young boys were castrated in order to maintain the purity of their voices; these castrati sang in operas in which women were forbidden to appear. And until this century, eunuchs were employed as the guardians of harems in order to prevent questions about the paternity of children born to the numerous wives and concubines of Middle Eastern and Asian potentates. In the West, also until this century, surgeons removed women's clitorises, and later their ovaries, to treat their "mental disorders," which were often considered to be the result of masturbation and lesbianism. Women were "treated" in this fashion whether they were depressed, suffering from anxiety -- or refusing to toe the line dictated by society or their families. Many hospitals in the U.S. performed the operation long after the method had fallen into disrepute in Europe.

Historically, not all physicians have signed on to such programs. For example, the progressive Seventh-Century Byzantine physician Paul of Aegina, commenting on the practice of surgical castration, said that turning a normal body into an abnormal one was inconsistent with his religious beliefs and professional ethics. However, few such doubts about the morality of the procedure have been raised by the medical profession of today, even though the FDA has not approved either Depo-Provera or Depo-Lupron for this purpose -- which means that neither the safety nor the effectiveness of these drugs for chemical castration, nor their long-term side effects, is reliably known.

Medical and/or surgical "treatment" for conditions that have been redefined as "illnesses" and/or "aberrations" by society and its agents in the medical profession (who, in fact, often lead the charge) is not confined to efforts to reduce crime. Indeed, especially in the U.S., physicians in several specialities have "invaded" many aspects of life that heretofore were not considered the province of medicine. Childbirth, for example, has been medicalized with the "justification" that in some cases delivery may require extraordinary measures. As a consequence, this country has the highest rate of cesareans in the world, and many births are induced here to suit an obstetrician's golf or social schedule. Similarly, doctors all too frequently consider menopause to be a disease in need of curing.

Physicians in the U.S. today are also decreeing what shape and size human genitalia should be. Based on little more than the medical profession's opinion on what is an acceptable size for a female clitoris, and with even less knowledge about the long-term effects of the surgical procedure, surgeons proceed to excise those that are "too big," and therefore offend. [See "The Tyranny of the Esthetic," page 16.] They also lie to their young patients about what, in fact, they are doing, and encourage the child's parents to do so as well. The result is to severely traumatize the child, causing lifelong physical and/or psychological problems, including sexual dysfunction, the inability to experience sexual pleasure, identity confusion, and major difficulties in interpersonal relations.

Surgeons playing God also reassign the gender of infants born with ambiguous genitals, that is intersexual or hermaphroditic youngsters, without considering their underlying biological sex. Children born with XY (male) chromosomes but with rudimentary penises are surgically turned into "girls" who are proclaimed "normal," though they will never menstruate or be able to bear children. Girls with normal XX (female) chromosomes but whose clitorises are declared "abnormally long" undergo clitorectomies -- the same procedure that human rights activists have labeled "female genital mutilation" when it occurs in the developing world. In American hospitals such surgeries are carried out by American doctors on American children every day.

Another example: When young boys lose their penises as the result of trauma, such as a circumcision gone awry, they are assigned the gender most convenient for the surgeon carrying out the procedure -- that is, they are made outwardly female, given a "functioning" vagina, instead of a new penis, because creating a "vagina" is easier. Conceptually, however, such a vagina is simply a receptacle for a penis. The distinct sensations and sexual feelings of the individual concerned are not considered. Shockingly, few voices have been raised in opposition to this practice in medical literature. One exception appeared in the March 1997, edition of Archives of Pediatric and Adolescent Medicine. Drs. Milton Diamond and H. Keith Sigmundson, discussing the long-term effects of such surgery on a boy who lost his penis at the age of three because of a surgical mishap, concluded that even in cases where genitals are not clearly defined at birth, immediate surgery and sex reassignment may not be the best course to follow.

It is interesting to contrast this quest for "normalcy" -- read "perfection" of visible attributes -- in the United States with the early Greeks' view of hermaphrodites (the combination of Hermes and Aphrodite) as people with special attributes of God and Goddess who deserve to be appreciated for their uniqueness. The Jewish Torah also recognizes hermaphrodites, as does modern day India, whose Hijras are accepted by society.

We are on a slippery slope, indeed, when the medical profession maintains, falsely, that newborns (and even young children) are psychosexually neutral and, therefore, can be medically assigned a sex, and then raised to accept a particular gender role. Yet leading physicians at some of our top medical institutes have tinkered with human anatomy and physiology by performing mutilating surgery and/or prescribing powerful hormones, on the basis of social biases masquerading as scientific findings. And advances in medical science and surgical technology continue to provide the medical profession with more, and better, tools with which to change, reassign, and regulate our bodies and our behavior. The collusion between some consumers seeking to change their own sex or their children's appearance and doctors motivated by financial gain, individual hubris, and professional arrogance, has increased the power of medicine. As treatment methodologies are discovered or invented, the search for diseases has intensified. The tyranny of esthetics, the dissatisfaction with the biological given and the desire to find quick-fix solutions for complex issues have found medicine willing to undertake costly and dangerous procedures based on little to no information, dubious research and a shocking lack of concern for the overall health and well-being of society.


Mahin Hassibi, M.D., is professor of clinical psychiatry at New York Medical College in Valhalla, New York, and medical director of Choices Mental Health Center in New York City.


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