A Gender Variance Who's Who

Emil Gutheil (1889-1959) was born in Czerlany close to Lviv, which was originally in Poland, but then part of Austria-Hungary and now is in the Ukraine. He was educated at the University of Vienna. He became a neuro-psychiatrist at the university Psychiatric Clinic, and was mentored by psychoanalyst Wilhelm Stekel (1868-1940), who is credited with coining the term ‘paraphilia”.

We met him previously in the early 1920s when a trans man then 34-years old, whom Gutheil refers to only as ‘Elsa B’ came to Gutheil, seeking help to gain a transvestitenschein. He subjected B to 33 sessions of psychotherapy during which he continued to refer to B as ‘she’ and as a ‘woman’.

Gutheil became director of the Active-analytic Clinic in Vienna, but emigrated with his wife to the United States in the late 1930s in anticipation of the the Anschluß Österreichs, the Nazi takeover of Austria.

In 1939 in New York he founded the Association for the Advancement of Psychotherapy and in 1947 the AAP started publishing the American Journal of Psychotherapy. Gutheil remained loyal to the ideas of his deceased mentor Wilhelm Stekel (and, working with Stekel’s widow, edited his autobiography), in particular the idea that trans conditions had an environmental cause and successful therapy would dissuade patients from the pursuit of medical options. This of course would require many sessions of psychoanalysis. Gutheil had no examples of patients successfully ‘cured’.

Harry Benjamin wrote in The Transsexual Phenomenon (p29-30 in the Warner edition; p12-3 in the PDF version):

“Following the sensational Jorgensen publicity in 1952, I was asked to write an article on the subject for the now no longer existing International Journal of Sexology. In this article, which appeared in August 1953, 1 chose the term transsexualism for this almost unknown syndrome. I did the same in a lecture (as part of a symposium) at the New York Academy of Medicine, before the Association for the Advancement of Psychotherapy in December, 1953, discussing male transsexualism” [i.e. trans women] “only. … In the years following the Hamburger et al. publication in the A.M.A. Journal and my own in the American Journal of Psychotherapy in 1954 (constituting the lecture of the previous year) there were hardly any references to transsexualism, in the American medical literature. ”

The symposium had been suggested by Gutheil and was held 18 December 1953. Benjamin read his paper, "Transsexualism and transvestism as psychosomatic and somatopsychic syndromes", and Gutheil and two others responded from their respective experiences and standpoints. This was the second time that Benjamin used the term ‘transsexual’.

All four papers were published in Gutheil’s American Journal of Psychotherapy, 8,2, 1954 without any editorial comment, but with “Transsexualism and Transvestism” added to each title.

• Harry Benjamin. “Transsexualism and Transvestism as Psycho-Somatic and Somato-Psychic Syndromes”.

Benjamin reviewed the various terms proposed by his predecessors. Then he writes:

“Naturally not every act of ‘cross-dressing’ is transvestitic. Only if it occurs in an atmosphere of emotional pressure, sometimes to the point of compulsion and is accompanied by a more or less distinct sexual satisfaction can the term be applied . Otherwise it would be simple masquerading of a non-affective nature .”

[Editorial comment: this is in line with Hirschfeld’s Die Transvestiten but not his later works such as Sexualpathologie, 1919. ]

“While the male transvestite, enacts the role of a woman, the transsexualist wants to be one and function as one, wishing to assume as many of her characteristics as possible, physical, mental and sexual.”

“Transsexualism as well as transvestism are decidedly more frequent among men than women, like most other sexual deviations. Due to the more permissive fashions in women, female transvestism is less conspicuous, but naturally can involve for the individual the same frustrations and often tragic situations as in men.”

[Editorial comment: In 1953 the evidence did point to this conclusion. However the relative proportions are quite different in the 21st century - as also they were in Weimar Germany.]

“The transsexualist is always a transvestite but not vice-versa. In fact, most transvestites would be horrified at the idea of being operated.”

Sexuality:

[Transsexuals] “consider the fact that they are attracted to men natural because they feel as women and consider themselves of the female sex. … Transvestites on the other hand are in the majority heterosexual, although their principal sexual outlet seems to be auto-erotic.”

[Editorial comment: This is retained in The Transsexual Phenomenon of 12 years later when Benjamin assigns Kinsey scale numbers to each of his types. The Transvestites are Kinsey 0-2; The True Transsexuals are Kinsey 4-6. The erasure of gay transvestites is in this early paper. Benjamin had been introduced to Virginia Prince by Louise Lawrence a few years earlier. Certainly he accepted some of her ideas. Hirschfeld had also erased gay transvestites in his 1910 work Die Transvestiten, but reversed this in Sexualpathologie, 1919 - the former but not the latter in the bibliography at the end of the paper.]

On etiology, Benjamin writes:

“The effeminate male may look and behave as he does on a purely psychosomatic or psychological basis (imitating his mother, for instance) but he may also be the product of a somato-psychic mechanism originating in his chromosomes. It is often impossible to distinguish between the two.

Havelock Ellis has this to say in regard to etiology : "Early environmental influences assist but can scarcely originate Eonism. The normal child soon reacts powerfully against them. 'We must in the end seek a deeper organic foundation for Eonism.' "

Benjamin proposed three types:

1. The principally psychogenic transvestite. “He is miserable when dressed as a man and immediately comfortable and relaxed in the clothes of a female. He has become an expert in cosmetic make-up, yet is occasionally in social or legal difficulties. He assumes a female first name and wants to be referred to as 'she.' … In fighting his peculiarity he sometimes over-emphazises masculinity and becomes known as a ‘tough guy.’ ”

2. The intermediate type. “ .. he inclines at times toward transsexualism, but is at other times content with merely dressing and acting as a woman. He wavers between homo- and heterosexual desires usually according to chance meetings.”

3. The somatopsychic transsexualist. “Feminine appearance and orientation is often striking in these people but masculine features are compatible with full transsexualism. The conviction of these endocrine males that they are really females with faulty sex organs is profound and passionate.”

Benjamin retained this 3-part typology in his The Transsexual Phenomenon of 12 years later where his six Types were still sorted into three Groups:

Type 2 here became Group 2 and thus Type IV on Benjamin’s scale, 'Nonsurgical Transsexual, Kinsey 1-4'. Just what this is became confused: sometimes a Virginia Prince ‘transgenderist’ ( a term which would also include Sylvia Rivera); sometimes a true transsexual who chose or had to put up with being non-op; but also a waverer such as Benjamin’s one example, Peter/Irene, a rather well-known musician from Oregon, married for twenty-five years, who apparently never did transition.

He comments on psychotherapy.

“All therapy, in cases of transsexualism—to the best of my knowledge—has proved useless as far as any cure is concerned. I know of no case where even intensive and prolonged psychoanalysis had any success. If we are dealing with a constitutional deviation, we can hardly expect to influence it .”

And then again 2 pages later: 

“In my opinion, psychotherapy for the purpose of curing the condition is a waste of time . A basic conflict would be too firmly anchored in the constitution. All that the psychiatrist can possibly do is to relax tension, to develop and reinforce realistic thinking, and to supply guidance. That, of course, is not a cure.”

 

• Emil Gutheil. “The Psychologic Background of Transsexualism and Transvestism”.

Gutheil accepts Benjamin’s proposed use of the term ‘transsexual’.

Like Benjamin he refers to Hirschfeld’s Die Transvestiten, but not his later Sexualpathologie, 1919, and includes the former but not the latter in the bibliography at the end of his paper. He does not erase gay transvestites in the way that Benjamin does, but in the very different way of insisting that all transvestism is a type of homosexuality, even though this is unknown to and denied by the patients themselves. He cites one of Hirschfeld’s patients: “I never felt attracted to men. However, dressed as a woman, I liked to flirt and joke with them. I felt flattered to be mistaken for a woman.” A behaviour that Virginia Prince also admitted in her sessions with Robert Stoller.

He rejects Benjamin’s etiology:

“The neurosis of the transvestite is frequently considered as a sequel of the existing "biologic error. " Since the biologic component cannot be established satisfactorily , such a concept must be accepted only as a hypothesis. However, closer psychiatric exploration of the transvestite reveals to all who are familiar with the methods of psychiatric investigation that the patient's neurosis is due to specific pathogenic factors, most of which are accessible to scientific inquiry . The most important finding of the psychiatric investigation is that the patient's desire to be a woman is a symptom of this neurosis and is imbedded in a setting of other neurotic mechanisms of contributing value.”

He continues:

“In my opinion, transvestism is the result of six psychopathologic factors. They are : (1) latent (or manifest) homosexuality with an unresolved castration complex; (2 ) the sadomasochistic component ; (3 ) the narcissistic component; (4 ) the scoptophilic; (5 ) the exhibitionistic , and (6) the fetishistic component. In every case all six tributaries are represented in varying degrees. In some cases, the homosexual component is conscious and manifest; in others the fetishistic, or sadomasochistic features predominate.”

He concludes:

“What about psychotherapy? Hasn't psychotherapy been unsuccessful in so many of these cases! My answer is—that as far as the evaluation of the pathogenesis of transsexualism is concerned, it does not matter. Poor therapeutic results do not necessarily prove that the etiologic concept is wrong. If our therapy does not succeed, we must investigate the causes of our failure, learn from our mistakes and improve our approach. In most of the unsuccessful cases the patients' uncooperative attitude may be considered as the main source of failure . … I think, however, that to do justice to the transvestites we must also educate the patients themselves. We must show them how, while fantasying a future physical metamorphosis, they are, in reality, harking back to their neurotic past, to their infantile fears and pleasures, and point out to them how futile it is to try solving one's sexual problems—in effigy.”

• Danica Deutsch. “A Case of Transvestism”.

Deutsch from the Alfred Adler Consultation Center in New York presented a single case study which was regarded as a ‘cure’.

A patient is referred to as “O.R.” and is a man in his early 30s, married four years who had dabbled as a child and after marriage in cross-dressing. He had tried a psychiatrist, but stopped because of the cost. He went to the Center. They interviewed O.R. and then his wife, who then worked on his lack of self-confidence and even shared cross-dressing with him. Deutsch, of the Center, concludes:

“This case represents a classical example of the Adlerian concept of 'masculine protest.' Interesting is also that the patient compensated for his organ inferiority (bad eyesight) by scoptophilia and fetishism.

The favorable outcome after such a short period of treatment can be attributed to the positive aspects of the client's personality. According to Benjamin's categories, this case can be classified as a 'simple male heterosexual psychogenic transvestite.' Though he was self-centered, he was not so completely discouraged as to deviate into manifest homosexuality. His fantasies were always of heterosexual character; though in feminine clothing, he assumed the role of the male.

Moreover, the cooperation of his wife cannot be overlooked. She refrained from everything that might feed his neurosis, his feeling of inferiority and incompetence; she avoided overindulgence, or a critical or domineering attitude . She rather helped him to apply his newly gained insight to obtain a positive relationship based on equality.”

• Robert Veit Sherwin. “The Legal Problem In Transvestism”.

This is the first consideration of the legality or otherwise of transvesting and or having genital surgery in the US.

“… in the strict sense of the word, there are no laws concerning either transvestism or the various medical aspects concerned with sex transformation. But this fact in no way prevents or nullifies the popular conception that everything connected with this subject is illegal in this country. … Legislators are seldom willing to tackle problems involving sex head-on. The result is that law enforcers are therefore forced to utilize whatever laws they have at their disposal, and whether these laws actually fit the problem often seems of little consequence.”

He then discussed the mis-application of the Disorderly Conduct and the Mayhem laws.

[Editorial comment: Sherwin did not discuss the many cities in the US starting with Columbus, Ohio in 1848 that passed municipal laws against cross-dressing.]

See also the 1967 symposium at the New York Academy of Sciences.

• Emil Gutheil. “XVI. Analyse eines Falles von Transvestitismus,” in Wilhelm Stekel. Der Fetischismus, vol. 7, Störungen des Trieb- und Affektlebens. Urban & Schwarzenberg, 1923: 534-570. Translated by S Parker: “Analysis of a Case of Transvestism” in Sexual Aberrations: The Phenomena of Fetishism in Relation to Sex. John Lane The Bodley Head Ltd, 1930: 281-318.

• Harry Benjamin. The Transsexual Phenomenon. Warner Books reprint Edition 1977: 29-30.

• Werner H Engel, Frederic Wertham, Paul H Hoch, William Wolf, Lewis R Wolberg & Hilda Stekel. “In Memoriam: Emil A Gutheil, M.D., 1899-1959”. The American Journal of Psychiatry, 13,4, 1959. Online.

• Linda Heidenreich. “A Historical Perspective of Christine Jorgensen and the Development of an Identity” in Bonnie Bullough, Vern Bullough & James Elias (eds). Gender Blending. Prometheus Books, 1997: 274-5,

• Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, 2002:105-7.

• Rainer Herrn. Schnittmuster des Geschlechts. Transvestismus und Transsexualität in der frühen Sexualwissenschaft. Giessen, 2005: 76n6

Emil Gutheil (1889-1959) was born in Czerlany close to Lviv, which was originally in Poland, but then part of Austria-Hungary and now is in the Ukraine. He was educated at the University of Vienna. He became a neuro-psychiatrist at the university Psychiatric Clinic, and was mentored by psycho-analyst Wilhelm Stekel (1868-1940), who is credited with coining the term ‘paraphilia”.

In the early 1920s a trans man then 34-years old, whom Gutheil refers to only as ‘Elsa B’ came to Gutheil. He states: 

“Case 70. Introductory remarks: This patient agreed to an analysis under one condition: that under no circumstances should we destroy her particular sexual strivings. She was only desirous of enlisting our aid in gaining permission from the police to wear men’s clothing.”

B was a government clerk and also played the violin. Despite being there only to get support in obtaining a Transvestitenschein, a legal permit to ‘cross-dress’, he did attend 33 sessions with Gutheil, during which the psycho-analyst continued to refer to him as ‘she’ and as a ‘woman’. B’s father had died when the child was two, and B had been rejected by his mother, who had wanted a boy, and raised by his grandparents. His mother's second husband repeatedly told B that he was ugly. B had dressed as male since teenage, and urinated standing up. His hair was short in a male style. Religious scruples inhibited him from having sex with women (what others would regard as ‘homosexuality') and personal taste from having sex with men. He found wearing men’s clothing to be erotically arousing, even to the point of orgasm. When wearing male attire “a great oppression leaves me and instead of feelings of inferiority, I feel free and easy”. B saw himself as the father of a family. 

With the outbreak of war in 1914, B was suspected of being a Serbian spy and severely beaten on the street. That was the first time that he begged the police for a Transvestitenschein so that he could legally wear male clothing. He was held for six days, at first examined by a police surgeon, and then by a psychiatrist. But he was not given a Transvestitenschein.

Gutheil’s paper on B was included as Chapter XVI of Stekel’s book on fetishism. The two psycho-analysts criticised Hirschfeld for overlooking latent homosexuality as an important factor in transvestism, although as Bullough points out they take every denial of homosexuality as an admission. This despite Gutheil’s final twist that 

"the transvestitism is an anchorage of the patient’s heterosexuality, the difference being that instead of the forbidden incestuous object she has fixed upon a symbol : the clothing. … the chief cause of the flight being an active castration complex expressed in a manifestly sadistic phantasy”.

Stekel’s book title was (in translation) Sexual Aberrations: The Phenomena of Fetishism in Relation to Sex, and his idea was to systematize the structure of all paraphilias as a single entity under the model of fetishism. He was in reaction to Magnus Hirschfeld’s biologically oriented model of sexual intermediaries. However B’s transgender orientation does not fit the model.

They conclude: 

“Despite its striking inner resemblance with fetishism, we cannot consider transvestitism as a form of genuine fetishism. It is a special form of a compulsion neurosis in which the patient’s desire for the genital of the other sex is displaced to the clothing.

The transvestite satisfies himself with the appearance of belonging to the opposite sex; he makes use of the clothing in order to possess some rudiment of reality in the fictitious transformation which he has accomplished. Whereas the fetishist reconstructs an infantile scene and becomes a child again in order to experience something definite, the transvestite projects his wish into the future and anticipates the great miracle, the miracle of his sexual metamorphosis.

Fetishism is thus retrospective and transvestitism prospective in purpose.”

We are not told if B was granted his Transvestitenschein.

Havelock Ellis, in the 1928 edition of his Eonism, included a four page summary of Gutheil’s chapter. He regarded B as “female Eonist”.

In 1937, Los Angeles psycho-analyst Ralph Greenson was in Vienna to be analysed by Wilhelm Stekel. However 12 March 1938 saw the Anschluß Österreichs, the Nazi takeover of Austria. Stekel and his wife immediately fled via Switzerland to England where he killed himself in June 1940 for medical reasons. Greenson returned to Los Angeles. Gutheil had emigrated to the US in 1937 where he founded the Association for the Advancement of Psychotherapy and the American Journal of Psychotherapy.

We do not know what happened to B in the Third Reich.

• Emil Gutheil. “XVI. Analyse eines Falles von Transvestitismus,” in Wilhelm Stekel. Der Fetischismus, vol. 7, Störungen des Trieb- und Affektlebens. Urban & Schwarzenberg, 1923: 534-570. Translated by S Parker: “Analysis of a Case of Transvestism” inSexual Aberrations: The Phenomena of Fetishism in Relation to Sex. John Lane The Bodley Head Ltd, 1930: 281-318.
• Havelock Ellis. “Eonism” In Eonism and Other Supplementary Studies, Random House, 1928: 17-23.
• Vern L. Bullough & Bonnie Bullough. Cross Dressing, Sex, and Gender. University of Pennsylvania Press 1993: 214-6.
• Clare L Taylor. Women, Writing, and Fetishism 1890-1950: Female Cross-Gendering.Clarendon Press, 2003: 90-3.
• Patricia Gherovici. Transgender Psychoanalysis: A Lacanian Perspective on Sexual Difference. Routledge, 2017: 48-54.
• Katie Sutton. Sex between Body and Mind: Psychoanalysis and Sexology in the German-speaking World, 1890s–1930s.University of Michigan Press, 2019: 186-7, -191.

Despite the cisplaining, the misogyny of Stekel and Gutheil, it is a shame that this case is not better known. The real-life persons behind Sigmund Freud’s case studies have been identified and we know what happened to them afterwards. With B we do not know.

It is heartening that B does not want to be ‘cured’. He is and wants to be a man, but male hormones will not be available until the late 1930s.

He is also quite open about finding male attire to be erotic. It is a misfortune of sexology and psycho-analysis that it came to be dogma that a) women are not fetishistic, b) cross-dressing by women was pragmatic, not transvestic - that they did so to get a better job and/or to marry a woman, not as an end in itself. This of course did erase many female assigned persons from discourse and from history, but not from reality.

As it happened, we had to wait for Louis Sullivan in the 1980s and Pat Califia in the 1990s to explain that, for some trans men, male clothing is erotic.

Romeo Greenschpoon was raised in Brooklyn, by parents who were immigrants from Russia. His physician father, a Shakespeare enthusiast, had named his twins Romeo and Juliet, which created some ribbing. The boy changed his first name to Ralph.

Ralph did pre-med at Columbia University. There being discrimination against Jews at US medical schools, he studied medicine at the University of Bern in Switzerland, and graduated in 1934. Ralph also married a Swiss woman, Hildi, and they moved to Los Angeles for Ralph to do an internship at the Cedars of Lebanon Hospital. They anglicised their surname to Greenson in 1937.

Ralph Greenson returned to Europe to become a psychoanalyst and was analysed in Vienna by Wilhelm Stekel (a maverick in the psychoanalysis movement, who coined the term ‘paraphilia’ which was later popularized by John Money, and who distinguished transvestism from fetishism). However 12 March 1938 saw the Anschluß Österreichs, the Nazi takeover of Austria. Steckel and his wife immediately fled via Switzerland to England. Greenson returned to Los Angeles, and resumed analysis with Otto Fenichel (an orthodox Freudian, who had written about transvestites needing a fantasy of girls with penises).

Greenson enrolled in the US Army in 1942, and initially worked in a veterans' hospital in New York state, until he cracked his skull while working in a military ambulance. This exempted him from overseas service and he served as chief of the neuropsychiatric unit at the Army Air Force Convalescent Hospital in Fort Logan, Colorado, where he became known for his work with soldiers suffering post-traumatic stress. He also observed gambling among US officers, and wrote a paper on it for the psychoanalytical journal American Imago.

Back in Los Angeles as a civilian, in 1946 Greenson bought a house at 902 Franklin Street in Santa Monica from Eunice and John Murray who could no longer afford it. The Murrays divorced, and Eunice was hired by Greenson as his housekeeper, assistant and sometimes companion for his clients.
 
He was a founding member of the Los Angeles Psychoanalytic Society and was appointed to the faculty of the University of California Los Angeles (UCLA) medical school. A gifted raconteur, he became one of the best-known psychoanalysts in Los Angeles, famous for his lectures and teaching. Greenson was also a violinist and he and some friends held a weekly salon where they played chamber music. He became friendly with screenwriter and novelist Leo Rosten (1911-1997), also Jewish and from New York who was the brother-in-law of Margaret Mead. Psychoanalysis was then in vogue and Rosten recommended Greenson as an analyst to his Hollywood friends – Frank Sinatra, Tony Curtis and Vivien Leigh came to Greenson’s private practice. Greenson suffered a heart attack in 1955, and afterwards he worked from home in the afternoons: many of his better-known clients who didn’t want to be spotted entering a medical facility, preferred to see him there.

In February 1960, during the filming of the movie Let’s Make Love, co-starring Yves Montand and with a script revised by her husband Arthur Miller, Marilyn Monroe (born 1926) had a breakdown, and her New York psychiatrist, Marianne Kris, recommend that Greenson be brought in on a temporary basis. He had fifteen sessions with her 11 February to 12 March, and was appalled by the drugs that she was taking. Greenson was considered daring in accepting Monroe because of her suicide attempts. Other psychiatrists had had their careers damaged after a patient’s suicide, and Monroe was so famous. In addition Greenson was overworked. He had already had a heart attack, and had cut down on the number of his patients, but he still taught classes at UCLA, supervised psychiatrists in training, and served on the board of directors of the American Civil Liberties Union (ACLU).

In late August Monroe returned to Los Angeles from Nevada where she was filming The Misfits, again from a script by Arthur Miller, and Greenson revised her drug prescription. After the film she returned to New York, and in between dates with the newly elected John F Kennedy and Frank Sinatra, she saw her psychiatrist, Marianne Kris, forty-seven times in two months.

In January 1961 Kris had Monroe committed to a mental asylum at the New York Presbyterian Hospital. Only the dramatic intervention of her previous husband, the baseball star Joe DiMaggio, got her out. She no longer wanted to continue therapy with Kris, and wrote a long letter to Ralph Greenson. By June Monroe was living in Los Angeles and seeing Greenson as often as five times a week. It was as if her needs were insatiable. He wrote to Marianne Kris how Monroe called him at all hours, threatened suicide, and then improved, only to break down again.

“I had become a prisoner now of a form of treatment which I thought was correct for her but almost impossible for me”.

Leo Rosten wrote a 1961 novel, Captain Newman M.D, based on Greenson’s wartime experiences in Fort Logan, Colorado.

In December 1961 Greenson placed his friend and housekeeper, Eunice Murray (1902 – 1994), to be nurse and companion to Monroe. Murray had never seen a Monroe movie. Monroe was delighted to find that Murray was an excellent seamstress, as several of her clothes needed to be taken in. Monroe – who was still exploring alternate spiritualities – was fascinated to discover that Murray was a Swedenborgian. In February 1962, Murray helped Monroe look for a house, and they found an ideal one at 12305 Fifth Helena Drive, Brentwood, only just over a mile from the Greenson residence. Greenson’s sister’s husband, Mickey Rudin, a well-known Hollywood lawyer became Monroe’s agent. Greenson held analysis sessions with Monroe at his own house at the end of each day, which led to his inviting her to stay for meals and musical evenings, and she met his wife Hildi, and his grown children Joan and Daniel.

A 5-minute drive from Monroe's House to Greenson's

Hildi suffered a mild stroke in February, and Greenson needed a rest from Monroe. They left on 10 May for six weeks in Europe and Israel. Monroe had been dumped by John F. Kennedy, and was having difficulties with director George Cukor on Something’s Got to Give, and, against precedent, the Fox Studio executives ignored her birthday on 1 June (they were in panic that the filming in Rome of Cleopatra with Elizabeth Taylor was going to bankrupt them). The next day she phoned Greenson’s house and his children went round. They called Milton Wexler, psychiatrist, Greenson’s designated locum. Monroe had Murray phone Greenson in Europe, and he returned 6 June. He met with the Fox Studio executives, but to no avail. They fired her on 9 June, but by the end of the month were negotiating to get her back. She was then interviewed by Life and Cosmopolitan, and did her first photo shoot for Vogue.

At UCLA there were discussions about a new clinic, discussions that used the newly formulated expression: 'gender identity'.

Eunice Murray sometimes stayed overnight, and was doing so on the night of 4/5 August 1962. Around 3 am she suspected something to be wrong and called Greenson, who came round and broke into Monroe’s locked bedroom via the window. He found her dead from a drug overdose – this was confirmed by her physician, and the police were summoned. She was the only patient who died in Greenson’s care.

Later that year Robert Stoller, Richard Green and several UCLA psychiatrists founded the Gender Identity Research Clinic. This was the first gender clinic so named, although those at Johns Hopkins and Charing Cross had been doing pioneering work in the field without such a name. The UCLA GIRC was explicitly oriented to research, not to providing support and surgery to trans persons. While Stoller was the Director, Greenson was Senior Psychoanalytic Consultant. His son Daniel was also on the team as a Research Associate. At this point Greenson’s experience with trans persons was minimal.

The film version of Captain Newman M.D., starring Gregory Peck as the Greenson character, was released in 1963. Greenson had had his name completely removed from the credits for fear that one of his patients would sue him for the portrayal.

In 1964 Greenson presented a paper “Drugs in the Psychotherapeutic Situation,” which is generally taken to be a thinly disguised account of Marilyn Monroe being promiscuous. Also that year he interviewed a trans woman who is assumed to have been Tamara Rees (who had completed transition in 1954). Greenson diagnosed her as in flight from homosexuality. He claimed that some persons had such a dread of their own homosexuality that it undermined their sense of gender identity: if I love a man then I must be a woman. However, Tamara Rees was then on her second marriage. She and her husband adopted children and remained together until his death decades later. This same stance re flight from homosexuality was adopted by the anti-gay psychiatrist Charles Socarides in New York a few years later.

Later that year Greenson took over from Richard Green the analysis of a five-year-old boy, whose mother had brought him in after neighbors and his teacher commented on his frequent cross-dressing. Greenson and the UCLA referred to the child as ‘Lance’. He treated Lance mainly at the swimming pool at his own home, where he even taught Lance to swim. Most of the sessions were comprised of games in the water. This helped Lance to overcome his fears about being alone with a male adult. He bought Lance a Barbie doll, but restricted its use. Apparently Lance stopped cross-dressing. As Greenson saw it, he replaced Lance playing with the doll by playing with an adult male. According to Greenson, Lance had had difficulty differentiating loving an object from wanting to be the object. Initially he had referred to the doll as ‘me’.

Stoller and Greenson refined the concept of ‘gender’ that was being used at UCLA, by using the term ‘gender identity’ to refer to “one’s sense of being a member of a particular sex”.

In his 1965 public lecture, “Masculinity and Femininity Reconsidered”, Greenson had this to say: “It is not true that girls and boys are identical in behavior until the phallic or oedipal phase. For example, girls do much more playing with dolls than do boys, and boys are more prone to be ‘blanket lovers.’ This is an indication of a greater tendency to fetishism in boys. Boys who play with dolls are more apt to become transvestites." and “Deep analysis of fetishism and transvestitism in men, as well as deep analysis of neurotics, indicates that there exists in men a deep wish to be a woman. This is not just a wish for castration or a defense against castration anxiety; it is an indication of a special problem in individuation. In early development it becomes necessary to differentiate oneself from the mother. In individuals who fail or who do this only imperfectly there is apt to remain a need to become a woman. Both boys and girls go through a normal phase of envying mother. The girl has a special problem in changing her love object from mother to father. The boy has a special problem in changing the object of his identification from mother to father. This has important implications for the development of masculine or feminine traits.” (Nemiroff et al, p166)

In 1967 he was able to complete his The Technique and Practice of Psychoanalysis,which has become a classic in the field. He advocated an orthodox approach to the therapy, not such variances as he had done with Marilyn and Lance.

In 1968 Greenson proposed a developmental theory for homosexuality: “The male child, in order to attain a healthy sense of maleness, must replace the primary object of his identification, the mother, and must identify instead with the father. I believe it is the difficulties inherent in this additional step of development, from which girls are exempt, which are responsible for certain special problems in the man's gender identity, his sense of belonging to the male sex. ... The male child's ability to dis-identify will determine the success or failure of his later identification with his father.”

In 1972 Greenson gave a lecture for West German television, and surprised them by doing so in German. The English translation was entitled “A MCP Freudian Psychoanalyst Confronts Women’s Lib”. “I was first made aware of the possibility that man's envy of women was more widespread than I had anticipated by some clinical experiences that I had at the Gender Identity Research Clinic at the UCLA Neuropsychiatric Institute. In that Clinic we see patients who desire a surgical change of gender. People come there who believe they are ‘really’ a man in a woman's body or a woman in a man's body, or who simply insist they cannot live in their assigned gender and want an anatomical, surgical readjustment. Incidentally, these patients are clinically not psychotic. My theoretical training had led me to expect that, on the basis of penis envy, most of the patients would be women hoping to achieve a male habitus. To my surprise, two-thirds of the patients were men desiring to be transformed into women. The wish in men to be a woman is far more widespread than the conscious attitudes of men and women indicate, and more than the psychoanalytic literature would lead one to expect. Incidentally, transvestism, masquerading in the clothes of the opposite sex, only occurs in men, not in women.’ (Nemiroff et al, p260)

Greenson died age 68 in 1987.

The Greenson papers on Monroe and other celebrity and rich clients have been filed with the Special Collections at UCLA and will not will available to the public until 2039.

• Ralph R Greenson. “On Gambling”. American Imago, 4,2, April 1947: 61-77.
• Leo Rosten. Captain Newman, M.D. Fawcett Publications, 1961. A novel based on the wartime experiences of Rosten’s friend Ralph Greenson, and issues with empathy and post-traumatic stress.
• David Miller (dir). Captain Newman, M.D. Scr: Richard L Breen, Phoebe Ephron, Henry Ephron, based on the novel by Leo Rosten, with Gregory Peck as Josiah J Newman. US 126 mins 1963.
• Ralph Greenson, “Drugs in the Psychotherapeutic Situation,” presented at a conference on “Psychotherapeutic Drugs: Indications and Complications,” January 12, 1964, USLC Center for the Health Sciences.
• Ralph R. Greenson, “On Homosexuality and Gender Identity,” International Journal of Psycho-Analysis, 45, 1964. Analysis of Tamara Rees.
• Ralph R. Greenson. “A transvestite boy and a hypothesis”. International Journal of Psycho-Analysis, 47, 1966: 396–403.
• Ralph R Greenson. The Technique and Practice of Psychoanalysis. International Universities Press, 1967.
• Robert Stoller. Sex and Gender: On the Development of Masculinity and Femininity, Science House,1968: 144, 152-3, 161, 254, 263, 266.
• Ralph R. Greenson, "Dis-Identifying From Mother: Its Special Importance for the Boy," International Journal of Psychoanalysis, 49, 1968: 370.
• Robert J Stoller. Sex and Gender Vol II: The Transsexual Experiment. Hogarth Press and the Institute of Psycho-analysis, 1975: 41, 53, 104-5, 124, 293.
• Ralph R Greenson. Explorations in Psychoanalysis. International Universities Press, 1978.
• Janet Malcolm. Psychoanalysis: The Impossible Profession. Rowman & Littlefield, 1980: 45, 74-5.
• Kenneth Lewes. The psychoanalytic Theory of Male Homosexuality. Simon and Shuster, 1988: 192, 197-8, 204, 206.
• Robert A. Nemiroff, Alan Sugarman & Alvin Robbins (eds). On Loving, Hating and Living Well: The Public Psychoanalytic Lectures of Ralph R. Greenson. Karnac, 1992.
• Luciano Mecacci. Il caso Marilyn M. e altri disastri della psicoanalis. Giuseppi Laterza & Figli, 2000. English translation by Allan Cameron. Freudian Slips: The Casualties of Psychoanalysis from the Wolf Man to Marilyn Monroe. Vagabond Voices, 2009: Chp 1.
• Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, 2002: 115, 126, 173.
• Pierre-Henri Castel. La métamorphose impensable: essai sur le transsexualisme et l'identité personnelle. Gallimard, 2003: 88-9, 432n17.
• Daniel Greenson. “Greenson, Ralph (1911-1979)” in Alain de Mijolla. International Dictionary of Psychoanalysis. Macmillan Reference, 2005.
• Douglas Kirsner. “‘Do as I say, not as I do’: Ralph Greenson, Anna Freud, and superrich patients”. Psychoanalytic Psychology, 24, 3, 2007: 475-486.
• J Randy Taraborrelli. The Secret Life of Marilyn Monroe. Rose Books, 2009: 158, 164, 166, 168, 180-190, 199, 201, 203, 205, 215, 217, 224-6, 228-9, 240-2.
• Riccardo Galiani. “Un cas, deux écritures, une catégorie”. Topique, 3, 108, 2009: 143-156. Online.
• Christopher Turner. “Marilyn Monroe on the couch”. The Telegraph, 23 June 2010. Online.
• Richard Green. “Robert Stoller’s Sex and Gender: 40 Years on”. Archives of Sexual Behavior, 39, 2010: 1461.
• Lois W Banner. Marilyn: The Passion and the Paradox. Bloomsbury, 2012: 164, 166, 308, 329, 332-4, 341-2, 349-350, 352, 358-9, 363-372, 375-6, 380-8, 391-407, .
• Jat Margolis & Richard Buskin. The Murder of Marilyn Monroe: Case Closed. Skyhorse Publishing, 2014: Chps 3, 16, 17, 20, 21, 24, 25. Also p1-3, 5, 32, 34, 41-4, 47, 51-2, 55, 57-9, 61, 67, 74, 76, 83, 92-3, 98, 121, 125, 153-5.
• “Dr Ralph Greenson”. Marilyn Forever, May 10, 2014. Online.

EN.Wikipedia(Ralph Greenson)      EN.Wikipedia(Death of Marilyn Monroe)      Find a Grave
_______________

The books on Ralph Green that discuss his involvement with Marilyn Monroe don’t mention his involvement with the GIRC; those that discuss his involvement with the GIRC don’t mention his involvement with Monroe. Janet Malcolm mentions neither, nor does the article on Greenson in the International Dictionary of Psychoanalysis written by his son Daniel.

There are an amazing number of personal interconnections in the Marilyn Monroe case.  See the diagram on p33 of Mecacci's book.  For example Greenson's patient Frank Sinatra was also a lover of his patient Monroe.   Eunice Murray's former husband John Murray was the analyst of Anton Kris who was the son of Marrianne Kris, Monroe's New York psychoanalyst. 

If you google Greenson and Marilyn Monroe, you will find him accused of everything from having an affair with her, to controlling her life, to being complicit in her murder. Caveat lector.

Part I: Life
Part II: theory

Unless otherwise noted, page references are to The Sexual Century.

Person and Ovesey follow the old psychoanalytic tradition of referring to trans persons by their birth gender, and thus a heterosexual trans woman is in their terminology a ‘male homosexual’.

Development model

Person and Ovesey were influenced by the development model of psychoanalyst Margaret Mahler, and from this proposed that a child's separation-individuation anxiety produced a fantasy of symbiotic fusion with the mother which the transsexual tries to resolve by surgically becoming her mother.

“The male transsexual is defined by most workers as having a female core gender identity. From our experience, it seems more accurate to say that transsexuals have an ambiguous core gender identity. … [this] permits the disorder to be conceptualized psychodynamically in conflictual terms as a neurosis. In our opinion, transsexualism originates in extreme separation anxiety occurring early in life, before object differentiation has been accomplished. To alleviate the anxiety, the child resorts to a fantasy of symbiotic fusion with the mother. In this way, mother and child become one and the danger of separation is nullified. We believe that this reparative fantasy is the psychodynamic basis for transsexualism in the male and that the transsexual phenomena can be understood clinically as attempts to ward off threats to psychic fusion with the mother.” (p 107-8)

Typology

They proposed a typology of transsexuals as follows (as summarized by Vitale):

1 Primary - functionally asexual and who progresses resolutely toward a surgical resolution without significant deviation toward either homosexuality or heterosexuality, no evidence of effeminacy in childhood.

2a Secondary, homosexual - effeminate from earliest childhood, preferred girls as playmates, avoided boyish pursuits and were "mother's helpers." Crossdressing began in childhood, initially for narcissistic satisfaction, but later at puberty to attract male sexual partners. Cross-gender fantasies were frequently tied to identification with movie actresses and drag queens. The authors note that the homosexual cross-dresser wants to be noticed and to this end often wears flamboyant and colorful clothing and engages in theatrical endeavors.

2b Secondary, transvestic - appropriately masculine, and occasionally exceedingly hyper-aggressive and hyper-competitive. They neither played with girls nor engaged in female pursuits. They fantasized about being girls when cross-dressed, but valued their assertiveness and maleness.
This typology was in contradistinction to Stoller’s writings where the homosexual early transitioner was regarded as primary.

Trans men

With regard to trans men, Ovesey and Person write:

“we have concluded from a study of female transsexuals that there is no female equivalent of primary male transsexualism. In our opinion, the transsexual syndrome in women develops only in homosexuals with a masculine gender role identity. Female transsexualism, therefore, can be classified as another form of secondary (homosexual) transsexualism.” (p 112)

Homosexual transsexuals

Of male homosexuals, Person and Ovesey write:

“The vast majority of male homosexuals lack the propensity for a transsexual regression. The propensity exists almost entirely in cross-dressing effeminate homosexuals who comprise a very small segment of the homosexual population.”

They divide homosexual transsexuals into two subgroups:

a) passive effeminate homosexuals who

“in many ways present a caricature of typical female norms. They are interested in such things as cooking and decorating, but most of all, they seek a love relationship with another man where they can assume the female role. … on the surface they are passive and dependent, but they often dominate their mates through oversolicitousness. In this respect they, they tend to duplicate the close-binding behaviour frequently ascribed to their mothers. Often a relationship is terminated because the lover feels suffocated.”

b) the more aggressive, though equally effeminate, drag queens. They

“are usually involved in a community of other queens. They treat each other as ‘sisters’, and sexual relations within the group are rare. …. Narcissism is institutionalized in an endless series of drag balls and parties. … The queen claims that he wants involvement with a hypermasculine man who will overpower him …[however] he frequently prefers to be the active partner in anal intercourse. … These queens are quick to violence, both verbal and physical.”

Two examples are given: C. a 33-year-old who lives with mother and has worked only two years in his life. He met a man in Spain while on holiday and maybe the man would marry him if he had the operation. D. works as a drag queen and also turns tricks. His family know that he is gay, but not the rest. He has lost interest in sex, but hopes that post-op he would find a ‘real man’.
(p 127-135)

Transvestic Transsexualism

“transvestic transsexuals have the typical personality structure of their parent group, transvestites. The personality is organized on an obsessive-paranoid axis with attenuation of both tender affectivity and sexuality. These patients are hypercompetitive, may be hypermasculine, and engage in endless struggles for power with other men. … The relationship with the wife is essentially dependent. As such, its success is determined by the personality of the wife and her capacity to tolerate both cross-dressing and minimal sexuality. … Mental life is characterized not only by irritability and preoccupation with power struggles but also by bouts of depression. … they are countered most frequently by cross-dressing and many instances by resort to alcohol. … Suicide attempts are common, as we would expect in a patient population so prone to depression.” (p135-142)

Transvestism

Person and Ovesey went with the definition that transvestism is done by male heterosexuals (not gay men nor women) for fetishistic sexual arousal, although they concede that it may also be done ‘to relieve anxiety about gender role identity’. They divide transvestites into masochistic and non-masochistic. The psychoanalyst Milton Jucovy had proposed the concept of ‘initiation fantasy’ as a central part of male transvestism. Person elaborated that there are two versions: forced initiation by a dominant, big-breasted, booted phallic woman, and also initiation by a kindly woman who dresses the man to save him from ‘Mafia killers’ or some such.

DSM III

In 1978 the Archives of Sexual Behavior published Virginia  Prince's "Transsexuals and Pseudotranssexuals" in which she proposed that the only true transsexuals are asexual, socially-inadequate men who would function better as women, as "less is expected of women". She presumed that bisexuals (2,3,4 on the Kinsey scale) of their nature do not become transsexuals. She also proposed two kinds of 'pseudotranssexual' based on sexual orientation.

"The preoperative homosexual group (Kinsey 5,6) gave much higher scores on all questions dealing with sex and lower scores on those questions dealing with gender, while those in the heterosexual group (Kinsey 1,2) gave high scores to gender type questions and much lower scores on the sex type questions".

The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) 1980 added transsexualism for the first time, and subdivided it into asexual, homosexual, heterosexual and unspecified. Thus it was roughly congruent with Stoller, Person-Ovesey and Prince. Furthermore ‘transvestites’ was defined as done by a heterosexual male. Again congruent with Stoller, Person-Ovesey and Prince. However to the chagrin of Prince (who had been insisting on a differentiation from fetishism) it was defined as done for sexual excitement.

• Robert Stoller. Sex and Gender. Science House, 1968.
• Ethel S. Person. “Some Differences Between Men and Women: We think and behave different for biological and psychological reasons, not just cultural ones”. The Atlantic, March 1988. Online.
• Ethel Person & Lionel Ovessey. “The transsexual syndrome in males I: primary transsexualism”. American Journal of Psychotherapy, 28, 1974: 4-20.
• Ethel Person & Lionel Ovessey. “The transsexual syndrome in males II: secondary transsexualism”. American Journal of Psychotherapy, 28, 1974: 174-193.
• Ethel Person. “Initiation fantasies and transvestism: discussion”. Journal of the American Psychoanalytic Association, 24, 1976:547-551.
• Lionel Ovesey & Ethel Person “Transvestism: A disorder of the sense of Self”. International journal of Psychoanalytic Psychotherapy, 5, 1976: 219-235.
• Virginia Prince. "Transsexuals and Pseudotranssexuals", Archives of Sexual Behavior, 7, 4, 1978: 263-272. Reprinted in Richard Ekins & Dave King (eds) Virginia Prince: Pioneer of Transgendering. The Haworth Medical Press, 2005: 33-7 and the International Journal of Transgenderism, 8,4, 2005: 33-7.
• Ethel Person & Lionel Ovessey. “Psychoanalytic Theories of Gender Identity”. Journal of the American Academy of Psychoanalysis. 11, 2 (Apr 1, 1983): 203.
• Ethel Spector Person. “Harry Benjamin and the Birth of a Shared Cultural Fantasy”. In The Sexual Century: 347-366.
• Vern L. Bullough & Bonnie Bullough. Cross Dressing, Sex, and Gender. University of Pennsylvania Press 1993: 219-220..
• Ethel Spector Person. By Force of Fantasy: How We Make Our Lives. Penguin, 1996.
• Anne Vitale. “Primary and Secondary Transsexualism--Myths and Facts”. www.avitale.com, January 22, 2000. http://www.avitale.com/PrimarySecondary.htm
• “Initiation Fantasy” in Salman Akhtar. Comprehensive Dictionary of Psychoanalysis. Karnac Books, 2009: 146.
• Ethel Spector Person. The Sexual Century. Yale University Press, 1999.
• Elizabeth. “The Person Ovesey Transsexual Study”. Notes from the T side, October 3, 2010. http://ben-girl-notesfromthetside.blogspot.com/2010/10/person-ovesey-transsexual-study.html.
• Leslie Kaufman. “Ethel Person, Who Studied Sexual Fantasies, Dies at 77”. New York Times, Oct 20, 2012. Online.
• Irene Silverman. “Ethel S. Person, Psychoanalyst”. The East Hampton Star, October 25, 2012. Online.
• Stephen Burt. “Ethel Person”. The New York Times, December 30, 2012. Online.
• Molly Haskell. My Brother My Sister: Story of a Transformation. Penguin, 2014: 15, 73.

EN.Wikipedia
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Surely the non-homosexual transsexual group should have been called ‘heterosexual transsexuals’ or even better ‘gynephilic transsexuals’. To put ‘transvestic’ in the type name predisposes to a negative interpretation just as much as calling them ‘autogynephilic’.

I have previously commented on similar attempts at typology. See Kay Brown androphilic and gynephilic, and Anne Vitale. I still think that 3-part typologies of transsexuals are better than Blanchard’s 2-part – but I am certainly not recommending the Person-Ovesey model. Vitale’s model regards the pathology as gender deprivation anxiety - non-standard gender identity as such not being a pathology. Thus Vitale’s approach is preferable if we are to continue with typologies. Those who transition as soon as possible, those who spend some time living as gay before transition and those who marry and have children before transition are intuitively three different types. However to define the three types by adding psychoanalytical interpretations and to ignore the great variety within each type ends up defaming all and sundry. The intuition of three types does lead to some valuable insights, but to reify the three types leads to severe distortion.

In part I, I mentioned Elizabeth who writes Notes from the T Side. Apparently she is a Benjamin VI (High Intensity True Transsexual), a Vitale G1 and a Stoller Primary; but a Person-Ovesey Secondary and a Prince Pseudo-transsexual. This is an excellent example of how typologies should not be taken literally.

I am not aware of any trans persons who actually identity with the Person-Ovesey model. Rachel Webb identied as a ‘constructed woman” as per Janice Raymond; Kay Brown and Kiira Triea identified as Blanchardian HSTS; Anne Lawrence, Willow Arune, and probably Maxine Petersen self identify as autogynephiliacs. But no-one has in public identified as a Person-Ovesey secondary transsexual.  This despite the fact that the Person-Ovesey papers came out over a decade before Blanchard's.

It is difficult to reconcile the portraits of all three types of transsexuals as described by Person-Ovesey with the range of creativity and achievement of individuals featured in this Encyclopedia. Apparently Person was charming and easy to get on with face-to-face. However when you read the descriptions of trans persons in her book, then obviously she was not so nice.

Furthermore, the typology that Person-Ovesey come up was far from original.   In its basic structure adheres closely to street stereotypes current at the time.   All Person-Ovesey really did was revise the psychoanalytic dialectic to support the model.   This despite Person being credited for doing field work in porn shops and transvestite parties!   How come she never saw those of us who do not fit into the model - and I strongly argue that those of us who do not fit are the majority.   She must have worked at ignoring those of us.   This is later called erasure.   Yes, there are some trans people who are like those described.   There are some who have the separation-anxiety neuroses described.   There there are even more who do not.

I have not found any record of Benjamin’s reactions to the 1974 Person-Ovesey papers on Primary and Secondary Transsexuals.

We should remember that two decades earlier, Benjamin had provided a few of his patients to Federick G Worden & James T Marsh who quite disappointed the volunteers and in effect refused to listen to them, because they thought that they knew in advance what transsexuals were.

The New York Times obituary says: “Her work, upsetting the conventional thinking, found that many transsexuals and transvestites did not perceive themselves as homosexuals but rather saw themselves in many different lights — sometimes, for example, as a woman trapped in a man’s body, and sometimes as a heterosexual who preferred a feminine demeanor.” Surely this and more had been established by Magnus Hirschfeld over 50 years before.

Molly Hacker commends Ethel Person in her book about her trans sibling. But did she never read Person’s book? Does she actually regard her sibling as a ‘transvestic transsexual’, in effect a fetishist? If she does not, how can she commend Person in her book?

This is Anne Vitale’s summing up of Primary and Secondary Transsexualism:

“It is with dismay that I continue to encounter individuals with gender identity issues using the terms Primary and Secondary Transsexualism as diagnostic indicators. The terms show up repeatedly in Internet chat rooms, in the Internet news groups, in my email, and by individuals presenting to me in my private practice. The individuals who self-identify as Primary Transsexuals are usually using the term to mean that they are "Benjamin Type VI, true transsexuals." Those who self-identify as Secondary Transsexuals are usually trying to diminish their condition and to find some way to deal with their gender dysphoria without having to face the possibility of transitioning. As we shall soon see, neither term has ever had anything to do with severity or prognosis. There is no hierarchy of transsexualism. There are no Primary Transsexuals or Secondary Transsexuals. There are only gender dysphoric individuals who need help.”

See also A Blanchard-Binary Timeline.