The medical journal Psyche published answers to a questionnaire sent to twenty-eight doctors concerning a report by Dr. Medard Boss, delivered

at the 66th Congress of South-west German Psychiatrists and Neurologists in Badenweiler, in which he presented the case of a transvestite “under its existential-analytical aspect.”

The treatment ended with the total castration of the patient by Dr. Boss, including amputation of the penis with implantation of artificial labiae.

The report provoked critical comments from some of his colleagues followed by a rejoinder from Dr. Boss.

In view of the significance of the case for the doctor-patient relationship, the editors of Psyche circulated the following questionnaire to the colleagues whom Dr. Boss had named:

  1. Do you consider an intervention like that performed by Dr. Boss permissible from the general medical standpoint or not?
  2. Do you consider such an intervention permissible from the standpoint of the psychotherapist?

I had first of all to plough my way through the report of this case.

The totally superfluous existentialist jargon complicates the situation unnecessarily and does not make for enjoyable reading.

The patient was obviously bent upon getting himself transformed into a woman as far as possible and equally set against any other kind of influence.

It is quite clear that nothing could be done about it psychotherapeutically.

That settles Question 2.

An operation like this has nothing to do with psychotherapy, because anyone, the patient included, could have advised himself to ask a surgeon to castrate him.

If Dr. Boss gave him this advice, that is his own private affair, and something that one does not make a song and dance about in public.

Question 1 is not so easy to answer.

On the principle nulla poena sine lege an intervention of this kind is “justified” if the law either permits it or does not forbid it.

There is no law against cosmetic operations, and if I succeed in persuading a surgeon to amputate a finger for me that is his and my private affair, a problem of individual ethics.

If anyone who is compos mentis wishes to be castrated and feels happier for it afterwards than he did before, there is not much in his action that one can fairly object to.

If the doctor is convinced that such an operation really does help his patient, and nobody is injured by it, his ethical disposition to help and ameliorate might very well prompt him to perform the operation without anyone being in a position to object to it on principle.

Only, he should realize that he is offending the collective professional ethics of doctors in a hazardous way by his somewhat unusual and unconventional procedure.

Moreover, the operation affects an organ that is the object of a collective taboo; that is to say, castration is a numinous mutilation which makes a powerful impression on everyone and is consequently hedged about with all sorts of emotional considerations.

A doctor who risks this intervention should not be surprised if there is a collective reaction against it.

He may be justified before his own conscience, but he risks his reputation by violating collective feeling.

(The hangman is in much the same situation.)

Insults of this nature are not in the interests of the medical profession and are therefore, quite rightly, abhorred.

Dr. Boss would have done better to preserve a decent silence about this painful affair instead of proclaiming it urbi et orbi with “existential-analytical” eclat, however concerned he was to justify himself in the eyes of his profession.

Evidently he has only the dimmest notion of how much his action offends professional medical feeling.

So I can answer Question 1 by saying that, for the above reasons, I consider the intervention, from the medical standpoint, hazardous if not impermissible.

From the individual standpoint I would prefer to give Dr. Boss the benefit of the doubt. ~Carl Jung, CW 18, Pages 347-348

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