Pioneers of Transgendering:
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This paper is one of a number that we have written or plan to write which outline and assess the role of certain people who have had a significant influence on current thinking and/or practice concerning transgenderism. As with the other papers, this one cannot claim to be complete and we would welcome any further information which we can incorporate into later versions.
Charing Cross Hospital may have other claims to fame, but to many of us it has been for many years the first hospital to spring to mind when transsexualism or sex reassignment is mentioned. Similarly these topics were, for something like 20 years, inseparable, at least in Britain, from the name of the subject of this paper - John Randell.
John Randell - the man
John Bulmer Randell was born in Penarth, Glamorgan, Wales on August 25th 1918. He attended the Welsh National School of Medicine' which is where he qualified in 1941. From 1942- 1946 he was a Surgeon Lieutenant in the RNVR and then worked at Guy's, St George's and St Thomas's. On 1st January 1950, he became Physician for Psychological Medicine at Charing Cross. He died of a heart attack on 30th April 1982, aged 63.
Randell's involvement with transgenderism
By the end of the 1950s, Randell was able to report on 50 cases of transvestism and transsexualism that he had been involved with (Randell, 1959): in his MD thesis of 1960 he listed 61 male and 16 female cases. During the 1960s he saw on average, 50 new cases a year. During the 1970s the number of new referrals seen by Randell rose from around 100 to nearly 200 per year (approximately an incredible four a week).
According to figures given to us by Randell himself, he had seen 2438 (1768 male and 670 female) transgendered patients by 1980. The obituary written by Alice Purnell says that he had 'some six thousand patients on his file' (Purnell, 1982). Whatever the real number, it was certainly large in comparison with even the figures given for Harry Benjamin - 1560 from 1938 to his retirement in 1979 (Wheeler and Schaefer, 1988, p 179).
And Randell was basically dealing with all these patients by himself although by the late 70s he would pass on patients who had been accepted for surgery and who were simply on the waiting list to a clinical assistant, Dr Guercken. Nevertheless even around 1980 only about half of his time was spent working with transsexuals, the rest with general psychiatric patients.
The First International Symposium on Gender Identity was held in London in July 1969. This was sponsored and organised by the British Albany Trust and the American Erikson Educational Foundation. The conference brought together some of those working in this field in Britain and received substantial press coverage. Most of the press reports on the conference were short and concentrated on the figures which were given of the number of so-called sex change operations which had been carried out ('BRITAIN'S SEX CHANGE TOLL' (Kent Evening Post, 28/7/69). Even the more detailed accounts in the serious press stressed the numbers aspect ('1,000 SEX CHANGES IN 20 YEARS' (Times, 28/7/69); '41 HAD CHANGE OF SEX' (Guardian, 28/7/69). John Randell's name crops up in a number of these reports which appear to herald the beginning of his media career.
During the 1970s Randell was the main 'expert' in the UK sought out by the media for press articles and appearing on the occasional radio programme. The few other medical professionals involved at that time managed to keep their anonymity or at least had a much lower profile. In 1980, the News of the World claimed that Randell and the urologist who performed the surgery, Peter Phillip, had made London the 'sex-change capital of the world' (News of the World, October 12 1980).
Randell and sex reassignment
Despite being familiar with Benjamin's writings, in 1959 Randell was generally not in favour of the use of surgery for transsexuals; nevertheless he found two patients, 'so manifestly lacking in masculine traits and so feminine in appearance, manner and speech that this step (surgery - DK) is logical' (1959, pp. 1449-50).
Some of Randell's early patients received surgery abroad. Apparently the satisfaction expressed by those who had been operated on persuaded him to change his view of it and in the late 1950s Randell began a long association with the urologist Peter Phillip who began to perform some surgery, initially castration and penectomy but later also vaginoplasty.
Charing Cross was possibly the only hospital where this surgery was regularly if not frequently available during the 1960s. In a report published in 1969, he (Randell, 1969), reported on 29 males and 6 females who had been operated on but in his report to the London conference that year which was not published until 1971 the figures given are 44 males and 8 females. The press reports gave an overall figure of 41.
Whatever the precise number of operations sanctioned by Randell up to this time, the number of patients involved constituted only about 10% of the nearly 500 that he had seen by that time. Moreover, we should also bear in mind that the surgical interventions that had taken place were not always the full set of procedures that were available even at the time: of the 29 males in the 1969 paper, only just over a third had undergone vaginoplasty not all with satisfactory results.
During the 1970s the frequency of operations increased. Based on figures supplied by Randell himself the number of operations carried out at Charing Cross during the 1970s was on average just over 30 a year, more than one a fortnight. But although the number of operations were increasing so were the number of referrals so the percentage of patients receiving surgery only increases to about 15%. By 1980, approximately 100 of the 670 ftms he had seen had been operated on and 250 of the 1768 mtfs. What happened to the remaining 2088 is not known.
From the early 1960s then, Randell recognised that surgery could be an appropriate intervention. By the late 1960s he was arguing, firstly, that transsexuals could not be cured (ie induced to accept their assigned gender) by psychotherapy or any other means and, secondly, that in suitable cases, the outcome could be favourable. But he was not in favour of surgery on demand and in his various publications he outlines a number of criteria by which to decide who should be recommended for surgery. These vary slightly in the wording but, in addition to being free of serious mental disturbance, being of sufficient intelligence and being single, the most important one seems to be that the patient is 'accepted socially without detection in the new gender role' (1973, p 78). Several people have pointed out to us that in part this meant conforming to Randell's own (traditional?) view of gender roles; for example, always wearing skirts (for mtfs). In his conference paper in 1969 he commented on male patients who 'try to override one, and manipulate, assert themselves'. 'I think' he said, 'if they are going to be ladies they should be ladylike. Conformity and not giving trouble is surely what we are looking for' (1971, p 159).
British medical practitioners have not contributed a great deal to the literature on transgenderism. Even today, Randell's contribution (though small) is probably still the largest (if we except Richard Green!). Numerically they even approach Benjamin's (see our other conference paper).
Not heavyweight pieces by any means, Randell's writings were mainly reports of cases he had seen and general accounts of the nature of transvestism and transsexualism as it was seen at the time. Mostly concentrated in the 1970s, they served a useful function in disseminating information at a time when it was still hard to come by.
Randell's first publication on transgenderism was a 1959 article in the British Medical Journal. The following year he submitted an MD thesis on the topic to the University of Wales. This may have been the very first higher degree thesis on the topic anywhere in the world.
Nothing more was published by him until he made a contribution to the Green and Money volume in 1969. A period spent by Richard Green at the Maudsley Hospital in the mid 60s seems to have enabled links to be made with the European contributors including Randell. There are two aspects of this piece to which we wish to draw attention.
Firstly, there is Randell's conclusion that surgery (even the limited variety which he reported) was beneficial. Those undergoing sex reassignment, he wrote, are; 'subjectively and objectively improved both in their adjustment to their environment and in their own feelings of well-being and satisfaction in their gender role'. (1969, p 379) Nevertheless he cautions that great care must be taken in selecting candidates for surgery.
Secondly, there is his insistence on the primacy of the original anatomy as determining 'real' or 'true' sex. Thus he writes. 'I do not subscribe to the opinion that a phenotypic male can have a female psyche. Those who profess to have such mental orientations are in fact anatomical males with obsessional beliefs or overvalued ideas that they are female; and therefore psychiatrically abnormal' (1969, p.367). This leads him to make such statements as 'those transsexuals who are skilful female impersonators can make a superficially convincing presentation of femininity . . .' (1969, p.375) and to constantly refer to sexual orientation as homosexual or lesbian in relation to assigned sex.
During the 1970s he published a number of articles mostly short pieces outlining the nature of transvestism and transsexualism as it was seen then. He also published his only (so far as we are aware) book, 'Sexual Variations' in 1973. Most space is devoted to chapters on Transvestism, Transsexualism and Homosexuality with shorter chapters on Fetishism, Masturbation, Sadism and Masochism, Rape and Incest, Satyriasis and Nymphomania Exhibitionism and Frotteurism and Group Sex and Voyeurism. The title Sexual Variations rather than Deviations or Disorders was quite progressive for its time and in writing things such as 'crossdressing conducted in a restrained manner for the enjoyment of the participants cannot be regarded as socially reprehensible, dangerous or harmful' (1973, p.63), Randell sounds to be singing from the same songsheet as other liberal voices such as Kenneth Walker and Harry Benjamin.
His last publication was in 1977 and was a short piece in the Nursing Mirror. This was similar to some of his other pieces including a bit of history, a bit of anthropology and a summary of the nature of transsexualism, the possible causes and the justification for surgery. The piece is interesting in that the emphasis is (unusually) on ftms who he continually referred to as 'these ladies' (1977, p.46). The emphasis is probably because in the same issue was an early auto- biographical piece by Mark Rees writing anonymously as 'John' (was this a gentle dig at Randell?).
Randell's article ends with a sentence which, although the tone is rather arrogant and patronising, was probably read with hope by transsexuals who saw it at the time: 'These individuals need our tolerance and sympathy and certainly not rejection and derision' (1977, p.47).
Corbett v. Corbett (The April Ashley case)
Randell was an expert witness in the infamous Corbett v Corbett case (the April Ashley case) in late 1969/70. Randell appeared for Arthur Corbett who was petitioning for his marriage to April Ashley to be annulled on the grounds that she was a man. Lord Justice Ormerod praised Randell's evidence in which he stated that he 'considered that the respondent (ie April Ashley) is properly classified as a male homosexual transsexualist.' The outcome as we know was not a favourable one for April Ashley and set a precedent which people have been seeking to overturn ever since. It was a judgement which was strikingly in line with Randell's view of transsexuals.
Randell and his patients
Over the years we have spoken to a number of Randell's ex-patients and he is also mentioned in some published autobiographies. Few speak of him with praise and affection. Most comment on how brusque, rude, cold and harsh he was although Tula writes of him as 'absolutely charming' (Tula, 1982, p.118-119).
Randell was certainly aware that he was not generally liked by his patients but claimed not to care arguing that he was doing what was in their best interests.
His manner was evidently so noteworthy that it invited attempts at explanation. A common view was that his manner was deliberately adopted in order to test his patients commitment with only the most determined being prepared to carry on. Stella, a mtf who was a patient of Randell's in the late 1970s saw his behaviour towards her as a deliberate strategy, reasoning that it was to sort out those who 'could stand on their own feet' from those who couldn't. Similarly, Alice Purnell argued that 'this was in order to allow the client to overcome their own difficulties and actually decide which course to take' (1982).
Evidently his colleagues also sought to explain it as one of his obituaries hints that his short manner may have been a reflection of his hearing difficulties.
Randell's insistence on the primacy of the original anatomy in determining 'real' or 'true' sex was also a feature of his contacts with patients. Mark Rees wrote that 'he continued referring to me in the female pronoun even years after I had became (sic) Mark. Although willing to give me the treatment he made it clear that in his eyes I was a female and a lesbian' (Rees, 1996, p.83).
Stella (ts interviewee) said that at the very first interview she had with Randell he pointed out that she would always be a male and that the operation would not change that fact. Four years later after she had fulfilled his criteria and had received surgery from Peter Phillip she was not unnaturally elated. She tried to share her satisfaction with Randell and wanted to thank him for helping her. She was rebuffed however with a gruff reminder that 'it hasn't made you a woman, you know - you'll always be a man'. Which seems rather cruel.
Tula, the exception again, however says that he referred to her as 'young lady' (Tula, 1982, p.118-119).
Fortunately, Randell can actually be heard in action in the Julia Grant television documentaries which were first screened in June 1979 and October 1980 and which focused on her quest for surgery. Randell was the invisible and anonymous psychiatrist in the programmes whose identity was revealed (to those who did not already know) in the subsequent press coverage and in Julia's books. Why Randell agreed to do the programmes is a mystery for they certainly did not show him in a good light and in fact confirm the picture of him painted by most of his other patients. Even the Daily Telegraph's reviewer was shocked and wrote about one of the encounters captured on camera:
Unfortunately, there was little his patients could do about it if they wished to be recommended for surgery by him. Like many others Mark Rees wrote that he tolerated Randell's behaviour because there was no alternative, nowhere else to go.
What then was Randell's contribution?
His writings are not as numerous or as sophisticated as some of his contemporaries in other countries. They were often brief introductions to the topic which, at the time, served a useful purpose. His contributions via interviews to press reports and his occasional appearance on a radio programme also played a key part in influencing what little information people had about transgenderism in those days.
During the 1960s and the 1970s the possibility of surgery was kept alive in Britain, largely due to the work of Randell, even though it was to be a reality for only a small number of the people who made it to his door. Alice Purnell again wrote in the Beaumont Bulletin obituary that '. . . he did help many' and 'for a long time he was the only English source of help'.
The SHAFT obituary similarly concluded that 'More than any other single psychiatrist in the U.K. he helped us'.
Assessing the outcome of his interventions is beyond the scope of our expertise and this paper. Alice Purnell claimed that; 'He was professionally cautious' and that '. . . Few cases that went via his vetting process were mistaken in their decisions.
The SHAFT obituary too concluded: 'for those fortunate patients for whom a gender role change was practical, who had the patience and motivations to persevere, his techniques were outstandingly successful' although by what criteria success is being judged is unclear.
Most of his patients as we have seen did not go on to obtain surgery via his recommendation and what happened to them we do not know. Most of those who did obtain his blessing seem to regard their time in his care as a purgatory - something they had to suffer for the sake of their future happiness.
Whilst this evaluation might seem on the whole to be negative, we will conclude by posing the questions 'Would anyone else have taken on transsexual patients in the late 1950s and would they have stayed working in the field for the next 20 years if John Randell hadn't?'
Citation: King, D., (2002), Pioneers of Transgendering: John Randell, 1918-1982, GENDYS 2002, The Seventh International Gender Dysphoria Conference, Manchester England.
Web page copyright GENDYS Network. Text copyright of the author. Last amended 18.07.06