THEY RESTARTED GENDER SURGERY FOR PROFIT??? Paul McHugh on John Money and Johns Hopkins (#22)
17 July 2025
With Paul McHugh
gender-clinics
At ninety-four, psychiatrist Paul McHugh remains one of medicine's most singular truth-tellers. His decision to close Johns Hopkins' gender identity clinic in 1979 was not an isolated act of conservatism but one step in a career defined by tracing a recurring pattern: psychiatry following culture instead of evidence. Multiple personality disorder, recovered memory, gender identity — McHugh sees the same mechanism at work in each. This episode examines what that pattern reveals about how medical institutions behave, and why the question 'what if we're wrong, again?' may be the most important one medicine keeps failing to ask.
Paul McHugh is ninety-four years old and still the most uncomfortable presence in a room of psychiatric professionals. As University Distinguished Service Professor of Psychiatry at Johns Hopkins — and its former department chair — he brings decades of clinical and institutional experience that most of his critics lack. What makes him unusual is not his scepticism of gender-identity medicine in isolation, but what that scepticism sits within: a career-long pattern of watching psychiatry mistake cultural belief for clinical evidence. This episode traces that pattern across three distinct episodes in recent psychiatric history. First came the multiple personality disorder epidemic of the 1980s and 1990s, in which therapists and patients together constructed elaborate inner worlds that largely dissolved when the therapeutic climate changed. Then came recovered memory: the conviction that forgotten trauma could be retrieved through suggestion, with devastating consequences for families. Now comes gender identity. McHugh argues the underlying mechanism is the same in each case — a cultural belief enters clinical practice, and medicine follows rather than interrogates it. Central to the episode is John Money, whose influence on gender medicine was profound and, for a long time, largely unexamined. McHugh describes witnessing Money's lectures and finding in them the ideological roots of what later became mainstream practice: the conviction that subjective identity can be cleanly separated from biological sex, and that medicine's role is to affirm that conviction rather than probe it. Understanding Money is understanding where the current framework came from — and why its scientific credentials were always shakier than its advocates claimed. Perhaps the sharpest moment is McHugh's articulation of a guiding principle: psychiatry works on ideas, not flesh. The point is not an objection to surgery in every context — it is a statement about what the discipline is for. When psychiatry moves to altering bodies in order to affirm a psychological self-concept, it has entered territory where a central idea is being accepted rather than examined. That is a significant disciplinary boundary, and medicine crosses it without always noticing. McHugh shut down Johns Hopkins' gender identity clinic in 1979 because the follow-up evidence did not justify the procedures being performed. Decades later, the hospital reopened it. The episode asks what changed — and the answer is not straightforwardly the evidence. It is the institutional environment: shifts in professional consensus, sustained activist pressure on academic medicine, and the financial and reputational rewards that now accompany alignment with a cultural orthodoxy. That is an institutional story as much as a medical one, and it tends to repeat. At ninety-four, McHugh offers something rare: a long view across multiple cycles of psychiatric fashion. He has watched beliefs peak, become orthodoxies, and eventually recede — and can describe what they share. The episode closes with his counsel to younger clinicians who see the same pattern today but face serious professional consequences for naming it. His career makes a single argument: that medicine needs its sceptics, especially when institutions are moving fast and culture is providing the answers before anyone has properly formed the questions.
