Understanding Benjamin's Types

A recurrent theme I’ve observed lately on trans blogs is the mis-application of Harry Benjamin’s Sex Orientation Scale (S.O.S). This scale was published in 1966 with the release of Benjamin’s groundbreaking book The Transsexual Phenomenon.

With a few significant corrections (e.g. later researchers have noted that sexual identity and sexual orientation are certainly not as closely correlated as Benjamin’s initial scale implied), I think the scale holds up surprisingly well. But it doesn’t hold up well at all in the case of people who want to use it for purposes divorced from Benjamin’s intent.

The S.O.S. was developed to address the need for a diagnostic tool which accounted for a group which, at the time, was entirely unrepresented in the medical literature. Previously when seeking professional treatment, transsexuals had been (mis)classified as either homosexuals or transvestites and (mis)treated accordingly. Benjamin wanted to call out, in practical terms usable in clinical practice, a more suitable set of guidelines for accurately diagnosing and effectively treating transsexuals.

He knew it wasn’t a perfect tool – in fact he took pains to point out some of its known flaws. Here is a telling excerpt from Benjamin’s introduction of his S.O.S (all emphases below are mine):

“The following chapters will make use of the types from I to VI in relating case histories and in establishing a diagnosis of the respective patients. Referring to Table I will then enable the reader to get a somewhat clearer picture of the particular individual and his or her problem. It should be noted again, however, that most patients would fall in between two types and may even have this or that symptom of still another type.“

Or, in laymans’ terms, these are approximations. They’re intended to help physicians establish patient diagnoses. Don’t expect any single individual to fall neatly and perfectly into any of these types. They’re intended as practical guidelines, not hardbound rules.

He goes on to say:

“It has been the intention here to point out the possibility of several conceptions and classifications of the transvestitic and the transsexual phenomenon. Future studies and observations may decide which one is likely to come closest to the truth and in this way a possible understanding of the etiology may be gained. If this etiology should ever be established through future researches, classifications may have to be modified accordingly. In the meantime, the S.O.S. may serve a pragmatic and diagnostic purpose.“

Layman’s translation: This ain’t gospel. It’s a work in progess. I’m relying on you – medical professionals – to keep this thing in harmony with the best available evidence. I hope you find it useful. If not, please make it better.

Here’s a quick flowchart showing Benjamin’s message about the purpose of the S.O.S.

Another item of note: Benjamin didn’t put much stock into the whole “early” versus “late” transitioner when it came to his standards. And he most definitely did NOT see these types as something any given patient must fulfill to the letter from initial presentation through final treatment. He observed patients initially diagnosed as one type who dramatically shifted to another over time, based on the totality of the evidence. He accepted this as a natural part of the diagnostic process.

Unlike less reputable researchers into transsexual lives, Benjamin didn’t assume that a patient was a liar for revealing something which challenged his preconceptions. He always assumed his own understanding of all the intricacies of how this condition affected individual lives to be incomplete.

Benjamin makes it pretty clear how he himself used these standards in relating examples of three different types of transsexuals. One such story begins with the patient showing up at Benjamin’s office at the age of 28, married, father of three children, a successful salesman, and asking for help because his recurrent transvestism was threatening his marriage.

Type III transvestite, you might think? Benjamin implies that was his initial diagnosis. But as more evidence came to light his diagnosis changed. That person described above is his example of a Type VI “high intensity” transsexual. They don’t get any more transsexual in Benjamin’s book.

If an expert like Benjamin could err so dramatically in diagnosing a patient, why do others seem so certain they can grab a few facts about a person – like marital status, age, and crossdressing history – and make a slam-dunk, unchangeable diagnosis every time?

Benjamin’s work was all about helping people. He found transsexuals a miserably unhappy and tragically underserved segment of the population. He didn’t look for someone else to blame. He rolled up his sleeves and made fixing this problem his life’s work. Those who use that work as a basis for belittling, mocking, and abusing others could not be more divorced from the example of Harry Benjamin himself, and do his legacy no favors.