Graeme McGrath

Graeme McGrath, now retired, was an odd hybrid, a consultant psychotherapist: a physician working as a psychotherapist. He did not specialise in transsexuality, but dabbled, and three friends found him very helpful. I saw him in 1998, and that Autumn I got copies of the letters he had sent to my GP. I think the diagnosis accurate, though I hope I have grown beyond it now:

Mr Languish’s difficulties are related to a narcissistic personality structure. He is clearly unhappy and at times has felt despairing and, I suspect, suicidal. I am not sure formal psychotherapy is likely to help, and will require a direction and intensity of therapy which we cannot offer.

A month later:

His attitude throughout the interview was detached and somewhat ironic. It is increasingly clear that this functions as a very powerful defence against acknowledging the strength of his feelings. He briefly became extremely distressed, but when I tried to explore this he controlled himself very rapidly and returned to his normal way of interacting.

A further month:

Although he was keen to tell me about particular incidents when he had experienced intense feelings, I felt it was difficult to engage in any fruitful discussion of these. He tends to ruminate in a rather intellectual way and I thought his preoccupation with his own mental processes was part of his general difficulty in engaging with others rather than the kind of psychological reflection which leads to effective change.

I do not think exploratory psychotherapy has much to offer Mr Languish now. He is not transsexual, but his cross-dressing serves an important psychological function. Although he often feels extremely distressed and unhappy, I suspect that even if he were able to engage with the process of psychotherapy the threat to his defences may well make him feel much worse without necessarily leading to any effective change. He may well get something from a relatively non-intensive supportive relationship with someone who might be able to help him adapt to his chosen lifestyle. I suspect that this may well be available through the transgender network with which he is already in touch. I have not arranged to see him again and have discharged him from my care.


A few years after I transitioned, I felt wary and alert in the tribunal waiting room in Manchester, and then realised: I had noticed a medical report another representative had, which happened to have Graeme McGrath’s letterhead. Those letters really got to me. I burned them and some other tranny papers in 2009.

His diagnosis is wrong: I am transsexual. I would not still be expressing myself female were I not. His diagnostic error comes from exalting the scientific “understanding” over the reality: some trans women are observed to have certain characteristics, therefore anyone without one or more of those characteristics is not a trans woman.

The personality issues: Yes, that is how I was. I am better able to relate to people now. I am more aware of my own feelings, and more self-accepting. I think they come from being female and forced into male role, and being intuitive and touchy-feely in a family where that was devalued in favour of control and rationalism.

I am going back to this now to see how I have ended up unemployed. It helps me understand. It helps me value my journey.

I feel ready to go back into the World again. I feel no particular sense of entitlement, though some resentment of the difficulties I have faced. I am better able to face the World.