What happens when a psychiatrist looks at the data and says no? Paul McHugh's journey from confronting John Money's pornographic medical lectures to closing Johns Hopkins' gender program in 1979 reveals how a profession meant to examine ideas became enslaved to them. As major medical journals now "affirm" psychological identity over biological reality, McHugh watches psychiatry repeat the same pattern that gave us multiple personalities and recovered memories. At 94, this veteran of psychiatry's culture wars explains how asking one simple question—should psychological ideas take precedence over physical facts when they diverge?—became medical heresy.
About Paul McHugh
Dr. Paul R. McHugh is University Distinguished Service Professor of Psychiatry at Johns Hopkins. He closed the gender identity clinic in 1979, co-founded the False Memory Syndrome Foundation, and created the Mini-Mental State Examination used worldwide. Former chairman of psychiatry at both Oregon and Johns Hopkins, he served on President Bush's Council on Bioethics. At 94, this psychiatry rebel remains its most controversial voice—accused by activists of having mystical "powers" to stop research while simply insisting we "work on ideas, not flesh."
The Pornographer Professor
McHugh's first Hopkins battle came over John Money's medical school lectures. Money was showing pornographic films simultaneously—"heterosexual, homosexual"—calling it education. "You don't teach about humans by showing people acting like dogs in a park," McHugh told the "sex crazy" Money. This early clash revealed what McHugh would spend decades fighting: sexual ideology masquerading as science.
When Surgeons Begged for Help
"You don't know what it's like for us every day to be cutting into healthy bodies because you psychiatrists can't figure out what the problem is." One Hopkins surgeon's confession revealed the moral injury of early gender surgery. The surgical team "gradually felt more and more coerced" by Money's promises. When studies showed patients weren't happier after surgery, McHugh had his answer: "We weren't making women out of these people." The surgeons' relief was palpable—until they discovered gender surgery was "very profitable business."
The Anatomy of Psychiatric Contagion
McHugh maps how psychiatric crazes evolve through five phases: latent (few believers), explosive (sudden spread), saturation (peak adoption), immunity (growing resistance), and stagnation (retreating to fringe). Multiple personality disorder followed this pattern exactly. Gender ideology is now hitting saturation: "People are beginning to ask themselves whether they've done the right thing." The pattern is predictable; the damage is not.
Blamed for 45 Years of Missing Science
The New York Times podcast blamed McHugh personally for transgender medicine's research drought. Celebrity surgeon Marcy Bowers claimed his 1979 clinic closure caused decades of scientific stagnation. "What power!" McHugh marvels. "I just stopped a therapy that didn't do what it said it would do." The accusation reveals the field's pathology: when ideology fails, blame the messenger. McHugh wasn't stopping research—he was demanding it.
The Overvalued Idea
"The best example of an overvalued idea that has had such destructive force is anti-Semitism." McHugh's framework explains how shared beliefs become "ruling passions" that reshape reality. Unlike delusions (individual false beliefs), overvalued ideas spread through groups, gathering passionate adherents. Anorexia shows the pattern: once you start starving, "psychotherapy doesn't work because you can't register." Trans ideology follows the same destructive path.
The Question Nobody Will Debate
"Should a psychological idea take precedence over the physical facts when they diverge?" McHugh has asked this simple question for 45 years. No one will debate it. Instead, they assign motives: he must be hateful, bigoted, pursuing "ulterior motives." The New England Journal of Medicine now publishes articles about "affirming" gender identity. The American Medical Association endorses subjective identity over biological reality. In a field built on examining ideas, the biggest idea can't be examined.
Money's Final Humiliation
After the twin boys scandal, John Money faced ultimate bureaucratic defeat. The dean agreed he could continue—if every publication "had to go over my desk first." The pioneer of gender theory, in his 80s, trudging to McHugh's office with manuscripts. "Oh, John, this will do. Others won't do." It was "torture for the poor guy." The man who taught with pornography, who declared gender malleable, reduced to seeking approval from his greatest opponent.
The Courtroom Prophecy
"We'll have apologies maybe in courtrooms where the apologies prompted by very large settlements, financial settlements like with the multiple personality." McHugh has seen this before: psychiatrists swear recovered memories are real, juries convict innocents, then million-dollar settlements and public apologies. Now psychiatrists swear gender identity is immutable, children know their true selves, blockers are reversible. The lawsuits are already starting. The apologies will come. The only question is how many must be harmed first.
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