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Boyish Mannerisms and Womanly Coquetry: Patients with the Diagnosis of Transvestitismus in the Helsinki Psychiatric Clinic in Finland, 1954–68


This article examines the case files of patients diagnosed with Transvestitismus [transvestism] in the Psychiatric Clinic of the Helsinki University Central Hospital in the years 1954–68. These individuals did not only want to cross-dress, but also had a strong feeling of being of a different sex from their assigned one. The scientific concept of transsexuality had begun to take form, and this knowledge reached Finland in phases. The case files of the transvestism patients show that they were highly aware of their condition and were very capable of describing it, even if they had no medical name for it. Psychiatrists were willing to engage in dialogue with the patients, and did not treat them as passive objects of study. Although some patients felt that they had been helped, many left the institution as frustrated, angered or desperate as before. They had sought medical help in the hope of having their bodies altered to correspond to their identity, but the Clinic psychiatrists insisted on seeing the problem in psychiatric terms and did not recommend surgical or hormonal treatments in most cases. This attitude would gradually change over the course of the 1970s and 1980s.

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This work was supported by the Kone Foundation (grant no. 57-16878). I would like to thank Heini Hakosalo, Jouni-Matti Kuukkanen, Petteri Pietikäinen and Hanna Putkonen for their comments and support. I am also grateful to Sanjoy Bhattacharya, Alexander Medcalf, and the anonymous reviewers for all their help.

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1. Transsexuality is nowadays regarded as a gender identity that is inconsistent with the person’s assigned sex. Definitions vary, implying the multidimensionality of sex and gender. In this article, the concept of transsexuality is also used to describe individuals who were themselves capable of describing their identity, despite the fact that the linguistic term transsexualitydid not exist for them or for the psychiatrists. This choice has been made to emphasise that it was the transsexuals, not the physicians, who coined the concept.

2. Hereafter, the Helsinki Psychiatric Clinic.

3. The sexual anomalies included Bestialismus, Exhibitionismus, Transvestitismus, Fetischismus, Homosexualitas, Masochismus, Sadismus, Sexualitas pathologica, and Sodomia: Nomenclatura statistica internationalis morborum et traumatum et causarum mortis: Tautinimistö (Helsinki: Lääkintöhallitus, 1953), 40.

4. Suomen virallinen tilasto XI Lääkintölaitos: Lääkintöhallituksen kertomus vuosilta 1939–52 (Helsinki: Valtioneuvoston kirjapaino, 1955); Suomen virallinen tilasto XI: 58: Yleinen terveyden-ja sairaudenhoito 1955 (Helsinki: Valtioneuvoston kirjapaino, 1957).

5. On the change in the diagnosis of psychopathy, see Katariina Parhi and Petteri Pietikäinen, ‘Socialising the Anti-Social: Psychopathy, Psychiatry and Social Engineering in Finland, 1945–68’, Social History of Medicine, forthcoming.

6. The Hospital District of Helsinki and Uusimaa archives and the Psychiatric Clinic of the Helsinki Central Hospital, patient records 1954–68, henceforth HPCA.

7. This argument is based on my unpublished research results.

8. See Jan Löfström’s work on homosexuality in general, and his analysis of silence in Jan Löfström’s, ‘Miten päätellä, onko hiljaisuus vaikenemista¿“Homoseksuaalisuus” agraarikulttuurin perinneaineistoissa’, in Antti Häkkinen and Mikko Salasuo (eds), Salattu, hävetty, vaiettu: Miten tutkia piilossa olevia ilmiöitä (Tampere: Vastapaino, 2015), 121–35.

9. See Ilpo Helén, Äidin elämän politiikka: Naissukupuolisuus, valta ja itsesuhde Suomessa 1880-luvulta 1960-luvulle (Tampere: Gaudeamus, 1997), 292–343.

10. Meyerowitz Joanne, How Sex Changed: A History of Transsexuality in the United States (Cambridge, MA: Harvard University Press, 2002), 7.

11. In some of these cases the diagnosis of Homosexualitaswas also used, and one patient was diagnosed with Sexualitas pathologica.

12. See Marc Micale, ‘The Ten Most Important Changes in Psychiatry since World War II’, History of Psychiatry, 25, 4 (2014), 485–91, 488.

13. Prudovsky Gad, ‘Can we Ascribe to Past Thinkers Concepts they had no Linguistic Means to Express?’, History and Theory, (1997), 1531.

14. Which is far from unchallenging because constructivism is understood differently in different contexts and by different researchers, for discussion on the problem see Jouni-Matti Kuukkanen, ‘Demystification of Early Latour’, in K. François, B. Löwe, T. Müller and B. Van Kerkhove (eds), Foundations of the Formal Sciences VII (London: College Publications, 2011), 161–84.

15. Hacking Ian, ‘Making Up People’, Historical Ontology (Cambridge, MA: Harvard University Press, 2002), 165.

16. Prosser Jay, Second Skins: The Body Narratives of Sexuality (New York: Columbia University Press, 1998).

17. Moa Holmqvist, Könsväxlingar: Nedslag i svensk translitteraturhistoria 1800–1900 (Unpublished licenciate thesis: University of Uppsala, 2014), 11.

18. I have come across one patient in Oulu Central Mental Hospital in northern Finland. The patient was prescribed tranquillizers. Another patient in the Psychiatric Hospital for Prisoners in Turku, Finland, was given a diagnosis as Homosexualitas, but according to his own description, it is evident that he perceived himself as a woman. Besides these single mentions, Helsinki Psychiatric Clinic has received the patients hoping for sex reassignment surgery.

19. The Finnish Personal Data Act (523/1999) defines the data as sensitive. Protecting the privacy of the data subjects is necessary.

20. The guidelines of the Finnish Association for Transgender and Intersex Rights (TRASEK), at, retrieved 18 August 2016.

21. See e.g. Vern L. Bullough, ‘Transsexualism in History’, Archives of Sexual Behavior, 4 (1975), 561–71; Gordene Olga MacKenzie, Transgender Nation (Bowling Green, OH: Bowling Green State University Press, 1994), 26–56; Sabrina Petra Ramet (ed.), Gender Reversals and Gender Cultures: Anthropological and Historical Perspectives (London: Routledge, 1996); Tiia Aarnipuu, Trans: Sukupuolen muunnelmia (Keuruu: Like, 2008).

22. The pseudonym belongs to Karl Heinrich Ulrichs. On Ulrichs’ life, see Hubert Kennedy, Karl Heinrich Ulrichs: Pioneer of the Modern Gay Movement (Concord, CA: Peremptory Publications, 2005).

23. Backman Johan af, ‘Ett fall af konträr sexualkänsla’, Finska Läkaresällskapets Handlingar, 24, 2–3 (1882), 151160.

24. Three publications by Magnus Hirschfeld were used in an article on homosexuality and crime. See Akseli Nikula, ‘Homoseksualiteetti ja sen oikeudellinen arvosteleminen’, Duodecim, 7–8 (1919), 248–73, 272.

25. Ibid., 264–7.

26. Ibid., 267, 269.

27. Dorchen Richter was Hirschfeld’s assistant who underwent castration in 1922 and had his penis removed and vagina constructed almost a decade later. Elena Mancini, Magnus Hirschfeld and the Quest for Sexual Freedom: A History of the First Sexual Freedom Movement (New York: Palgrave Macmillan, 2010), 69–70.

28. Lunbeck Elizabeth, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton, NJ: Princeton University Press, 1994), 193194, 299–300.

29. Nikula, op. cit. (note 24), 271.

30. Herzog Dagmar, Sexuality in Europe: A Twentieth-Century History (New York: Cambridge University Press, 2011), 31.

31. Fleck Ludwik, Genesis and Development of a Scientific Fact (Chicago and London: The University of Chicago Press, 1981), 27.

32. See Maja Bondestam, Tvåkönad: Studier i den svenska hermafroditens historia (Riga: Nya Doxa, 2010); Jonas Liliequist, ‘Cross-dressing and the Perception of Female Same-Sex Desire in Early Modern Sweden’, Sex, State and Society: Comparative Perspectives on the History of Sexuality (Umeå: Nyheternas tryckeri KB I Umeå, 2000), 337–52.

33. The National Library has digitised newspapers in Finland from 1771 until 1920. Combination of technologies including optical character recognition enables fuzzy searches, which in turn have made possible the thorough searches on the topic. Impi’s family and education background are covered in Nikula’s report. Nikula, op. cit. (note 24), 264–5.

34. Oosterhuis Harry, ‘Sexual Modernity in the Works of Richard von Krafft-Ebing and Albert Moll’, Medical History, 56, 2 (2012), 152153.

35. Excerpt from a piece of writing that one of the patients dedicated to medical science, HPCA.

36. Also known as Maria Hospital.

37. Mak Geertje, Doubting Sex: Inscriptions, Bodies and Selves in Nineteenth-Century Hermaphrodite Case Histories (Manchester: Manchester University Press, 2012), 67.

38. HPCA.

39. On the discovery of drumsticks, see Ursula Mittwoch, Sex Chromosomes (New York: Academic Press, 1967), 165.

40. HPCA.

41. HPCA.

42. HPCA.

43. Sorainen Antu, ‘Rikollisia sattumalta: Oikeustapauksia naisten keskinäisestä haureudesta 1950-luvun Itä-Suomesta’, in Rahikainen Marjatta (ed.), Matkoja moderniin: Lähikuvia suomalaisten elämästä (Helsinki: Suomen Historiallinen Seura, 1996), 187212.

44. Ibid., 204–5.

45. HPCA.

46. Sorainen, op. cit. (note 43), 204–5.

47. HPCA.

48. HPCA.

49. HPCA.

50. HPCA.

51. Stålström Olli, Homoseksuaalisuuden sairausleiman loppu (Helsinki: Gaudeamus, 1998), 232.

52. HPCA.

53. HPCA.

54. Hormia Armo, ‘Sexuell pseudodifferentiering hos enäggiga tvillingsyskon’, Finska Läkaresällskapets Handlingar, 99, 2 (1956), 201217.

55. See Leah Cahan Schaefer and Connie Christine Wheeler, ‘Harry Benjamin’s First Ten Cases (1938–53): A Clinical Historical Note’, Archives of Sexual Behavior, 24, 1 (1995), 73–93, 87.

56. See Malla Suhonen, ‘Transsukupuolisuuden näkymätön historia’, in Kati Mustola and Johanna Pakkanen (eds), Sateenkaari-Suomi: Seksuaali-ja sukupuolivähemmistöjen historiaa (Keuruu: Like, 2007), 63; see also Pimenoff, who has noted that patients were sometimes treated in locked wards, but whether this took place in Finland, is left unmentioned. Veronica Pimenoff, ‘Transseksuaalisuus’, Lääketieteellinen Aikakauskirja Duodecim, 109, 4 (1993), 368.

57. I am not aware of the extent of the use of anabolic steroids, but I have frequently come across Anabolin in mental hospital records as well as in advertisements in Finnish medical journals. I have not been able to connect the use of Anabolin to treatment of sexual anomalies. As far as the description of Anabolin goes, it was prescribed for ‘difficult catabolic states’ and ‘aplastic anaemia’. Pharmaca Fennica (Helsinki: Lääketeollisuusyhdistys, 1975), 115.

58. HPCA.

59. HPCA.

60. Librium is a chlordiazepoxide, the first benzodiazepine to be synthesised, and aimed at symptoms of anxiety.

61. HPCA.

62. HPCA.

63. HPCA.

64. HPCA.

65. Jorgensen also published an autobiography in 1967, but it has not been translated into Finnish.

66. Emm Hans, ‘Hra Jörgensen on nyt neiti’, Seura, 3 (1953), no page numbers.

67. Meyerowitz, op. cit. (note 10), 67.

68. HPCA.

69. Hamburger Christian, ‘The Desire for Sex Change as Shown by Personal Letters from 465 Men and Women’, Acta endocrinologica, 14 (1953), 361375, 364.

70. Sørensen T. and Hertoft P., ‘Sex-Modifying Operations on Transsexuals in Denmark in the Period 1950–77’, Acta Psychiatrica Scandinavica, 61 (1980), 5666.

71. Hymylehti, 1, 60 (1966), cover page.

72. HPCA.

73. HPCA.

74. Essig Laurie, Queer in Russia: A Story of Sex, Self, and the Other (Durham, NC, and London: Duke University Press, 1999), ix.

75. HPCA.

76. Rastas Merja, Oikeus oman identiteetin mukaiseen elämään? Tutkimus transseksuaalien elämästä ja asemasta Suomessa (Helsinki: Sosiaali-ja terveyshallitus, 1992), 38.

77. The Finnish Castration Law controlled all castrations in the country. In 1970, the new Castration Law (282/70) was enacted. It was unclear whether it applied to transsexuals. Helsinki Psychiatric Clinic asked for clarification from the National Board of Health, but did not get an official reply. See Rastas, ibid., 36–41.

78. HPCA.

79. HPCA.

80. HPCA.

81. Lydecken Kivi, ‘Transseksuaalien hoidosta’, Lapinlahti, 20, 2 (1987), 4348.

82. Garland Jameson, On Science, Law, and Medicine: The Case of Gender-“Normalizing” Interventions on Children who are Diagnosed as Different in Sex Development (Uppsala: Uppsala University, 2016).

83. Finnish honorary title.

84. HPCA.

85. Schaefer and Wheeler, op. cit. (note 55), 75, 81.

86. On contacts, see Meyerowitz, op. cit. (note 10), 130–67.

87. See e.g. Jan Wålinder, ‘Transsexualism: Definition, Prevalence and Sex Distribution’, Acta Psychiatrica Scandinavica, 43, S203 (1968), 255–8.

88. HPCA.

89. Alanko Antti and Achté Kalle, ‘Transsexualism’, Psychiatria Fennica, (1971), 343358.

90. Meretniemi Kari, ‘Pitäisikö transseksuaalit leikata’, Lapinlahti, 20, 2 (1987), 5864.

91. Garland, op. cit. (note 82), passim.

92. Alanko and Achté, op. cit. (note 89), 349–52.

93. See the scheme in Alanko and Achté, op. cit. (note 89), 352.

94. Lydecken Kivi, ‘Transseksuaalien hoidosta’, Lapinlahti, 20, 2 (1987), 4348, 45.

95. Cohen-Kettenis P.T. and Wålinder J., ‘Sex reassignment surgery in Europe: A survey’, Acta psychiatrica scandinavica, 75 (1987), 176182.

96. Rastas, op. cit. (note 76), 39.

97. Ibid., 41.

98. HPCA.

99. See e.g. Erkki Petman, ‘Kurt Forsman haluaa rinnat: Hymylehti maksaa hoitokulut’, Hymylehti (1971), 114–15; Erkki Petman, ‘Sukupuolenvaihdoksia useita – rintaleikkauksia hyvin paljon’, Hymylehti (1971), 115.

100. See other studies on the lives of transsexuals in Finland, e.g. Veronica Pimenoff, Geschlechtsumwandlung in Finnland 1970–2002: Eine historische und empirische Studie zu Geschlechtsumwandlungen unter den Regelungen des Kastrationgesetzes bis zur Einführung des finnischen Transsexuellengesetzes (Unpublished PhD thesis: University of Ulm, 2008); Maarit Huuska, Transseksuaalisen sukupuoli-identiteetin rakentuminen (Tampere: Sosiologian ja sosiaalipsykologian laitos Tutkimuksia A 30, 1998); Outi Hannuksela and Nina Tölli, Sukupuoleen selviytyminen – seitsemän suomalaista transseksuaalia (Saarijärvi: Stakes, 1998); Suhonen, op. cit. (note 56), 53–65; Hanna Vilkka, Keho: Omaa sukupuolta koskevan tiedon ja ymmärryksen perusta transsukupuolisilla (Helsinki: Yliopistopaino, 2006); and Jan Wickman, Transgender Politics: The Construction and Deconstruction of Binary Gender in the Finnish Transgender Community (Åbo: Åbo Akademi University Press, 2002).

101. Amnesty International, The State Decides Who I Am: Lack of Legal Gender Recognition for Transgender People in Europe (Amnesty International Ltd, 2014), Index: EUR 01/001/2014, 40–8.

This work was supported by the Kone Foundation (grant no. 57-16878). I would like to thank Heini Hakosalo, Jouni-Matti Kuukkanen, Petteri Pietikäinen and Hanna Putkonen for their comments and support. I am also grateful to Sanjoy Bhattacharya, Alexander Medcalf, and the anonymous reviewers for all their help.

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