The Los Angeles Times from Los Angeles, California • Page 49

LOS ANGELES TIMES MONDAY, JANUARY 23, 1995 E5: DOCTOR IV if 'c if ii "As long as my hand's steady and HAPPY Continued from El feelings about one's life." Among the conclusions they list in a paper to be published in an upcoming issue of Psychological Science: Happiness is not determined by a time of life. Teen angst, midlife crises, empty-nest blues and old-age depression aren't the problems we've been led to think: "Knowing someone's age gives no clue to the person's average sense of well-being," they report. While women tend more to miserableness than men and men to antisocial personality disorder-when all's said and done, happiness is an equal-opportunity condition. European Americans report only slightly more happiness than African Americans, and African Americans are slightly less prone to depression. Individual misery can indeed stem from poverty, and there is a marginal connection between a nation's wealth and its collective happiness, Myers and Diener report.

But such correlations are neither key nor universal: Studies found the Irish, for instance, generally more satisfied than the richer folks in what was then West Germany. And lottery winners' euphoria soon dumps them back to their pre-wealth emotional state, the researchers found. Moreover, only 32 of U.S. residents polled in 1993 said they were "very happy" as opposed to 35 in the 1957 when, in real terms, the U.S. per capita income was only half as high.

Some happyologists believe there are traits and attitudes that can lead to a happier frame of mind although things here get chicken-or-eggy. According to the Myers and Diener study, happy people tend to: Like themselves. (Maybe that's because happy people are more likable.) Feel that they have control over their lives. (Did anyone doubt that prisoners, nursing home patients and the subjects of despots would say they're less happy as a rule?) Are optimistic. (Happiness is usually determined by self-evaluation.

Wouldn't optimists tend to look on the bright side of their mental state?) Are extroverted. (But aren't the woeful more likely to mope? Beyond that, the researchers said, happy people have more friends and closer relationships. Married people are happier, as a rule, than divorced, separated or otherwise single people, and happy people enjoy their work. Arthur A. Stone, a professor of psychiatry and psychology at the State University of New York, Stony has even shown that "positive affect," of which happiness is a component, can be good for the immune system.

"I don't know of any evidence, behavioral or physiological, that suggests happiness is detrimental," Stone said. Pressed, though, he did concede: "When you become happy, you can also become aroused. I guess someone with a cardiovascular disease might be at some small risk." Bentall's original proposal made a similar (if spurious) point: "Consistent clinical evidence of an association between happiness, obesity and indulgence in alcoholic beverages makes it reasonable to assume that happiness poses a moderate risk to life." He went on to note that mental illness, by some standards, is defined as "any deviation from the norm by way of excess or deficit, which confers upon the sufferer some form of biological disadvantage." Happy people, for example: "Overestimate their control over environmental events (often to the point of perceiving com pletely random events as subject to their will)." "Seem to wish to force their condition on their unhappy companions and relatives," causing tension. "Give unrealistically positive evaluations of their own achievements." "Believe that others share their unrealistic opinions about themselves, and show a general lack of evenhandedness when comparing themselves to others." Happy people are often "carefree, impulsive and unpredictable in their actions." In a phone conversation from his office in Liverpool, Bentall expressed concern that his proposal not be misinterpreted, as it was when the British press came upon his original paper in 1992. "Some of the British newspapers reported it as if I were insane myself," Bentall said.

"Others reported it deadpan, like a real scientific discovery. My mother wouldn't speak to me. "My point was that it's very difficult to draw up criteria for distinguishing sanity from insanity," he said. And with the ground separating sanity from insanity so shaky, even happiness can be pushed into psychologically problematic muck, he said. For instance: At least one mental-health expert, he said, has recently disputed the notion that hearing voices qualifies someone as insane.

"A Dutch researcher has found that a lot of people who hear voices aren't distressed by them," he said. "They're perfectly happy. Or as happy as the rest of us." So, the argument goes, "If they feel OK about it, why should they have psychiatric treatment?" By the same token, he said, happy people are overly optimistic, have inflated opinions of themselves and tend to misread the world, while depressed people realize that they don't have much control over events "a much more accurate view." "Moderately depressed people are more realistic than people who are moderately happy," he said. -And since it's usually assumed that being able to perceive reality is the mark of good mental health, well. The unspoken conclusion is not a pleasant thought for a Prozac nation whose economy is driven by gurus, therapists, big-screen television salesmen and others who peddle access to that supposedly positive condition.

But then, the chronically cheerful will almost certainly put a happy face on this news. i A Photos by ROSEMARY AUL For The Times to do transsexuals," Biber says. gloved fingers to create space for the vagina, gently pushing aside connective tissue. Biber stretches the inverted penile skin around a form, pulls it down and inserts it into the new cavity, first making an incision for the urethral opening. Later, he'lf use excess flaps of skin to create the labia.

(Many patients opt to return six months later for further plastic surgery to improve the appearance of the labia.) When the sutures heal and the hair grows back the result will look natural, he says. Biber finishes by shaving some cartilage from the front of the patient's trachea to make a more feminine-looking Adam's apple. After Biber's assistants close the incision, the patient is wheeled to recovery. Three weeks later back in Oklahoma City, Henryetta pronounces herself satisfied with the outcome of the surgery. "Everything that I had anticipated and was expecting is exactly the way it is, and now I'm legal." One of the first things she did was change the name on her driver's license.

"The clerk reached over and patted me on the hand and said, 'You can live your life the way you Holly Carr, a volunteer with the, International Foundation for Gender Education in Waltham, estimates that 30,000 people worldwide have had sex-change surgery. Another 50,000 probably would have the surgery if they had access to it, she says. Apart from Trinidad, sex-change operations are commonly performed in such far-flung places as Neenah, Montreal, Brussels and London. Biber, Carr says, greatly improved the standards of sex-change surgery. "He was the first to do a good job at it," she says.

"Some of Biber's people were really enthusiastic. I think he did a really neat job, compared to his predecessors." Surveys of Biber's former patients show most are satisfied with the results, says Marsha Botzer, a Seattle therapist and founder of the Ingersoll Center, which offers counseling to trans-gender and transsexual people. "We've completed 200 case histories, and out of that we have a 93 positive response on the surgery itself," she says. "It's almost embarrassingly positive. "He's a great guy," says Botzer, who's known Biber for 12 years.

"He seems to be honestly concerned with his patients. He's someone who gets great satisfaction when people are happy." ANNUAL Continued from El working on his farm or on one of his cattle ranches. Trinidad's most famous resident has no plans to retire. "As long as my hand's steady and my mind's clear, I'm going to continue to do transsexuals," he says. Biber built his practice in this coal-mining town nestled in the eastern foothills of the Rocky Mountains where the Purgatoire River reaches the Great Plains.

As the mines have shut one by one, the population of Trinidad 193 miles south of Denver has fallen to about 8,400. Some places might resent being known as the "Sex-Change Capital of the World," but Trinidad's residents are used to it. Down at the Dairy Queen, Delfi-na Vialpando takes a break to ponder Biber's legacy to the community. "When I broke my arm a long time ago, he's the one who fixed it," she says. "It's a normal thing now.

Everybody's OK with it, I think." In a nearby booth, Louis Volturo extends his right index finger, severed two years ago in a butcher-shop accident. "He put my finger back on," Volturo says, his wife Sheila nodding agreement. "I owe him my life, I guess." Although they once had reservations about Biber's sex-change practice, the Volturos say they're used to the idea. "If it helps people, more power to them," Louis Volturo says. "They're lucky if they have somebody to help them." Biber's latest patient is Henryet-ta (formerly Henry, "call me a 22-year Army veteran who retired with the rank of sergeant first-class.

At 43, she is slight, with permed, red-highlighted hair and blue eyes behind large -framed glasses. Growing up, "No one ever came up to me and called me a sissy," she says. "I was never that kind of a person." But she always felt feminine on the inside. Ten years ago, while stationed in Germany and living in an off-base apartment, she started cross-dressing after hours. Until recently, Henryetta says, she'd never been romantically involved with anyone.

"I did not go out on dates. I've never been married. I just didn't participate," she says. "I lived in my own world. There are a lot of things I missed." She moved to Oklahoma City after her discharge in August, 1993, and began hormone treatments to prepare for sex-change surgery.

She also adopted a new name and gender identity. As the hormones lightened her beard, raised her voice and caused breasts to develop, Henryetta delighted in her new self. "There are still little euphoric highs," she says. "Like when you're in the store shopping and someone comes up and says, 'May I help you, Biber requires that his patients follow standard guidelines for sex-change surgery. Henryetta, for example, lived full-time as a woman, began attending group therapy and underwent a second psychological evaluation.

(Therapy is required to ensure that people are really ready to take the big step.) Meanwhile, she made arrangements with Biber, who had operated on several of her friends with good results. Insurance doesn't cover the surgery, so surgeon's fees, hospital charges, counseling and hormone therapy are all paid for out of pocket about $30,000, Henryetta says. About $11,000 of that goes to Biber and the hospital. On the eve of the surgery, Henryetta insists that she is comfortable with her decision. SMITH Continued from El vibrations.

If the quarterback has good vibrations, his team will win. Stan Humphries has good vibrations. That's how I knew the Chargers were going to beat the Steelers and the Dolphins. Stay away from books analyzing the game. I bought John Madden's book on football, hoping to be let in on some of the secrets.

Madden said, "Forget the quarterbacks. Keep your eye on the tackles and the guards." Unfortunately, I let my wife read it before I took her to our first Super Bowl. She didn't seem to be enjoying the game. I asked her what was the matter. She said, "I can't tell who the tackles and the guards are." Of course she couldn't.

Nobody can, once the play is called and they all crash into a mass of flesh on the line. Best to keep your eye on the quarterback and the man he throws the ball to. A word of advice might be helpful on the domestic aspects of Super Sunday. I'm afraid the game causes many divided households. I 1 my mind's clear, I'm gbing to continue "One day she comes in and sits down at my desk and nays, 'Can you do my Biber recalls.

"I said 'What kind of She said, 'I'm a I said, 'What's Biber found a surgeon at Johns Hopkins University who agreed to send some hand drawings of a technique that was primitive by today's standards. The operation turned out well, and Biber soon was getting cases referred by word-of-mouth. But he says he was ostracized by other doctors for doing sex changes. Transsexuals, they insisted, were suffering from psychiatric problems best treated non-surgi-cally. Since then, scientists have recognized gender dysphoria syndrome as a legitimate disorder and posited several theories about its cause.

Currently, they suspect a genetic abnormality. Biber sought from the start to reassure his neighbors. "We educated the public here," he says. "The best thing I ever did was get together with the Ministerial Alliance I gave them three lectures." Biber gets more respect from colleagues these days, and the $800,000 to $1 million a year his patients bring the nonprofit hospital helps it stay open. Biber has refined the procedure five or six times over the years.

He says his work is so good that one former patient is married to a gynecologist who doesn't suspect a thing. In addition to his 3,000 male-to-female transformations, Biber has also performed about 250 female-to-male operations, which are less common because the results are still unsatisfactory. Biber screens patients to make sure they don't make a decision they'll regret. Most are in their late 20s, but he once operated on an 84-year-old because "she wanted to die as a female," he says. "It's such a hard life that they've lived," he says.

"We try not to rip them off. The poor people they don't have a lot of money." Outside the OR, Biber greets a wan-looking Henryetta, who hasn't gotten much sleep. They pose for a picture and he pats her gently on the arm. After being anesthetized, she is prepped for surgery, her feet fitted into stirrups attached to the operating table. The team works with relaxed concentration.

Biber wields his scalpel steadily and confidently, providing a running commentary for the benefit of a visiting nurse. In the "destructive" phase of the operation, he "skins" the penis, retaining the skin and discarding the spongy inner tissue. Then he removes the testes before using his (. he J. I I' 'Everything that I had anticipated and was expecting is exactly the way it is, and now I'm Henryetta Three weeks after her sex-change operation During the procedure, the surgeon will remove the penile tissue and testes and use the excess skin to fashion a vagina, virtually indistinguishable from that of a biological woman.

Patients can have sex and even reach orgasm because the nerve connections remain intact. "I don't consider this a mutilation," Henryetta says. "This is more like a hysterectomy to me. It's an operation that's necessary and required." But it was tough when Henryetta, an only child, told her parents of her decision. Her mother took it hard.

"She looked at me and said, 'I gave birth to a son. You will always be my son and there will be no change in my But Henryetta's father has called to wish her well, and both parents still love her, she says. "My parents taught me to be anything that I wanted to be when I was growing up." Stanley Biber came to town in 1954 after commanding a MASH unit in Korea. He worked at a clinic, intending to stay for a year. Charmed by the town, he never left.

For years he ran a general medical practice while serving as the town's only surgeon. He raised his nine children here. His oldest, 46, is a urologist; his youngest, 8, is a third-grader. He performed his first sex-change surgery a man-to-woman operation in 1969 after being approached by an acquaintance who was a social worker. don't think it is sexist for me to point out that not as many women as men like football.

My wife really tries, but her heart isn't in it. When that situation occurs, both parties should be gracious. A man should not be short-tempered with his wife because she does housework while he's watching the game. A woman should not resent her husband's complete absorption in the game for a few hours, even if he takes a few beers. There is one word of advice, though, I might offer to any home-maker who doesn't like football.

Clean house if you must, but don't turn on the vacuum cleaner when the game is on TV. And watch your language. Several years ago we were gathered in the home of our neighbors, the Daltons, to watch a Super Bowl game. Just at the kickoff, Mrs. Dalton struck a theatrical pose in front of the TV screen and said, "Who's playing, fellows?" A woman ought to have some respect.

By the way, the Chargers will win. Jack Smith's column is published Mondays. FIRST Continued from E3 workers thought it was fun to joke about how many passengers we would be picking up on the way to our dates. Another date made me the butt of a joke at a New Year's Eve party, when he danced around the room by himself, inebriated, and almost mistook someone's clothes closet for a water closet. "Is this a computer date?" a dismayed friend asked.

No, a computer probably could have done better. A long-distance relationship held over the phone and with infrequent visits did not hold up for me, either. Each time we would see each other in person, he would declare he was not ready for the responsibility of a relationship. How much less responsibility could one have than a phone call or two a week and a Christmas card once a year? Finally I have proof that many wrongs do make a right. I got a good chance to know a man well through my former job, and he is now not only my best friend, but my leading man who listens to my tales of wrong men.

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