Prof. Dr. Dick F. Swaab
Did you know that brain research has led to changes in juvenile law and the transgender law? Dick Swaab, a prominent physician and brain researcher, known to the general public for his book ‘We Are Our Brains’, is also a professor at Zhejiang University. In this article, he talks about his work in the Netherlands and in China. How his first Chinese PhD student in Amsterdam introduces him in China and, thanks to his groundbreaking research on the sexual differentiation of the brain, is crowned ‘honorary gay’ of the gay student association in Hangzhou.
My first Chinese student
In 1991, long before we all used email, as director of the Netherlands Institute for Neuroscience and professor of Neurobiology at the University of Amsterdam, I surprisingly received a letter from a student from China. The student who wrote to me, Jiang-Ning Zhou, said he had followed my publications and asked if it was possible to do his PhD research with me. I wrote back to him, as is customary with such requests, that this was only possible if he could obtain a fellowship that would cover his living expenses for four years. Usually, I heard nothing back, but this time it was different. Half a year later, I received another letter from Zhou, stating that he had received a Nuffic fellowship for his PhD research at the Brain Institute, but that he wanted to postpone his arrival because he wanted to learn Dutch first. I wrote back that this would be a waste of his time, because in our institute there were twenty nationalities, all of whom spoke poor English, so it would be better if he came immediately. Chinese people do what the boss says, and in 1992, Zhou came directly to the Netherlands. Upon arrival, he told me that, besides his fascination with the brain changes in Alzheimer’s disease, for which he had received his fellowship, he had become intrigued by a part of my research published in 1985 and 1990 that was very controversial in China, namely brain differences between men and women and between heterosexual and homosexual men. That was an unexpected statement for someone from China, where very strict rules regarding sexual behavior applied at the time. Back then, a boy and a girl were not even allowed to walk hand in hand down the street.
Transsexual donors
During his PhD research, Zhou noticed that the brain area important for sexual behavior, the Bed Nucleus of the Stria Terminalis (BNST), was twice as large in men as in women. I then suggested looking at this structure in the brains of transsexual donors. Indeed, it turned out that a female BNST was present in genetically male brains, and vice versa. This reversal of sex differences thus corresponded to how transsexual individuals experience their gender identity, but not with their birth certificate or passport. Our sex organs differentiate in the first few months of pregnancy, and the child’s brain develops in a male or female direction during the second half of pregnancy. These two processes can therefore be influenced separately, resulting in transsexuality. This finding was published in the top journal Nature, and Zhou established his reputation with it, especially when our article was chosen as one of the top 100 scientific articles worldwide. Our finding that there was a biological basis for transsexuality had major societal consequences. It played a central role in the adoption of an English law making it possible to change the sex on passports and birth certificates, and was used for the same purpose in the European Court of Human Rights of the Council of Europe.
Professor in China
In 1998, Zhou introduced me to China for the first time, and I became a visiting professor. Given our shared research interests, it was natural for me, starting in 1998, to also discuss the sexual differentiation of the brain in my lectures in China, not only in relation to male-female differences but also in relation to homosexuality and transsexuality. However, for the audience, this was absolutely not self-evident. One of Zhou’s PhD students later told me, when she was working with me in Amsterdam, that this had been a bewildering experience for her. It was even the first time that she, although a doctor in China, had heard homosexuality discussed. Only in psychiatry was it known, but there the idea existed that homosexuality was a disease. During the discussion after one of my lectures, a psychiatrist even stated that homosexuality hardly existed in China and that it occurs so frequently in our Western society due to decadent Western society. My response was that homosexuality is a variation that occurs roughly equally often worldwide, but that it remained hidden in China due to repression. This view has proven correct in China over the years.
In the following years, China changed rapidly. At Zhejiang University in Hangzhou, I became a Qiu Shi (Seeking the Truth) Professor. I supervise PhD students there who often also come to work for a few years at the Brain Institute in Amsterdam. I teach about the structure, functions, and diseases of the brain. In 2012, by invitation, I gave a lecture on the sexual differentiation of the brain. Among the students were a few boys waving the rainbow flag, which I had to sign afterwards. Thus, I became a sort of ‘honorary gay’ of ‘The Queer Forum’, the gay student movement of Hangzhou. Things were heading in the right direction with China, I thought then, but ten years later, this organization has disappeared. Whether this is due to a ban, we do not know. During a domestic flight in China in 2014, I saw on the front page of the China Daily, a government-controlled newspaper for foreigners, cheerful photos and a positive article about an LGBT festival around Valentine’s Day with the headline: ‘The rainbow flag flies high in Shanghai’. China was rapidly progressing in the acceptance of homosexuality, at least in the academic world, but in the countryside, homosexuality is still a taboo. However, same-sex marriage is still not possible in China. Gay boys often return to their parents in the village with a female friend, pretending she is their future wife.
The lecture course in China
Although our brain research is primarily fundamentally oriented, research on the human brain always has a direct relationship with societal problems. With my former student Professor Ai-min Bao, we teach the course ‘Brain and Society’ at Zhejiang University. There, in 32 lecture hours (half based on discussions and presentations by student groups), we discuss topics that are still very controversial in Chinese society, such as:
– Sexual differentiation of the brain: transsexuality and homosexuality.
– The effects of environmental chemicals and medications on the brain development of the child in the womb. They are not cautious enough with medications during pregnancy in China.
– Brain and criminality in relation to prison and the death penalty in China. The development of the prefrontal cortex, important for establishing moral frameworks and inhibiting impulses, is not mature before the age of 23. That is why juvenile law in the Netherlands was raised to age 23 in 2014. That was the only time politics in the Netherlands listened to neuroscience.
– Depression and suicide. Due to the taboo surrounding brain diseases in China, the last thing people do is go to a psychiatrist for depression treatment, and the suicide rate is consequently three times higher than in the West.
– Brain diseases such as Alzheimer’s, Parkinson’s, autism, schizophrenia are discussed, along with the importance of brain banks for research into causes and therapies. Many psychiatric problems like borderline personality disorder, anxiety disorders and OCD ‘did not exist’ in China when I first came there in 1998, but now they are recognized and appear to be just as frequent as in the West.
– End-of-life issues, completed life, and euthanasia. Euthanasia is forbidden in China. Its introduction would be a major problem due to strong distrust of doctors by patients and their families.
– We also explain that during brain development, every brain becomes different. This even applies to the brains of conjoined twins, who have the same DNA and have experienced everything together since conception. This also means that communism is ultimately a utopia, because nobody is equal, while socialism will always remain a necessity. After all, due to the enormous complexity of brain development, there will always be unlucky individuals who need society’s care.
– The students also receive a list of Western films with neurology and psychiatry-related topics. They can easily find these films online because they know how to ‘climb over the (internet) wall’. They must choose a film themselves and then write a critique of it. Several of these have been published in the Zhejiang University journal.
In the West, people think that such a degree of academic freedom is impossible in China, but there is much interest in the course, and it is supported by the University administration.
