Television (Review) / A change isn't always as good as a rest

THE UNSEEN focus of A Change of Sex (BBC 2) has been Julia Grant's psychiatrist, an offscreen personality of Dickensian force. When she first encountered him, she was a he, George Roberts, a young man seeking referral for a sex- change operation. That long, slow process was first documented by David Pearson in 1979, in films that have been repeated over the last two weeks. For the final programme, broadcast last night, he had returned to see whether the scars had healed.

While George was waiting for surgery, he was dependent on this invisible presence, forced to endure the experience of being treated like a naughty schoolboy. No wonder they're called patients, you thought, as he sat there biting his lip. It was difficult to know which was more irritating - the impertinence of some of the questions ('Are you some sort of local exhibit?' the psychiatrist asked, when Julia said she had got a job serving food in a club) or the cold punctiliousness about clinical procedure ('Your need is not paramount. What matters is that things should be done properly and medically'). What made this desk-side manner all the more dismaying was the feeling that all psychiatry is at something of a loss in the face of such inner compulsions: 'Do you really feel you're a woman?' he asked, as if a yes / no answer would somehow solve the puzzle.

Watching last night's programme, this man, if he's still around, might well have been congratulating himself on his caution. For though Julia insisted that she didn't regret having surgery, it was clear that it had caused as many problems as it solved. A few weeks after the operation she haemorrhaged badly and was treated in hospital by doctors unaware that they were dealing with a self-made woman. Their treatment, for a suspected miscarriage, damaged her still further, and effectively made sex impossible. Hormone deficiencies have taken four inches off her height. Fifteen years on - after alcoholism, bankruptcy and personal humiliation - she has little in her life but intense work, a labour of lovelessness.

Her greatest bitterness, though, is still reserved for that psychiatrist. She now knows what many post-operative transsexuals know - that unhappiness and alienation aren't located in the genitals, and can't simply be snipped away with a scalpel. But, in her case at least, it seems likely that that knowledge wouldn't have changed her decision, only her expectations. And if she had been more confident and aware when the original surgery went wrong, she might have gone back to her surgeon rather than scarring over in silence. Enquiring about corrective surgery now, she nervously asks whether she would need a psychiatric reference first - the memories of those painful interviews clearly just as vivid as the pain of surgery.

Shortly after Tim Curry had been camping it up as a demonic clown, in the horror movie It, you got the real thing in To Catch a Killer (BBC 1), a nasty shudder of coincidence for dedicated couch- potatoes. Unless something spooky is going on, I assume that Stephen King got the idea for his monster from the fact that John Wayne Gacy, a serial killer of teenage boys, occasionally dressed up as a clown to entertain children. It certainly made for a memorable scene in this real- life drama, which centred less on the murders than on the attempt to make a case against a man who was a pillar of the local business community. Taunting the detective who is trailing him, Gacy, in full motley, re-enacts part of his crime as if it was an innocuous magic trick. I confess I was gripped, but I couldn't help wondering what this adept piece of story- telling might look like to the parents who know the ending already.