TRANSSEXUALISM

Transsexualism is characterized by the desire to belong to the sex opposite one's assigned, biological sex, and by the demand for a reassignment of one's sex with the help of hormones and surgery—all this in the absence of any biological anomaly that is detectable with current means of investigation. This distinguishes transsexualism from intersex states and pseudo-hermaphrodites. With transexualism, people speak of an unshakeable conviction of belonging to the other sex. It would be more appropriate to speak of an indomitable desire to live as a member of the other sex, as well as the desire to bear a corporal sign of this belonging, which is what makes transsexualism historically unique.

In 1953 the endocrinologist and sexologist Harry Benjamin was the first to name the syndrome that had previously been confused with transvestism. Perhaps he had retained the expression "Psychopathia transsexualis" used by D. O. Cauldwell in 1949, although he claimed he had no conscious memory of it, or "seelischer Transsexualismus" the expression used by Magnus Hirschfeld in 1923, although he makes no mention of it. It took more than ten years for the term transsexualism to become accepted.

In the same year, 1953, the Journal of the American Medical Association (JAMA) published the observations of C. Hamburger, G. K. Stürup, and E. Dahl-Iversen concerning the case of George, operated on in Denmark, who became Christine Jorgensen. Benjamin declared that psychotherapy was powerless to treat transsexualism and that the only possible treatment was sex conversion surgery along with hormone replacement therapy for life. A large number of specialized centers opened in the United States for treating the sexual identity disorders that Norman Fisk called "gender dysphoria" in 1973. However, some of those subsequently closed down.

Hormono-surgical sex reassignment hardly deserves to be called a treatment. A palliative at best, it consists in transforming a healthy, hormonally well-balanced, and functioning organism into an artificial intersex, a mutilated organism that requires hormone replacement therapy. In order to justify such an unusual treatment it would be necessary to prove that although they may be compromising their physical health, patients derive benefits from it in terms of their mental health. However, existing follow-up studies are incomplete and insufficient. Not all subjects continue to be seen. Those who are seen are generally satisfied. With few exceptions they do not regret their operation but they end up realizing that that their dearest wish, to really be changed into a human being of the opposite sex, has remained unrealizable.

Compared to female transsexuals becoming male, male transsexuals becoming female constitute a larger group (three biological males for every biological female demanding reassignment) that is more heterogeneous, suffers from more serious pathologies, and is characterized by very mediocre social integration (prostitution, public assistance). Many patients request sex reassignment after a period of their lives spent as transvestites or homosexuals. The most cautious physicians defending hormono-surgical sex reassignment make a point of identifying patients who essentially suffer from identity disorders, whom they refer to as true or primary transsexuals, which they consider to be the only indication for hormono-surgical sex reassignment.

An effort has been made to present primary transsexuals (male to female) as normal subjects who, by reversing their identity, inform their mothers of the truth of their primary identification (Robert Stoller). It is difficult to consider that transsexuals do not suffer from serious psychic disorders at the narcissistic level. Psychoanalysis has extended its field of application from the neuroses to borderline cases, and in this respect it may be possible to try to treat transsexuals. The difficulty is great because denial and splitting dominate the mental organization. They put everything on the corporal level and nothing on the psychic. The availability of medical hormono-surgical sex reassignment makes it more difficult to reach them through psychoanalytic psychotherapy. Interesting attempts have nevertheless been made, often by psychoanalysts from the school of self-psychology (particularly Lothstein).

Treatment of children suffering from sexual identity disorders shows promise if the parents are treated at the same time, and in this way observing how the children respond to their parents' problems by thinking that they should belong to the opposite sex in order to be loved by them.

Colette Chiland

See also: Gender identity; Masculine protest (individual psychology); Self-representation.

Bibliography

Benjamin, Harry. (1953). Transvestism and transsexualism international. Journal of Sexology, 7 (1), 12-14.

Chiland, Colette. (1997). Changer de sexe? Paris: Odile Jacob.

Stoller, Robert J. (1968). Sex and gender: On the development of masculinity and feminity. New York: Science House.

——. (1985). Observing the erotic imagination. New Haven, CT: Yale University Press.

Zucker, Kenneth J., and Bradley, Susan J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.

transsexualism (tranz-seks-yoo-ăl-izm) n. the condition of one who firmly believes that he (or she) belongs to the sex opposite to his (or her) biological gender. In adults gender reassignment surgery is sometimes justifiable, to make the externals of the body conform to the individual's view of himself (or herself).
—transsexual adj., n.