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Exploring Transsexualism

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This intriguing volume is a work by a French psychoanalyst with extensive experience of working with transsexuals. It is a useful addition to the debate on transsexualism and the definitions of sex and gender.

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10 Chapters

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1. Transsexualism: what’s new?

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It would seem that there have always been people, men and women, who reject their original sex and wish to live as members of the opposite sex. What is new is the term “transsexualism”, as is the offer that some physicians make to “reassign” a person’s sex. The way in which contemporary society comes to terms with the condition is new, as is the train of ideas it brings in its wake.

I. The word itself

It is an easy matter to put a date on the word itself. It developed in three stages.

Firstly, in 1923, Magnus Hirschfeld, a German sexologist, used it occasionally in the form seelischer Transsexualismus (transsexualism of the soul or mental transsexualism) when referring to the intersexed. Then, in 1949, D. O. Cauldwell wrote a paper with the title “Psycho-pathia transexualis” in which he described a case that we would nowadays call female-to-male transsexualism. Finally, in 1953, Harry Benjamin coined the word transsexualism, a term that in the space of ten years or so would establish itself as the correct designation for a highly specific condition, different from transvestism or eonism.

 

2. From the intersexed to transsexuals

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Though a new word may not have been coined as regards the intersexed, a new meaning was given to an old word thanks to their condition: “gender”.

I. John Money and the invention of gender

John Money was a psychologist in the world’s first paediatric endocrinology unit, set up by Lawson Wilkins at the famous Johns Hopkins Hospital in Baltimore. Children from all over the United States – and many from elsewhere – who presented intersexed conditions were seen in this unit.

These children may or may not manifest some degree of ambiguity as to their external genitalia, but they do possess a mixture of male and female characteristics such that it is difficult to know what sex should be attributed to them. Nowadays the problem is better understood than in the 1950s and we have new means of investigation at our disposal (karyotyping, improved hormonal measures, laparoscopy, etc.) that enable us, if not to give a simple answer, at least to frame the question in much more comprehensive terms.

From time to time in the past, the problem was discovered only at puberty, when sexual development did not follow the expected path as laid down by the child’s assigned sex.

 

3. The psychoanalyst and the transsexual

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Each transsexual is different from all others, even though their request for hormonal and surgical sex reassignment may be the same (or almost the same). This is a point that must never be forgotten, even if writing a short book on the subject means that we cannot enter into every detail. It is possible to search for and discover common factors in the way in which their minds work. But we have to pay close attention to the details of what transsexuals tell us; this may throw light on the particular path they have followed in life and perhaps even allow access to deeper levels of communication with them.

In the following paragraphs, I shall discuss first of all the case in which a transsexual consults, already convinced of the diagnosis and the consequent need for hormonal and surgical sex reassignment. The Resolution of the European Parliament voted on 12 September 1989 mentions the “psychiatric/psychotherapeutic differential diagnosis of transsexualism, by way of help with self-diagnosis”. Though some patients are uncertain and ask for help in order to have a better grasp of what may be involved, many have already decided on their self-diagnosis – so that to talk of “help with self-diagnosis” is in fact a euphemism.

 

4. Treatment

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Even though we may think that “sex change” is a mad response to a mad request, it does exist, and it is legal or even commonplace in some countries (although it does remain banned in others). Patients who really want such treatment will manage to find it. And, as Stoller writes [1968: 247]:

The general rule that applies to the treatment of the transsexual is that no matter what one does – including nothing – it will be wrong.

We are faced with a problem which defeats us; there is no correct solution.

I. Hormonal and surgical sex reassignment

Doctors are unquestionably in good faith when they think that, after a sex change, patients suffer less; they say that a new life is dawning for these patients even though they do not feel euphoria, even though there are still difficulties, and even though they will gradually have to realize that the media have been less than truthful – they are not wholly men or women in the same way as those born men or women are: they do nevertheless feel better and happier.

 

5. How the transsexual’s mind works

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One of the reasons that makes a psychotherapeutic approach with transsexuals so difficult has to do with the way their mind works. The type of functioning which I am about to describe is, to all intents and purposes, shared by all transsexuals in whom the identity component is a decisive factor.

I. On the defensive

“Transsexuals lie,” one of my fellow doctors tells me. In fact, they say what they imagine will force the doctor to agree to the transformation which they so much want to have.

One young woman, pleasant and forthcoming, spoke to me in a way that made me feel sympathetic towards her. She told me that it all went back to her childhood: she had always refused to wear skirts or dresses. Later, I met her mother who showed me some of the very few photographs which had survived the auto-da-fé of the family album which the patient had instigated when she took the decision to live as a man, towards the end of her adolescence, after a love affair had broken up: I could see an adolescent girl of about 15, with a pony-tail, wearing a Liberty print dress that she had sewn herself.

 

6. Masculinity and femininity

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It is time to address the fundamental issue concerning what masculinity and femininity really are. If we ask a transsexual, for whom the question of being acknowledged as a man or as a woman is of vital importance, what a man or a woman is, the answer we obtain will be remarkable for its sheer poverty. Transsexuals are not inclined to write essays on the topic, and often the answer will be a mere “It’s what I am” – whereas, for the observer, it is precisely what he or she is not … If they do elaborate on their answer, transsexuals fall back on the social stereotypes prevalent in their culture.

The distinction between the two dimensions male/female and masculine/feminine is very important, but is not always easy to express; it depends on the language that we use. In English, for example, there is no problem, just as the difference between “sex” and “gender” is easy to express.

I. Male or female

It was to some extent as a result of the invention of gender that it became obvious that the male/female dimension had to be differentiated from the masculine/feminine one. One’s sex is male or female – this is a biological matter – whereas one’s gender is masculine or feminine – a social and psychological matter, the psychological aspect being fundamentally influenced by social factors, with little heed for biology. The differences between male human beings and female human beings are universal; the same is not true of those between masculine and feminine.

 

7. The development of gender identity

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The intersexed (1.7% of the general population, 3% present genital ambiguity) and transsexual individuals (one in every 30 000 to 100 000, depending on the statistics quoted) form only a small proportion of the general population. We can, however, learn much about the development of gender identity by studying them.

I. In the other’s mind

Gender identity is usually considered to be a secondary phenomenon, developing in the context of the classic Oedipus complex between three and five years of age, or in the early genital phase (Roiphe and Galenson), i.e. in the second half of the second year of life. That may well involve the individual’s representation of what the difference between the sexes actually is, but not his or her feeling of gender identity, which develops earlier. The self is not neuter; it has gender.

A baby (though in some languages the word is grammatically neuter) is never neuter as far as the parents are concerned; and the latter strongly influence the infant’s growing awareness of what he or she is. For the parents, their baby began to have a specific gender in their Oedipal dreams as children and adolescents, then again during the mother’s pregnancy in their fantasies involving the forthcoming child. (According to Michel Soulé, learning of the baby’s sex by means of ultrasound scans is equivalent to a voluntary abortion of fantasy representation, but this is not in fact the case: knowledge of what the scans say does not interrupt fantasy activity. Some parents, however, prefer to remain in the dark and do not wish to be informed of the scan results on this particular point.) The baby is there, and must be either a boy or a girl, not something neuter. Whenever there is any doubt about which sex to attribute to the new-born, such that the doctors request that any decision be postponed until a later date, this is intolerable for the child’s parents. [See Anne-Marie Rajon’s remarkable article (1988).] The child must be given a name, and choosing a first name which could apply equally well to both sexes [Lee, for instance] does not answer the question asked by family and friends: “A boy or a girl?”. Cathecting the child’s sex determines a whole series of words, feelings, attitudes and behaviour. From the very beginning of life babies are treated differently according to whether they are girls or boys; much research still has to be done to highlight the actual details of this phenomenon. According to Lézine, Robin and Cortial [1975: 140]: “Any discrepancy between the infant’s own rhythm and the mother’s facilitating or restricting attitude seems to be more pronounced in the case of girls than in that of boys.”

 

8. Atesting time for us

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Transsexuals put us to the test. We cannot remain indifferent to their suffering; nor can we stay aloof as they challenge us with the question that means so much to them. We respond with our own subjectivity: to say that any one human being is a man or woman is initially a statement about surface criteria; conformity to social criteria which vary according to cultural patterns; deep-down psychological criteria which vary according to the expectations each of us has.

The various kinds of discourse that surround transsexuals are part of the diversity of the universe of discourse, in which, whatever our willingness to do so, we can never find common ground. We have no choice but to make a personal choice.

We have to hold on to reliable points of reference and, in spite of our compassion, we must not lose the “sex compass” – in other words, unqualified acknowledgement of the sexual difference (which constitutes one of the aspects of human finitude), the acceptance of that difference and the ability to make that “raw” biological fact meaningful in our life as human beings.

 

9. Conclusion

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In Chapter IV, I quoted Stoller [1968: 247]: “The general rule that applies to the treatment of the transsexual is that no matter what one does – including nothing – it will be wrong.” We are anyway downstream and not upstream from decisions which have already been taken as to the legality of sex-change surgery and of modification of civil status. Some pressure groups have succeeded in obtaining the support of European institutions, the accent being put on the respect of one’s right of privacy. Those countries which have so far resisted are now coming round: for example, the United Kingdom, which until recently did not allow any modification of one’s birth certificate, the argument having been that, since a birth certificate records an event which has already taken place, we cannot turn around and say that what has taken place has not in fact taken place. The result of that position was that transsexuals could never marry since, in Great Britain, marriage between two persons of the same biological sex is prohibited; on the other hand, the United Kingdom is very liberal when it comes to changing one’s name, modifications to civil status records, passports, etc.

 

10. References

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Beauvoir, S. de (1949). Le Deuxième Sexe. Paris : Gallimard. [The Second Sex. Translated and edited by Parshley, H. M., with an introduction by Crosland, M. New York, Alfred A. Knopf, 1993].

Benjamin, H. (1966). The Transsexual Phenomenon. New York: Julian Press.

Baudelot, C. and Establet, R. (1992). Allez les Filles! Paris: Le Seuil

Bradley, S.J., Oliver, G.D., Chernick, A.B. and Zucker, K.J. (1998). “Experiment of nurture: ablatio penis at 2 months, sex reassignment at 7 months, and a

psychosexual follow-up in young adulthood”. Pediatrics, 102, 1, July 1998.

Breton, J., Frohwirth, C., Pottiez, S. and Kindynis, S. (1985). Le transsexualisme. Étude nosographique et médico-légale. Paris: Masson.

Chiland, C. (1997). Changer de sexe. Paris: Odile Jacob. [Transsexualism: Illusion and Reality (translated by Philip Slotkin). London: Continuum; Sage, & Middletown, CT., USA: Weysleyan University Press, 2003.]

—(1999). Le sexe mène le monde. Paris: Calmann-Lévy.

—(2003). Robert Jesse Stoller. Paris: Presses Universitaires de France.

 

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