Volume I, Number 1, July - September 1997
Contributions to the Emerging Field of Transgender
This paper discusses the limitations for social scientists of the medical categories of transvestism, transsexualism and gender dysphoria. These categories presume pathology, limit our gaze to a narrow range of cross-dressing/sex-changing phenomena and hide from view the behavior of all except those who are seen as problematic, for example transvestites and transsexuals themselves. The concept of a process of blending gender is considered useful in that it allows a concern with those who - in the sense of mixing or combining, and in the sense of harmonizing - attempt to, or succeed in, blending various aspects of the culturally established components of gender, either in respect of themselves (e.g. transvestites, transsexuals) or in respect of others (e.g. medicine, the mass media).
The paper is divided into five parts and focuses on key areas in the emerging field of transgender studies: the experiences of those who cross-dress and change sex; the way in which these phenomena have been socially patterned over the past few decades; the significance of the medicalization of gender blending; the enormous popularity of gender blending in the mass media and the various debates concerning the political role of those who blend various aspects of gender.
Each part provides a summary of key aspects of earlier research and reports on current developments in the field. In each part, a shift is traced from the idea of blending genders in the sense of mixing together elements of some preexisting gender categories to the idea of living 'beyond gender' altogether. This shift is hardest to discern in the more conservative areas of medicalization and the mass media, and most obvious in the radical political and cultural literature.
|The status of the shift is, perhaps most problematic
in the areas of 'experiencing' gender blending and its
social organization. The paper concludes by summarizing
the usefulness of the term 'gender blending'. The
particular advantage of the term is that it enables a
polyvalent stance to be taken on the study of both those
who themselves gender blend, and those who blend the
gender of others. In particular, the concept of 'blending
genders' allows for a sensitive treatment of individuals
who are attempting to harmonize gender and it opens up
for inquiry the medical profession's attempt to do
likewise. "The naming or identifying of things is,
then, a continual problem, never really over and done
with." (Anselm Strauss, 1977: 25).
This paper demonstrates a revised gender scale which we have designed for use in clinical medicine. Our gender schema identifies a continuum of gender identification, and is designed for representation of the self, rather than being primarily relational. In addition, it accommodates ungendered and "other gendered" identities, and permits evolution of the self-perception over time. It is intended to be used in a primary medical care setting, by providing patients with blended identities or other gender concerns with a mechanism with which to discuss these issues with their treating physicians. Its clinical application will be illustrated through the histories of three prototypic individuals, all of whom are genetically female, but only one of whom presented to a gender program. The commonalities in childhood and adolescence among these three people, and their differing adult gender identities, will also be discussed. Currently, one has undergone sex reassignment and is now a man. The other two consider themselves genderblended, and have incorporated this identity into their adult lives. Our goal in presenting this paper is to encourage discussion of gender identity in general medical practice and to improve the medical care of patients with non-traditional gender identities.
This paper presents preliminary results concerning the relationship of self and gender in patients requesting or seriously considering sex change. Specific attention is paid to pathological features in regulatory processes of the self-system as well as on personality factors associated with different types of gender disorders. Based on the results of retrospective analyses a prospective study was designed to identify subtypes of gender dysphoric patients based on a scrupulous psychiatric and psychpathological evaluation. The evaluation procedure consists of (i) clinical interviews, (ii) a structural interview according to concepts of Kernberg, and (iii) a set of self-developed and standardized questionnaires. The results indicate significant psychopathological aspects and narcissistic dysregulation in a substantial proportion of patients. Different subtypes of self-(dys)regulation seem to emerge which are discussed with special reference to differential diagnosis and prognostic factors.
Based on the results of a retrospective analysis of all patients that have consulted our gender dysphoria team at the psychiatric outpatient clinic of Hannover Medical School during a one-year period, a prospective study was designed to identify subtypes of gender dysphoric patients by means of a scrupulous psychiatric and psychological evaluation (Becker & Hartmann 1994). This contribution will concentrate on pathological features in the regulation of the self-system and on some associated personality factors. A number of preliminary empirical results of the first 25 consecutive patients of our prospective study will be presented with a special focus on the results of the psychometric instruments we have employed. Since the number of 5 biological females is too small for statistical comparisons, the data presented here only refer to biological males.
Our preliminary results indicate significant psychopathological aspects and narcissistic dysregulation in most of our gender dysphoric patients. Among biological males different subtypes of self-(dys-) regulation and corresponding MMPI-profiles seem to emerge. Results of the narcissism inventory indicate that of the 4 main dimensions (the threatened self, the traditional narcissistic self, the ideal self, the hypochondriac self) scales covering aspects of the ,threatened self show the most significant deviations while a number of patients do not have a negative body-self. The implications of these results should be considered when thinking about differential diagnoses and prognostic factors.
This paper offers a sociological view of the medical treatment of transsexualism.
Based on a theoretical notion of sex/gender as a
social construction, it conceives of transsexuality as a
culturally specific case of gender migration,
characterized by the notion of a falsified body. The
paper asks how medicine is involved in the very
constitution of this phenomenon. Four aspects are
indicated: Medical practices shape gender migration into
transsexuality a) by turning it into a property of
individuals with a 'transsexual substance', b) by
devaluing earlier forms of gender migration, c) by
reducing gender oscillations to single events, and d) by
implanting a so called 'gender identity' into bodies.
Is there a right to choose ones own sex according to the Brazilian law? Is the Brazilian law system tolerant of medical interventions in sex reassignment? After these medical interventions is it then possible for the transsexuals to change their name and sex in the birth register? And can these people marry, or adopt a child?
These questions have not yet been given a clear answer in the legal writings and legislation in Brazil. Some evolutions over the past twenty years can be noted and will be examined in this paper, however they did not lead to a special legal regime about transsexualism. The Brazilian Constitution of 1988 assures equal treatment for all people, independently of sex, race, religion and age, and condemns all forms of discrimination (Art. 3, IV Constituição Federal). The Brazilian Constitutional Law guarantees a right to privacy and to a self image. Whether this constitutional approach could be used to assure legal rights to transsexuals after sex reassignment is not certain. The majority of authors agree with this influence of constitutional law in private law as source of new subjective rights. However this line of reasoning in transsexual matters has never been adopted by the Superior Courts.
This article examines these important issues with a private law approach. The two major areas to be examined are: firstly, the Brazilian legislation on this matter and, secondly, the practical effects and the case law. So in the first part we would like to present the actual legislation and case law de lege lata, by explaining its background and considering the extent of its application in Brazilian practice; in the second part we will expose some tendencies of change de lege ferenda.
Transsexuals have the strong feeling, often from childhood onwards, of having been born the wrong sex. The possible psychogenic or biological etiology of transsexuality has been the subject of debate for many years. Here we show that the volume of the central subdivision of the bed nucleus of the stria terminalis (BSTc), a brain area that is essential for sexual behaviour, is larger in men than in women. A female-sized BSTc was found in male-to-female transsexuals. The size of the BSTc was not influenced by sex hormones in adulthood and was independent of sexual orientation. Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones.