Submitted as a requirement for the degree of 13C3C9CC312 PIIII,C3E3C31?1-ne of Brunel, The University of West London A C U 1N/ 'T I 1•1 G FOR -I- NUFL1 i SM James Bryan Tully 1987 A13 'T Ft A This study reports the systematic collection of accounts from 204 transsexual subjects, most of whom attended the Gender Identity Clinic at Charing Cross Hospital (Fulham). A review of the literature covers cross gender behaviour in other societies, recent biological, social and psychological studies on gendered and cross gendered behaviour, a medical history of transsexualism and 'sex reassignment surgery'. Psychological 'frames' for the study of cross gendered careers are derived from attributional theories, and symbolic interactionist approaches to the construction of sexual categories of behaviour and experience. The collection of accounts follows a methodology derived from Harr& and his associates' ethogenic approach to the study of social behaviour, and the principles of generating 'grounded (sociological) theory' propounded by Glaser and Strauss. There is a short statistical section on the population of research subjects as a whole. Transexuals' accounts, some 500 exerpts, are marshalled under nearly 200 headings and subheadings. These cover almost all areas of relevant life experience. The conclusions argue that there is a fundamental weakness in the imposition of psychiatric 'syndromes' on gender dysphoric phenomena. Rather, 'gender dysphoric careers' are proposed as fluctuating enterprises in the construction of meanings, some meanings being more fateful and workable than others. An attributional — 'imaginative involvement' model to account for transsexualism is explicated. The implications which can be drawn from this, for the way the management of these unfortunate people could be improved, completes the text. ACCOUNTING FOR TRANSSEXUALISM The Gender Identity Careers of over 200 men and women who have petitioned for surgical reassignment of their sexual identity. Bryan Tully CONTENTS Summary Introduction Acknowledgements vii Transsexual Rage and Despair ix Transsexual Rhetoric CHAPTER ONE : THE PROBLEM OF TRANSSEXUALISM 1 • HISTORICAL AND CROSS CULTURAL VARIATION AND MEANING OF CROSS GENDER EXPRESSION 2 • HISTORY OF THE DIAGNOSIS OF TRANSSEXUALISM 3 . DIFFICULTIES IN THE DIAGNOSTIC CLASSIFICATION OF TRANSSEXUALISM 4 DIFFICULTIES IN THE DIAGNOSTIC CLASSIFICATION OF CHILDREN EXHIBITING CROSS GENDER IDENTITY AND BEHAVIOUR 6 DIFFICULTIES OF DIAGNOSTIC CLASSIFICATION ASSOCIATED WITH PROGNOSIS AND THERAPEUTIC OUTCOME 8 . DIFFICULTIES OF DIAGNOSTIC CLASSIFICATION ASSOCIATED WITH PSYCHOLOGICAL THEORIES OF GENDER DEVELOPMENT AND SOCIALIZATION 10 DIFFICULTIES OF DIAGNOSTIC CLASSIFICATION ASSOCIATED WITH BIOLOGICAL DISPOSITIONS 13 )• 'IMAGINATIVE INVOLVEMENTS', ALTERNATIVE PERSONIFICATIONS, AND OTHER DISSOCIATIVE EXPERIENCES 15 , CONCLUSION AND THESIS TO BE EXAMINED 19 CHAPTER TWO : STUDYING ACCOUNTS; THE CHARING CROSS PROJECT 20 ACCOUNTS AS DATA 21 L. PRINCIPLES AND METHODS OF GATHERING ACCOUNTS IN THE CHARING CROSS PROJECT 23 - SUBJECT GROUPS AND INTERVIEWING SCHEDULE 25 7 JUDGING THE CREDIBILITY OF ACCOUNTS RENDERED 27 • STATISTICAL FINDINGS CONCERNING THE RESEARCH POPULATION 29 CHAPTER THREE: TRANSSEXUAL ACCOUNTS: CHILDHOOD AND ADOLESCENCE 34 I. CHILDHOOD NATURE 36 il.MALE TO FEMALE TRANSSEXUALS . Physical impairments and stuttering 36 .2. Physical appearances linked to gender 36 3 . Childhood fears 38 f . The introverted reader 40 5 • The child's sense of failure as a male 40 • Sexual aspects of childhood experiences 40 -7 • Atypical childhoods 42 e • Atypical, aggressive and disturbed childhoods 43 ..13 FEMALE TO MALE TRANSSEXUALS • Happy, independent childhoods 45 a • The constraints of gender socialization for females 47 .2 • Responses to a spoiled sense of self 48 CHILDHOOD BEHAVIOUR 50 MALE TO FEMALE TRANSSEXUALS . Childhood 'nervous timidity' 50 2 . Childhood transvestism 51 3 • Childhood sexual behaviour 52 . Disturbed behaviour 53 3 FEMALE TO MALE TRANSSEXUALS 1. • Tomboy behaviour 54 FAMILY LIFE 55 4 MALE TO FEMALE TRANSSEXUALS 1. • Family difficulties affecting childhood experience 55 . Extreme closeness to mother 56 3 . Father figures 57 J3 FEMALE TO MALE TRANSSEXUALS I . Family difficulties 58 4- CHILDHOOD GENDER IDENTITY 59 4 MALE TO FEMALE TRANSSEXUALS t . Original gender assignments accepted 60 • An early imaginative hope corrected by an appropriate cognitive exercise of gender constancy 60 3 . A quality of femininity 60 # • Being like a girl 61 5 . Desire to belong to the company of girls 61 4 . Feeling 'different' 61 -7 • Cross gender behaviour and interests without a crystallized cross gender identity 62 FEMALE TO MALE TRANSSEXUALS 62 6 ADOLESCENT NATURE 64 4 MALE TO FEMALE TRANSSEXUALS 1 • Cross dressing desire and homosexual orientation 64 • Adolescent effeminacy 64 3 • Defective appearanes and disabilities 65 4_ • The losing struggle for masculinity 66 • Undifferentiated anxieties of adolescence 67 13 FEMALE TO MALE TRANSSEXUALS / . The limitations of female socialization in adolescence 68 2 • Appearance 69 3 . The crisis of sexual feelings 70 CI . FEMALE TRANSHOMOSEXUALS 70 ADOLESCENT BEHAVIOUR 72 A MALE TO FEMALE TRANSSEXUALS I • Transvestism 72 .2 . Poor social relationships 72 3 • Sexual behaviour 73 4. Disturbed behaviour 74 3 . FEMALE TO MALE TRANSSEXUALS . Antagonism 75 2 • Disturbed behaviour 75 3 . Sexual behaviour 76 ADOLESCENT GENDER IDENTITY 77 A MALE TO FEMALE TRANSSEXUALS . Adolescent troubles 77 41 • Adolescent memories re-collected and revised 78 3 • Sexual desire, self image and gender identity 79 17 • Desire for normality 80 FEMALE TO MALE TRANSSEXUALS • Menarche, a watershed 81 . Lesbianism and transsexuality 81 CHAPTER FOUR: MANHOOD AND WOMANHOOD, DOUBTS AND DESTINIES 83 1 ADULT NATURE - APPEARANCE 84 / • Awareness of abnormalities 84 :.41. • Poor masculine appearance 85 a. ADULT NATURE - PERSONALITY PROBLEMS 86 3. ADULT NATURE - RELIGIOUS/SPIRITUAL 87 4: ADULT NATURE - PHYSICAL DISORDERS 89 5. ADULT NATURE - PSYCHIATRIC AND PSYCHOLOGICAL DISORDER 89 41. MALE TO FEMALE TRANSSEXUALS L . Neurotic anxiety and depression 90 . Psychopathic tendencies 92 . Multiple problems 93 4- . Psychoses 94 FEMALE TO MALE TRANSSEXUALS 95 DISSOCIATIVE EXPERIENCE 97 4 TRANSSEXUALS I . Gender role dissociation 97 • Imaginary companions and alternative personalities 100 :3 . Intensively vivid 'Imaginative Involvements' and 'psychic' experiences 101 . Amnestic barriers to early history 103 :5 . Identification with another person 104 C . Hypnosis and sense of gender 105 TRANSHOMOSEXUALS 105 7 MARRIAGE 110 A MALE TO FEMALE TRANSSEXUALS / . Compatible marital relationships 110 2 • Incompatible marital relationships 111 • Sexual problems in marriage 113 .8 FEMALE TO MALE TRANSSEXUALS 114 g CHILDREN 115 A MALE TO FEMALE TRANSSEXUALS . Adjusted children 116 2 . The underestimation of the impact of parental transsexualism on children 116 3 . Disturbed children 117 4- . Transsexuals' problems in relating to their children 118 3 FEMALE TO MALE TRANSSEXUALS Female transsexuals' own children 119 . Female transsexuals' partners children 120 CONSORT RELATIONSHIPS - PRE-ASSIGNMENT 121 A MALE TO FEMALE TRANSSEXUALS 124 • Glossing homosexual incongruities 121 . Fairy tale dreams about consorts 122 '3 • The best laid plans 123 FEMALE TO MALE TRANSSEXUALS 124 (0 CRIME 125 • Marginal life styles 126 . Legal problems 126 . Victims of crime 127 ft DRUG ABUSE 128 12 BELIEFS CONCERNING THE 'CAUSE' OF TRANSSGENDER FEELINGS 129 /.. Biological state causes 131 2 . Programmes or forces 132 . Strange happenings in the womb 133 4:- . Psychological influences 133 . The creation and dispensing of 'causes' 135 8 CONVERSION, CONVICTION AND COMPULSION, THE TRANSVESTAHOLIC ROAD TO SEX REASSIGNMENT 136 . The variety of early transvestite experience 137 2 • ' Transvestaholicism' 139 3 • The addictive model and 'craving' 140 . Renunciations 142 . Re-labelling transvestite behaviour 143 14- SEXUAL FANTASY AND BEHAVIOUR RELATED TO GENDER IDENTITY 146 A MALE TO FEMALE TRANSSEXUALS ( . Gender roles in sexual intercourse 146 2 . Homosexuality 148 3 . Aggression and vulgarity associated with masculinity 150 Sexual attraction to females 151 S . Bisexuality and the social function of the female role 152 6 • Non sexual relationships with females 153 • Androgynous roles 154 Z) • Other sexual deviations 155 • Sexual conflict 156 (C) • Imagination and the body 157 it • Lack of sexual desire 159 A FELE -rieftWs euLs / . The need to take an active and controlling role in sexual activity 160 Z. Lesbianism 162 3 . Experiments with men 165 'Abandonment' vs control 168 • Residual fears of male rejection 168 6 • Fear of rape and sexual aggression 169 -7 • Questionable feelings 170 • Lack of sexual desire 171 CI . MALE TRANSHOMOSEXUALS 171 32). FEMALE TRANSHOMOSEXUALS t • The rejection of hetrosexual males 174 2. • A female heterosexual transsexual or transsexual transhomosexual ? 175 ifT DISSOCIATIVE ASPECTS OF SEXUAL EXPERIENCE 176 4. MALE TO FEMALE TRANSSEXUALS . 176 (‘ ORGASMS 177 4. MALE TO FEMALE TRANSSEXUALS . Male orgasmic dysfunction 177 2. • Cross genderization of orgasmic experience 179 25 FEMALE TO MALE TRANSSEXUALS 181 C. MALE TRANSHOMOSEXUALS 181 17 SEXUAL PROBLEMS 182 /1 MALE TO FEMALE TRANSSEXUALS / . Impotence 182 2. • Hypersexuality 184 PROGRESSIVE TRANSGENDER IDENTITY DEVELOPMENTS 185 It MALE TO FEMALE TRANSSEXUALS ( . Surrender of attempts to meet expectations to function as a member of the male sex 186 2 • The resolution of conflict and confusion