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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).
Gender Identification
and Sexual Orientation Among Genetic Females with Gender
-blended Self-perception in Childhood and Adolescence.
A. E.
Eyler, Kathryn
Wright
Abstract
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.
Self and gender: narcissistic
pathology and personality factors in gender dysphoric
patients. Preliminary results of a prospective study.
Uwe
Hartmann, Hinnerk
Becker,
Claudia Rueffer-Hesse
Abstract
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.
Introduction
The two intriguing concepts of self and gender are of
major importance for the field of gender dysphoria, but
at the same time both are complex and controversial. In
recent years, the clinical, etiological, and
psychopathological diversity of gender dysphoric patients
had to be increasingly recognized by professionals.
Looking at the remarkably different gender and
developmental backgrounds of individuals with gender
problems, many - including DSM-IV - have done away with
the term ‘transsexualism’ as a distinct
diagnostic category. This nosological shift, however,
should be accompanied by improvements in the precision of
differential diagnoses and clinical subtyping allowing a
better fine-tuning of clinical managment. Existing
approaches have mainly been restricted to gender and
sexual orientation variables whereas personality and
psychopathological factors associated with gender
disorders have rather been neglected.
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.
The Medicalization of Gender
Migration.
S.
Hirschauer
Abstract
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.
Legal aspects of
transsexualism in Brazilian law - a privat law approach -
C.
Lima Marques, E.
Ramos da Silva
Abstract
Is there a right to choose one’s 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.
A sex
difference in the human brain and its relation to
transsexuality.
J.-N. Zhou, M.A. Hofman, L.J.G. Gooren and D.F. Swaab
Abstract
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.
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