How Being a Transgender Person Causes Stress
The theory of transgender identity that my writing is based upon posits that transgender identity is the psychological manifestation of the brain’s sex differentiation. Even if scientific evidence continues to support a biological cause for what we know as gender diversity, whether a label of “medical”, “illness” or “syndrome” is attached to gender diversity is still determined by cultural beliefs of what constitutes illness. A biological basis for transgender identity development could in theory lead to a “medical” intervention. The availability of a medical intervention would raise questions about the ethics of such a treatment.
For example, see the work of the Netherlands group who in a recent study concluded, “The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder. Male-to-female transsexuals have female neuron numbers in a limbic nucleus.” Kruijver FP, Zhou JN, Pool CW, Hofman MA, Gooren LJ, Swaab DF. Journal of Clinical Endocrinology and Metabolism, 2000 May; 85(5): 2034-2041.
Mental health professionals typically define transgender identity in terms of a medical diagnose, Gender Identity Disorder, and medical concepts, such as “gender dysphoria” caused by the incongruence between gender identity (either feminine or masculine) and the sexed body (either male or female). For example, when an apparently biological male experiences a feminine gender identity. I posit that incongruence between gender identity and sexed body is not sufficient in itself to cause psychological distress.
I posit that psychological distress in the transgender person is caused by:
psychological suppression of gender identity expression motivated by fear of social subjugation, for example, a natal male with feminine gender identity suppresses expression of feminine appearance, behavior, and gender roles.
social subjugation of the transgender person by individuals and institutions, for example, a natal male who has transitioned into living as a female is addressed as “sir” by co-workers, is terminated from their job without just cause, or has no legal right to seek redress in the courts for unjust termination. Social subjugation of persons transgressing gender expression norms often leads to conflict between the instinctive desire to express one’s gender identity and the desire to avoid the pain of social subjugation.
The psychological distress caused by suppression of gender identity can be alleviated by:
expression of gender identity in the social world, for example, a natal male with feminine gender identity dresses in feminine attire, adopts feminine gender roles, and takes a regimen of medically supervised sex hormones to induce female secondary sex characteristics.
modification of gender identity through psychotherapy to conform to the natal sex, so that gender expression is in harmony with cultural gender expression expectations. This approach is based on a psychopathology model in which normal gender identity development has gone awry. There is insufficient psychological research to support that modification of gender identity is possible. However, efforts to modify transgender identity through psychoanalysis have been reported on sporadically. For example, see Colette Chiland’s article, The psychoanalyst and the transsexual patient, International Journal of Psychoanalysis, 2000 Feb; 81 (part 1): 21-35, and responses by Richard Ekins and M. Spritz, Responses to Colette Chiland’s ‘the psychoanalyst and the transsexual patient’, International Journal of Psychoanalysis, 2001 Apr; 82 (part 2): 389-390 and 390-391.
The way we personally experience our own gender identity is determined by our beliefs about gender conformity and transgression. Whether we express our gender identity authentically, even if doing so means transgressing culturally determined definitions of masculine and feminine, is determined in part by our vulnerability to social disharmony, stigmatization, and loss. For example, we may believe that for a man to dress or live as a woman is sinful lifestyle, a mental illness, a biological neurological anomaly, an expression of gender diversity, or a spiritual two-spirited calling. However, no matter what we believe about our gender identity, failing to express our felt gender identity causes inner disharmony.
Most people’s gender identity (i.e., the personal experience of one’s gender as male or female) is congruent with their gender expression. People whose gender expression instinctively conforms to the cultural expectations about gender expression based on natal sex live in harmony with cultural expectations for gender expression. However, those of us whose gender expression does not conform to the culture’s expectations about gender expression live in disharmony with cultural expectations for gender expression.
Transgression of the culture’s gender expression norms produces social disharmony, and social disharmony produces stress for the gender transgressor, the people in the gender transgressor’s life, and for the institutions within the culture.
Social disharmony causes strain on the transgender person, and this strain may result in physical problems (e.g., headaches, gastrointestinal upset) and psychological problems (e.g., shame, depression, anxiety). Strain produces an effort to reduce the strain . The transgender person may attempt to reduce the social disharmony by suppressing transgressive gender expression, but at the expense of increasing inner disharmony.
The transgender person attempts to express his or her felt gender identity in the social world as do non-transgender people do. The reason for this is that gender is a relational phenomenon that orders social relations. The health and well-being of transgender people suffers great harm by attitudes of intolerance and hatred toward diverse gender expression. The reason that the incidence of depression is higher in TG persons and in TG adults than in TG youth is because of being stuck between inner disharmony and outer disharmony. The real hope for transgender persons and all who express their gender in diverse ways is in a more enlightened, tolerant, and compassionate society. It is through facing outer social disharmony, coming out, and social and political activism, that we can evolve into a more just society, but we need a vision, and must have faith.