Research Information System
MOD.PERSPECT.PSYCHIAT., vol.No. 7, pp.447-467, 1976 (Scopus)
Two views of the treatment most appropriate for transsexuals appear in the psychiatric literature. The first, which does not regard transsexualism as a sexual perversion, favors surgery on the theory that the transsexual's core gender identity is nonconflictual. Since the male transsexual throughout his development has, typically, experienced neither castration anxiety nor masculine feelings, and dislikes his genitalia and the masculine appearance of his body, surgical alteration of the external genitalia and the modification of hormonal balance seem to offer logical answers to his need. Even some adherents of this view, however, advise caution in deciding upon sex change surgery. Intensive clinical work with 20 male and 5 female transsexuals and their responses to psychological testing nevertheless support a second view. This does not regard surgery as the answer for emotional illness. The desire of an individual to change his sex arises from factors present in other perversions. Having been unable to pass successfully through the symbiotic and separation individuation phases of early childhood, the transsexual is characterized by the same original anxiety that generates the other perversions. The male transsexual wants to unite with the 'good mother' only. He perceives the penis as a tool of aggression and, as Rorschach tests showed, the symbol of evil. The individual obsessed with the desire to have his penis removed is indicating his wish to avoid aggression. The female transsexual's defensive organization, like that of her male counterpart, resembles that of patients with borderline personality organization. Like male transsexuals, they see the surgeons as 'all good', and psychiatrists as 'all bad', or vice versa. The female transsexual longs for a penis not only in order to become a 'man' but also, on a more basic level, to become psychologically complete since she feels 'unwhole'. Rorschach productions of patients who had had surgery revealed masked depression. Although the splitting of their images and the splitting of their areas of experience also defended them against depressive feelings, the mending of such splitting forces them to face up to their anxiety and depressive feelings. For this reason, as well as because sex change surgery has become relatively easy to secure, the transsexual is usually reluctant to embark on the much needed psychotherapy, or, having embarked on it, to persist in it.