The Tempest Over Sex Identity*
(revised 9/03)
By Lisa M. Hartley, ACSW-DCSW


In Conclusion:

It is a profound human tragedy that the transgendered person is consistently viewed as the dysphoric one--the one with the problem. The research seems clear that transgender is a physical incongruity of sex identity where the brain, now seen as the origination of sex identity, is not matched by the genitals. This biological fact continues to be ignored, resulting in an the ongoing error of sex identity designation that is genitally based. The primordial error is then compounded by cultural socialization that relentlessly pressures the transgender person to conform to gender roles that are not congruent to the person’s true sex identity. The induction of stress, that I call CIS, needs to be identified as a predominant exacerbating factor in the internal and external suffering of transgendered persons. The stark reality is that the culture itself commits a serious crime against the true and courageous spirit of the transgendered person, who is only trying to correct a tragic mistake of a wrong birth sex identity designation, and a wrong gender socialization. In the final analysis, it is the culture that suffers from dysphoria, in that it refuses to understand and accept the transgendered person. It seems to me, then, that the culture must stop the wounding of transgendered persons, resolve their dysphoria, and reach out to assist them medically, legally, in housing and employment, and in the process of public policy making. Along with the cultural institutions, everyone in the culture needs to reach out with acceptance and compassion toward transgendered people. Then, a tragic mistake would be corrected.

The Process of Becoming—A General Overview of the Transgender Journey

Stage One: In the Beginning, there was a Catastrophic Mistake

Infant given biological sex identity designation by observation of the external genitals. Stereotypical gender specific reactions by medical staff and parents occurs immediately.

Infant with ambiguous genitalia (intersexed) may be surgically assigned a sex identity.

Birth records are completed including the sex identity designation and the name of the child.

Stage Two: Primary Socialization

Parents and family celebrate the child’s arrival

Formal announcements are made in the newspaper and elsewhere.

Intense Socialization in gender role expectations begins immediately.

Stage Three: The “Awakening”*----the sex identity quandary is realized---

The child awakens to a feeling of being “different” or of not “feeling comfortable”
with expectations. (*I thank Dr. Randi Ettner for this term)

Stage Four: The Internal Struggle to Understand (Internal CIS)

*This stage will take as long as the person needs in order to identify and
resolve the sex identity incongruity. For some, it will take several years. For others,
several decades. Common elements seen throughout the internal CIS struggle include:

Fascination with the opposite sex and gender roles.

Cross-dress openly or in secret discreet settings.

Continuous struggle with shame, guilt, fear and low self-esteem.

The purge/purchase phenomenon.

Some developmental issues that may occur include:

The child begins to struggle with the need to conform to outside expectations versus the
need to explore and understand the internal true sex identity.

As the child interacts with others inside and outside the home, there are often experiences
of being a victim of bullying and other types of social wounding by others that
exacerbates an already low self-esteem.

Use of magical thinking and fantasy in daydreaming and play to “experience” the gender role
that is congruent to the true sex identity.

The important process of homeostasis.

Awareness of the social consequences of the desire to “change” results in suppression of
desire, fear, guilt, shame, diminished self-esteem, and feelings of futility.

Decision to:

Carry on as the world has assigned her/him to be, OR

Demand assistance in sex/gender “change,” OR

Act out the inner conflict by:

Anti-social behavior,
Exhibiting emotional disturbance,
Developing addictions to escape the stress,
Other (e.g. become withdrawn, chronically depressed, or compliant in a passive aggressive way).

Continued relentless internal struggle compels the person to seek:

Information, AND/OR
Connection with the “community,” AND/OR
Psychotherapy, OR
An escape from the pain through drug/alcohol abuse, a “drop out” marginal lifestyle,
acting out behavior, which has social consequences, or, tragically through suicide.

Stage Five: The Victory---The conflict is resolved within and homeostasis (balance) is achieved!

Eventual resolution of the sex identity incongruity and acceptance of one’s true sex identity
brings profound inner peace and euphoric happiness.

Stage Six: “Coming Out*”---The formal Courageous fear-filled Step and the experience of External CIS

*Extremely stressful because, like everyone else, the primary internalized socialization that
transgendered people have learned placed a strong prohibition on “sex change.” Yet, the
fear of punishment is overruled by the power of the need for homeostasis, which relentlessly
compels the transgendered person to be their genuine self—to express their true sex identity.

Who must know:

Telling family.
Telling friends.
Telling the employer and employees.
Telling others that need to know.

Responses from others to our “coming out” include:

Shock

Attempts to stay “cool” to prevent sending the transgendered person into a “psychotic episode”
Supportive statements like, “Are you happy? Well. That’s all that counts!”
Seek out others to spread the word and to find comfort

Fear

Fear about what others might say (guilty by association)
Fear for the transgendered person’s safety
Fear of cultural pressures to “correct” the transgendered person
(enforce conformity to birth assignment of sex identity
The hope that this is only a phase that will go away

Anger

Why is this person putting us through this mess!!?
Attempts at forcing conformity
Expressions of caring laced with discontentment (e.g. using the wrong pronoun)
Development of “rumors” about the transgendered person
Experiencing emotional distress (e.g. depression or anxiety)
Outright rejection
Emotional and/ or physical abuse
Discrimination and hate crimes against the transgendered person

Estrangement and mourning

Feeling the loss of the “other” familiar person
Becoming detached from the transgendered person
Avoidance of contacts or interaction
Intimate relationships are seriously strained
Moving toward a decision about the future relationship with the transgendered person

Concern

Decision to terminate the relationship or to invest in saving the relationship with
the transgendered person
Sharing concerns and fears with the transgendered person
Beginnings of thought about the phenomenon of transgender

Need for information and support

Start to read information provided by the transgendered person
Seek information from other sources such as:

friends
church
legal resources
internet
therapist/psychiatrist
media (TV, radio, print media)

Achieving and integrating a true understanding of transgender

Achieved from integrating outside information and personal reflections
Decision to re-connect with the transgendered person despite the risks of cultural attitudes
and responses Transgender is no longer an “issue”

Re-acquaintance with the “new” person

Becoming accustomed to seeing the “other” person
Valuing the transgendered person

Acceptance and love

Gradual process toward meaningful acceptance
Integration of the transgendered person in everyday life

Advocate---Ally or a Supportive role

Join with the transgender community to achieve the goal of being fully integrated into all
aspects of the broader cultural life.

In a formal way, one may make a name change and complete changes in legal documents,
such as driver’s license, birth records, social security records, etc.

Stage Seven: Living with CIS---Making a Life

Adjusting to and rising above other people’s reactions,

Overcoming the stress of cultural isolation and marginalization,

Networking within the transgender community, OR

Finding a new life in as normal a way as possible apart from the “community,” OR

Becoming an advocate, an activist, or an educator/writer

Developing a normal competency and routine in the true sex identity and gender role, whether living full time
(transsexual) or part time (cross-dresser/transgenderists),

Developing new traditions in celebrating holidays, etc.

Dating and mating (what is your orientation?),

Setting goals and making a contribution or legacy for others,


Adjusting to life developmental stages, including aging gracefully,

Dealing with illnesses,

Planning one’s end of life care and burial,…and

Other…(because no list involving human beings can be exhaustive!)

*Copyright 2001 (revised 9/03) by Lisa M. Hartley, ACSW-DCSW---all rights reserved

[reprinted here with kind permission of the author]

REFERENCED BIBLIOGRAPHY

Zhou, J.-N., Hofman, M.A., Gooren, L.J., and Swaab, D.F., A Sex Difference in the Human Brain and it’s Relation to Transsexuality, Nature Magazine, #378: pp. 68-70, November 1995.

Kruijver, Frank P.M., Zhou, J.-N., Pool, Chris W., Hofman, Michel A., Gooren, Louis J.G., and Swaab, Dick, Male to Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus, The Journal of Clinical Endocrinology and Metabolism, Vol. 85, No 5, pp. 2034-2041, 2000.

Hendricks, Melissa, Into the Hands of Babes, Johns Hopkins Magazine, September 2000.

Chung, Wilson C.J, DeVries, Geert J., and Swaab, Dick F., Sexual Differentiation of the Bed Nucleus of the Stria Terminalis in Humans May Extend into Adulthood, The Journal of Neuroscience, February 1, 2002, 22,(3): 1027-1033.

Cannon, Walter B. The Wisdom of the Body, Second Edition, WW Norton, New York, 1939.

Wilchins, Riki Anne, et al, First National Survey of Transgender Violence, April 1997, GenderPac, 332 Bleecker Street, #K-86, New York, NY 10014-2980.

Ettner, Randi, Confessions of a Gender Defender: A Psychologists Reflections on Life Among the Transgendered, Chicago, Spectrum Press, 1996.

ADDITIONAL RECOMMENDED BIBLIOGRAPHY

--Colapinto, John, As Nature Made Him: The Boy Who was Raised as a Girl, HarperCollins publishing, 2000.

--Kotula, Dean, “A Conversation with Dr. Milton Diamond,” an internet document found at http://health.ftmaustralia.org/library/02/0100.html, created April 26, 2003, Revised May 3, 2003, Copyright 1999-2003, prepared by Craig Andrews for FTM Australia, all rights reserved.

--The Harry Benjamin International Gender Dysphoria Association, Inc., Standards of Care for Gender Identity Disorders, Sixth Version, February 2001.

--Moir, Ann and Jessel, David, Brain Sex: The Real Difference Between Men and Women, New York, Dell Publishing, 1991.

--Ettner, Randi, Gender Loving Care: A Guide to Counseling Gender Variant Clients, New York, WW Norton & Company, 1999.

--Bockting, W. and Coleman, E. editors, Gender Dysphoria: Interdisciplinary Approaches in Clinical Management, New York, Haworth Press, 1993.

--Denny, D., Gender Dysphoria: A Guide to Research, New York, Garland Publishing, 1994.

--Walworth, Janice, Transsexual Workers: An Employer’s Guide, Center for Gender Sanity, P.O. Box 10616, Westchester, California, 97296-0616, 1998.

--Feinberg, Leslie, Transgender Warriors, Boston, Beacon Press, 1996. 20.

--Bornstein, Kate, Gender Outlaw: On Men, Women and the Rest of Us, New York, Vintage Books, 1994.

--Bornstein, Kate, My Gender Workbook, New York, Routledge Press, 1998.

--Boenke, Mary, Our Trans Children, Washington, DC, PFLAG, 1998 (Booklet).

--Boenke, Mary, Transforming Our Families: Real Stories About Transgendered Loved Ones, Imperial Beach, California, Walter Trook Publishing, 1999.

--Stuart, Kim Elizabeth The Uninvited Dilemma, Metamorphous Press, P.O. Box 10616, Portland, Oregon, 97296-0616, 1991.

--Benjamin, Harry, The Transsexual Phenomenon, New York, Julian Press, 1966. Last reprinted in 1989 by the Outreach Institute and Renaissance. Can also be reviewed on the internet in the International Journal of Transgenderism, electronic books published by Symposion.

--Sullivan, Louis, From Female to Male, The Life of Jack Bee Garland, Alyson Publications, Inc. 1990.

--Brown, Mildred and Rounsley, Chloe Ann, True Selves: Understanding Transsexualism, San Francisco, Jossey-Bass Publishers, 1996.

--Kirk, Sheila and Martine Aliana Rothblatt, Medical, Legal and Workplace Issues for the Transsexual, Together Lifeworks, P.O. Box 93, Watertown, MA, 02272-0093, 1995.

--Devor, Holly, FTM: Female to Male Transsexuals in Society, Indiana University Press, 1997.

--Evelyn, Just, “Mom I Need To Be A Girl”, Imperial Beach, California, Walter Trook Publishing, 1998.

--Bohjalian, Chris, Trans-Sister Radio, (A novel), New York, Harmony Books, 2000.

--Morris, Jan Conundrum, New York, Henry Holt and Company, 1987.

-- Cossey, Caroline, My Story, Boston, Faber and Faber, 1991.

Web Site Information

www.ifge.org   (International Foundation for Gender Education)
www.ntac.org   (National Transgender Advocacy Coalition)
www.symposion.com/ijt/   (International Journal of Transgenderism)

The above websites have been helpful for me. One of the best starting points in getting to Transgender websites, and there are hundreds of them, is to use a drive engine. I use ‘YAHOO’—at the home page click on ‘Society and Culture’—when that page opens, click on gender—when that page opens click on ‘transgender.’ This will get you to many good sites from which more can be accessed, especially if you are in the mood to surf the net. Chat rooms are generally not the best areas for information. They are wonderfully supportive to many struggling with the many issues of transgender. Most find others who have ‘been there--done that.’ There are the usual pitfalls, e.g. Porn, which, in my opinion, shouldn’t be accessed anyway. I have found that the IFGE (International Foundation of Gender Education) website has access to a number of excellent websites.


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The Tempest Over Sex Identity*
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By Lisa M. Hartley, ACSW-DCSW
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