Transcript Gender Identity Dysphoria: Diagnosis or Self-Diagnosis? Gendercare Gender Clinic Wal Torres,MS,PhD Copyright 2001-2005 Gendercare English translation by Sonia John Gender Identity Disorders • According to Section F.64

Gender Identity Dysphoria:
Diagnosis or Self-Diagnosis?
Gendercare Gender Clinic
Wal Torres,MS,PhD
Copyright 2001-2005 Gendercare
English translation by Sonia John
Gender Identity Disorders
• According to Section F.64 of the ICD-10 of the WHO, the following
gender identity disorders (GIDs) are classified as health problems:
• *Transsexualism (F.64.0 and F.64.2)
• *Crossdressing (F.64.1)
• *Transgenderism (F.64.8), which is included under gender identity
disorders not otherwise specified (GIDNOS)
• It is important to note that gender identity disorders have nothing to do
with the issue of sexual orientation, and that gender dysphoric persons
may be heterosexual, homosexual, or bisexual.
• Although gender identity disorders are recognized as health problems,
the choice of sexual orientation--whether heterosexual, homosexual or
bisexual—is in no way a health problem because it is simply a matter
of taste.
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WHO-World Health Organization, from UN.
ICD-10 – 10th edition of the International Code of Desiases.
What Is Gender Therapy?
• *It includes the diagnosis of gender identity disorders (GID and
GIDNOS) per Section F.64 of the ICD-10 of the WHO.
• *It includes the post-diagnosis treatment of these persons, which may
involve gender transition and hormone replacement therapy (HRT).
• *It includes psychological counseling for these persons during the
diagnosis and possible transition stages.
• *Transition can involve surgery to correct secondary sex
characteristics, including possible sex reassignment surgery (SRS) in
cases where it may be advisable.
• *It includes psychotherapy and sexual counseling after sexual
reassignment surgery.
• *It is equally beneficial in male-to-female (MtF) cases as in female-tomale (FtM) ones.
Diagnosis of both MtF and FtM
cases of Gender Identity
Dysphoria
SELF-DIAGNOSIS
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*Every person who has some form of GID, whether transsexual (F.64.0 or
F.64.2) or transgender (F.64.8), knows as a young child or as an adolescent that
he or she is different from other people, even if he or she does not know
exactly why or how. Many times these people confuse themselves with
homosexuals, because families and societies often mistakenly classify them in
that way.
*All of these people possess, for different reasons and in different situations,
an unexpected femininity (MtF) or masculinity (FtM). Even when they do not
openly reveal this to society, they are privately aware of it.
*The person with GID is intimately aware of being different, and knows that
the difference has to do with identity, particularly gender identity.
*In light of this awareness, the GID diagnosis involves an element of selfevaluation by the patient, a process that needs to be encouraged and properly
evaluated by the psychotherapist.
*The psychotherapist does not diagnose; he or she only stimulates the patient
to self-diagnose, and guides him or her in this process.
Diagnostic Tools
• *Two useful diagnostic tools are available to assist in the patient’s selfdiagnosis: the life history (anamnesis) and Gendercare tests of
unexpected femininity or masculinity.
• *The life history can be charted through face-to-face consultation, in
which the therapist identifies with the patient and leads him or her to
open up to reveal a complete history. The events in this history will
allow the therapist to understand the patient’s motivations and the
reasoning behind the self-diagnosis, so that the therapist will be able to
judge if the reasoning and self-diagnosis are or are not reasonable and
coherent.
• *A high-quality life history can be effectively obtained through
emailing, without the direct presence of the psychotherapist.We
suggest always email anamnesis for all MtF and FtM patients.
*The second diagnostic tool is the use of specific tests to evaluate the
presence and origin of an unexpected femininity or masculinity.
*Gendercare has developed the MFX and FMX tests expressly for this
purpose.
*The patient can take these tests either in person or online, which is
convenient and also minimizes the possibility of outside interference
with the results.
*These tests probe the various stages of the patient’s life, trying to
stimulate the patient’s memory, especially his or her self-view and
feelings during these life stages.
*In other words, these diagnostic tools lead the patient to a systematic and
objective self-diagnosis and reveal the developmental dynamic of his
or her unexpected femininity or masculinity.
• *With the results of the patient’s life history and the test of
unexpected gender expression in hand, the therapist will be
able to verify how the patient expresses himself/herself and
how in reality he or she identifies.
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• *When a gender identity disorder exists, it will be possible
to verify how the patient self-diagnoses.
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• *The patient’s self-diagnosis must always be respected by
the therapist. The therapist’s function is to clarify the selfdiagnosis for the patient, especially to show him or her at
certain key moments (such as when deciding between the
choices of transsexualism and transgenderism, or between
crossdressing and transgenderism) the pros and the cons of
each option, in order to help the patient self-diagnose and
deal with the eventual life adjustments that are required.
Trauma
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*As we already mentioned in other presentations, the great majority
of cases of crossdressing and transgenderism originate from trauma,
as do some cases of transsexualism.
*In the life history we can detect the presence or absence of trauma
based on:
a) Maternal rejection
b) Paternal violence (physical or sexual)
c) Family violence (by the father against the mother and/or
siblings)
d) Later sexual abuse (father, siblings, cousins, friends, etc.)
e) Miscellaneous
*In the test of unexpected gender identity, trauma is usually
indicated by a lack of structure and stability throughout the patient’s
lifetime.
Biological Etiology
• *The majority of cases of transsexualism have a biological etiology,
determined by genetic and endocrinological factors, often aggravated
by the emotional state of the mother during pregnancy.
• *These conditions always result in cases of transsexualism (but do not
result in crossdressing or transgenderism), but do not cause subsequent
psychological problems like those that occur as the result of childhood
trauma. Consequently, a certain calmness and passivity is
characteristic of transsexuals.
• *Transgenderists differ in being more aggressive and possibly even
violent. This is the result of a long-standing and continual
aggressiveness which ultimately is expressed socially, and which is the
person’s sole defense mechanism.
• *A patient’s aggressive and defensive attitudes indicate prior trauma
and a more likely diagnosis of transgenderism than of transsexualism.
This is not an ironclad rule, but it is a high probability.
• *The life history and the tests of unexpected gender identity easily
permit differentiation between these types of cases.
The therapist’s diagnostic
capability
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*It’s ordinarily difficult for any therapist to remain aware that a diagnosis always arises
from the patient’s reality--never from the preconceived and theoretical ideas of the
analyst.
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*Therefore all GID analysts should always learn to identify with the patient. This is the
only way he or she can fully understand the diagnosis of GID in all of its nuances and
with all the varied forms GID expression may take.
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*The therapist should be adequately prepared to work with GID cases. A doctorate in
psychology or psychiatry (which is recommended by the HBIGDA) is not in itself
sufficient unless the therapist is also capable of identifying with the GID patient.
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*Even more questionable is the value of psychotherapy by analysts who have obtained
doctoral and master’s degrees by conducting theoretical “research” from outside the area
of patient-oriented (clinical) practice.
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*No one can effectively study a culture without being immersed in it for some time. In
order for a therapist to understand the self-diagnosis of GID patients, it’s indispensable
to have a strong initiatory experience as a GID person in a GID environment.
Learning with Ethnology
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*Consider the writing of Juana Elbein dos Santos, Ph.D., from her doctoral
dissertation in ethnology at the Sorbonne in the 1970’s:
*”The ethnologist, with rare exceptions, lacks background experience and does
not live sufficient time within the group, and so the majority of the time his or
her observations are imposed “from without” and are colored by his or her
own frame of reference; it’s rare that the ethnologist speaks the language of the
study subjects, and he or she often relies on information from study
participants who in turn speak the language of ethnology poorly.”
*In her dissertation, she goes on to say: “To be initiated, to learn the features
and values of a culture from the inside through a dynamic relationship within
the heart of the group, and at the same time to be able to derive from that
empirical reality a group’s organizing principles, dynamic meanings and their
symbolic relationships, in a conscious effort of abstraction as an outsider—this
is a highly ambitious undertaking against which the odds of success are
stacked.”
Initiatory Experience
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*Individuals with GID always live in a social and cultural existential ghetto
that results from the ignorance of society about who they are and why they are
like they are. Many are prostitutes who lead a sub-human existence. Trauma
abounds in their lives, beginning in their infancy, permeating their adolescence
and culminating in their adulthood.
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*What psychotherapeutic approach can best help alleviate such debilitating
stresses?
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*Regardless of the psychotherapist’s background, as an outsider it’s necessary
that he or she have “initiatory experience,” that is, have the radical and
prolonged experience of being at minimum a crossdresser, openly and
publicly, for a period of months or even years in his or her customary social
environment. This is the initiation we propose in order to meet Elbein dos
Santos’s requirements to establish the credentials of a psychotherapist coming
“from the outside.”
The Language
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*After the initiatory experience we are proposing, it will be easy for the
therapist to understand the language of GID.
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*Only after experiencing a profound real-life initiatory experience can a
psychotherapist “from the outside” understand the violence resulting from
post-traumatic stress disorder (PTSD), spontaneous weeping, loss of hope and
attempts at suicide.
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*In this way it will be possible through the language of GID to establish a
therapy regime based on identification with the patient, engaging in social and
psychological interchange, rather than employing pre-conceived theories from
the outside and analyzing patients as if they were laboratory animals.
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*The language of GID is the language of empathizing with another in his or
her desperation. It is also the language of identification with nature’s vital
forces, which the Egyptians in the time of the Pharaohs knew well how to tap.
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*Still, the best solution will always come “from the inside toward the outside,”
even though the opposite approach is not, strictly speaking, impossible.
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Conclusion
*To the psychologist or psychiatrist, the sexologist or other analyst of GID cases: do you
want to learn how to deal with these cases, but you are not personally gender dysphoric?
*1. Make yourself gender dysphoric—experience a real-life initiatory experience as a
crossdresser, publicly exposing yourself to the hostility of society for six months or a full
year.
*2. Learn the language of gender dysphoric suffering by suffering as a gender dysphoric
person does.
*3. Identify with your GID patients, using techniques of psychological identification.
*4. Learn how to work with them, and to make contact with their inner reality that you have
already personally experienced (even if to a lesser degree).
*Then, using a good life history and Gendercare’s MFX and FMX tests of unexpected gender
identity/ expression, a diagnosis will be easy and the treatment will be simple, and it will be
possible to anticipate a cure or at minimum a significant alleviation of the problem.
*But always remember: Transsexual GID generally has a biological etiology and involves a
discordance between the patient’s mental gender and his or her sexual organs, caused by
genetic and hormonal factors aggravated by the mother’s emotional state during pregnancy.
However, transgenderism and crossdressing almost always are the consequence of trauma.
And only the patient himself or herself knows the deepest truth about the possible roots of the
problem.
*Identify with the patient…help him or her to self-diagnose.
*Then, you will have made yourself a real gender therapist!
Bibliography
• Colapinto, J.—As Nature Made Him—Harper Collins,
2000 ;
• Elbein dos Santos, J --- Os Nagô e a Morte --- Editora
Vozes, 1975;
• Freitas, M.C. --- Meu Sexo Real --- Editora Vozes, 1998.
• The End