Gender Identity Disorder
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Gender Identity Disorder: Understanding And Responding

James Phelan MSW Doctor of Psychology (clinical) Master social work, Board Certified Diplomate, Internationally Certified Alcohol & Drug Counselor 

He self describes as having Obsessive Compulsive Disorder and Attentions Deficit Disorder, and that his practice deals primarily with alcohol and other addictions. 

He is a psychotherapist associate to the American Psychoanalytic Association and Noble Health Affiliate to the national Association for the Advancement of Psychoanalysis.  

Ethical conflicts: The American Psychoanalytic Association code of ethics.  

Gay Lesbian Bisexual and Transgender Issues

The American Psychoanalytic Association opposes and deplores public or private discrimination against gays, lesbian, bisexual, and transgender individuals.

The Association’s component training institutes select candidates for training on the basis of their interest in psychoanalysis, talent, proper educational background, psychological integrity, analyzability and educability, not on the basis of sexual orientation.

Reparative Therapy

Same-gender sexual orientation cannot be assumed to represent a deficit in personality development or the expression of psychopathology.

Anti-homosexual bias negatively affects mental health, contributing to an enduring sense of stigma and pervasive self-criticism in people of same-gender sexual orientation through the internalization of such prejudice.

As in all psychoanalytic treatments, the goal of analysis with homosexual patients is understanding. Psychoanalytic technique does not encompass purposeful efforts to "convert" or "repair" an individual's sexual orientation. Such directed efforts are against fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized homophobic attitudes.

Down loaded 6/22/10 http://www.apsa.org/About_Psychoanalysis/Social_Issues.aspx  

National Association of Social Workers code of ethics

4.02 Discrimination

Social workers should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical disability.

4.03 Private Conduct

Social workers should not permit their private conduct to interfere with their ability to fulfill their professional responsibilities.

Downloaded 6/22/10 http://www.socialworkers.org/pubs/code/code.asp

These are in direct conflict with his Same Sex Attraction Notebook, Practical Exercises For Men In Recovery from Same Sex Attraction. 

The title of Jim's presentation was gender identity disorder, understanding and responding. In this case I am working from his PowerPoint presentation and my notes. 

What is GID,  “simply a confusion between the a persons actual physical gender and that to which they are actually identify", SS note the word confusion used in this instance. I have tried to find out where this use of “confusion” originates and have as yet been unsuccessful, my suspicion is that it comes from some place in the religious right. 

Jim then goes on to show what is in DSM-IV TR and also includes ICD 10 transsexualism description.   

 Psychoanalytic and other interpretations and under that he puts delusion (psychotic disorder), obsessive, and addictive behavior. 

Politics of Science under this he has “some professionals argue to provide hormonal therapy as harm reduction. Rather than treating the condition as pathological some argue that physical modifications bring the body into harmony with one's perceptions.  Presently the American psychiatric Association says that GID is a disorder if one is distressed or impaired by at.  Special rights groups argue that GID is a normal variance of gender and sexuality and the only change needed is societal acceptance. I will skip a couple of the bullet points here and skip down to A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment related procedures he then made a comment that Marci Bowers is making lots of money doing SRS supported by tax dollars and insurance. The final note here was, “LGBTI community, can subcultures unite under same pathological conditions (e.g. gangs terrorists etc)?”

SS: to my knowledge tax dollars are not being used to support SRS and most insurance companies do not yet include this benefit. 

Dr Paul McHugh  who shut down the Johns Hopkins gender identity clinic in 1979  Is quoted concerning a study done on findings from those who had undergone GRS/SRS.“ The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled (McHugh 2004)”   

SS Notes: McHugh is a noted Catholic conservative and argues that gender variance is essentially a lifestyle choice or an ideology that offering trans-health services is effectively collaborating in a patient's delusion he has described it as akin to giving liposuction to an anorexic person. 

The study was done by Jon K. Meyers abstracts of his work are at the end of this document. 

Onset

“The onset of GID takes place in early childhood however no evidence of genetics.”

SS: This was contradicted by David Maynard in his presentation, Is It My Fault. 

“Parents usually start to notice cross gender behaviors between ages seven and 11, however surfacing of these behaviors start much earlier.” SS: evidence is usually by age two to four. 

Family of origin

“out 20 cases of GID reported in the literature all occurring in the context of disturbed family functioning” SS: this came from a blog quote in Psychology Today 2009 no references are given and Psychology Today is not a peer-reviewed journal.  I have written to the author of the blog asking for her references. As of 7/1/2010 over a week since I wrote this as yet to receive a reply.  As a totally unsubstantiated blog entry I think you can attach the importance to it which it deserves. 

“As for transsexuals most come from homes where they did not receive affirmation from and identification with the same-sex parent.  Sometimes this is due to abuse or neglect.  This leads to self defense emotional detachment from and this identification with the same-sex parent.”  This is a quote from Jerry Leach, A Transgender Manual. Jerry has no qualifications and material concerning him is on Gender Tree.  

Outcomes of GID if not treated

Untreated GID can but not always lead to the adult sexual identification confusions:

Homosexuality (study show as high as three fourths)

 SS note: I have not been able to find the studies. And I have suspicions they came from Zucker et.al. a study done by Virginia Prince and Dr. Richard Doctor repeated twice over a 20 year span indicate that the incidence of homosexuality among transgender particularly cross-dressers is less than in the general population.

Transvestic fetishism (cross-dressing(CD)) (Note: there are some men who have cross-dressing behaviors not because they want to be women, but as a way to objectify the feminine without the emotional attachment). SS Note: in this case this is the only reference really given concerning crossdressing and he clearly has no understanding of what is involved. 

Consequences

Homosexuality: greater chance of disease, psychiatric instability, drug and alcohol problems, violence etc. source NARTH

Transsexual/gender reassignment:

Hormonal complications

Body trauma/risks

Appearance of an “unattractive fake looking woman” but then what about women that are less than attractive… SS note: he made a rather derogatory comment.

Psychiatric illness, notably personality, mood, disassociative and psychotic disorders. SS No big surprise when you're part of an oppressed minority.

Expense

Family turmoil

Early sexual exploration, unsupported by reference

Study by Zager found that 25% of young men with GID attempted suicide; 6% completed.  SS note: No argument with the numbers, and I will add that better than 30% of runaway throwaway kids are TLGB.  The consequences are as a result of culture, the culture of the religious right greatly exacerbates this whole situation. 

Early intervention

According to research (no reference was given) clinical intervention is necessary to prevent gender dysphoria because those of adulthood conditions are substantially associated with greater life-threatening high risks.  I found the “research” by Dr. George A. Reckers professor emeritus of neuropsychiatry and behavioral science and an ordained Southern Baptist minister recently caught with a rent boy.

Source document http://www.genesisce.org/docs/IdentityConfusion.pdf  

At this point I'm going to depart from his presentation and take out a couple of pertinent items and make comments. Jim appears to have adopted the theories put forth by Elizabeth Moberly, that the cause of gender brands is a result of a lack of bonding with the same-sex parent. And one piece of advice that he gives that I find very disturbing is that "opposite sex parents must be taught to distance themselves and affirm the other parents gender role model". 

Ministering to those with GID

Don’t excuse it.

Don't justify it.

Don't normalize it.

Don't compromise your religious convictions. 

Do:

Get to the root of the problem.

Help them process the hurts and be there with them in their pain.

Encourage them to take responsibility.

Teach them that it is not inborn, rather a choice. SS: again this is contradicted by David Maynard in his talk.

Teach them the effect this has on others

Reach out, encourage them.  Don't betrayed their trust.

Teach them that God loves them and can forgive and heal them just like he can anyone. SS: the difficulty is however that God does not have a problem with being transgender and it is entirely a culture problem.  

SS: Comments: only three of the listed fourteen sources are those that I could have used in writing a serious paper for school, and one of them is DSM IV TR.

The tone of voice when he was speaking in my opinion was judgmental and certainly lacked any apparent compassion.

It was also very apparent that he has very little familiarity with those that are transgender and I would question his competence (a serious charge). I will write him and offer to help him gain familiarity and competence with our community

 

Derogatis LR, Meyer JK, Vazquez N. A psychological profile of the transsexual. I. The male. J Nerv Ment Dis.   1978 Apr;166(4):234-54.

The present research introduced standardized psychological measurement into the clinical assessment of the male transsexual. Thirty-one males with a presenting complaint of gender dysphoria were carefully screened as to their correspondence with current nosological conceptions of transsexualism, and administered the Derogatis Sexual Functioning Inventory (DSFI) as part of their clinical psychometric work-up. The DSFI is an omnibus self-report scale providing measurement in the primary domains of sexual information, sexual experiences, sexual drive, sexual attitudes, psychological symptoms, affects, gender role definition, and sexual fantasy. Transsexual profiles were contrasted with those of a comparison group of 57 normal heterosexual males. Results of the comparisons revealed the transsexuals to show a significant decrement in accurate sexual information, and a marked reduction in the variety of sexual experiences they have been involved in. They also revealed a reduction in drive levels; however, this was qualified by which indicator of drive was used. Significant elevations in psychological symptoms and dysphoric affect were also noted, particularly of a depressive nature. Gender role definitions were markedly polarized in the feminine direction for male transsexuals, and their fantasy endorsements revealed some of the classic transsexual themes. The ability to develop this quantified and standardized psychological profile is viewed as an important step in accurately assessing the nature of these complex individuals, and developing a more accurate understanding of their condition.

After Joel Elkes was replaced by McHugh, Meyer was assigned to do a long-term follow-up study of 50 transsexuals who underwent SRS at Johns Hopkins.   Meyer's report,   issued in 1977 and published in 1979 (see below), claimed that SRS confers no objective advantage in terms of social rehabilitation for   transsexuals. Although the paper was widely criticized as flawed, it led to the October 1979 closing of the Johns Hopkins Gender Identity Clinic.

Meyer JK, Reter DJ. Sex reassignment. Follow-up. Arch Gen Psychiatry.   1979 Aug;36(9):1010-5.

Although medical interest in individuals adopting the dress and life-style of the opposite sex goes back to antiquity, surgical intervention is a product of the last 50 years. In the last 15 years, evaluation procedures and surgical techniques have been worked out. Extended evaluation, with a one- to two-year trial period prior to formal consideration of surgery, is accepted practice at reputable centers. Cosmetically satisfactory, and often functional, genitalia can be constructed. Less clear-cut however, are the characteristics of the applicants for sex reassignment, the natural history of the compulsion toward surgery, and surgery's long-term effects. The characteristics of 50 applicants for sex reassignment, both operated and unoperated, are reported in terms of such indices as job, education, marital, and domiciliary stability. Outcome are reviewed. The results of long-term follow up data are discussed in terms of the adjustments of operated and unoperated patients.

Below is another attempt by Meyer to theorize on all this, through the lens of psychoanalysis.

Meyer JK. The theory of gender identity disorders. J Am Psychoanal Assoc.   1982;30(2):381-418.

Experience with more than 500 patients over the last decade has led to the conclusion that the quest for sex reassignment is a symptomatic compromise formation serving defensive and expressive functions. The symptoms are the outgrowth of developmental trauma affecting body ego and archaic sense of self and caused by peculiar symbiotic and separation-individuation phase relationships. The child exists in the pathogenic (and reparative) maternal fantasy in order to repair her body image and to demonstrate the interconvertability of the sexes. Gender identity exists not as a primary phenomenon, but in a sense as a tertiary one. There is, no doubt, a tendency to gender-differentiate in a way concordant with biological endowment. Nevertheless, gender formation is seriously compromised by earlier psychological difficulty. Gender identity is a fundamental acquisition in the developing personality, but it is part of a hierarchical series beginning with archaic body ego, early body image, and primitive selfness, representing their extension into sexual and reproductive spheres. Gender identity consolidates during separation-individuation and gender pathology bears common features with other preoedipal syndromes. Transsexualism is closely linked to perversions, and the clinical syndromes may shade from one into another. However, what is kept at the symbolic level in the perversions must be made concrete in transsexualism. In this regard there is a close relation to psychosis. The clinical complaint of the transsexual is a condensation of remarkable proportions. When the transsexual says that he is a girl trapped in a man's body, he sincerely means what he says. As with other symptoms, however, it takes a long time before he begins to say what he means.

 

Last modified: 12/24/13