IDENTITY AND IDENTIFICATION

1. IDENTITY AND IDENTIFICATION Molo M., Cappai E.. - Cerne - Via della Rocca 24 bis – Turin - Italy - Contact: mtmolo@attglobal.net This study is about 50 GID clients coming to our private clinic over the last five years. The full spectrum of transgenderism is represented: they are biological male or female, 38 of them asking for surgery, 5 for hormonal therapy, 7 subjects wanting to clear a confused identity. Among them there are some similarities and some differences: They are “cured” in different ways: some undergo one session, during which we suggest a treatment center near their hometown; others require a six-month observation which usually results in the prescription of hormonal therapy; some are treated for a longer period of time, until they reach a congruent identity or they simply decide to interrupt the therapy; the remaining group undergo the regular two-year sessions with a final certification suggesting surgery. Of course their stories and the results of their psychological tests are different. SUBJECTS Of the 50 subjects examined, 31 are biological male (..%) and 19 are biological female (..%). They underwent an assessment about prenatal life, birth, physical and emotional health in childhood and adolescence, death in the family, traumas, relationship with parents, onset of cross behaviour and cross-dressing, denial of secondary sexual characteristics, sexual orientation and sex drive. METHODS We used the following psychological tests: Rorschach, Machover, M.M.P.I., B.S.R.I. These assessment data enable us to establish a differentiation of “core” transsexuals. Notes on psychological testing: a big problem arises. In fact transsexuals “seem to be free of significant psychopathology both on clinical interview and on objective test measures, but exhibit severe psychopathology on projective tests” (Lothstein). Rorschach and Machover are projective tests, the other two are self-evaluation questionnaires. Our choice enables us to evaluate rational and unconscious aspects of human personality. In our country Rorschach Test is used in every personality evaluation. Following Machover theory, the drawing of a human being is none other than the projection of one’s own body image, or rather the projection of one’s ego image. MMPI-R presents three scales about validity, one of these is the “k factor”: defensive attitude against psychological inquiry when its value is high. The most interesting scale for GID subjects is Mf scale, which shows that typical opposite sex behaviour is present when this value is >70. B.S.R.I. refers to personality characteristics considered to be typical of masculinity or femininity. Four results are possible: high masculinity (masculine), high femininity (feminine), high masculinity and high femininity (androgynous), low masculinity and low femininity (undifferentiated). Rorschach. Here we only considered table III (sexual identification), table IV (father figure), VI (sexuality), VII (mother figure). Machover. Succession of the two drawing, inverted or normal. M.M.P.I. Mf scale. B.R.S.I. Masculine, Feminine, Androgynous, Undifferentiated. First of all we considered the subjects presenting a confused identity: we did not find any common characteristic. Then we compared them with the ones asking for therapy (hormonal or surgery): the two groups did not differ significantly.Since the groups showed no significant differences, here we present our data about all the subjects. • RESULTS • Of 47 subjects, 47% (22) had prenatal or birth related problems, while 61% (29) suffered in childhood and 23% (11) in adolescence. • The father was violent in 21% (10) and absent in 29% (14); 3 subjects ( 6%) had problems with a dominant or violent mother. • A quarter was the last born child. 10 (21%) were the only children. 2 (4%) had a twin with GID. • Many spoke about a tendency to cross dressing since childhood (89%). Most of them discovered their GID before puberty (73%). All of them (33) except 1 did not accept their secondary sexual characteristics. • A large majority felt the sexual orientation towards people of the same biological sex (38/46), 5 are bisexual. A minority (5/26) experienced low sex drive. • Two important remarks: • These data are an actual reconstruction of past events, although not confirmed by valid proof. Moreover there may be a bias: subjects say what they think is more useful in convincing the experts that they are transsexuals suitable for the SRS: in childhood they played with toys of the opposite sex, they liked cross dressing, they felt at ease with children of the opposite sex, they were disturbed by the development of their secondary sex characteristics, and so on. • Only typical elements were found; no specific element was found. This means nothing is present in all the subjects. Only a specific element allows a true diagnosis and highlights a possible ethiology. • Psychological testing. • A thorough testing (all the tests for all the subjects) was impossible, but we have data about 36/46 subjects (78%). We examined 32 Rorschach protocols. Of these, 11 presented problems related to table III, 16 to table IV, 9 to table VI, 12 to table VII. B.R.S.I. was completed by 40 subjects, 24 male and 16 female. In the male group 8 resulted androgynous, 3 undifferentiated, 11 feminine and 2 masculine. In the female group 4 were androgynous, 5 undifferentiated, 3 feminine and 4 masculine. 46 subjects completed the M.M.P.I.-R protocol. 5 were at the threshold of validity, 9 could suggest a simulation. Of all the protocols 28 had the Mf scale >70 (normal value), 11 when we considered the valid protocols only. 21 had pathological values in other scales. There were 42 Machover drawings. Of these 38 had an inverted succession. Even regarding psychological testing we found typical aspects, but none of them were present in all the subjects. Two people did not refer any problem; they and their lives were completely normal. CONCLUSIONS In the light of our psychological testing nothing seems to specifically characterize GID people, even if some elements are typical. The same is true about their life experiences. In our opinion a more accurate analysis of identity development should be taken into consideration. Animal studies (with cautions) could be re-examined, for example the case of monkeys which, deprived of a contact with their “soft” mothers, show an atypical sexual behaviour, and only by living in groups recover their instincts. Without imprinting, is “imitation” required? Self identity begins as physical identity, mainly sensitive, accompanied by pleasure and satisfaction. From this the body image develops, where perceptions are connected to emotional and affective experiences, never fixed but evolving throughout their life. Many factors may interfere with a normal development, crucial ones are probably situated near the oedipical period, in which genital structures and their innervations mature. Fantasies accompanying the pre-genital period of life are important for a correct sexual identification. During the phallic-oedipical development the concept of a difference in gender identity emerges, which stabilizes in a permanent way at the end of adolescence. Is psychological testing useful? In our opinion, it is. Tests assess GID people’s ego-strengths and weaknesses; they suggest the potential for engaging in psychotherapy. Transsexuals reflect about their life experiences and acquire a deeper knowledge of themselves, abandoning the simplistic view of “I am a boy/girl trapped in a wrong body”. REFERENCES AMERICAN PSYCHIATRIC ASSOCIATION (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III). Washington D.C.: American Psychiatric Association. Trad. it.: DSM-III Manuale Diagnostico e Statistico dei Disturbi Mentali, Milano: Masson, 1983. AMERICAN PSYCHIATRIC ASSOCIATION (1994). Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). 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