E XT RE ME FE MININIT Y IN BO YS 58

Sex and Gender

VOLUME II
THE TRANSSEXUAL EXPERIMENT

Robert J. Stoller, M.D.

Professor of Psychiatry
DEPARTMENT OF PSYCHIATRY,
SCHOOL OF MEDICINE
UNIVERSITY OF CALIFORNIA AT LOS ANGELES

JASON ARONSON
New York
 CONTENTS

Acknowledgements page vii

Introduction
1
Part I
THE HYPOTHESIS

1 Bisexuality: The ‘Bedrock’ of Masculinity and Femininity 7

2 Extreme Femininity in boys: The Creation of Illusion 19
3 The Transsexual Boy: Mother’s Feminized Phallus 38
4 Parental Influences in Male Transsexualism: Data 56
5 The Bisexual Identity of Transsexuals 74
6 The Oedipal Situation in Male Transsexualism 94
7 * The Psychopath Quality in Male Transsexuals 109

Part II
TESTS
8 The Male Transsexual as ‘Experiment’ 117
9 Tests 126
10 The Pre-Natal Hormone Theory of Transsexualism 134
11 The Term‘Transvestism’ 142
12 Transsexualism and Homosexuality 159
13 Transsexualism and Transvestism 170
14 Identical Twins 182
15 Two Male Transsexuals in One Family 187
16 The Thirteenth Case 193
17 Shaping 203
18 Etiological Factors in Female Transsexualism: A First Approximation 223

Part III
PROBLEMS
19 Male Transsexualism: Uneasiness 247
20 Follow-Up 257
21 Problems in Treatment 272
22 Conclusions: Masculinity in Males 281
References 298
Index 313
 Part I
THE HYPOTHESIS
 7

THE PSYCHOPATH QUALITY

IN MALE TRANSSEXUALS

Most people who work with adult male transsexuals have noticed that the
patients have a mild irresponsibility, apparently unmotivated by the
circumstances, and of no practical benefit. It is like the quality
pathognomonic in people diagnosed as psychopathic personality, though in
the case of the latter it is an outstanding feature of their personality and
functions to get them the good things in life to which they are not
considered entitled by others. In male transsexuals this behavior is benign
and does not lead to hedonistic criminal behavior. It takes instead the
gentle form of lightness in their sense of commitment to us as their
therapists or providers. It is perhaps most manifest in their practical
arrangements about appointments with us. As often as not, patients either
fail to keep their first appointment or come quite late,* after pleading by
letter or phone that they be evaluated instantly. They are unconcerned
about the absence or lateness and seem not to sense the inconvenience or
to fear reprisal should we be irritated. Generally, this casual handling of
appointments continues as long as we know the patient, except during the
heated-up period when the patient is obviously motivated to display good
behavior in the hope of getting definitive treatment. Then, our contact ends
not with formalized agreement or with the more subtle variations on letting
go that one sees with patients in analysis or psychotherapy, but with the
patient simply not showing up one day for a scheduled appointment.
Whenever this happens, it is unexpected; as different from one’s other
patients, nothing had seemed to provoke it. It is not flight. Almost always,
there is no later phone call or letter within a sensible period of time

109

* In our research team, we practically consider the diagnosis of transsexualism made,

before ever having seen the patient, when ‘she’ fails to appear at the appointed time
for the first visit.
110 THE TRANSSEXUAL EXPERIMENT

explaining or excusing the not showing up, but rather weeks or months or
years later the patient will pick the contact up again without
embarrassment and rather as if no time had passed in the relationship
between the two of us.
The second quality is the lying, which seems childish, because it brings
no obvious benefit to the patient. (I am here quite specifically talking of
lying, not unconscious falsification; it is because it is lying that I am
always puzzled in its presence.) Since it has to do with past events, it has
aroused suspicion (1) that the whole past history these patients give is
untrue, but I have found this is not so. In regard to the major events in the
patients’ lives, their stories have held up against checking by each of their
parents, their siblings, and others outside of the families. The lying does
not usually concern their gender disorder or establishing their rights to
change sex.* Instead, it will be on seemingly minor issues, such as where
one went to school, how long one lived in a neighborhood, or has one in
fact met the noted so and so. Not that other people do not lie about such
inconsequential matters; what strikes me is that the behavior starts so early
in the relationship with me and persists throughout, without change,
regardless of what is happening between us.
The third expression of this psychopathy is that these people do not have
lasting relationships with others. No matter how well they simulate a
lively, human exchange, one soon realizes this is either a glass-smooth
facade without fingerholds, or despite occasional experience with warmth,
one is surprised how easily the patients slip away—and not from fear due
to lack of trust or fear in anticipation of greater closeness. They may fall in
love with someone—who is to judge that—but the relationship is good for
weeks only.
These three manifestations take place usually in the absence of criminal
behavior† (except for the law-breaking necessary for

* Nowadays, this must be differentiated from the impenetrable fog of lies that
almost all males requesting ‘sex change’ manufacture from their television viewing
and reading in order to simulate the history and appearance of transsexualism closely
enough to convince the authorities.
† Always with the male transsexuals I have known, though there is a report that
contradicts this (2). I cannot judge, for the authors’ criteria for diagnosing
transsexualism are broader than mine.
 THE OEDIPAL SITUATION 111

passing from one sex to the other) or other manipulations aimed at

unscrupulous financial gain, fame, or harm to others.
The only ‘explanation’ I have heard was in the diagnosis game, which
goes something like this: anyone who would act like these people is either
psychotic or a psychopath (both terms used more pejoratively than
diagnostically). Those who say they are psychotic do so in belief that a
man must be crazy to say he is a woman. Those who prefer the psychopath
label point to the absence of clinical psychosis, the sexual aberration, the
insistence on the law-breaking behavior (i.e. trying to pass as a member of
the opposite sex), the lack of concern about the seriousness of one’s
personality disorder or demands upon decent society, and the flamboyant
behavior (in fact) in which many of those seeking ‘sex change’ indulge
(people whom I feel are not actually transsexuals). However, this explains
nothing and is actually based on inaccurate observations.
I suggest a different explanation, which stems from an odd quality
present in the transference (and thus difficult to experience unless one
works extensively with the patients psycho-therapeutically). What I sense
then is the unchangingness of the patients’ feelings toward me; the patient
likes me no more or less once she is familiar with me. This familiarity
occurs when she discovers I am not dangerous and can be helpful. Rather
early, these people come to trust us as much as they ever will. In analysis
and in other insight therapies, much of the work can be seen in the light of
testing trust (and changes as treatment moves): does the therapist
understand the patient’s feelings and motives; can the therapist be honest
with the patient; is the therapist frightened off by his discoveries about the
patient; etc., etc. In working out these problems, the transference is
displayed and the patient’s relationships with the past, especially parents,
illuminated. I have found no such struggle with male transsexuals I have
worked with extensively.
For years this has puzzled me; I did not even know how to ask my
question. Was it possible there was no transference, was the nature of the
transference hidden (the hiding itself a form of transference), was I failing
to delineate the form of the transference because of ineptness of technique
or flawed imaginativeness? All I had to go on was a bland, pleasant
relationship, inappropriate only in that I constantly felt there should have
112 THE TRANSSEXUAL EXPERIMENT

been more to it, if previous experience with other patients is a guide.

Knowing that the transference holds essential clues to the patient’s past, I
felt deprived, for these clues seemed not forthcoming.
But then, suddenly, it occurred to me that the information was already
there (an experience I have had over and over in searching to understand
transsexualism; my failure, once again, was in accepting and absorbing
what was observed). While still not in full command of the answers, I feel
that the following fits.
The thesis: the reason I could not detect a significant transference
relationship lies in the oedipal situation. We have seen that the transsexual
as infant and small boy is not treated as a separate person by his mother or
father. The case of his father is simple. This man gives no style or
dimension to his son, for he just is not firmly there and so at best is an
indistinct quality that suffuses the household rather than a person of
dimensions and presence. Certainly, this cannot be said for mother. But let
us look again at what we have found in the mother-infant symbiosis. We
have seen that the mothers cherish this marvelous creation of their body
and see their son as a long-awaited extension of their body. He is their
feminized phallus, and they hold him against themselves with all the
intensity generated by their desire that he be as one with them forever. But
they try not to let him escape; escape, a process which under other
circumstances has been called, more wholesomely, separation and
individuation, is necessary for masculinity. The problem for the
transsexual is that his mother does not accept him as a separate person.
She does not accept him as a person; he is her thing (as Khan has put it
[3]). Freud said that the superego is the heir to the oedipal conflict.
Although the transsexual learns guilt—his mother teaches right and wrong
and her son usually becomes an ordinary citizen in regard to law, customs,
and private politenesses to others—he has not engaged in an oedipal
conflict. And so he has not coveted a parent and risked the other parent’s
threats. As a result, there is none of the ‘tonus’ of character structure or
neurosis that struggle usually provides.
Articulating this eased the formerly indefinable feeling these patients
create in me with their bland non-commitment to our relationship. They
did not need us, the humans with whom
 THE OEDIPAL SITUATION 113

they talked; they simply needed us, the potential administrators and
manipulators of aspects of the real world they had to change. An intense,
prolonged tie to us was not possible, not because it was forbidden but
because, I fear, the potential does not exist within them.
This understood, other clinical data fell into place. In the transsexuals’
descriptions of their feelings for friends and lovers, there also was this
blandness (which appears after the first days of histrionic passion). Again
was seen the pseudo-relationship, wherein one gets things from people and
even imitates real relationships but with an emptiness in the core of their
being, felt by the patients, by those they knew, and by me. I feel that this
endless reaching toward people, which never culminates in the person
being seized and incorporated, is the result of an absence created by
mother’s inability to transmit, moment-by-moment throughout the years, a
feeling that her infant had a being of his own. Transsexuals’ descriptions of
their beloved and of their own loving emotions usually sound like
interviews of movie stars in fan magazines rather than one human talking
to another.
How odd it is that the adult transsexual usually looks so much more
feminine than ‘her’ mother (see last chapter). If that appearance sprang
simply from identification with mother it would not be so intense, so
sexualized. Most transsexuals have the great facade, like models and
beautiful actresses. In the early days of their passing, this is an exuberance
stemming from the new freedom to be like a woman, but later, when they
settle cozily into their role, they still sparkle busily. This does not come
from inner joy, of course, but as with women with hysterical personality, is
partly the result of constantly scanning the world with vigilant eyes to see
who is watching. That is not surprising in view of the way these mothers
used their infant more as a piece of their own anatomy than as a creature
who will have his own individuality.
This is not the defensive coldness one sees in the obsessive-compulsive
nor the frozen-fright state we call schizoid personality; the transsexual
does not stir inside one’s empathy the sensations those patients do. Being
with the transsexual in psychotherapy is usually—barring external
disasters—a benign, pleasant experience, a relationship that does not
114 THE TRANSSEXUAL EXPERIMENT

progress, that has no melody or rhythm, in which the patient demands little
from us as humans but rather from us as fixers and soothers. I enjoy them
when with them and do not miss them when they are gone. And that, more
or less, is how they feel about me. This lack of a firm transference
relationship may contribute strongly to there not being any transsexuals yet
psychoanalyzed.
This psychopathy is not present in female transsexuals I have known:
male and female transsexualism have different psychodynamics.

Chapter 7

1. Worden, F. G. and Marsh, J. T. (1955). ‘Psychological Factors in

Men Seeking Sex Transformation’. JAMA 157.
2. Hoenig, J., Kenna, J., and Youd, A. (1970). ‘Social and Economic
Aspects of Transsexualism’. Brit. J. Psychiat. 117.
3. Khan, M. M. R. Personal Communication.