Question: What's the percentage of crossdressing that you find related to obsessive behavior? It seems from what I see on TV that Prozac changes such behavior in a broad way.
To the best of my knowledge, I do. I've worked with a number of people who have had surgery over the years and they have reported to me what their experience has been1 and what I do is relate that information, and tell all the horror stories that I am aware of. I also advise people to talk with an endocrinologist who has had experience with postoperative clients, because such a medical doctor can make observations more objective than mine, which are anecdotal.
The problem you run into outside of therapy is that when transgender people get together in a group and talk about their surgeries and their vaginas, they tend to make it sound better than it really is. It tends to sound a lot better than what someone might say to me in individual therapy. But on the whole, the majority of people I have worked with who have gone ahead and had reassignment surgery do not regret it and feel that it is much better than their previous experience.
Question: In your practice, do you find a psychic difference between transsexual s and transvestite; do they dream differently? Yes. In terms of themes. It's very helpful in terms of assessment to look at what the themes are in your dreams. person who starts out as a crossdresser and becomes a transsexual develops changes in her dreams and begins to dream like a transsexual.
Question: What is a typical transsexual dream? I can't say that there's a typical transsexual dream in terms of content. One difference is, transsexuals as a group tend to dream of themselves as women; crossdressers tend to dream of themselves crossdressed. There is a real difference in terms of who is the dreamer, what is the ego state of the dreamer.
Often a transsexual will dream of herself going back in time, but in the past they are a little girl. For a transsexual, the dreamer is usually female. For the transvestite, there are a lot a dreams about risk taking and escaping with a strong sense of being crossdressed, and also dreams of themselves as hurt little boys. That's the main difference, but there are others.
Question: What's the percentage of crossdressing that you find related to obsessive behavior? It seems from what I see on TV that Prozac changes such behavior in a broad way.
I don't know yet. My friends in Minneapolis who are doing the research on that are going to be presenting their findings in November, and that is one of the questions I have too. The researchers are wonderful people and have worked extensively with this community, and they were saying that the last thing they wanted to do was take away any part of anyone's identity. They started with a small group of people who said they were obsessing all the time, and what they found was a tremendous sense of relief for most people.
Because in the gender community people talk to each other, they began getting more and more people showing up wanting it, and many of them began completely letting go of crossdressing. Now this is- brand new research. Joe over here is a psychiatrist to whom I have referred some people that he has put on Prozac. In some it doesn't affect the gender dysphoria at all, and in others it does. We only have 5, so I don't have a large statistical sample, and I am very interested in finding out the results of such studies myself.
Question: You made an extreme distinction between a transsexual and a transvestite in that a transsexual feels herself a girl and a transvestite just dresses up as an escape.
No, no, no. If I gave the impression that transsexuals and transvestites are very different, I was not trying to do that. At each end of the continuum, and there's not exactly a continuum but ignoring the sissy boys for a moment, the people at the ends are very, very different, but most people are in the middle. There is a tremendous amount of crossing over, and of ambiguity in classification. But if I'm asked specifically a question, about differences I see in dreams for instance, then I'll be thinking of the extremes at the ends.
Question: What specifically is gender dysphoria?
Gender dysphoria was a term that Norman Fisk came up with in the late 70s I believe, trying to come up with a generic term which applied to everyone who had some kind of gender discomfort or confusion. t that time, he did not mean to include in it crossdressers who had no transsexual fantasies. However, the term is often used in this community for everybody, and when I use it, I am talking generically about some kind of gender identity concern. In the literature, though, you may find it only to refer to people who are either transsexuals or transgenderists.
Question: How many crossdressers involved in relationships go further into transgenderism?
That is an excellent question. I don't know. I am the wrong person to as I' because I see a disproportionate share of those. I think a good way to find out would be to do a research project with this community.
Question: Now that women's roles are greatly expanded, and most women today don't fit the old stereotype, has there been a comparable change in the way transsexuals see themselves, or do they still tend to perpetuate the old stereotypes? Another good question. There has indeed been a change in the population I see. In general, transsexuals seem to be changing in their perception of themselves at about the same rate as women in general in the society. People are no longer bound, as they used to be, by the same old stereotypes. There is much more diversity now, which I am very pleased to see.
Question: When I first came to you, I couldn't have called myself a transsexual because I wasn't contemplating surgery. I think categories are harmful . For me it wasn't a question of defining myself in a category, but of finding a way of living that brought a sense of wholeness. My experience is that one becomes a transsexual when one starts experiencing life as a woman.
I agree with you in that regard. Trying to simplify, it helps to look at three types because the therapeutic issues are different, but what actually happens, as you know, when you come in, is you are not spending time in categories, but trying to decide how you want to live and what is best for you. It is highly individualized. Still, treatment tends to run according to type, and categories are still useful, especially academically. And for insurance purposes, to get psychotherapy paid for, I have to label you, and everyone else who walks through my office.
Question: When I began, I had no sense of options of how I want to live; I felt I was stuck with a diagnosis. I never hear people say, "I am living as a transsexual because for me it is the best way to resolve my life issues. Instead, they define themselves as being born into a category without choice.
The only solution I have is in therapy. I am just working with whomever is sitting in front of me, in an individualized way.
Question: I would like to hear people talk about these being resolutions to life situations rather than this is what you are, because one of the things I have noticed in the years I have done therapy is when you label somebody, frequently they become it.
That is true. I have felt that, not just about 'gender, but the whole DSM IIIR. I personally am a recovering alcoholic, and for a long time, wherever I went, my whole sense of who I was that, and I don't want to be just that, so your point is well taken.
Question: You were saying some people think they are transsexuals but they're really not and are merely using that to escape, but on the other hand, there are people who have been forced into the male role and primarily want to escape from that and they really should escape from that, so the whole thing gets very confusing. Might it not be more productive in each case simply to focus on where do you really want to go, rather than where you've been?
We do both. This is giving you an overview, but what happens in therapy, with me anyway, and hopefully with other people, is we are dealing with what's going on with you. We really are.
