Transsexualism: Illusion and Reality
Publication Year: 2004
"Transsexualism is a stimulating, proactive and important book. Colette Chiland does not back away from difficult issues. She forces all of us to look at our assumptions about transsexualism and to re-examine what gender and sex really mean" - Christine Ware, author of Where Id Was: Challenging Normalization in Psychoanalysis
"In a nutshell, the book offers a much-needed alternative view of transsexuality from a psychiatric and European point of view… Chiland's interesting and well presented book is a valued reminder of how different the same topic can appear in an alternative perspective" - Transgender Tapestry
Colette Chiland exhibits a masterful and encyclopedic knowledge of transsexualism, drawing together the insights of depth psychology, psychoanalysis, history, anthropology and sociology for rethinking transsexualism in terms of identity, subjectivity and the ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Sex
- Chapter 2: Transsexualism, or Requesting a Sex Change
- Chapter 3: Changing Sex at other Times and in other Places
- Chapter 4: The Essence of the Masculine and of the Feminine
- Chapter 5: Children Who Reject Their Sex
- Chapter 6: The Unbearable Bodily Changes of Puberty
- Chapter 7: Men Who Request a Sex Change
- Chapter 8: Women Who Request a Sex Change
- Chapter 9: After the Sex ‘Change’
- Chapter 10: Change of Civil Status
- Chapter 11: Changing What People Have in Their Minds
- Chapter 12: Conclusion: Our Culture and Transsexualism
Disseminations: Psychoanalysis in Contexts[Page ii]Series Editor: Anthony Molino
Reason and Unreason: Psychoanalysis, Science and Politics by Michael Rustin
The Vitality of Objects: Exploring the Work of Christopher Bollas edited by Joseph Scalia
Dreams and Drama: Psychoanalytic Criticism, Creativity and the Artist by Alan Roland
Levinas, the Frankfurt School and Psychoanalysis by C. Fred Alford
Transsexualism: Illusion and Reality by Colette Chiland
© Editions Odile Jacob, avril 1997
English translation © Colette Chiland 2003
Reprinted by Sage Publications in 2004
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I cannot over-emphasize my debt to Robert Stoller, who opened the way to a different kind of investigation from that prevailing in the general run of sex-change literature, to a different way of listening to the patient, and to the thesis that a particular kind of family dynamics operates between a ‘transsexual’ child and that child's parents. Stoller's untimely death put an end to my exchanges with him, which were always marked by his warm friendship and his passion for psychoanalysis. I did not always agree with his theories, but without him I should never have been able even to start thinking about the problem of changing sex.
This book would not have been written had I not been welcomed to their units by Professors Jacques Breton and Pierre Banzet. Professor Banzet's secretary, Patricia Billon, performed the arduous task of tracing patients who had had surgery so that we could follow them up.
Finding all the necessary books and articles was tantamount to a treasure hunt, in which I was greatly helped by Susan Coates, Robert Emde, Robert and Marcelle Féger, Maurice Godelier, Dider Houzel, Otto and Paulina Kernberg, Serge Lebovici, Gaïd Le Maner, Leslie Lothstein, Peter Neubauer, Lionel Ovesey, Ethel Person, David Rosenham, Bernard Saladin d'Anglure, Denis Salas, Kari Schleimer, Hélène E. Stork, Beatrice and Immanuel Wallerstein, and Kenneth Zucker. The librarians at Cornell Medical Center – The New York Hospital, Westchester Division, White Plains, and of the many libraries of Stanford University placed the truly remarkable resources of all the American libraries at my disposal. A detour via the British Library gave me access to books that could not have been found anywhere else, where they were reserved for me on the days I requested.
At the Alfred-Binet Centre, René Diatkine was a constant source of encouragement to me in my work. The following members of my team took part in the research on children and their parents, adolescents, and adults: Roberta Bettini, Marie-Pierre Dufaure-Lebouteiller, Alain Gibeault, Marie-Françoise Lefèvre, Pierre Mattar, and Michèle Pollak-Cornillot. Our notes were typed up by my secretary, Danièle Orenstein.
Simone and Gaston Wolf-Labant supported me every day in my work.
I wish to express my warmest thanks to them all![Page viii]
A word of introduction to this ‘very French’ book is perhaps in order for the English-speaking reader. I belong to a now disappearing tradition of university professors of clinical and pathological psychology who first trained as philosophers and later became psychiatrists and psychoanalysts. Through this initial background as a philosopher I acquired a taste for exactitude in the use of concepts and the reading of texts, and it has also led me to consider clinical data in the context of ideas about human existence and the culture in which the patient develops and lives.
My concern with transsexuals over the past 20 years is not due to any particular attraction to their specific problem situation, but is the outcome of a long progression. I began by running a seminar for several years on the subject of women, the modern world, and psychoanalysis, which led to a number of publications. Of these, I shall mention only one contribution published in English, entitled ‘Clinical practice, theory and their relationship in regard to female sexuality’ (Chiland, 1980). I aligned myself with the authors who took issue with Freud over his conception of women as ‘castrated men’ and drew attention to the positive aspects of femaleness.
My interest then turned to sex differences in psychopathology. Whereas a great deal of work has been published on sex differences in psychology, there have been no studies covering the field of psychopathological differences between the sexes as a whole. Yet it has been found throughout the world that more boys than girls are sent to child psychiatrists; as an indication of the orders of magnitude involved, in the unit in which I worked, the sex ratio was 162 boys to 100 girls over a 15-year period. The sociocultural hypothesis that this is because parents are more concerned about their male than their female children is untenable in view of the greater biological fragility of boys (in terms of perinatal mortality and of childhood mortality and morbidity) and men (whose life span is shorter). Consideration of the various symptoms reveals a high ratio of boys to girls for most – higher than the sex ratio of children who see a psychiatrist. There is no simple explanation for this fact.
Finally, one day Antoine, a four-year-old boy, came into my office. I had read Robert Stoller's books, in particular Sex and Gender (Stoller, 1968, 1975), and it seemed to me that Antoine conformed in every respect to the description of what he then called a transsexual boy and was later to term a [Page x]very feminine boy. I undertook with my team to treat Antoine and his parents.
I gave an account of this treatment at a one-day conference that was also attended by Professor Jacques Breton. At the end of the day, he said to me: ‘Since you are interested in transsexualism, why don't you come and work in my clinic?’ To tell the truth, I had not been interested in transsexualism, but in Antoine … That is how I came to spend eight years working in Professor Breton's Gender Identity Clinic at the Fernand-Widal Hospital in Paris. Here I saw patients of a kind I had never encountered before; and I read the literature. I was fascinated by the general question of the development of gender identity, and by the difficulty of grasping the nature of the mental functioning and pathology of these patients, who refuse to be seen as suffering from mental disorders but feel themselves to be the victims of a ‘mistake of nature’ which they ask the medical practitioner to rectify by giving them their ‘true’ body. The origins of this pathology remain a puzzle. Might the aetiology be biological, so that these patients are suffering from a form of intersex? Even if this is so, some part is played by the interactions with the environment that we witness when we see the young child and the parents together. In every case the problem is rooted in the patient's early life and affects the patient's being, sense of existence, and self.
I published some papers – in particular, one on childhood and transsexualism (Chiland, 1988) – and patients began to be referred to my unit. We formed a working and research group (made up of psychoanalytically trained psychiatrists and psychologists and a social worker) and followed up a limited number of patients in depth. I personally interviewed about 300 patients (of all ages – children, adolescents, young adults, and older adults) who suffered from gender identity disorder, the adults among whom had requested hormonal and surgical sex reassignment. I conducted a follow-up study of 49 reassigned patients.
The more patients I see, the more aware I become of individual variations. We use the word ‘transsexuals’ as a matter of terminological convenience, and may investigate what they have in common. Yet it must not be forgotten that each patient has his own history and his own mode of speaking that go beyond the stereotyped formulas learned from the media and from militant groups. The ways in which each patient differs from the others constitute the criterion for evaluating the possibility of psychological help, which, however, these patients are on the whole very reluctant to contemplate and to accept. Yet we are now seeing surgically reassigned patients who, long after their operations, request psychological help or even [Page xi]a psychoanalysis. A particularly interesting case history was published by Danielle Quinodoz, who works in Geneva (Quinodoz, 1998, 2002a, 2002b).
One's theoretical positions must not prevent one from being available to meet and listen to people (Chiland, in press). Although the relationship with some aggressive patients in whom the transvestite component predominates may be difficult, with others it proves to be warm and fruitful; even if they do not wish to commit themselves to a psychological treatment, they report that they are pleased to find a place where they can talk about the reality of their situation.
Transsexualism in the modern sense of the term belongs to our culture. In every age some people have rejected their assigned sex and tried to live as members of the other sex. There have been and still are cultures that offer a place to, and reserve a particular social status for, persons who are ‘neither men nor women’. However, hormonal and surgical sex reassignment characterizes our culture, in which scientific and technical advances have made it possible.
At the same time, our culture is fascinated by everything out of the ordinary. The media would rather focus on people who stand out from the crowd than on those who present no problems. Television programmes on sexuality feature wife-swappers, sadomasochists, prostitutes, protagonists of the porn industry, and the like; they do not show us the lives of ordinary folk, but suggest that ordinary folk dream in secret only of the extraordinary … The boundaries that ought to separate private from public life are becoming blurred. Exhibition is destroying intimacy. Under the banner of tolerance, the result is a ‘loss of sexual bearings’. Some situations are quite crazy.
Inherent in the transsexual contention is a contradiction that lies deep within our culture. Transsexuals say that their identity is defined not by the sex of their body but by that of their mind and soul. Yet they are not content to occupy the symbolic place of the other sex (although a so-called transgender movement, preferring gender change to sex change, has recently arisen), but require a bodily token of their change of status. This bodily token, or ‘neo-sex’, becomes the proof of the truth of their assertion that they are members of the other sex. Our culture accords primacy to material, biological reality, and although it has much to say about the symbolic order, it sets little store by the symbolic life.
As the reader will have gathered, this book is concerned with transsexuals, whom it discusses on the basis not of a priori ideas but of my clinical experience – in which I have done my best to understand patients [Page xii]and to relieve their suffering, even if I have not always succeeded. The book is not concerned with homosexuals. Homosexuality is a completely different matter. Transsexuals visit doctors, and need them, at most for the purpose of obtaining their bodily ‘transformation’, which the doctor sees as a mutilation. Homosexuals seldom consult a doctor, and do not ask for a mutilation. In this book it is not my intention to express personal opinions on societal issues except where those opinions are grounded in clinical experience.
I should like to thank my translator, Philip Slotkin, who took great pains to translate my French text into English as exactly and faithfully as possible while eschewing the jargon of neologisms. Translation is a difficult trade, and indeed an impossible task – for words do not have one-to-one equivalents, and it is not just a matter of substituting a word in one language for its counterpart in the other. The words that a given language accepts or rejects reflect profound differences in conceptualization. For instance, in English ‘gender’ has come to be the normal term for social or psychosocial sex, but the equivalent French word cannot always be used in this sense. Similarly, words like sexué or sexuation, used in French with reference to the division between the sexes, will not go into English directly. Some effort will therefore be called for on the part of English-speaking readers to adapt to the difference of perspective between this book and the English-language literature, and I wish to thank them for it in advance.
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