Shirah Vollmer MD

The Musings of Dr. Vollmer

Boy or Girl: Introducing a Continuum

Posted by Dr. Vollmer on January 23, 2010

This blog will continue my series on gender.

But let me tell you, this gender thing is history. You’re looking at a guy who sat down with Margaret Thatcher across the table and talked about serious issues.
George H. W. Bush

The term ‘gender identity’ was used in a press release, November 21, 1966 to announce the new clinic for transsexuals at The Johns Hopkins Hospital. This was originally a medical term used to explain sex reassignment surgery to the public.

The formation of a gender identity is a complex process which starts at conception, but then involves learning experiences after birth. Language and tradition in many socieities insist that every individual be categorized as either a man or a woman, although there are societies, such as Native Americans, where they acknowledge two-spirit, and this includes multiple gender categories.

Some people refuse to be categorized. RuPaul Andre Charles (b. 11/17/60) is an American actor, drag queen, model, and singer-songwriter who first gained fame in the 1990s. RuPaul is famous for saying “You can call me he. You can call me she. You can call me Regis and Kathie Lee; I don’t care! Just as long as you call me.”

During the 1950s and 60s, psychologists began studying gender development in young children, partially in an effort to understand the origins of homsexuality which was viewed as a mental disorder at the time. In 1958, the Gender Identity Research Project was established at the UCLA Medical Center for the study of intersexuals and transsexuals. Psychoanalyst, and my supervisor, Robert Stoller MD documented the findings from this projet in his book Sex and Gender: On the Development of Masculinity and Femininity (1968). He is also credited with introducing the term gender identity to the International Psychoanalytic Congress in Stockholm, Sweden in 1963. At the same time, behavioral psychologist John Money was working at Johns Hopkins Medical School’s Gender Identity Clinic (established in 1965). Dr. Money popularized an interactionist theory of gender identity, suggesting that up to a certain age, gender identity is relatively fluid. Money remains a controversial figure because of his assertion about the fluidity of gender identity.

From 1990 to 1992, I worked at the Los Angeles Gender Center. The Los Angeles Gender Center is a group of clinicians who evaluate adults who are searching for a medical intervention to change their appearance so that the world will respond to them in the way that matches how they feel. To the extent that self concept may be informed by how a person understands how others perceive them, then when there is a disconnect between how one feels and how one is perceived, mental distress ensues. When faced with this dilemma, there are options. One could seek psychotherapy to help them deal with this discrepancy. One could seek hormones and surgery to change their appearance so that others respond differently to them. One could try to change society such that there is a continuum between male and female. Perhaps the combination of these three options is the answer.

Psychiatrists have the opportunity to support a continuum for gender. Our new diagnostic manual is scheduled to be released in 2012. We could eliminate the diagnosis of gender identity disorder. We could return to the pre-Hopkins Transgender Clinic days when gender was a field of study and not part of a diagnostic label. Analyzing the phenomena of gender should be left to scholars.

In looking back over fifty years, the creation of the diagnosis of gender identity disorder is evidence that we lost our way. Mental health practitioners need to focus on well-being. When we collude with gender stereotypes then we violate our fundamental principle of “do no harm”. If we broaden the notion of gender, we then develop a more expansive view of our world. This parallels the goal of psychotherapy which is to broaden one’s thinking in order to tolerate the difficulties both in ourselves and in others.  Embracing complexity is our mission. Putting gender on a continuum is a first step.

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