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is a title well-chosen for Colette Chiland's most recent book on the subject of
gender identity disorder. The author, a psychoanalyst who has worked with
transsexuals prior to and following their hormonal and surgical sex
reassignment, aims to familiarize psychotherapists with various aspects of
transsexualism, should they be confronted with it. Therefore, her work contains
neither thorough insights nor lengthy arguments on causes, symptoms and
treatments. Instead it offers a glance at the different problems related to
transsexualism and an account of the author's personal experiences with them.
For Chiland, the main question of concern is whether psychotherapy can
be fulfill a purpose in the 'treatment' of transsexuals in times where sex
reassignment operations have become the norm. Eventually, her answer will be a
positive one. Despite the many difficulties that will have to be overcome,
Chiland believes psychotherapy can be a place where transsexuals can speak
freely about themselves and their condition without having to live up to
certain patterns of behavior and thought.
This feeling of having to live up to a certain pattern is a major
complicating factor in therapist's conversations with transsexual 'patients',
though. Chiland explains that prior to any sex reassignment operation the
transsexual's desire to obtain such an operation at all costs will induce the
transsexual to lie about his or her past and true feelings. She claims that
clients will obscure their feelings of ambiguity, their doubt and conflicting
fantasies in order to produce a personal history consistent with the pattern of
a primary transsexual (i.e. a transsexual 'from birth') and to obtain
surgery. This hinders the therapeutic process that depends upon the ability to
speak truthfully and on the ability to question oneself.
Moreover, the many problems transsexuals are
confronted with after a sex reassignment operation (such as the inability to
change their civil status, to marry a person of the now opposite sex or to
adopt a child) are all consequent to the decision to operate. On the one hand,
the author sharply (and, in my opinion, rightly) condemns the prevailing
ambiguous societal attitude that approves and promotes surgical treatment for
transsexuals but subsequently leaves them in a no mans land between male and
female. She does not hesitate to call this a violation of transsexuals' right
to life. On the other hand, Chiland argues that this complex problematic
sharpens the need for alternative forms of treatment, for example
While remaining at the surface on the best option to take in this
therapeutic dilemma, Chiland embarks on the quest of defining the causes of
transsexuality. She contends that a certain group or transsexuals might like to
hear that transsexuality, like intersexuality, is attributable to biological
factors (genetic or other). Chiland explains that this desire is caused by the
belief that transsexuals would no longer be blamed for their condition if
biological causation could be proved. According to the author there is no
conclusive evidence for this position. Moreover, she criticizes the societal attitude
that casts a slur on people for their psychologically caused condition. If transsexuality, like homosexuality, has
psychological causes tracing back to the child's interaction with its parents
in very early childhood, should it be blamed for this -- Chiland asks -- when
it is no more responsible for these early interactions than it is for its
biological heritage? In any case, the author claims that the causes for
transsexualism are not social ones. Unlike feminism, transsexualism is not
caused by a discomfort with the social roles attributed to the sexes. To the
contrary, transsexuals will try to conform to the social roles attributed to
their desired sex, exactly because they long for social recognition of this
Chiland therefore emphasizes the importance of distinguishing between
one's biological sex (male/female), one's core gender identity (which is formed
in the early years of childhood) and one's social gender (masculine/feminine).
As she thinks the biological argument is debatable, it seems that 'core gender
identity' is where the (primary) transsexual differs from 'normal' people,
whose core gender identity coincides with their biological sex and social
gender. Despite all this, the author recognizes that an operation is often the
only viable solution for transsexuals, but emphasizes that it is not a cure,
but merely 'care': an operation cannot change males into females, but only
bring relief to males who feel they are and want to live as females. The
argument for sex reassignment operations as a treatment for transsexualism, in
Chiland's view, is one of compassion.
Throughout the book, the author
stresses the importance of the 'compass of sex', her term for the biological
fact of sex difference. Even though she seems to plead for a third social gender
in some places -- which would certainly accommodate intersexuals and possibly
some transsexuals- her general message seems to be to confront transsexuals
with the biological reality that their sex can never be changed completely.
Chiland's main advice to psychotherapists dealing with transsexuals is to be
aware of the many complexities it involves, to avoid judgment, not to take sex
change operations for granted as the best treatment and to keep confronting
clients with 'the compass of sex' -- whether before or after an operation. She
is realistic about the effects of psychotherapy -- which her experience proves
to be limited -- but maintains that psychotherapy can be useful before as well
as after a sex reassignment operation, as long as it is a place where
transsexuals can speak truthfully. Exactly how that truthfulness can be
secured, she does not clarify.
takes a look at gender identity disorder from a variety of perspectives and
with sufficient complexity; although in its complexity the discussion is not
very profound. Readers expecting the experimental method and an inductive
argumentative structure will be disappointed by this book and should resort to
one of the many works of reference or one of Chiland's earlier books. Nevertheless,
this book provides a highly informative and balanced overview of the issues
raised by this controversial disorder, accessible to anyone interested in
transsexualism. Moreover, the text is indeed as 'challenging' as was promised
by the jacket blurb: Chiland's questions are highly relevant and call for deep
reflection about the way health care workers and society handle transsexualism
and about how transsexuals think of themselves.
Ieven received a BA in Medical Science and an MA in Philosophy from the
University of Leuven, Belgium. She is currently working there as a teaching
assistant in the field of legal and political philosophy and is in the process
of obtaining a PhD.:
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