Notes on Gender Role Transition

By Anne Vitale Ph.D.

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 T NOTE #5

Guilt & Shame:
The Unfortunate Twins of Gender Dysphoria

October 12, 1996

My handy, online edition of the American Heritage Dictionary (3rd Edition, 1992, Houghton-Mifflin, Softkey International, Inc.) defines guilt and shame as follows:

guilt n. 1. The fact of being responsible for the commission of an offense. 2. One that brings dishonor, disgrace, or condemnation. 3. A condition of disgrace or dishonor; ignominy. 4. A great disappointment.

shame n. A painful emotion caused by guilt. 1. The fact of being responsible for the commission of an offense. 2. (Law) Culpability for a crime or lesser breach of regulations that carries a legal penalty. 3. a. Remorseful awareness of having done something wrong. b. Self-reproach for supposed inadequacy or wrongdoing. 4. Guilty conduct; sin. Strong sense of guilt, embarrassment, unworthiness, or disgrace.

Guilt and shame have long been significant components in psychotherapy. This is true no matter what the underlying issue. The reasons can be traced directly to our culture's use of both of these emotions in complex programs of moral and social control. Sometimes they are used constructively and sometimes not. Pathology occurs when there is too much or too little of these unfortunate twins.

Excessive guilt and misplaced shame are what therapists typically find when working with individuals struggling with gender identity issues. For example, in my practice, callers setting up the intake appointment go to great lengths to avoid using such words as cross-dresser, transsexual, or transgendered to describe themselves. Fortunately, they give enough clues about why they want to make an appointment without my having to ask them directly.

If one is able to look at gender dysphoria objectively, free of any social connotations, feelings of shame over crossdressing or being gender dysphoric appear to be inappropriate. Most of my clients are upstanding, law abiding, hard working, honest, and productive citizens. Typically, they are highly educated, hold medium to high level positions in corporate or government organizations, and are well respected for their abilities. If they have children, they want to be good parents. Typically, they are the very model of what society professes to value most in its citizens.

Now if we look at these same people with the same objectivity, this time to understand their feelings of guilt, a person would probably find much to judge negatively. A typical gender dysphoric's life is strewn with lies of omission, half-truths, surreptitiousness, broken commitments, and gross manipulation. All of which most gender dysphoric individuals are painfully aware of.

Consider this: from the first moment of defined existence, a person is identified and then classified as either male or female. This classification by sex assigned at birth influences every moment of a person's life thereafter. The very essence of socialization -- how each of us relates to our parents, friends, spouse, lovers, our work, our religious and philosophical beliefs -- everything we are, is contingent on assigned sex. I think you can imagine the enormous challenge a person with Gender Identity Disorder faces trying his or her best, every day, every moment, to live up to an assigned sex he or she has no innate affinity to.

Most gender dysphoric individuals are aware of their world. Given their condition, which they accurately perceive to be outside the experience of most people, they are often hypersensitive to what society defines as gender appropriate behavior. In a complicated attempt to conform, most gender dysphorics make dedicated efforts to gain positions of social value. Initially this is done to convince themselves of their normalcy. When that fails, it is done to convince others. Marrying and having children are often an extension of these efforts. Unfortunately, even these good intentions eventually become something to feel guilty about.

Surely it is alright to be female and surely it is alright to be male. Yet many of my clients come in feeling that they are among the lowest of the low. For decades they have kept within themselves what they believe to be one of the worst secrets imaginable. Long before they give anyone a chance to evaluate their dilemma, they often view themselves as being sick, perverted, queer, or even out-and-out freaks. They are convinced that if they openly express their inner gender feelings, they will be considered uncaring and selfish. Worse yet, they fear, with some justification, that they will be ostracized by the people they love the most.

We all know that society's message is clear: stay within the boundaries of behavior allotted to your assigned sex or face possible banishment from all that you know and love. The reasons for this social dictum are very complex and outside the scope of this note. However, I believe it is safe to say that it has something to do -- at least in part -- with sexism. In our patriarchal culture, the control mechanism for males is shame. It is expressed through deprecation of all behavior that is not certified masculine. Accordingly, shame expressed by genetic males who wish to be female far exceeds that experienced by females who wish to be male.

The irony for most male-to-female transsexuals is that as males they are forced to participate in institutional sexism from deep within its ugly bowels. All male children learn early that being male is a privileged state. Furthermore, they learn that they are expected to contribute and commit to its continuance. Typically, male-to-female histories reveal that as boys, no matter how much they envied the girls and wanted to be one, they still found that being male had its inherent advantages. Unfortunately, boys also learn that to be accepted by their peers and eventually advance from boyhood to manhood, they must denounce all behavior that is considered feminine. This forces gender dysphoric boys as young as five or six years old to go underground with their desires to be female. To compensate for this deception, they typically make superhuman efforts to at least appear masculine. My male-to-female client load currently contains eight fathers, a motorcycle gang member, a Viet Nam Medal of Honor winner, an ex-submarine Captain, and a foreign revolutionary.

Guilt and shame represent deeply ingrained concepts, so ingrained that it is common for each of them to outlast gender transition. Even though most post-transition transsexuals are glad that they are now free of the dysphoria, shame continues to plague some individuals. The most common manifestation of chronic shame is internalized transphobia: a self-loathing and belief that they are sexually perverted. Transphobia is so persistent that on occasion I have found it present twenty years after what would otherwise be considered a successful transition. Yet with hard work and a realistic appreciation of the newly assigned sex, even this deep seated shame can eventually be eased and even turned into pride of accomplishment.

Guilt, on the other hand, is easier to ease in post-transition transsexuals. If the transsexual's new life has a sense of authenticity, guilt has a way of easing almost on its own. The key is acceptance, and acceptance comes with time. Parents routinely accept their new son or daughter. Similarly, siblings make genuine accommodations for their new brother or sister. Individuals return to society as responsible doctors, lawyers, parents, spouses, and active business and community leaders.

The good news is that post-transition transsexuals routinely go on to reconstruct their lives in ways that far exceed their expectations. It is getting through transition that is difficult, and much of transition is dealing with the unfortunate twins of guilt and shame.

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Copyright, 1996 by Anne Vitale, Ph.D. Dr. Vitale is a Licensed Psychologist specializing in gender related issues. Her office is located at 610 D Street, San Rafael CA 94901, (415) 456-4452. This Note may be reprinted in any non-profit organization's newsletter if Dr. Vitale's name and address appears with it. Other publications must obtain written permission from Dr. Vitale. A copy of any reprints must be sent to Dr. Vitale.