What You Can Change _. And What You Can't - Martin E. Seligman [74]
Transsexuals have had their “wrong sex” belief for as long as they can remember. And they are doomed to have it for the rest of their lives. Every kind of psychotherapy has been tried on transsexuals. So rare is any success that the single clear case in the archives of successful change calibrates just how intractable this problem is.2
John was born in 1952 and always thought of himself as a girl. He was the baby of the family, frail and delicate beside his tomboy older sister. When he was four, he started to wear makeup and was delighted when his sister started school because she got lots of new clothes for him to dress up in. [Transsexuals always cross-dress. But they are transvestites only by a technicality. A transvestite male wears women’s clothes to get turned on sexually; a transsexual male wears them because he believes he is a woman.]
John envied his mother and sister, and loathed his maleness. He went to school, but did badly. Isolated and lonely, he occupied himself with cooking and housekeeping. As a teenager, he read about transsexualism and about the important discoveries being made at the Johns Hopkins Medical School. He took estrogen and felt tranquil and calm for the first time in his life. He was also delighted that he no longer got erections. He took a job at a fried-chicken stand and started to save up for sex-change surgery. It was at this time that he was seen by a psychiatric team and formally diagnosed as a transsexual.
He took the name “Judy” and began to live as a woman, preparing for surgery. He passed well as a woman, and with hormone treatment wore bikinis to the beach. Just as surgery was to begin, Judy disappeared.
Several months later, Judy reappeared at the chicken stand. But not as Judy—as John. When he subsequently presented himself to the psychiatric team, he wore a three-piece suit and short hair, had clipped fingernails, and strutted manfully. He related his story enthusiastically:
On his way to surgery, he kept a promise to the stand owner to check in with a local physician who was a member of a fundamentalist religion (John was a lapsed Baptist with no religious interest). The physician told John that he could make it as a woman, but that his real problem was possession by evil spirits. The physician performed a three-hour exorcism with prayers, exhortations, incantations, and the laying-on of hands. John fainted several times, but when it was over, the physician said he had removed twenty-two evil spirits, and John was free of the delusion of being a woman for the first time in his life. He was followed closely for the next two and a half years by the psychiatric team and was clearly male—psychologically as well as physically. He did well in his job, was promoted, and was looking forward to marrying—a woman.
Sex change. Psychotherapy changes sexual identity rarely, if ever.3 The only thing that reliably works is to change the body to conform to the unshakable sexual identity. This is why sex-change operations were developed. Once a headline-making novelty, these operations are now routine. Tens of thousands have been done. Once the patient convinces the diagnosticians that his or her transsexual identity is unshakable, the long process of changing the body to conform begins. In the more common male-to-female (MF) case, the person first lives for a few months in the female role, changing his name, and dressing and acting like a woman. Hormonal treatment is begun, and breasts grow, the voice changes, and facial hair disappears. Surgery itself is then undertaken. The testicles are removed and the penis is cut off—though its skin is preserved to line the new vagina, making pleasurable intercourse and even orgasm possible.
In the female-to-male (FM) transformations,