The lives of transgender people and those considering the process are often agonizing. They experience significant distress or impairment concerning their strong desire to transition to the gender other than the one assigned at birth.
Many psychiatrists regard their plight as a mental-health problem. Under categories for children, adolescents and adults, the problem is termed Gender Dysphoria (discontent) in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Publishing, 2013).
The disorder’s symptoms are varied and painful. According to Wikipedia, adults with gender dysphoria are “at increased risk for stress, isolation, anxiety, depression, poor self-esteem and suicide.” Symptoms of the disorder in children include “disgust at their own genitalia, social isolation from their peers, anxiety, loneliness and depression.”
The psychotherapy that was practiced decades ago tried to help these people become reconciled with the gender assigned at birth. Now the emphasis is more on providing affirmative care for the patient, with treatment driven by the patient’s desired outcome. Attempts to “cure” them by having them reconcile with their birth characteristics have been ineffective. It’s not helpful, the American Psychological Association says, to force a transgender child “to act in a more gender-conforming way.”
While compassion and support for the individual are essential, there are certain deeper psychological aspects of this problem—issues involving self-doubt, self-rejection, and feelings of being trapped—that aren’t getting sufficient recognition and understanding.
This knowledge about deeper emotional dynamics can be presented to transgender individuals, children included, as part of the overall psychological interventions that can help guide them as they consider crucial life decisions.
All of us benefit from deeper understanding of how suffering and self-defeat are generated from within. Heterosexual men and women can certainly be as challenged by psychological issues as members of the LGBTQ community. Most people, whatever their gender or sexual preferences, are challenged by negative emotions and undesired behaviors. In general, just about everyone experiences some degree of neurosis. That’s because inner conflict is a universal condition (see, Free Yourself from Inner Conflict and Neurosis Unbound). In varying degrees, we all struggle to find inner peace and harmony through self-acceptance.
We all have “pet” ways in which we can feel both pleasure and pain. When our inner conflict is active, we register dissatisfaction, aggravation, discouragement, cynicism, anger, and fear. Inner conflict and emotional distress can revolve around matters of identity, money, sex, work, career, physical appearance, popularity, health, and relationships. Transgender people, of course, find themselves preoccupied with gender identity, and genetic variations, hormones, or differences in brain functioning do likely contribute to their emotional and physical predicament. Yet, like the rest of us, they are also bringing to the table their set of psychological issues deriving from unresolved inner conflict. They can end up focused intensely on their desires and perceptions concerning gender preference, not recognizing that their conflict over this issue can be a reflection of psychological inner conflict.
Three such conflicts—involving negative emotions associated with self-doubt, self-rejection, and feelings of being trapped—are at play in the psyche of transgender people. The first, self-doubt, is a nagging sense of insecurity and inner fear that’s common to all people (See, The Core of Being). Again, it’s all a matter of degree. When self-doubt is particularly acute, all manner of painful and self-defeating symptoms can arise.
Self-doubt is a result of inner conflict. An individual consciously wants to feel good about herself or himself. Unconsciously, however, this individual is inclined to revert on an emotional level to an inner default position that’s associated with feelings of unworthiness, insignificance, and emptiness. As part of the conflict, the individual is compelled unconsciously to cover up or deny just how prepared and willing, at an unconscious level, he or she is to continue to experience this self-alienation. For genetic or other reasons, as mentioned, transgender people experience self-doubt in gender terms. To cover up their emotional resonance with the unresolved self-doubt (which forms a familiar sense of identity), they produce an unconscious defense that says, to this effect: “I don’t want to feel so empty inside, so disconnected to myself. I know I would feel my true self, my real being, if I transition to a woman (or man). Look at how intensely I want that. That proves I want to feel connected.” Underneath this claim, though, is their unconscious determination to live through the familiar self-alienation.
The second issue involves self-rejection. In a discussion of transgender people, the American Psychological Association says, “Some transgender people, transsexuals in particular, experience intense dissatisfaction with their sex assigned at birth, physical sex characteristics, or the gender role associated with that sex.” This “intense dissatisfaction” points to self-rejection, which is a common negative emotion even among people in the general population. Self-rejection is a variant on self-criticism, self-condemnation, and self-hatred. It is always present in people who are particularly sensitive to feeling rejected or criticized by others.
When people are prone to self-rejection, they’ll not only be sensitive to feeling rejected by others but they’ll also be inclined to act out in ways that provoke others to be rejecting of them. Psychiatry’s diagnostic manual (DSM-V) says, “In older children, gender-variant behavior often leads to peer ostracism, which may lead to more behavioral problems.” In other words, being gender variant is associated with the experience of rejection from others. More insidiously, being gender variant can be a means to “act out” an emotional sensitivity to feeling rejected.
When self-rejection is an issue, transgender people as well as others are caught in this conflict: Consciously, they want to feel loved, but unconsciously they harbor self-rejection. The conflict puts them in a no-win situation; they can’t really feel love when others make it available to them. What feels more familiar, instead, is being a person incapable of love or unworthy of love. In this conflict, love (or even pleasure) doesn’t linger long. What persists, instead, is self-rejection.
These individuals now are compelled to come up with reasons to account for why they feel so bad about themselves. What accounts for their painful sense of being defective or flawed? “Something is really wrong with me,” the reasoning goes. “Something about me is not right.” Rather than see that the problem is self-rejection (reinforced by an active inner critic), transgender people are convinced the problem is due mainly if not entirely to their existence in the wrong gender. They’ll find inner peace, they believe, by transitioning to the other gender.
It’s difficult to get an accurate accounting of how many among those who transition are disillusioned by the experience. Some are evidently pleased enough after hormone treatment and surgical intervention, yet many apparently feel some degree of disappointment. Evidence of dissatisfaction with the transition can be found here, here, here, and here.
The third psychological issue—feeling trapped—is also a relatively common experience among the general population (see, A Remedy for Feeling Trapped). With this emotional sensitivity or weakness, individuals are inclined to experience a variety of life situations—career, marriage, relationships, locale, family—through a sense of being trapped. They feel they have no option but to remain stuck in place and thereby helpless to act on other possible options. Yet, in a predicament that promotes self-defeat, they tend to remain stuck in a painful place because they’re unconsciously determined to go on living through the familiar unresolved weakness associated with helplessness and feeling trapped.
People can feel trapped in painful emotions such as anxiety, fear, depression, guilt, and despair. They can feel trapped in addictive behaviors. They can also feel trapped in their body and trapped in their gender. Again, a defense is produced to cover up one’s willingness to hold onto this painful sense of being helplessly trapped in the wrong gender. For transgender people, the defense might read: “I don’t want to feel trapped in this gender. I want to escape from this trap. I want to transition to the other gender. Rather than being trapped, I want to feel the freedom of being who I really am.”
A psychological defense such as this can produce in an individual a powerful impulse to carry out, however irrational and self-defeating, the claim made by the defense. If the claim is, “Being in a different body and gender will make me happy,” then the individual is required to seriously consider that option in order to make the defense work. Unconsciously, such individuals want their defense to protect them from having to face inner truth concerning their resonance with (or unconscious collusion in maintaining) an unresolved negative emotion, especially the weakness of inner passivity. Hence, the possibility of transitioning to another gender becomes an emotional preoccupation if not an obsession. Understanding this dynamic is vitally important to the process of making good decisions.
Typical psychotherapy offered to transgender people does not approach their inner life at this depth. So transgender people are not getting all the information that can help them make the best informed decision for themselves.
My latest book has just been published. It’s titled, Our Deadly Flaw: Healing the Inner Conflict that Cripples Us and Subverts Society (2022), and it’s available here in paperback (315 pages) or as an e-book.