While gender identity (and orientation) impacts one’s psychological make-up, is it fair to assume that those experiencing discomfort in their assigned gender warrant a psychiatric diagnosis? In Rottnek’s book, he questions if GID is simply a way to pathologize children with atypical gender identification and behaviors? He appropriately raises the issue of normality versus nonconformity with regard to sexual identity or sexual orientation. He believes that what is abnormal is the pain, internal and external conflict, and anxiety that traditional, heterosexual cultures and societies place on children growing up as homosexuals or transgendered people. Remember, diversity is not pathological; however, being forced to adapt to a gender that does not feel comfortable is.

I do not think we could accurately discuss GID or sexual orientation without addressing culture. We learn from what is modeled by our family, friends, authority figures, and society, and in the process discover sex-appropriate skills, behaviors, self-concepts, preferences/interests, and personality attributes. Many families either directly or indirectly send the message to keep non-traditional sexual relations and non-conforming identity behaviors a secret at all costs. Consequently, many individuals either repress or deny their sexual identity and orientation because the risk of being alienated from one’s family is too costly. It can be even more challenging for ethnic minorities to disclose their gender identity discomfort or homosexual orientation because they are already oppressed and socially ostracized.

There are many who believe that children, adolescents, and adults who struggle with GID can control their behavior and desires by being strongly encouraged to adhere to one’s birth assigned gender and “gender-appropriate” behaviors. The focus becomes one of acting more gender appropriate than self-appropriate. While there does not appear to be a single cause for GID, studies suggest that genetics, hormones, biological/physiological, psychological, and psychosocial/familial aspects come into play. We know that children can be born with both male and female genitalia due to genetics but many continue to be reluctant in believing that genetics play a role in GID.

GID in childhood does not always lead to homosexuality in adulthood. However, it is possible that gender identity issues in childhood may be early, healthy signs of pre-homosexuality. Again, these two concepts are inter-related but one cannot assume that A leads to B. It is crucial for therapists working with GID or homosexual clients to have established their own healthy, objective sense of self. Therapists need to be knowledgeable and willing to learn about other cultures. They need to be sensitive and respectful about their terminology and expectations, and should be capable of thinking beyond conventional means. Therapy may very well be the first place where an individual can feel safe to openly and honestly discuss his/her self-identity and sexual orientation.

Reference:

Rottnek, M. (1999). Sissies and Tomboys: Gender Nonconformity and Homosexual Childhood. New York: New York University Press.

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