Aude Michel

The transsexual: what about the future?

Since the 1950s, sexual surgical reassignments have been frequently carried out. As this surgical therapeutic procedure is controversial, it seems important to explore the actual consequences of such an intervention and objectively evaluate its relevance. In this context, we have carried out a review of the literature. After looking at the methodological limitations of follow-up studies, the psychological, sexual, social, and professional futures of the individuals subject to a transsexual operation are presented. Finally, prognostic aspects are considered. In the literature, follow-up studies tend to show that surgical transformations have positive consequences for the subjects. In the majority of cases, transsexuals are very satisfied with their intervention and any difficulties experienced are often temporary and disappear within a year after the surgical transformation. Studies show that there is less than 1% of regrets, and a little more than 1% of suicides among operated subjects. The empirical research does not confirm the opinion that suicide is strongly associated with surgical transformation.

Transsexualism and Connection with Reality: Rorschach Data

From a formal point of view, transsexualism presents the characteristics of delusion: despite the anatomical evidence, and without letting themselves be inf luenced by the contradiction that sets their conviction against their perception, transsexuals assert that the reality is not what they feel. A real sense of feminine identity is not denied by the fact of having a penis; the absence of a penis in no way alters the certainty of being a man. It is understandable that particular attention has been paid to the question of possible psychosis in efforts to account for such a delusional belief. This possibility is especially plausible given the fact that delusion focused on sexual identity is a classic theme in schizophrenia, and, until recently, a psychiatrist would immediately think of this possibility when confronted with a question of transsexualism. This is one of the reasons why sex-change candidates are so regularly subjected to psychodiagnostic tests. Today there remains little doubt that transsexualism bears no particular relationship to schizophrenia. Most transsexuals present no symptoms of schizophrenia, even though they are focusing on a limited aspect of reality in the same way as a delusional psychotic might do. This has given rise to the notion of a focused delusion, which is sometimes used to convey the presence of a limited and circumscribed element of psychotic behavior in a person who does not otherwise display psychotic functioning. Thus, there would seem to be something like a nucleus of psychotic thinking, a center of resistance impervious to counter-arguments, not subject to the rules of logic, and operating on the basis of distinctive mechanisms, which brings to mind the Freudian notion of perversion with mechanisms of splitting of the ego, disavowal of castration, and the creation of a fetish.

Fuite dans l'imaginaire et dépendance: trait de personnalité ou défense opportuniste chez le transsexuel

Resume En analysant le fonctionnement psychologique de candidats au changement de sexe, nous avons observe le recours frequent au mecanisme qui consiste a se refugier dans la passivite et l’imaginaire afin d’eviter les situations deplaisantes, les responsabilites et les prises de decisions. Ce mecanisme inconscient identifie au Rorschach par Exner sous le nom de Snow White Syndrome (syndrome de Blanche-Neige) semblerait mis en œuvre de facon assez specifique face a la situation reelle dans laquelle se trouve le candidat au changement de sexe : celui-ci est en effet dependant des intervenants (medecins, psychologues, chirurgiens) pour atteindre son objectif (changement de sexe). La question se posait de savoir s’il s’agissait d’un element stylistique, c’est-a-dire d’un trait stable de la personnalite des transsexuels, ou d’une defense opportuniste. La dependance a l’egard de tiers, decideurs et executants, pourrait alors etre interpretee soit comme l’indication que ce trait de personnalite serait une condition favorable a l’elaboration de la problematique transsexuelle, soit comme une consequence de la situation reelle du transsexuel. L’hypothese du recours situationnel a ce mecanisme est exploree en comparant la frequence du syndrome de Blanche-Neige durant la phase de demande et d’attente de la reponse chirurgicale, a la frequence de ce syndrome apres realisation de l’objectif (changement de sexe). Le retest des memes sujets, apres qu’ils eussent ete operes, apporte un argument en faveur de la deuxieme interpretation puisque, en effet, le mecanisme cesse d’etre utilise des que la position de dependance passive n’existe plus. Dans cette hypothese, l’accompagnement psychologique du transsexuel devrait tenir compte de cet impact psychique de la realite anatomique afin de favoriser l’acces le plus precoce possible a une autonomie dont on decouvre que le transsexuel est capable. Envisagee sur le plan psychologique et d’un point de vue psychologique (par contraste avec un point de vue chirurgical), cette autonomie pourrait etre recherchee avant meme que le corps ait ete transforme, ce qui valide la pratique du real life test.

Comparisons of two groups of sex-change applicants based on the MMPI

Out of 29 men asking for a sex-change, 16 reported clinical anamnesis criteria for transsexualism according to the DSM-III–R, a more restrictive diagnosis than the DSM-IV gender dysphoria diagnosis. In addition, all the subjects had taken an MMPI which, of course, did not contribute to the transsexualism diagnosis but which served to describe their personalities. The 16 subjects diagnosed as transsexual and the 13 who did not qualify for this diagnosis were compared on the basis of personality variables measured by the MMPI. Certain differences became evident. The transsexuals systematically complied to cultural stereotypes of femininity without any uneasiness, whereas the nontranssexuals could be subdivided into two groups, those with a vague sense of ill-being linked to a pronounced feminine identity or those with only a slight feminine identity and who showed no particular difficulties.

Study of the Impact of a Gastroplasty on the Self-Image Through the Rorschach

Depuis plus de cinquante ans, differentes etudes ont revele que les personnes souffrant d’obesite morbide possedaient une image du corps et une image de soi depreciee. L’objectif de notre recherche est d’observer l’evolution de cette image de soi chez des personnes perdant rapidement du poids suite a une gastroplastie en analysant les sept differentes variables qui constituent le cluster perception de soi du Systeme Integre d’Exner. Pour ce faire, nous avons administre le Rorschach a trois reprises aupres de patients sollicitant une gastroplastie: le premier testing a eu lieu lors de leur hospitalisation, la veille de leur operation; les deuxiemes et troisiemes testings ont eu lieu apres une periode de trois et dix mois, le plus souvent au domicile du patient ou lors d’une visite de controle chez le chirurgien. Notre population se compose de 30 patients âges de 20 a 54 ans (avec une moyenne de 33 ans et 6 mois) et dont le poids variait de 94 a 144 kilogrammes (avec une moyenne de 115,7 kilogrammes) avant ...

Quelques données sur les différentes prises en charge des délinquants sexuels dans les pays de l’Union européenne

Resume Cet article examine d’une maniere comparative les legislations, les cadres institutionnels et les types de prise en charge qui, dans chacun des quinze pays de l’union europeenne, concernent les delinquants sexuels.