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Gender Identity Disorder

Dear Doctor, I have just found out something so shameful that it makes me want to kill myself because it will destroy our family. Doctor, my third born son is a female man. He got married just one month ago and his bride came to me in tears last week, saying their marriage has never been consummated because my son says he is actually meant to be a woman, so how can he be her husband? He told her a lot of crazy things like wanting to go to Europe to get castrated in order to become a woman and wanting to take family planning pills to become a woman. I could hardly believe my ears. To give you a bit of background history, I have five children - two older sons, then this son, then another son and the youngest is our only daughter. We treated them all the same, except that this third son spent a few years during primary school with his paternal grandfather. What happened was that when he was about five years old. His grandfather came to visit and noticed that this boy always preferred to play with the neighbour's daughters instead of his own brothers. He would play cooking games and dolls' games or skip with them for hours. When they performed a school play at Christmas, he wanted to be Mary and not Joseph and was very upset when the teachers refused to let him. When his brothers were learning to play rugby, he wanted to learn netball. His baby sister was born around this time and he put on her lacy socks and tie her ribbons on his head. He would also wear his friends' dresses and walk about like a girl, saying: "When I grow up, I will be a girl." His dad and I found it funny and thought he would grow up to be a comedian or something. His grandfather, however, was furious. He accused us of trying to turn his grandson into a girl. I tried to tell him the boy was just a funny character and would change as he grew up and that the other boys, including the younger brother, were not like that. But he would not listen. He took my son to the village with him, saying he would teach him to be a man. He lived with him for three years. He was a very strict disciplinarian and when my son was returned to us at the age of eight, he no longer played with girls or talked about growing up to be a woman, so we assumed he had grown out of that stage of his life. I noticed, though, that he was no longer the happy child he had been, but was now a quiet kid who kept to himself and did not let people get very close to him. He grew up normally and went to a boy's secondary school, took part in male sports and was generally a normal man. He had one or two girlfriends, but never seemed ready to settle down. When years passed and all his brothers got married, including the youngest, we decided to intervene and arrange a customary marriage for him. The wedding took place just last month and now the wife is threatening to leave due to his abnormal ideas. The only thing I can conclude is that this must somehow be sorcery by people who are jealous that I have four sons or maybe it is sorcery by this woman, since it is after marrying her that my son started talking crazy. What can I do, doctor? If anyone finds out, I shall die of shame.

Mother of Bewitched Son

Dear Mother of Bewitched Son, Your son is not bewitched. He is suffering from Gender Identity Disorder.

What is gender identity? It is an individual's self-perception as being male or female, i.e. how a person identifies himself or herself whether as a male or as female.

So what is Gender Identity Disorder? This is a psychological problem in which the person's gender identity does not match his or her physical body. Normally, people who have male bodies perceive themselves as men and people with female bodies perceive themselves as women. However, in people with Gender Identity Disorder, those with male bodies perceive themselves as really being women inside male bodies, while those with female bodies perceive themselves as really being men inside female bodies.

What other features of Gender Identity Disorder can children show? * A strong and persistent identification with the opposite sex and feeling he/she is one of them, instead of his/her own sex. * A repeatedly stated desire to be the opposite sex. In your son's case he used to keep saying this, till his grandfather taught him not to say it. * A desire to live as the opposite sex, including a preference for clothes of the opposite sex. * A preference for opposite sex roles in imaginative play, e.g. your son wanting to be Mary instead of Joseph. * A very strong preference for playmates of the opposite sex and their pastimes, instead of having playmates of both sexes. * A desire to be treated as the opposite sex. * Feelings of great discomfort about one's real sex and a belief that he or she has the typical feelings and reactions of the opposite sex. Children with Gender Identity Disorder show all these features, and for a prolonged period of time. If a child just has a few of these features, or for only a brief period, he or she does not have Gender Identity Disorder

When does Gender Identity Disorder start? There are often early signs in childhood, which may later be suppressed due to society's expectations. It can also start in teenage.

Was my son's childhood behaviour a hint of the future problem? Yes. Those were early signs of a potential (but not definite) future problem with identity. Your son, even at that age, did not identify himself as male and his grandfather realized this.

Is Gender Identity Disorder the same as being a sissy or a tomboy? No, no, no, and please do not think that because a girl is a tomboy or a boy is a sissy they will grow up with Gender Identity Disorder. Gender Identity Disorder is an abnormality, but BEING A TOMBOY IS NOT ABNORMAL AND BEING A SISSY IS NOT ABNORMAL.

What causes Gender Identity Disorder? The truth is that nobody knows. There have been many theories about abnormal levels of hormones before birth, theories about upbringing and parental expectations, theories about social environment etc., but all these are just theories, not fact. Up to now, doctors have not been able to identify the specific cause of Gender Identity Disorder. What is clear is that it is not caused by parents trying to make the child the opposite sex as your father-in-law accused you of doing. You did not give your son Gender Identity Disorder and the grandfather was wrong to accuse you. Your son's wife also did not cause the Gender Identity Disorder and you are wrong to accuse her.

Can women also have Gender Identity Disorder? Yes, they can, although Gender Identity Disorder is much more common in men than in women. A woman may feel she is supposed to be a man and reject the evidence of her femininity. She may complain that she is actually a man trapped inside a female body. As a child, she may refuse to wear dresses, even compulsory female school uniform, she may insist on standing up to urinate like a boy, she may insist on having a boy's haircut and may even modify her name to make it sound boyish. As a teenager she may try to hide evidence of her female shape by avoiding tight-fitting clothes or by bandaging her chest to flatten the breasts.

Do kids grow out of Gender Identity Disorder? No. Gender Identity Disorder is persistent. They may learn to hide it, but they do not grow out of it. They just push it to the background.

How come his grandfather cured him of it as a child? He did not. Because the grandfather made it clear that such behaviour was unacceptable and not funny, your son quickly learnt not to display it, since he was probably afraid of his grandfather's anger. However, the behaviour simply went underground. The fact that your son no longer talked about wanting to be a girl does not mean he stopped wanting to be one, he just learned not to express his wishes. The fact that he stopped playing with girls' toys likewise meant he had learned it was not a good idea to play with girls' toys, especially in grandpa's house but, inside, he still preferred them to boys' toys. He tried his best to act as society expected, by dating girls, acting masculine and so on, but his heart was never really in it. This tension between what he desired inside and what he felt he must show on the outside probably contributed to his becoming the quiet, more reserved person you noticed. Your son still had Gender Identity Disorder.

Why did he agree to marry? Family pressure and obligations, not wanting to let you down after the trouble you had gone to and the wish to be accepted all led to his marriage, although he knew the marriage would most likely fail. Sometimes people with Gender Identity Disorder marry because they desperately hope that marriage will cure them of the problem, i.e. change their gender identity, but it does not.

Maybe my son is just impotent No. Gender Identity Disorder is not the same as impotence. Impotence means a person is unable to have sex. Your son is fully capable of having sex, but he simply does not want to have sex with his wife because he would prefer to be a woman like her, instead of being her husband.

What is this strange talk about family planning pills? What your son is referring to is hormonal treatment. It is not actually family planning. What happens is that doctors can prescribe for man medicines which contain female hormones. These medicines can make the man's breasts grow and his body becomes more feminine in shape, but HE IS STILL MALE, because the hormonal drugs cannot change his chromosomes. Likewise, if a woman with Gender Identity Disorder is prescribed medicines which contain male hormones, she will grow a beard, develop a deep voice, her periods will stop, but SHE WILL STILL BE A WOMAN because the drugs cannot change her chromosomes.

Just out of interest, do people really get surgery to change their sex? Yes. This operation is called a sex-change or sex re-assignment, but it is not available in Papua New Guinea. It is not a simple matter of asking the doctor to cut off the bits of your body that you do not want. In the countries where such operations are carried out, the people have to undergo several steps before surgery.

What do they do? First they have to undergo psychological testing by a psychiatrist to find out whether they really have Gender Identity Disorder and why they wish to change their sex. If they have other mental illnesses or are not sure what they really are or what they want, they are rejected for surgery, because the surgery cannot be reversed. If the psychiatrist thinks they are suitable for the sex-change operation, then they give the patient a trial period of about two years, in which the patient must live and work as a person of the opposite sex fulltime while receiving hormonal treatment. For example, a man wanting to change into a woman might be told to spend two years using a female name, going to hair salons, putting on makeup, using women's toilets and urinating sitting down, sitting and walking like a woman, working as a secretary, joining women's groups and generally living as a woman, 24 hours a day. If they manage this successfully and are prepared to continue this way for life and still want to go ahead with the surgery, only then will the doctors consider operating on them.

Why such a long procedure? Because the surgery cannot be reversed later. The person has to be absolutely sure this is what he or she wants because the surgery is basically irreversible castration. If the person later changes his or her mind and decides he or she would like to return to the original sex they were born with, the surgeons cannot re-attach the organs they removed. Surgery is permanent. A person who has had a sex-change operation is called a trans-sexual.

That's terrible. Can I get a court order preventing my son getting such an operation done? No. It is not illegal for him to undergo the operation or take the hormonal drugs.

Aren't such people longlong to want to do this? No, they are not longlong. People with Gender Identity Disorder do not hear imaginary voices or see visions nobody else can see, they are not harmful to others etc. Apart from this problem with their gender identity, they are like other members of society.

If not longlong, then they must have some organs missing. No, they have all the normal internal and external sex organs that people of their sex should have and they produce sperm and eggs just like other people. You see, the problem is not the lack of the appropriate male of female organs, the problem is that the mind does not fit the body. Therefore, Gender Identity Disorder is a mental disorder, not a physical disorder.

Is this what is called homosexuality? No. A homosexual person differs from other people in his or her sexual orientation, while a person with Gender Identity Disorder differs from other people in his or her gender identity. A homosexual is a person who is sexually attracted to people of his or her own sex, instead of being sexually attracted to people of the opposite sex. A person with Gender Identity Disorder is not necessarily sexually attracted to the same sex; many just want to change their external appearance.

So why change their body if they are not homosexual? They wish to change in order to bring their physical bodies in line with their feelings about their gender identity

Why not change their gender identity to match their physical bodies instead? That is what they usually try to do first. Your son, for example, has been trying for years to adopt the role men should have, being masculine, growing a beard, dating women and even marrying. However, he did not succeed and now he wants to try and change his body to match his psychological gender identity, instead of vice versa.

I think all this is very unnatural, very un-Melanesian and it is better to have a dead son than live with this shame. Your son is still your child, no matter what you think of his behaviour and feelings. He needs help or he may well end up committing suicide. Do not be in such a hurry to disown him. Get him help.

Why can't he simply forget this nonsense and live as God made him? It is not that simple, or he would have done it years ago. He would need help if he decided to live as a male and he would also need help if he decided to live as a woman.

How? Next week we will discuss the problems faced by people with Gender Identity Disorder and how they can be helped.

Note: IF YOUR CHILD IS A TOMBOY OR A SISSY, PLEASE DO NOT CONCLUDE THAT HE OR SHE HAD GENDER IDENTITY DISORDER. MANY NORMAL CHILDREN ARE TOMBOYS OR SISSIES.