How does an individual develop identification with the male or female gender? What factors are decisive in this process?
In what ways do hormones, culture, and emotional bonds shape core gender identity—the foundation of the Self? These questions will be addressed in the following section.
The Role of Hormones in Prenatal Development:
In 1972 Money and Ehrhardt offer evidence that parents, under ordinary circumstances, even if they believe they are treating baby boys and baby girls exactly the same way, show gender-determined differences in their behavior toward their infants. Although there are male/female differences based on prenatal hormonal history, these differences do not automatically determine postnatal male/female behavioral differentiation: feminizing hormonal pathology in males and masculinizing hormonal pathology in females, except under conditions of extreme degrees of hormonal abnormality, may influence gender-role identity more than core gender identity.
Excessive androgens in a girl's prenatal period may be responsible, for example, for tomboyism and increased expenditure of energy in recreation and aggression.
Inadequate prenatal androgen stimulation in a boy may cause a certain passivity and nonaggressiveness but does not influence core gender identity.
Hermaphrodite children who are reared unambiguously as girls or boys will develop a solid identity as male or female in consonance with rearing practices, regardless of their genetic endowment, hormonal production, and even—to some extent—the external appearance of genital development.
An equally important factor is the way identity develops within the context of family relationships.
The Influence of Upbringing and Family Relationships:
A number of studies indicate that transsexualism —that is, the establishment of a core gender identity contrary to the biological one in individuals with a clearly defined biological gender—has not been found to be related to genetic, hormonal, or genital physical abnormalities. Although the research on subtle biological variables, particularly in female transgender individuals, raises the question of some possible hormonal influences, the overriding evidence is of severe pathology in early psychosocial interactions.
In this regard, psychoanalytic exploration of children with abnormal sexual identity, as well as of the history of transgender adults, provides information about significant patterns first described by Stoller (1975b).
These include:
- For male transgender individuals (biological males who experience themselves as having a core identity as a woman), a mother with strong bisexual personality components who is distant from her passive or unavailable husband and who engulfs her son as a symbolic provision of completeness for herself. Blissful symbiosis, which implicitly eliminates the boy's maleness leads him both to excessive identification with the mother and rejection of the male role that has been unacceptable to her and inadequately modeled by the father.
- In female transgender individuals, the mother's rejecting behavior and the unavailability of the father propel the daughter, who feels not reinforced as a little girl, into becoming a substitute male and ameliorating her mother's sense of loneliness and depression. Her masculine behavior is encouraged by the mother, whose despondency then lifts, and leads to improved family solidarity.
Early parental behavior (particularly maternal) that influences core gender identity, and sexual functioning in general, is not exclusive to humans. Harlow and Harlow (1965), in their classic work with primates, demonstrated that an adequate attachment by means of secure, physically close contact between infant and mother is essential for the development of a normal sexual response in adult monkeys: the absence of normal mothering and, secondarily, of interaction with peer groups in critical developmental phases disrupts the later capacity for adult sexual response.
Particular attention should be given to the contribution of Dr. Otto Kernberg, whose concept clarifies how the formation of gender identity is linked to the integrity of the ego.
Dr. Otto Kernberg’s Views on the Integrity of the Ego:
Special attention should be given to the views of Dr. Otto Kernberg, M.D. He emphasizes that the assignment and adoption of a core gender identity determine, for practical purposes, the reinforcement of gender roles considered male or female. Insofar as an unconscious identification with both parents—an unconscious bisexuality that is a universal finding in psychoanalytic exploration—also implies unconscious identification with roles socially assigned to one or the other gender, there exist strong tendencies toward bisexual attitudes and behavior patterns, as well as toward bisexual orientation as a universal human potential. It may well be that the strong social and cultural emphasis on core gender identity ("You must be either a little boy or a little girl") is reinforced or codetermined by the intrapsychic need to integrate and consolidate a personal identity in general, so that the core gender identity cements core ego identity formation.
In fact sexual identity may constitute the core of ego identity.
Clinically, we find that a lack of integration of identity (the syndrome of identity diffusion) regularly coexists with problems of gender identity, and stress, transgender individuals usually show severe distortions in other areas of identity as well.
Thus, biological factors, upbringing, and deep unconscious processes interact in a complex balance to shape what Dr. Otto Kernberg described as the core of our identity—the foundation of an integrated ego.
Transgenderism is an extraordinarily complex phenomenon. We urge against approaching it in a stereotyped or reductionistic manner. In considering the origins of transgender identity, it is essential to take into account all possible contributing factors in the formation of the individual: genetic, hormonal (both maternal during the prenatal period and those of the transgender individual), as well as psychological, deeply unconscious determinants.
The study of these processes not only expands our theoretical understanding but also deepens psychotherapeutic practice, since questions of identity concern who we are, how we love, how we express aggression, and the place these dynamics occupy in our psyche and relationships.
(c) Yuliia Holopiorova,
Ukrainian Association of Transference-Focused Psychotherapy