May 19, 2014

Anne Vitale on Crossdreaming in Middle Age

What happens to gender dysphoric crossdreamers when they enter middle age?
Illustration photo by Volodina

The psychotherapist Anne Vitale has written a very interesting book on various transgender conditions -- including various shades of crossdreamer -- called The Gendered Self.

I am taking the liberty of quoting the book liberally, as I think the book contains an important discussion of the gender identity struggles of adult crossdreamers, crossdressers and transgender.

Gender expression deprivation anxiety

Vitale points out that mid-life brings up new challenges for what I call crossdreamers -- especially the gender dysphoric ones (i.e. those that suffer from what Vitale calls "gender expression deprivation anxiety").

"Decades of trying to overcome their increasing gender expression deprivation anxiety begins to weigh heavily on the individual. Family and career are now as deeply rooted as they will ever be. The idea of starting over as a different sex seems impossible."

These persons often show up in therapy offices with symptoms mimicking depersonalization disorder, depression or generalized anxiety disorder, Vitale points out. They complain of panic attacks, irritability, sleeping disorder, inability to concentrate and weight loss.

Some disconnect from their families emotionally. Others find it hard to keep up their job performance. Some get suicidal at this stage.

The problem is that the feeling of dissonance does not go away as you get older. It might just as well get stronger.

The life of John

Vitale tells the story about John, a 51 year old male assigned medical research scientist, married for over 20 years and with three children, who came to her after a severe panic attack.


Vitale reports:

"He said that he was 'gender dysphoric' and that he was 'desperate'. Feelings that were once 'controllable through sheer force of will' had increased to where he was now having protracted periods where he would close his office door, lie in the corner on the floor and weep quietly while curled up in the fetal position, holding his genitals in pain.

"Other than intrusive and repeated fantasies of being female, he had refused to allow himself any overt form of female gender expression. The only other form of temporary relief came through masturbating. He reported feeling that if he was to cross-dress and be caught, he would dishonor his wife and family. Having attained international recognition for his work, he was also concerned about his professional reputation."

The invisible transgender

To the extent the fates of persons like John are mentioned at all in the transgender debate, it is normally as examples of perverts afraid of losing their "male privilege". To me that make no sense at all. If this had only been about a sexual kink, John would not face this kind of severe emotional pain. This is a clear case of gender dysphoria, if I ever saw one.

And I fear there are many like him out there. Indeed, I can recognize a part of my own story in his. These are the "dark transgender", the invisible ones, the ones that do not show up in government statistics.

I must admit that this case has made a strong impression on me, as it documents how far we have to go before we are able to alleviate all this suffering. At the moment it seems too many, both sexist scientists and transgender separatists,  are trying to make it worse.

John makes a choice

What happened to John?

Vitale says that they worked together for three years by way of individual, group and family psychotherapy, plus estrogen replacement therapy. John has now taken a female name and is living full time as a woman.

Vitale does not reflect on what would have happened to her if she had not gone down that road.

In denial

Vitale argues that what she calls "group three" (the category of MTF transgender that are most similar to the majority of transgender people reading this blog, I guess) may end up i John's position because they have spent so much time trying to rid themselves of their dysphoria:

"Being largely heterosexual, they often marry and have children, hold advanced educational degrees and are involved in high levels of corporate and academic cultures. These are the invisible or cloistered gender dysphorics. They develop an aura of deep secrecy based on shame and risk of ridicule and their secret desire to be the opposite sex is protected at all cost...

"The irony is that gender dysphoric symptoms appear to worsen in direct proportion to their self-enforced entrenchment in the gendered world they do not identify with. The further an individual gets from believing he or she can ever live as a member of the opposite sex, the more acute and disruptive his or her dysphoria becomes."

The lives of the non-dysphoric

Vitale does not say that this applies to all crossdressers, mind you:

"If the individual's gender dysphoria is a relatively minor one, cross-gender lifestyle changes in dressing and behaviors may be all that person needs to ease the anxiety. However, if the individual's dysphoria is profound, a simple life style change may be insufficient. In the latter case, the need for more authentic gender expression moves from a life-style problem to a life-threatening imperative."

Feel free to share your own experience as a comment!

The introduction to Vitale's book is available for free.

Discuss crossdreamer and transgender issues!