Research and discussion paper
Gender identity disorders and family acceptance
Aslihan Polat, Sahika Yüksel, Aysun Genc, Handan Meteris
Istanbul University, Istanbul Faculty of Medicine, Psychiatry Department, Istanbul, Turkey
Presented at the 6th spring symposium of the Turkish Psychiatry Association, 24-28 April, 2002, Antalya Turkey
Copyright Sahika Yuksel (for authors), to whom requests for reproduction and dissemination falling under copyright laws must be made
Introduction and objectives
Individuals with gender identity disorders demonstrate easily recognisable changes that are not in accord with established sexual roles and behaviours. These individuals are isolated from society and become the objects of varying degrees of segregation. The reactions of the family, the smallest unit of society, to its transgender member are evidently a reflection of the attitude of society. It can be expected that the family be influenced by the general social viewpoint in such a sensitive issue like sexuality. The relatives of these people who disturb social norms and are disapproved by society are generally ignorant about the subject and unable to provide support. There can be only a few instances that can be more shocking for parents than finding out that their child is transgender, despite the fact that the tendency of parents to hold themselves responsible for all the successes and failures of their children is gradually changing. Even the closest and most understanding parents experience a narcissistic wound when they learn that their child is transgender. It is as if they have a relative who is involved in criminal acts. The initial reactions resemble post-traumatic stress disorder.
A significant portion of published studies on sexual identity differences and related attitudes include data from Western European and Northern American societies. Studies made in Asian and Middle-Eastern societies with more traditional attitudes to sexuality are rather limited. The aim of this study is to investigate the acceptance of sexual identity differences by the families of transgender individuals. The approaches toward the question of sexual identity and sexual reassignment surgeries demonstrated by the families of individuals who applied to a psychiatry clinic demanding sex change and accepted the recommended process of evaluation were assessed for this purpose.
The attitudes and behaviours of the first-degree relatives of individuals who applied to the Psychoneurosis Psychotherapy Unit of Istanbul Faculty of Medicine Psychiatry Department toward the sexual identity of the individual were assessed. Families were evaluated in terms of their socio-demographic characteristics, attitudes toward religious and sexual matters, the time and age of the recognition of the sexual identity differences of their children and the processes of acceptance using a semi-structured questionnaire.
An experienced psychiatrist conducted face-to-face interviews after the informed approval of the transgender individuals in the treatment process.
37 relatives of 29 transgender individuals (14 biologically male, 15 biologically female) were interviewed. 46 % of the relatives were primary - secondary school graduates and 56.8 % were of medium income level. All but one of the families was of nuclear family structure. 65 % of the families voluntarily asked to have an interview. The majority of the relatives who came to the interview (56.8 %) were mothers. The first member of the family to observe the sexual identity difference and the relative demanding to have an interview were the same person in 67.6 % of the families. While 19 % of the families considered themselves as religiously conservative, 32.4 % stated that they were restrictive in sexual matters.
The majority of the families (54 %) mentioned that they had been aware of the situation of their relative for more than 5 years and had first noticed it during puberty (46%). Almost half of the group had noticed the difference in gender identity themselves, the other half had been informed of the situation by the transgender individual. The transgender individuals conformity to the family in that period was defined to be disordered by over half of the group (54 %). Only 27 % of the families stated that they felt responsible for the gender identity problem of their relative. The majority of the families (65 %) had tried to conceal the situation from the environment and 35 % did not inform other relatives. Those who complained about the negative and dismissive attitudes of other relatives were 24 % while those with positive and supportive approaches were 32.4 %.
The majority of the group (62 %) mentioned that they had no information about sexual identity differences at the time they had learnt about their relatives condition. More than half of the families (70 %) stated that they had experienced severe sorrow when they had recognised the fact while 16 % had been outraged. 51 % had tried to change the situation by talking or by force whereas 37.8 % had adopted a supportive attitude. 51.4 % had applied pressure on the individual to make him/her dress according to his/her biological sex while 43 % had tried to take him/her to a psychiatrist. Those who had applied violence were only 3 %.
An examination of the contemporary attitudes of the family toward the individual with sexual identity problems revealed that 46 % of the families had totally accepted the situation while 38% had accepted it only partly and 16 % totally rejected it. Female biological sex of the transgender (p<0.05), low level of negative sentiments when the family learnt about the situation (p<0.05) and high conformity of the transgender to the family in that period (p<0.05) were determined as positive predictors determining the attitude.
Almost the entire group (94.6 %) asserted that they nowadays had adequate information about gender identity disorders; 52 % stated the media as their source of information whereas 32.4% had received information from doctors. Most of the families (78%) were content with the treatment and mentioned that the conformity of the transgender relative to the family was improving (65 %). The expectations of the families were concentrated in two groups, namely, that the individual have the sexual reassignment surgery for the sexual identity he/she would like to have (48 %), or that he/she regain the behaviours suitable to his/her biological sex (43 %).
Individuals who apply to our clinic and who, after the evaluation of at least two professionals, are acknowledged to be transgender are followed through individual or group therapy for at least two years. Psychoeducation and information oriented meetings in which families get together are organised at least twice a year in this period. These meetings not only create a natural atmosphere for families to get to know one another, but also make it easier to accept their relative / child for families who have just started to participate or are more resistant. Furthermore, these groups provide the support that families need as they witness the process of change that their transgender relative goes through. These families who usually react to the segregation and exclusion that they are exposed to by our society (that still regards sex as a taboo) by introversion and isolation realise that "they are not alone" and acquire the opportunity to share their anger and sorrow.
The administration of interviews composed of two sections took around 90 minutes. The first section was designed to obtain information about how and when they had recognised that their child was different from his/her biological sex. Although they had known that their children was transgender for an average of such a long period as 5 years, their initial knowledge about transgender itself was mostly (62 %) very limited or incorrect. Among the reasons for the lack of information, embarrassment to speak about the situation and the tendency to conceal it were significant. Therefore information concerning the nature of transgender identity and its medical observation was provided in the second part of the interview. Beyond the provision of information, it was an atmosphere of admittance that was created by this dialogue with the "medical authorities". Subsequently conducted transgender family groups reinforced this atmosphere.
The families came to the interview with various motivations. Some hoped that their relatives would be persuaded to return to their biological identities. Most of them had admitted the situation and demanded information while some blamed themselves / their children in a desperate or outrageous manner. An evaluation of the attitudes of the families showed that the number of those who totally rejected the situation and applied pressure was low and the majority had admitted it. It may be argued that our group does not represent transgender and those who follow the treatment are those who are already sympathetic to the process of treatment and thus agree to have the interview. In other words, it may be claimed that we have interviewed family members who are closest to accepting the situation. However, despite this positive attitude and the increase in the related information possessed by families, it is striking that still the expectation of a significant group from the treatment is that their relative regain the behaviour suitable to his/her biological sex.
This finding may be interpreted, as showing that a part of the families who state that they have cognitively acknowledged the situation and demonstrate supportive attitudes have still not totally admitted it in the emotional level which is more difficult.
The majority of the families mentioned that they observed improvement in the conformity of their transgender relative to the family during the process of treatment and in their knowledge of the subject. If it is taken into consideration that harmony within the family is one of the parameters determining the attitude, this is in fact a significant factor for the reduction of negative and denying attitudes.
For correspondence please contact Sahika Yuksel at Istanbul Medical Faculty, Psychiatry Dept., Topkapi, Istanbul, Turkey. Fax (90)2126312400 or e mail at address given at top of page.