Gender identity crisis

formal programs here help Bobs to find life as Barbaras

By Elizabeth Price

When Bob was a little boy, he always imag. ined himself as a little girl. He never felt mascu line in any way.

School was difficult for him because his classmates teased him for being interested in such activities as fashion and grooming. He was not at all interested in traditionally, boyish: activities such as athletics.

When Bob was 16, he dropped out of school and began living full time as a young woman. He get a job as a waitress, he had boyfriends, and in everything he did, he looked, dressed and behaved as a young woman.

Eventually, Bob sought psychiatric counseling from doctors at University Hospitals. After three years of counseling and hormone treatments, he underwent surgery to change his body into what his mind always believed he was a woman.

Bob is now known as Barbara and at 26 is happily a complete woman.

112

There are more than 20 clinics in the United States to help people like Bob-Barbara overcome conflicts about their sexual identity. A limited number of persons with such identity problems are-surgically changed from a man into a woman. or from a woman into a man.

In Cleveland, there are two formal programs for people with these problems one a joint effort of Case Western Reserve University, Cleveland Metropolitan General Hospital and University Hospitals and a second at Cleveland Clinic.. Neither program is well publicized.

The doctors, psychologists and social workers åre generally protective of their patients, whom they are trying to help deal with what is often painful confusion.

The CWRU "gender identity program" was organized in the summer of 1975. Some 80 people with varying degrees of sexual identity conflict have been seen by members of the psychological team.

Seven people, all of whom were being seen by doctors before the summer of 1975, eventually were changed surgically from one sex to the öther.

The Cleveland Clinic's program was set up in January 1971. Doctors and psychologists make up its "gender assignment and eugenics committee." They are responsible for evaluating and counseling people with sexual identity conflicts.

If, after careful evaluation for a year or longer, the patient is found eligible for surgery, sex-change operations will be performed. Since 1971, some 100 people have been in the clinic's counseling program, and more than 30 sex change operations have been performed, the clinic reported.

The patient who eventually has a sex-change operation like Bob-Barbara is not typical, say the doctors and psychologists at CWRU. Based on their experience during the past several years. they say there really is no typical patient.

Music school is landmark

Legislation to add the Cleveland Music School Settlement to the register of the city's Landmarks Commission has been approved by City Council.

The settlement, a 42-room mansion at 11125 Magnolia Dr., was formerly the home of the late E. S. Burke, governor of the Federal Reserve Bank. The home was built in 1910 and acquired by the music school in 1938. It was designed by J. Milton Dyer, architect of Cleveland City Hall.

Surgery is not necessarily the only answer to a person's confusion and conflict. In fact, surgery should be the last step in solving sexual identity problems, experts say.

huns or

Susan, 23, hates to wear dresses, makeup and has little interest in cooking, decorating or men. She can't work because she is intensely uncomfortable being known as a woman.

Susan has erotic desires for other women, but she does not think of herself as a homosexual. woman. Rather, she sees herself as a man who is attracted sexually to women.

She lives with her mother and is very anxious whenever they are apart. Susan is now receiving psychiatric counseling to help her leave her mother and live independently before any decisions are made about her sexual identity..

One persistent question about people with sexual identity problems: How does this happen to people?

Dr. Stephen Levine, a psychiatrist and codirector of the CWRU program with Dr. Aaron Billlowitz, said no one is certain of the answer. However, there are two theories that are not mutually exclusive, he said.

One is that something happens to a child before birth, late in its fetal development, that interferes with the "charge" of masculinity or femininity, he said.

The other is more social than biological. Levine explained that early in the child's life, something happens in the interactions between parents and child to disturb the formation of a firm sexual identity. Generally, their early family lives are chaotic, he said, but not always.

Usually a person's core sexual identity is firmly established by the time he or she turns 4, Levine said. Typically, that sense of sexual identity as a boy or girl' continues unchanged as the child grows up.

People who are heterosexual do not always feel totally masculine or feminine all the time; some crossover is normal, Levine said. A man might feel gentle, sensitive or passive; a woman might feel aggressive, powerful or domineering. Internally though, heterosexuals have a core conception of themselves as male or female.

In contrast, people in conflict about their sexual identity, transsexuals, feel just the opposite of the sex they are physically.

Early in their lives, they incessantly play the part of the opposite sex in children's games. A little boy will play the part of the mother ir playing-house games. And they do not outgrow their strong interests in activities normally preferred by the opposite sex.

Especially after adolescence, they find it more and more difficult to live with their biological sex. Trying to live according to their biological sex only increases their discomfort. Sometimes dressing in clothing of the opposite sex relaxes them.

Unlike heterosexuals and homosexuals, transsexuals view their genitals and breasts with disgust. A man wishes he did not have a penis and testicles; a woman wishes she did not have breasts or a vagina. They feel no anxiety at all about the thought of losing their genitals. In fact, they say they would be relieved to be rid of them.

George is an unmarried salesman, 24, who appears and behaves in an effeminate way. Although he works every day as a man, he does not feel masculine at all.

To avoid thinking of himself as a homosexual, he sometimes secretely wears women's clothes, usually underwear. He occasionally has dressed completely as a women and gone shopping or out to eat in restaurant.

George is afraid to think of himself as a

homosexual, although he frequently thinks about having sex with men. He is now working with a psychologist to accept his homosexuality. He has been discouraged from having surgery to change

his sex.

The CWRU program for people with sexual identity conflicts gives them the chance to have a thorough medical and psychological evaluation and comprehensive care. The staff is made up of psychiatrists, psychologists, a social worker, a surgeon, an endocrinologist and lawyers.

Mental health professionals try to help these people understand their problems and decide if admission into the program will help them.

If admitted into the program, the man or woman can take advantage of many different services. These include psychotherpay, family meetings, hormone therapy and sex change' surgery,

A brochure for patients states: "Admission and participation in the Gender Identity Program is not a guarantee that sex-reassignment surgery will be performed. Some patients will choose to keep their cross-gender wishes confined to fantasy or periodic, private cross-dressing. Others will live and work in a cross-gender role (with or without hormones) without the likely possibility of surgery."

Surgery will not be done unless the patient has been in the program for at least a year. Both kinds of operations are done: women can be changed into men, and men can be changed into women. The latter change is less complicated and is done more often.

Of the 80 patients who began the CWRU program since September 1975, none has had surgery to change his or her sex. Twenty-four people are in psychotherapy with or without hormone injections. Some of these may eventually have surgery. Levine said.

Follow-up studies on patients treated at CWRU are not yet available. How these people eventually cope with their sexual identity conflicts or their sex change operations is still unknown.

"The major point is that we consider this a justifiable experiment whose aim is to help people live in more comfort. How they fare over a period of time is ultimately the question. And the answers are not in yet," Levine said.