38

AMERICAN JOURNAL OF PSYCHOTHERAPY

as such in public. Another compromise is dressing as a woman only in the privacy of the home. Both ways leave transvestites, and especially transsexualists, greatly frustrated and unhappy.

The transvestite wants to be accepted in society as a member of the opposite sex; he or she wants to play the role as completely and as successfully as possible. The male transvestite admires the fe- male form and manners and tries to imitate both with an intensity that varies greatly from case to case. The female transvestite, being legally immune, has it easier to identify herself with the male sex, acting the part of a man in appearance as well as in con- duct. Gutheil published an analyzed case of female transvestism in Stekel's book on Fetischism (5).

Transsexualism is a different problem and a much greater one. It indicates more than just playing a role. It denotes the intense and often obsessive desire to change the entire sexual status in- cluding the anatomical structure. While the male transvestite, enacts the role of a woman, the transsexualist wants to be one and function as one, wishing to assume as many of her characteristics as possible, physical, mental and sexual.

Transsexualism as well as transvestism are decidedly more fre- quent among men than women, like most other sexual deviations. Due to the more permissive fashions in women, female transvestism is less conspicuous, but naturally can involve for the individual the same frustrations and often tragic situations as in men. Since the social and legal complications are infinitely greater in male trans- vestism and transsexualism, this present discussion is largely con- fined to them.

The transsexualist is always a transvestite but not vice-versa. In fact, most transvestites would be horrified at the idea of being operated. The transsexualist, on the other hand, only lives for the day when his hated sex organs can be removed, organs which to him are nothing but a dreadful deformity. Therefore the trans- sexualist always seeks medical aid while the transvestite as a rule merely asks to be left alone.

To put it differently: In transvestism the sex organs are sources of pleasure; in transsexualism they are sources of disgust. That seems to me a cardinal distinction and perhaps the principal differ- ential diagnostic sign. Otherwise there is no sharp separation be- tween the two, one merging into the other.

It is quite evident that under the influence of sensational pub-