43

TRANSSEXUALISM AND TRANSVESTISM

quite evident in his history, were therefore able to make a corres- pondingly deep impression on the personality structure. Psycho- somatic and somato-psychic factors intermingle.

An attempt at therapy may be considered but prognosis-I be- lieve is poor. Personally, I have never seen a cure, but the patients usually do not persist in treatment long enough or have no real desire to be cured. The constitutional factors are possibly too deep and resist psychotherapeutic endeavors too strongly. Un- der the powerful suggestive influence of publicity like that of the Jorgensen case such transvestites may, for the first time, turn toward transsexualism.

3. The somatopsychic transsexualist. This type is well repre- sented by the case of Christine Jorgensen, who published the facts of her own case frankly and with a well-conceived self-analysis.

Feminine appearance and orientation is often striking in these people but masculine features are compatible with full transsexual- ism. The conviction of these endocrine males that they are really females with faulty sex organs is profound and passionate. Sug- gestive childhood influences are often evident in their histories, but may, in other cases, be vague and not sufficiently plausible to help in explaining the phenomenon. Therefore a still greater de- gree of constitutional femininity, perhaps due to a chromosomal sex disturbance, must be assumed in spite of the fact that the gona- dal status may appear within normal limits. Here, psychic her. maphroditism seems to be an apt description.

Sex life is largely cerebral and non-genital, satisfaction being derived more from their paraphilia that is to say their feminiza- tion fantasies and endeavors than from auto-erotism or homosexual contacts.

Hamburger and his associates have portrayed such a case in an article in the A.M.A. Journal (3). They analyzed the clinical facts and the surgical treatment with much insight and common sense, reaching the conclusion that "It is highly probable that eonism, (their term for transsexualism), is constitutionally conditioned."

After their report appeared, an interesting attempt was made in a letter to the A.M.A. Journal (9) to interpret the same case of transsexualism from a strictly psychoanalytic angle naturally with rejection of any treatment except psychoanalysis. Unfortunately, a theory that disregards biological factors in such cases-in my opinion-cannot convince and does not ring true.