From the beginning of the psychoanalytic thought, sexuality was the basic pillar of psychic structure of the person. It is shaped through a dynamic mixture of social and cultural morals and experiences, somatic urges, conscious and unconscious desires and it respectively shapes our behavior and our choices. At the same time, the gender identity, that is a basic part of the total sexual identity of the person, seems to be shaped from the outside biological reality but also through the internal recordings of the experiences and the person’s relationship with its primal objects. In gender identity disorder cases a common image is that of a psychologically and physically absent father and of an omnipotent mother figure, within which the child will express their own difficulties and unfold the unconscious maternal desire of the phallus and the paternal weakness to defend his own. Taking into account those intrapsychic factors we can understand the important role that homosexual choice play within the intrapsychic formation of the person and his family’s homeostasis.
KEYWORDS: sexuality, gender identity, disorders of gender identity, homosexuality
From the beginning of psychoanalytic thought, the issue of sexuality was a cornerstone in the theory of psychoanalysis. Sexuality itself can be seen & nbsp; as a mosaic of bodily impulses, unconscious desires, fantasies and symbolisms as well as conscious attitudes and behaviors within a personal experience of gender identity. It is formed under a web of social norms, religious customs, socio-cultural data and scientific ideas, which give it the character of a personal and historical experience (Weeks, 1985). Freud himself, through concepts such as the oedipal complex, the castration stress in the boy and the envy of the penis in the girl, placed these issues on a psychosexual developmental basis that shapes the mental structure and sometimes psychopathology. As he said, the complexity of human development forms a whole field of thought and reflection around these concepts of sexuality in terms of both their formation and maintenance. It introduces innate bisexuality and refers to a mixture of female and male elements that characterize each of us to a different degree and in a different way and significantly direct our sexual behavior and our identity.
Moving on to the concept of gender identity, a concept that began to be introduced in the second half of the twentieth century, we refer to a mental formation, a part of ourselves that is originally composed of biological factors such as genetic characteristics related to the body and then by intrapsychic but also environmental factors, as for example the psycho-emotional development of the child and their relationship with the primary object, mainly at the level of identifications and fantasies, around the issue of gender and body . Gender identity, which is a key part of shaping an individual’s overall identity, seems to be shaped not only by the external biological reality but also by internal recordings of the conscious and unconscious relationship with the parents and the primary mirroring of the child in their eyes, that is, through their gaze in relation to the child’s sexuality.
The sex of the child differentiates from the beginning the processes of shaping the gender identity. Boys begin their lives as heterosexual beings with their genitals visible and recognizable, in contrast to girls whose primary object of love is homosexual and their genitals are internal. One could argue that resolving the oedipus’ complex is a more achievable goal for boys than for girls. However, we must not forget that at an earlier stage of the development of gender identity, both the boy and the girl are in a phase of merging and interacting with their primary object and form their identity based on the early relationship and interaction with it.For Mahler, the beginning of the process of gender identity is placed in the period of separation and personalization and gradually reaches some completion in the oedipal period. Accordingly, Stoller states that the nuclear gender identity will be formed at the beginning of life up to 3 years, where the boy from the symbiotic relationship with the mother object will proceed then to masculinity and secondary identities to his father, leaving the initial bliss of the symbiotic relationship and mentally enduring a “castration” of this pleasure, which will not be traumatic for the members of the primary duo. It seems that the discovery and establishment of the boy’s masculinity (in relation to his father) begins and presupposes first, a castration experience (in relation to his mother). Especially for the boy, the early physical closeness and union with the mother, if not interrupted by the presence of the father, triggers a fantastically indivisible duo and sends the message of a father unable to fulfil his role as a male role model. This early and massive coexistence will create a long-term desire of the boy to return to the mother body and reject his masculine, different image. So his desire will not be to win a woman for himself (like his father) but to become a woman (like his mother). Homosexuals will thus seek “protection” from the “oral” or “anal” mother of the pre-oedipal stages, identifying with her and seeking the father symbolically in the erotic object of their choice. This inverted sexualization starts very early and prevents both aggression and the annihilation of the fusion relationship. But at the base of an inverted oedipus complex, the child as a branch of the mother does not destroy but humiliates the father, underestimating him on a fantasy level even more, thus reinforcing the desire – fantasy that he had been born a girl. In this dynamic of the couple the father is not included except as a person who expresses an incompetent self or a dangerous self. The mother is idealized as inaccessible and undefiled by any urge, while the father is invested with all the aggression and sexuality that the child fears. In fact, in many cases the image of an absent father and an omnipotent mother is common, as the child will be an accomplice in their own difficulties and will express the desire of the mother for an ideal phallus and the father’s inability to defend his own. According to Stoller, masculinity in boys as a result of their masculine nature is not only a confirmation of normal development but an achievement on many levels.
Later in adolescence the adolescent will renegotiate deficits of previous stages of development with intrapsychic conditions commensurate with his or her early experiences. With the onset of adolescence, pre-existing internal urges intensify, resulting in the adolescent suffering from a sense of lack of self-control, internally and externally, and in the sense that he or she now has the physical capacity to dynamically transfer their aggression and their sexuality in real life, which adds an extra degree of difficulty to the intrapsychic processes. At this age the quality of sexual relations and pursuits is more in the form of the inner path than the external pursuit. Taking into account these intrapsychic factors, we can understand the important role that the homosexual choice serves in preventing the collapse of early relationships with parental objects and the intrapsychic formation and family homeostasis of the individual.
Focusing on the factor of relationships with the parental objects and placing more emphasis on the existence of an intergenerational pathology, I will present the case of a teenager with a gender identity disorder from infancy. A. is the case of a 14-year-old adolescent at the beginning of psychotherapy, who was referred to me after a child psychiatric evaluation, in which he was diagnosed with gender identity disorder, transvestism as well as general difficulties in his mental function from infancy. As this is a treatment of several years with rich material which can not be presented extensively here, I will try in this presentation to focus mainly on how the parental psychopathology influenced the adolescent’s early relationships with the parental objects and contributed significantly to the development of the psychopathology of the teenager.
A. is a 14-year-old teenager, tall, stocky, with a beautiful face and long hair, who looks clumsy and immature. His parents initially turned to a psychologist at their place of residence, as they were particularly concerned and anxious about issues that had arisen in relation to their son’s gender, sexuality and homosexual tendencies. The psychologist clinically confirms these difficulties of A. that have intensified more due to the impending adolescence and refers them for child psychiatric evaluation. After the child psychiatric cooperation with the teenager and the parents, the serious difficulties around A.’s gender identity, his sexual pursuits and dramatizations, which extend over time and are consistent with general difficulties in his mental functioning. It is deemed appropriate and it is suggested to the family that A. starts psychotherapy and the parents consultation.
DEVELOPMENTAL AND FAMILY BACKGROUND
As for his developmental history, A. comes from an unplanned pregnancy, but without problems or complications. He was born naturally but was not breastfed. He was a quiet, calm baby who, according to his parents, showed no difficulties or delays in the various stages of his development and walked, sat and talked normally and gained control of his sphincters just before 3 years. No problems or diseases have been reported that have affected his development in terms of his medical history. However, they remember early on, him thinning his voice, playing with his sister’s dolls and adopting feminine behavior. Shortly afterwards he began to wear his mother’s clothes, jewelry and shoes inside the house. At the beginning of kindergarten he connects with a classmate and on a systematic basis begins sexual games, which he repeats for a long time with another child in elementary school.
In terms of family history, A. is the eldest child of a family of four and has a younger sister, with a small age difference. During infancy and early childhood, an important role in his upbringing was played by his paternal grandmother, who had largely taken care of him, as his parents initially found it difficult to meet their parental functions. When this grandmother dies, the father collapses mentally and develops major depression, as a result of which he now has regular monitoring by a psychiatrist and is receiving medication. Opposite the father’s difficulties is the mother, who works omnipotently, oppressively and sometimes violently towards A., especially when he was young.
Regarding the father’s relationship with A., there were difficulties in contact and communication between them. A. remembers a father who is truly and mentally absent, who is unable to cope with the needs of the child and to build a satisfactory relationship with him. Regarding his relationship with the mother, who has a dominant role in the family, A. experiences her presence as penetrating and omnipotent. Until recently, A. hid in various parts of the house or buried in the garden any of his personal data he wants to preserve. The mother, raised in an equally stressful environment, is unable to recognize A.’s emotional needs and to establish a caring relationship with him. Regarding the relationship with his sister, A. describes a symbiotic and interdependent relationship, where the two children transfer to their own link their mental deficits with the hope of redressing them. The absence of the parents, especially the father, is evident especially in matters of identification, with his sister acting as a tomboy and A. having a feminine appearance and behaviour from preschool age. A. remembers playing erotic games where they played the two girlfriends who were looking for partners, with the sister disguising, putting make up and dressing up A. Later, when the foreplay includes other children, the two siblings share the same friend. The desires but also the anxieties that emerge from all this lead his sister to reveal them to their parents and accuse him of being homosexual.
At the beginning of the psychotherapeutic relationship he has in mind a poem by Cavafy “Prayer” (1898), which he had just studied for school and wants to tell me because he was impressed:
The ocean took a sailor to its bed.
His mother, unaware that he’s dead,
lights a tall candle for temperate weather,
for his quick return, that they can be together,
and always to the wind she cocks her ear.
But while she prays, hopeful yet in fear,
The icon of Mary listens, grave and sad,
knowing she’ll never see the son she had.
So he begins with a reference to his relationship with his mother and a separation between them that sets the loss as the basis of the psychotherapeutic process. Then, the initial sessions with A. highlight the magnitude of his general mental deficits and inadequacies, which exist in the context of a pervasive sexual identity that unfolds through a false self. A.’s vulnerable and immature ego presents an early mental structure with fixations mainly in the primary relationship with the mother and with many symbiotic elements between himself and the mother object. The defence mechanisms are immature and ineffective to contain the early stress that emerges from the merging relationship with the archaic-phallic mother and the fantasies that accompany it. In addition, many issues arise around the formation of the physical Ego and its primary narcissism, as they emerge through his fantasies and daydreams. The Superego works weakly, helping him to achieve a basic superego organization of himself, but in a persecuting and highly indebted way. At this stage the relationship with his mother is characterized by ambivalence and anxiety and the relationship with the father is characterized by aggression and reciprocal rejection, intensifying A.’s difficulties for a possible normal resolution of the oedipus complex and trapping him in a constant search for both sexes. During this time his difficulties are also distinct in his relationship with his sister, towards whom he sometimes acts sadistically – aggressively and sometimes masochistically – submissively. The rest of the material of the initial psychotherapeutic session is also characteristic, where it refers to the Halloween costume, as a cover that hides his true self but he does not like it. In this case, he is upset that he has to wear the costume of a prehistoric man, which consists of a djellaba with tights and he needs to parade while dancing. Deeper desires are circulating, urging him to expose his body to the eyes of others and to provoke them erotically, resulting in intense anxiety. He wants to be restrained so as not to do what comes to him spontaneously and not to be the object of commentary as he imagines, as the inside and the outside, the obvious and the hidden are not limited. He remembers that this started when he was young, when others were constantly making fun of him and he learned to hide his thoughts. The internal conflict he is experiencing also contains a hope of redressing in the face of the difficulties of the past. At school he paints a theme entitled “Your world” and he paints half the landscape polluted and damaged and the other half a meadow with trees and plants. He says that these two pieces of his painting are incompatible with each other and he has to choose which one he prefers. An inner ambivalence emerges between two different aspects of the self that are both existent and desirable. In the initial phase of psychotherapy, issues are also raised to be addressed around the need for him to be able to express himself and to be particularly external in communication with his peers without abusing the limits and to lose control of himself and his impulses, but to be able to restrain and manage the intense fantasies (aggression – sexuality) that overwhelm him. Also an important part of the initial phase is covered by his need to speak and understand the sense of “diversity and inadequacy” he experiences in relation to his body, with his sexuality as he tries to match his different sides and desires. In this context he talks more about the relationship with the parent object, which is characterized by fantasies of union and merging and at the same time by fears of abandonment and non-existence.
He currently perceives himself as a man and a woman together and is in an inner search for boundaries. Typical is the phrase he says to describe that he likes to buy clothes: “only when I go shopping I feel that I deserve something”, describing his desire to be chosen as an object of satisfaction by others and even sexually to gain status and pleasure. Through therapy he seeks the context, the inclination and desires the control of the relationship both real and symbolic, often trying to catalyse the boundaries between us and to function in a merging way.
EARLY RELATIONSHIP WITH MOTHER
In the first period of treatment he talks about the primary relations in general and for this he refers much to pets and strays, which he wishes to take care of but does not succeed. He says that their canary laid three eggs for them and sitting them and that they have bought a pregnant rabbit which he is waiting to give birth to. She wants to see the newborns when their mother takes care of them, when she shows them her love and raises them tenderly. But then he mentions about his own bunny that he loves but he gets angry with it and often kicks and hits it so much that it has become very scared of him. He says that he also learned that way and while he knows that beating is not good, in his family it is hereditary. He later reports that he has taken care of a battered sparrow at home but he is unable to warm it up and feed it well. He says: If its mom did not teach it when it was little, how can it learn to survive on its own? He remembers how much the separation from his parents cost him, when they worked hard and he stayed with his grandmother all the time. He tries to bring back more memories from him and his mom. He says that his grandmother always calculated his age by adding nine months, he wishes he remembered his relationship with his mother from then on. He says that he only felt tenderness and care from his grandmother, while in relation to the mother who mentions her as absent, he feels more neglected and misunderstood by everyone, as if she does not know who he is as if he did not learn about himself. He does not know how to choose what he likes and what he does not, but he is always the obedient child who accepts what others arrange for him. Nobody listened to him when he said no and so he learned to say yes to everyone and everything.
EARLY ROLE OF THE FATHER
He begins to negotiate his difference by talking about the physical education class which makes him embarrassed about his body and that he prefers to hang out with girls at that time. He says: Does it matter that I am different? And he wonders if he disappoints the coach as much as his dad. Referring to his father, he says that he lost his grandfather and was orphaned at the age of five. He believes that this stigmatized his dad and their relationship as for him, everything revolves around him. He says: I wish I could say to him, sorry that I am not the dude son you were expecting, but you were not the father I needed. At the base of an inverted oedipus complex he rejects his father, underestimating him even more. A. made sure to put on make up every time the two of them went out with his dad to bother and hurt him, just as he had been hurt by him. He says that when dad was sick they quickly found out with his sister about depression. For a number of years he did not speak to them, it was as if he was missing even when he was home. They also could not talk to him because he was just shouting at them and taking pills. He is worried about him because he knows that men are more vulnerable, they die easier and faster than their wives and he thinks that being a man is dangerous. Gradually the desire for the father and for an identification with him grows starting from a physical curiosity: when the father is asleep he goes and observes him to see if they look alike, if he has anything in common with him. He is relieved that they look alike but still considers him weak and does not want to look like him. However, it is the father who gradually gives him the space to function as a subject with his own views, even if they disagree, while the mother wants to be, as she says, omnipresent and fulfilling everything. He says: Our relationship is well rooted, but suffocating. The children grow up better with his fathers, they become cool boys.
Proceeding to psychotherapy, after the therapeutic alliance and transfer relationship has been established, A. proceeds to deeper issues that need to be addressed, managing to further process the homosexual side of himself and the sexual fantasies that overwhelm him. He talks about the relationship with the mother and gives an earlier picture of the desires to merge and integrate with her, trying to compensate thus a deprived relationship with a distant and depressed mother. The fear of disorganization and madness emerges through the anxiety and fantasies that possess him when he tries to get emotionally close to his friends and classmates, ending up often adopting a false image and behaviour. He wants psychotherapy to include the theme of “madness and chaos that he lives in” with his female and male sides, in order for him to be able to withstand the difference between us and between the sexes, without feeling “that we are in danger of becoming unrestrained “, that is, impulsively uncontrollable. In addition, early castration fantasies emerge that threaten even his life and suggest that the possibility of identification with the weak and sick father is tantamount to an emotional annihilation. A mutual effort is made to symbolize the castration anxiety he has and not to be transferred to real fears that make it difficult for him. His Ego remains weak in the face of His impulses and in return the Superego functions in an arrogant and dysfunctional way. In the overall picture are added for processing again, issues concerning the body and that are accompanied by anxious fantasies about its perfection, its adequacy or respectively its impotence.
Sexuality, homosexuality and body
He says that sometimes things get confusing. He describes a herd of goats he saw on vacation, where the goat who was supposed to be the leader was cowardly and docile and the herd was lead by a very irritable and domineering goat resulting in the whole herd being confused. And he does not know how to be male. He says: I once bought a female duck, that was a male duck, and a rooster, which eventually became a hen and laid eggs. I was wrong and I had to find out for myself. Now he wants to buy a couple of ducks to be right. He thinks that since he was in his mother’s womb and sharing the same body, his mother may have had same-sex sexual desires that stigmatized him and he imagines her own desires for his own. This early and massive merger will create a long-term desire of the boy to stay in the mother’s body and reject his masculine, different image.
He also talks about incest, starting with the animal kingdom and how many abnormalities it can cause. He states, for example, that the result of an incestuous relationship will be a creature with female and male genitals that will not be able to survive. He also describes his own sexual experiences with other boys, saying that he feels ashamed, inappropriate, dirty, like his own desires and fantasies that he is a woman. He also imagines that he was born a girl but they changed his gender immediately after the birth because they wanted a boy and he feels confused with his body, he always felt that way and that is why he dressed in girls clothes, put on make up and made his hair, as if he was transforming again . Dad beat him in these cases but he describes him as a farmer who does not know how to raise his son and therefore does not want to look like him. He was always absent instead of present anyway. Again he only remembers getting beaten up, without understanding either why, or what he did right or wrong, or what is allowed and what is not allowed. He says: In fact, no limits, all loose, thus putting himself in a whirlwind of desires involving both sexes. He talks about his body and the photos he takes from the past that he is naked. He dreams that he is in the sea on a boat but he can not bear to see the seabed that has algae and dirt. Worried that something dangerous is hiding at the bottom of the sea,lurking. He does not want to approach or swim in the water, but a shark surges from the sea and threatens to bite what is left of his body, parts of his body or even symbolically cut off his head. However, the body is slowly beginning to function as a primary nucleus in order to function as a subject and to differentiate the inner and outer worlds. He begins to differentiate between the sexes and wants to delimit himself in matters that touch sexuality. The real loss of his paternal grandmother who had raised him, brings to the surface memories, fantasies, thoughts and feelings around the first years of his life and his primary relationships. During therapy, early needs for care arise from the therapist, whom he wishes to differentiate from both parents. Gradually a more restrained mental structure emerges and a hope of normalcy settles in his speech.
As for the transfer relationship, he first enters the object position, seeking integration with the therapist-mom and testing the limits and the differentiation between us. Often to achieve this he puts me in a strict – superego position so that he can achieve both. Putting me often in a motherly position, he tries in the process to elaborate aspects of the primary relationship and to organize himself more adequately towards me, with his Ego making significant efforts to conquer more mature defence mechanisms and to face the intense imaginary material that burdens him and presses him emotionally. Going forward, the transference relationship processes fantasies and emotions sometimes from the point of view of the omnipotent and levelling mother and sometimes on the part of the deficient and weak father. At the level of transference, I experience my need to care for and endure his weak, disorganized self that tries to mature, without losing its diversity and normalcy, towards a mother who allows him and who wants him to grow up as a boy, holding the phallus for himself.
In the next phase of psychotherapy, A. introduces with a more active role the issues of his sexuality depending on the relations between the two sexes. The pubertal changes of the puberty help him to differentiate himself from this feminine image and to turn to a father who will guide him and recognize his masculine status. The relationship with the mother is experienced as inadequate as he comes out of the position of her object and wants a care that will meet his different needs. Thus, he moves to a more depressed position experiencing sadness and anger and partly meaningfulizing his homosexual experiences as a search for union, contact, and arousal with a caring Other, with whom the sexualization of the body alternates. At the same time, a desire is formed for identification and support by the father with whom he begins to share common activities and who wishes to assist him in the male identity he seeks. It puts gender selection on the table and undertakes the defence and consolidation of his masculine identity in his social, school and friendly environment. As a teenager he claims his personal space, expands relationships with his peers and turns erotically to the opposite sex, gaining attachment for the first time and trying to flirt with a classmate, making plans on a fantasy and reality level to conquer and approach her erotically. For the first time, sexuality is invested libidinally and not aggressively (in the transgender relationship) or caring (in the homosexual relationship).
After the last summer vacation, where he has succeeded in entering University, he enrols as a student now but has decided to give Panehellenic exams again, wishing, as he says, to have another year to face the challenges of the adult life and sexuality, better prepared in order to achieve something better for himself, he also comes to negotiate the frequency of the sessions, wishing to work in the transfer relationship with a more active, autonomous role. A. in all this process, as he speaks has the opportunity to create connections and meanings between his past and his present and in different aspects of himself. Therapeutically processing the stimulus material, he separates it from its reality and manages to process it and then to adapt and integrate quite satisfactorily in its social and school environment.
In most children, their gender identity converges with their biological identity, however, in all human societies and cultures there is a percentage of children, mainly boys, where an internal conflict arises between the two. In these cases, the interaction, conscious and unconscious, between the child and his primary objects plays an important role as the parents contribute to the mental construction of their child’s gender identity in the early stages of his psychosexual development. In the case of A. the unconscious parental fantasies and projections placed him more in the position of the object, strengthened the unbreakable mother-child relationship and his identification as female. His life revolved around the needs of an omnipotent mother and an absent father who neither really nor symbolically offered the necessary identification for A.’s gender. The advent of puberty increased the urge pressure, his anxiety increased and his self-image was trapped in an undifferentiated male-female state. A volume of emotional and social difficulties emerged and a deep alienation was established in relation to his own mental processes, his body and the relationships he built with his environment. His only consolation is the reflection in his undifferentiated integrated mother part, his mass identification with it and his mirror-like search for the friends who surrounded him. The healing relationship as a another pole will cultivate his curiosity about the different Other and will assist in the recognition of his personal shortcomings, thus helping the emergence of a personal story. Elaboration of topics around symbolic functions, early needs, desires and defences, separation and differentiation, pre-oedipal anxiety, confusing body and self image give the therapy the character of a demanding process but also an irreplaceable opportunity.
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