Motivation and emotion/Book/2018/Gender transformation motivation

Overview
Gender dysphoria is the phenomenon of a person experiencing psychological distress due to a discrepancy between their assigned and experienced gender identity. People with gender dysphoria often describe feeling uncomfortable with their body and the social roles expected of their assigned gender (van de Grift et al., 2017). Gender dysphoria affects people in different ways. Some individuals will express their gender identity through their behaviour, dress or self image. Others may cross-dress or socially transition (transitioning into the affirmed genders pronouns and bathrooms). Finally, a small percentage of individuals will select to have a medical transition through gender-reassignment surgery and/or hormone treatment (van de Grift et al., 2017). Individuals who have transformed from their assigned to their affirmed gender often describe the experience as having the opportunity to be their authentic selves (Gaulopo et al., 2017). However, not all individuals who undergo gender transformation experience only positive psychological outcomes. Research supports that depression and substance dependence can co-occur in this population (Curtis, 2013).

Gender re-assignment surgery can have significant risks for physical health and functioning post-operation such as urinary difficulties and necrosis (death) of the flesh (van de Grift et al., 2017). Individuals who decide to medically transition have clearly decided that the operation is worth the risk. This poses questions to psychology such as: Why do individuals undergo such procedures? What is the motivation behind their decision? And do they live satisfied lives after being transformed?

The main purpose of this chapter is to understand what are the driving forces behind gender transformation. First, gender transformation will be discussed including its types and different ways of transformation for both men and women. Secondly, the motivation behind transformation will be explored, taking into account the medical conditions that lead to the change and some other causes. Thirdly, the impact of motivation change will be elaborated and finally, the positive and negative consequences of gender transformation will be discussed.

Focus questions
 * What is gender transformation?
 * What motivates gender transformation?

Motivation and gender transformation
Gender transformation, also known as sex reassignment surgery, involves a person undergoing a surgical procedure in which physical appearance and their existing functioning of sexual characteristics are changed to have a similar appearance that is socially associated with their originally identified gender (Lost & O'Connor, 2017). Gender has always been the most prominent part of human development despite of it being desirable or unavoidable. Males and females are raised differently in every society, where they acquire various expectations depending on the roles and aspirations. They are expected to act differently to emotional experiences and their work lives according to the assigned gender roles. Gender reassignment at any stage of life is difficult and hard to cope with socially and mentally but it seems to be more problematic when done in adulthood (Green, 2010).

Numerous biological and psychosocial factors were considered to explain the motivation behind gender transformation of transsexual individuals. Certain brain structures differences existed between gay and heterosexual men and similar differences were found in lesbian an heterosexual women (Boonzaier, 2017). Along with the biological factors, some environmental factors were also considered like failure to raise a child from infancy throughout adolescence as a girl/boy once their genitals were were accidentally mutilated is cited as disproving the theory that gender identity is determined by upbringing (Goldie, 2015).



Money perspective
According to John Money's perspective, he stated that children are born with the genitalia which is not open to more than one interpretation which means their identity is neutral. He proposed that children are primarily determined by the views shaped by parents from childhood by the appearance of their genitals (Goldie, 2015). According to Money, the sex reassignment surgery that he advised to the parents had been a complete success. As he advised parents to alter the gender of the child surgically to make the child resemble like a female and raise it as a girl. For many years, this surgical procedure was claimed to be successfully applied to the clients undergoing the transition. His views were widely accepted by other researchers and general public as well (Aust, Kaufmann and Ott, 2011).

Despite the success of the sex-reassignment surgery, unfortunately it was opposite for some of the clients who were transitioned during the childhood by their parents. They were far from living a happy life and resulted in drug abuse and some cases culminating suicide (Goldie, 2015).

Adult Reassignment Surgery Motivation
Sometimes we question why some people undergo surgical procedures to transform their assigned gender. McHugh (2014) argued that two main motives are the reason people undergo gender transformation, In first category homosexual men are the focus as they do not feel comfortable about their assigned gender they seek the surgery or reassignment of the  gender as a way to solve the problem. Whereas, in the second category if they are women in real the sexual interaction with men will be redefined as heterosexual. According to McHugh (2014), most of the heterosexual men who seeking sex reassignment are cross-dressers as they seek pleasure from wearing the clothes of the opposite sex that is women's clothes.

Aspirational surgery
Biologically, there is no easy explanation. To explain this concept, some transgender people stated that they always felt different from their assigned gender. Once they got the surgery done for gender change, they were more satisfied, which is called gender affirmation in medical terms. It also allows them to be who they are in real life (Fiani &Han, 2018).

However the motivation behind the change is aspirational rather that medical. The patients who went under surgery were reported lower gender dysphoria and improvement in their sexual relationships. Although, surgeries also come with their own costs such as higher risks of mortality and suicide related behaviours (Galupo et al., 2017).

Androgen insensitivity syndrome(Genetic males)
In this condition, cells stop responding partially or completely to androgens. This unresponsiveness results to impair or prevent the masculinisation of male genitalia in the developing foetus, as well as the development of male secondary sexual characteristics at puberty, but does not significantly impair female genital or sexual development (Levesque, 2011). This insensitivity to androgen is only significant when it appears in genetic males that is individuals having Y- chromosome. Clinical phenotypes in these individuals range from a normal male habitus with a mild spermatogenic defect or reduced secondary terminal hair, to a full female habitus, despite the presence of a Y-chromosome ( R Viner, 1997).


 * For example, girls with this medical condition look just like other girls from birth, but they start experiencing a change in their body when they reach puberty. This happens because they are actually genetic males ( Levesque, 2011).

Congenital adrenal hyperplasia(Genetic females):
This condition involves the excessive or deficient production of sex steroid which can impact upon the development of primary or secondary sex characteristics in some affected infants, children, or adults. Males with this condition lack an enzyme needed to make cortisol and aldosterone hormone due to which body produces more androgen. It causes male sex characteristics to appear early or inappropriately ( R Viner, 1997).



Check your knowledge


{Gender transformation is also known as sex reassignment surgery?} + True - False

{ Androgen sensitivity syndrome occurs due to?} + Cells stop responding to androgens - Excessive production of steroids - Deficiency of steroids - None of the above

{ According to Money perspective? - Child's gender is shaped by parental views - Gender identity is neutral - gender reassignment was a complete success + All of above
 * type="[]"}
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Main motivation theories to be discussed:
 * Psychoanalytic theories
 * Humanistic approach
 * Developmental theories
 * Queer theories

Motivation theories explaining gender transformation
Psychoanalytic, humanistic, developmental and queer theories all help us to understand and also offer a deep insight into what factors motivates gender transformation. Whereas these theories do not directly explore the motivation behind gender transformation, due to this gap in the literature these theories have been used to infer the motivational forces driving gender transformation (Fontanella, Maretti & Sarra, 2013).

Psychoanalytic theories
Early psychoanalytic theories suggested that issues with gender identities were due to childhood trauma, bad parenting practices, disturbances in attachment styles and some biological conditions. According to “disorder-oriented conceptualisation of gender” by psychoanalytic narratives individuals who cannot be identified as male or female are being put in the category of sexual deviants and mentally unfit (Robert Staller, 1968).

Freud's psychosexual stages of development
According to Freud, gender identity is associated with successful resolution of Oedipus complex( female counterpart known as Electra complex). Oedipus complex describes the unconscious sexual desire of the child towards the parent of opposite sex, while at the same time feelings of anger and jealousy towards the parent of the same sex (Kroger & Marcia, 2011). However, child successfully suppresses these unconscious sexual and aggressive desires and eventually identifies with the same sex parent and make them part of their nature by unconscious assimilation (Kuper et al., 2018) Moreover, Freud argued that by normalisation of societal and cultural norms and identification with the same-sex parent, the child develops a different sense of identity which is aligned with their own biological sex. Although, failure to successfully identify or normalise gender norms and being unable to solve Oedipus complex results in unresolved gender identity. Freud's concept of Oedipus complex was not without criticism as the opponents of this perspective argues that this concept of identity is more negative and tragic, instead of being able to create a deterministic view of gender identity (Kroger & Marcia, 2011).

Erikson's stages of psychosocial development
Like Freud and many others, Erikson continued to build upon that personality develops in an advance order and continue to develop upon each previous stage. This process is known as the Epigenetic principle ( Green, 2010). According to Erikson's psychosocial stages, during each stage person experiences a psychosocial crisis which could result in both positive and negative personality outcomes. Whereas, successful completion of each stage is necessary for a healthy personality and for acquiring basic virtues ( Fontanelle, Maretti & Sarah, 2013).

Erikson's fifth stage identity versus confusion indicates that during this phase adolescents explore their independence and develop a sense of self. The center of focus in this stage is on developing a personal identity. If this stage is successfully completed, it results in developing a strong sense of self which remains throughout life. The main elements of this stage are:


 * Psychosocial Conflict: Identity Versus Confusion
 * Major Question: "Who am I?"
 * Basic Virtue: Fidelity
 * Important Event(s): Social Relationships

As they transition from childhood to adulthood, teens may begin to feel confused or insecure about themselves and how they fit into society. As they seek to establish a sense of self, teens may experiment with different roles, activities, and behaviors. According to Erikson, this is important to the process of forming a strong identity and developing a sense of direction in life ( Fontanelle, Maretti & Sarah, 2013).

How does this apply to Gender transformation?

Erikson might explain gender change as an inability to successfully resolve psychosocial crisis and achieve inner sameness. He also stated that the individual experiencing gender confusion is may be due to split self-image and thus they are still in the state of exploration. Due to confused or unresolved sense of self individual experiences a number of physical and psychological symptoms ( Kuper et al. 2018).

Humanistic approach
According to humanistic approach, all human beings seek meaning of their lives and achieve self-actualisation - a state of fulfilment in which a person is achieving at his or her highest level of capability. Maslow stated that people achieve their full potential by moving from basic needs to self-actualisation (Maslow, 1971).

Maslow's personality and growth needs
According to Maslow ( 1971), growth needs and self- actualised individuals might shed light upon people undergo gender transformation. As the role of the growth needs is to provide energy and direction to fulfil one's potential and achieve ultimate self- actualisation along with developing one's true authentic-self. Maslow discovered variety of characteristics which help individuals to achieve self-actualisation and discover their true identity. According to him, such characteristics can be used to interpret and study more about the people who undergo gender transformation. Individuals who prefer to change their gender are more oriented towards growth needs and away from stagnation as they do not want to stick to the unresolved identity which leads to identity crisis ( Aust, Kaufmann & Ott, 2011). However, the course and form growth needs take is not restricted and varies from individual to individual which simply means they are displayed in different ways for different individuals. This is important to know as it clears out the point that why only minority of individuals prefer to undertake gender transformation surgery (Maslow, 1971).

According to Maslow's hierarchy of needs, the need to be honest and authentic motivates people who are struggling with identifying self gender and decide upon gender transformation (Maslow, 1971). Despite of all the discrimination and potential for stigmatisation these individuals are determined to be who they are and who they want to be. Few other researchers supported this idea that transsexual individuals behave and describe themselves in front of others in a way which capture their unique experiences and feels authentic ( Keen, 2010).



Freedom of expression and inquiry allows individuals to question themselves about who they are keeping gender binary on side and allows them to present themselves in a way that is in agreement with their true self. According to Meyer Bahlburg (2005), individuals with the absence of free expression will engage in some defence mechanism like rationalism to to suppress their non-confirming gender identities. Similar views were put forward by Moser ( 2016), that individuals who engage in unconventional acts tries to justify their actions such as dressing as opposite sex by doing it for the purpose of entertaining an audience. However, in some cases individuals hide their own true identity and change it according to the one which is more socially accepted.

Developmental theories
Most transexual people and the people who work on transexual individuals tend to believe that there is a underlying biological basis of transsexualism. According to developmental theories stage and narrative based approaches are used for the development of gender related identities (Kuper, Wright & Mustanski, 2018)

Devor's 14-stage model of transsexual and transgender identity formation
Devor proposed a 14-stage model of transsexual identity formation. It is important to keep in mind that this model cannot be possibly applied to all individuals in the same way as every individual is unique ( Devor, 2004). Moreover, each person views world in their own ways due to which some people may never experience some of the stages mentioned below:

Queer theories


According to queer theorists, social disclosure is the key to shape and reshape the sex and identity which states that they are merely the product of society. Queer theory explores and contests the categorisation of gender and sexuality ( Morrell, 2002). If identities are not fixed, they cannot be categorised and labeled, because identities consist of many varied components, so categorisation by one characteristic is incomplete, and there is an interval between what a subject "does" (role-taking) and what a subject "is" (the self) ( Winslow, 2012). This opposition destabilizes identity categories, which are designed to identify the "sexed subject" and place individuals within a single restrictive sexual orientation.In addition, it is important to understand that Queer Theory is not predominantly about analyzing the binary of the homosexual and heterosexual. There is an abundance of identities in which Queer Theory not only recognizes but also breaks down in relation to other contributing factors like race, class, religion, etc ( Morrell, 2002).

Queer theorists focus on problems in classifying individuals as either male or female, even on a strictly biological basis. Intersex individuals may for various biological reasons have sexual characteristics that the dominant medical discourse regards as disordered ( Mahalingham, Ricanek & Albert,2014).

Queer theory has been criticised due to its broad nature, being unable to refer to a specific set of characteristics, nor does it provide an adequate tool to measure such chracteristics. For example, Halperin (1995) allows that straight persons may be "queer," which some believe, robs gays and lesbians of the distinctiveness of what causes them to be marginalized. It desexualises identity, when the issue is precisely about a sexual identity.

Conclusion
It is quiet confirming that current literature is not sufficiently explaining non-confirming gender identities and transsexual individuals. These identities are not restricted by any boundaries such as culture, society, anatomy and biology. None of the theories except developmental theories mentioned in the chapter directly shed light upon the concept of transsexualism, however, indirect links of this concept were established with the theories to help explain the motivation behind gender transformation. Developmental theories explains transexual identity formation through fourteen stages from abiding anxiety to pride. Some medical conditions such as Androgen insensitivity syndrome and Congenital adrenal hyperplasia also lead transsexuals to go under surgical procedures to transform their gender. These procedure were successfully carried out in individuals suffering from these conditions and resulted in more satisfied and social life.

People who identify themselves as transsexual individuals must have to confront society's norms and entrenched belief system and evaluate the fears to accept themselves as they are biologically. Along with the society's norms they also have to face their own internalisation of those values and anxieties. Its never an easy process to know oneself as transsexed or transgendered as it requires a lot of bravery, honesty and self-determination.