Transsexualism and existentialism.
Abstract: This paper explores existential themes encountered in therapeutic practice with transsexual (trans) people. Drawing from her experience as a clinician within a large NHS clinic concerned with transgender care the author outlines the nexus of transsexualism with choice, freedom, authenticity, the existential 'givens', facticity and the making of a 'leap to faith'.

Key Words

Transsexual, trans, transvestite, transgender, authenticity, facticity, gender, givens.
Article Type: Essay
Subject: Sex role (Analysis)
Psychotherapy (Analysis)
Gender identity disorders (Analysis)
Existentialism (Analysis)
Author: Richards, Christina
Pub Date: 07/01/2011
Publication: Name: Existential Analysis Publisher: Society for Existential Analysis Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2011 Society for Existential Analysis ISSN: 1752-5616
Issue: Date: July, 2011 Source Volume: 22 Source Issue: 2
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 288874220
Full Text: Introduction

Transsexualism, or trans, is the condition whereby a person is assigned a sex at birth, but identifies with another sex. Thus a person may be assigned male at birth and identify as female (a trans woman or trans girl); or they may be assigned female at birth and identify as male (a trans man or trans boy). It may be that a person identifies as neither wholly male nor female, and indeed some authors have suggested that this is the case for everyone, whether they identify as trans or not (e.g. Carroll, Gilroy & Ryan, 2002). Transsexualism has been construed as a medical problem (e.g. APA, 2000), although it need not be a problem for the trans individual at all (Cole, O'Boyle, Emory & Meyer III, 1997) and indeed some writers have argued convincingly that it is simply another way of living (Bornstein, 1994; Herdt, 1996).

This paper will explore the intersections of trans with some common themes of existentialism. The author is Senior Specialist Psychology Associate within the National Health Service at the Charing Cross gender identity clinic (GIC). This clinic is the largest clinic in the UK for assisting trans people both through surgical and hormonal manipulation, and also through supportive psychotherapy to address any issues that arise as clients strive to live in a way which is authentic. The theoretical and practical considerations within this paper are drawn from the established literature on both trans and existentialism and also from the author's own clinical experience practicing existential psychotherapy and supportive psychological assessment from an existential standpoint with a mainly trans client group.

It should be noted that while trans issues intersect well with existential themes, many issues trans people bring to therapy are not specifically related to their trans identity (Shaw et al, forthcoming 2010). Thus the existential approach is of use, both for trans-specific and trans non-specific issues--a truly human approach. This may be contrasted to some other forms of psychotherapeutic assistance that posit a gender binary (people are either male or female) which is inextricably linked to biology and identity. These forms of assistance may be of less use to trans people who necessarily, although often implicitly, question such notions.

However transsexualism is conceptualised, one of the primary issues is, of course, how one can be in the world as oneself. This is a wider existential problem and consequently one which existential psychotherapy is well suited to address. This is especially the case regarding such issues as being free to choose to live one's life in an authentic role, and the potential for bad faith (Sartre, 1958) if a person does not do so and abrogates responsibility for that decision due to social factors (e.g. postponing transition due to assumed disapproval of a spouse or child). Such considerations will be a key theme in this paper which explores, necessarily briefly, how gender and transitioning gender may be viewed from an existentialist perspective.

Freedom and authenticity

De Beauvoir famously stated that 'One is not born, but rather becomes, a woman' (1949, p.267) meaning that being a 'woman' is to inhere the social norms that constitute the category. We may argue also that 'one is not born, but rather becomes a trans person', but in both cases we would be both correct and incorrect; as we shall see below.

Gender (1) is not generally considered to be an existential 'given' (van Deurzen-Smith, 1997). However, if we consider the 'givens' of existentialism to be those things that bind us independent of our freedom to choose--the constituent factors of the world we are thrown into if you will--then the question of gender as a ' given' becomes a r e-phrasing of the biological essentialist versus the social-constructionist arguments concerning the formation of gender. That is that, if gender is biologically determined it is a given (although we may still choose how we respond to that given): Whereas if gender is socially constructed it is not strictly a given (but may still be rather binding).

This dualistic argument, which mirrors the nature-nurture debate, has largely been resolved through recent findings that gender formation has a multi-factorial etiology that is both biologically and socially constituted (Barrett, 2007; Lev, 2004; Shaw et al, forthcoming 2010). In this way contemporary understandings may be construed as a bridge between the eigenwelt--the personal world of gender identity and the mitwelt--the world of gender presentation. It should be noted that I am using mitwelt in a special sense here in recognition of the fact that gender performativity (2) forms a class of 'epistemic action (3)' in which the person and the world constantly interact to constitute a person's gender and also the world that gendered person inhabits (Richards, 2010).

The trans person then, is both 'condemned to be free' with regards to their gender, in that they have choice over how it affects them and their gender presentation, which may, of course, be influenced by societal factors; and is also thrown into a world in which their gender is, at least partly, biologically determined (Chung, De Vries & Swaab, 2002; Kruijver, 2004; Zhou, 1995). Because there is some freedom to choose, the trans person is at risk of being inauthentic, or in 'bad faith', especially if they adhere to dominant cultural norms as many trans people do during a period of second adolescence when they are trying out their new gender presentation. This occurs in much the same way that cisgender (4) people experiment with gender presentations during their adolescence.

We can see then that 'bad faith' may provide a conceptual bridge between ideas that people are entirely free to select their own gender presentations on the one side and people's own felt sense of who they are on the other. The former side is often cited by the post-modern, radical-feminist and social constructionist understandings of trans as something which perpetuates a mythical 'gender dyad' through identifying with dominant gender norms; e.g. trans women stating that they 'prefer' to wear pink and always have (e.g. Raymond, 1979). Whereas on the latter side are those understandings (which often come from trans people themselves) that while gender presentation may indeed be socially constructed a step across the gender dyad from one gender to the other is personally valid; e.g. a particular trans woman does indeed prefer to wear the colour pink and was constrained from doing so by social norms (e.g. Serano, 2007).

The concept of bad faith suggests that through inhering contemporary gender norms, in whatever time and place, a trans person has the possibility to be both in bad faith (if they are solely bowing to cultural pressure) or in good faith if their gender choice is eudaimonic. Having undergone adolescence both trans and cisgender people often find something that [at least feels] authentic, notwithstanding the possible bad faith of cultural pressure to conform to gender stereotypes (5) (Walter, 2010).

Indeed, it may further be argued that, given that gender is not considered one of the existential givens, everyone is 'condemned to be free' with regards to their gender. We may further reasonably consider that anyone who is not trans (in that their gender is unconsidered) is in bad faith for refusing to recognise their choice (about what aspects of masculinity and femininity they take on), and for refusing to act upon it. This is borne out by the psychological research which has shown that those people who are androgynous, in that they are able to take on aspects which are socially construed as both masculine and feminine, are more psychologically healthy than those who are not (Bem, 1974; Grimmell & Stern, 1992).

I propose, on the basis of my clinical experience, that for adult trans people the constituting of an authentic self may come about through stages of introjection of an 'othered' gendered self, which is nonetheless recognisably herself. For example, in the first stage, a trans woman may view a cisgender woman (6) solely through her gender as a means of making it comprehensible. Thus she may see the cisgender woman not as a nurse, who is a trained health professional, but rather as a person doing a 'female', role. The nurse is construed through her gender rather than her profession, although the nurse herself may not be aware of her gender when caring for her patients. In this way the trans woman is I-It relating to the cisgender woman (Buber, 1958) through not allowing the totality of the cisgender woman's personhood into awareness, but rather by constituting her as a thing (her gender). The trans woman may be seen to be projectifying (7) upon the cisgender woman in that her worlding (Spinelli, 2007) is 'projected' onto the cisgender woman's gender.

In the second stage, the trans woman has introjected her own female self into her self, but her female self is still regarded as 'other' albeit an internalised 'other'--the trans woman is I-It relating to herself. This may be seen when trans people talk about their differently gendered selves in the third person. Cooper (2003), albeit without reference to trans, refers to this as I-me relating and encourages better internal communication such that a person can I-I relate.

In the third stage, and this is not always reached, this internal communication (8) may occur such that the trans woman integrates the female into her psyche to the degree that it is inseparable and thus is able to I-Thou (or I-I) relate to her self. This is necessarily independent of childhood socialisation, but may be through adult socialisation of a s ort which could be construed as a second adolescence. After this stage the trans person becomes comfortable with their self and is able to relate to themselves both in the past and the future without splitting it off from the present.

Time and finitude

This approach towards authenticity, which integrates past and future selves, mirrors existentialist understandings of time which Husserl calls erlebnis (Husserl, 1913) and Heidegger suggests is a necessary (almost sufficient) constituent of Dasein (Heidegger, 1927). In both these understandings time is not split into past, present and future, but rather is integrated in a non -linear fashion with each having the possibility of influencing the other. Thus a trans person is acting in bad faith if they choose not engage with their transition from one gender to another by storing it safely some time in 'the future' (see below); or by keeping their their childhood safely in 'the past', as they are refusing to recognise the integration of their temporal self.

But how might this integration come about? For the 'past self' it may occur as a result of at herapeutic endeavour, especially if a pluralistic intervention of a narrative-existentialist kind is employed. Both narrative and existentialist theory and therapy assert that we are constantly in the process of constituting our selves and of rewriting our 'historical' narratives (Payne, 2006; Spinelli, 2007 respectively). Thus the trans person's childhood narrative, which may appear to be at odds with the adult of a different gender, may be reconstrued as being a part of the formation of the adult, or that the gender was 'always there'--the classic trans narrative of 'always having known' or the 'woman trapped in a man's body' (Schrock & Reid, 2006).

Future integration of the self may require both a narrative reconstrual that allows the trans person to self actualise (9) (Maslow, 1943) in their preferred gender, and also make a 'leap to faith' (Kierkegaard, 1844). Trans people often offer a wide variety of practical reasons why a transition now would be impossible, while still maintaining that a transition in the future will happen (Barrett, 2007). This future may recede as the date comes closer, as when a person decides that they will transition when their children are old enough to understand/have started secondary school/ have passed their GCSEs/have passed their A-Levels/have started university/have passed their degrees/have got married/have had grandchildren who are old enough to understand. This procrastination may be construed as ontic anxiety masking ontological anxiety about whether to transition: The pragmatic, apparently altruistic (10,) concerns are a mask for the anxiety about the taking of responsibility for one's being-in-the-world. The pragmatic concerns often need to be ameliorated through a leap to faith, in which it is accepted that there will be no safe intervening period between being one gender and the other, but rather a step into the unknown is taken. No matter how many precautions are taken it is never possible for a person to predict with absolute certainty the outcome of their actions and this is markedly the case in the case of a gender transition.

It is notable that for many trans people transition occurs after a major life event over which they have no control--not uncommonly the death of a parent. Perhaps this demonstrates what Hegel termed finitude (1832)--a being towards death in which the trans person recognises themselves as next on t he escalator to oblivion and so realises that their careful marshalling of security through adherence to social rules will not prevent this--leaving them free to find meaning in their existence though the constitution of their selves and thus become, in both the Hegelian and contemporary sense of the word, real.


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(1) The representation of self as male, female or some other gender, whether to oneself (gender identity), or to others (gender presentation).

(2) This refers to the communicative nature of gender in which one uses gender, and outward signifiers of gender, as a personally authentic communication, both to others and to oneself (Butler, 1999). This does not mean to imply that the 'performance' is similar to that of an actor on a stage, as actors are aware that they are not really the character they are 'performing'.

(3) Epistemic action is action which is taken to influence cognition. For example the spatial rotation of a puzzle piece with one's hand, rather than one's mind in order to determine the fit; or the creation of a shopping list to aid memory. In both cases, and very many more like them, manipulation of objects external to the blood brain barrier influences cognition within (c.f. Clark, 1997).

(4) A cisgender person is a person who is content to remain the sex they were assigned at birth.

(5) Although I acknowledge the difficulty of disentangling cultural norms from chosen actions and identities.

(6) Or another trans woman with a suitably stable female gender identity

(7) I coin this term to accompany the objectification of women in which women are related to in an I-It manner and constituted through a part of them selves (their bodies; Greer, 1970); and the subjectification of women in which agency is pushed onto women, who are told that they have chosen to be constituted through a part of them selves (their bodies; 8 Gill, 2003).

(8) Although see the note on epistemic action above.

(9) In more traditionally existentialist terms, this humanistic concept may also here be conceptualised as a self-discursive Nietzschian (1883) 'will to power'.

(10) Although it should be noted that the evidence shows that children are not harmed in any way by having a trans parent (Barrett, 2007; Green, 1978).

Christina Richards is Senior Specialist Psychology Associate at the West London Mental Health NHS Trust (Charing Cross) Gender Identity Clinic. She works in this capacity as an individual and group psychotherapist.

Contact information: West London Mental Health NHS Trust (Charing Cross) Gender Identity Clinic, 179-183 Fulham Palace Road, Hammersmith, London, W6 8QZ. Email
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