45 Gender Identity Disorder
Name: Brandon Teena (Teena Ray Brandon)
Source: Boys Don’t Cry (movie, 1999)
Background Information
Brandon Teena is an adolescent,Caucasian female who grew up in Lincoln, Nebraska. Teena prefers to live her life as a male. She does not currently appear to have a stable and persistent means of income or employment. Teena steals because of her low social economic status and non effort to obtain an occupation. Her delinquent activity has led her to attain a juvenile record before she has reached the age of 21. Although, the whereabouts of her mother is unknown, there seems to be a distant to an almost nonexistent relationship between her and her mother. Her father died before she was born so there is absent fathering in her life from the beginning of her years. She lives with her cousin from time to time in a trailer home, yet her cousin does not support the trouble she gets into with the locals and the law. Her cousin and presumably other family members do not except her transgender choice to act as a male either. Teena mainly lives out of her travel bag with no stable, consistent place to call home. There doesn’t seem to be any health concerns. There is also no evidence that there is any family mental history as well. Brandon Teena, who‘s legal name is Teena Brandon, has always looked like a girl, yet reported that she had always felt as guy. Cutting her hair short, wrapping up her breasts, and wearing a fake penis has in fact resembled her as looking as a male. Her past does not show any previous drug or alcoholic abuse; however, recently she has been introduced to a selected few of drugs, such as marijuana, with a group of new friends in Falls City, Nebraska. Teena’s weakness appears to be females. Her goal is to have a surgical procedure to change her female sex characteristics.
Description of the Problem
Teena currently displays symptoms that indicate that she does indeed reject her identity as being a female physically. She seems to have emotional symptoms, especially when someone may mention that she is a girl and not a boy. Her cousin continued to tell her that she was a girl, that she needs to leave the girls alone, and that she needs to accept the fact that she is a lesbian. Although Teena knows that she is physically not a male, she denies being a lesbian or homosexual. Teena cross dresses and wears a fake penis and socks in her pants in order to portray body types like a male. She denies having sexual attributes such as a having a menstruation and tries to hide all of her sexual characteristics from others. She will claim to be a hermaphrodite before she claims to be a female. Teena has not ever had sexual intercourse with a male and has resisted from being touched any areas by her genitals from any of her sexual partners. Teena could pass for a male fairly easily with a short hair cut like a guy her age, male stature, and her cross dressing efforts.
Diagnosis
The diagnosis for Teena Brandon that seems to fit appropriately is Gender Identity Disorder in Adolescents or Adults (302.85).
A. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the opposite sex, frequent dressing as the opposite sex, desire to live or be treated as the opposite sex, or the conviction that he or she has the typical feelings and reactions of the opposite sex.
Teena acted like a male and desired to be treated like a male by everyone. Teena cross dressed to look like a normal guy her age would as well. She was also very attractive to girls.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of their sex. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
Teena desired to change her sexual characteristics through surgical procedures. She wrapped her breasts down in order to flatten them and wore a counterfeit penis in her underwear.
C. The disturbance is not concurrent with a physical intersex condition.
Even though Teena claimed that she was a hermaphrodite, she was full characterized and constructed as a female physically and biologically.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if (for sexually mature individuals): Sexually attracted to males, sexually attracted to females, Sexually attracted to both, Sexually attracted to neither
Teena was a part of the low social economic status population and also did not indicate a means of trying to obtain an occupation while she continued to steal things. Teena seemed to have a hard time getting along with everyone except for her female partners.
Accuracy of Portrayal
The average person watching this movie would see a reasonably accurate portrayal of the onset of Gender Identity Disorder, especially since Teena Brandon denies her gender and sexual characteristics as well as being a homosexual in any part of the movie. The movie helps the portrayal of gender identity disorder in a significant way by giving good examples of all the symptoms of gender identity disorder. Because the movie portrayed true events of someone’s life, most symptoms did seem neither inaccurate nor exaggerated. Teena fits the adult presentation of gender identity disorder because of her persistent frustration of her biological sex. She passed as the opposite sex by cross dressing and abstained from touching or letting female partners touching her genitalia. One may think that parental relationships were being mislabeled in the movie about gender identity disorder because the only whereabouts that were known about the parents were mentioned very briefly. The course of the disorder was also mislabeled because nothing about her childhood was revealed during the movie. If her childhood was identified during the movie, then gender dyshoria would have been prevalent in her life because research shows that children with gender dysphoria that persists into adulthood results in gender identity disorder. Teena showed to have constant discomfort with her sex as being a female which fits into the general descriptive feature of gender identity disorder. The reason why majority of people, friends, and family of Teena did not accept her sexual orientation is because there is a 1 in 100,000 occurrence opposed to 1 in 30,000 in men and men are more accepted than women. Throughout all of the details and information that was made available in the movie, the movie portrayed gender identity disorder appropriately.
Treatment
There are empirical studies that help support treatments for people who portray gender identity disorder. Psychotherapy would have been more helpful for Teena if her disorder was identified earlier. However, psychotherapy can still help Teena cope with her biological sex and behavioral patterns associated with the roles of her biological determined sex. It may reduce Teena’s transsexual behavior in a very subtle way, but probably not as much because her disorder was not caught in the beginning. Another treatment that could help Teena would be hormonal therapy of surgical procedure(s). Before having any surgical procedures Teena may be given hormonal therapy in order to prevent undesired sex characteristics of the unwanted opposite sex. Various behavior therapies could help Teena by helping her to modify her behavior towards the sex she wants to be. Triadic therapy may help Teena as well. This therapy includes three differ elements; living as the desired gender, sex reassignment therapy, and hormone therapy. However, she would not have to include all of these elements into her therapy.
Name: Dil
Source: The Crying Game (movie, 1992)
Background Information
Dil is a young mid-twenties biracial male that prefers to live his life as a female. Dil works as a hairdresser at a salon during the day and performs as a nightclub singer at night. The bar that Dil performs at is called “The Metro”. The Metro is a gay bar filled with lesbians, gays, and transsexuals. Most of the performers at The Metro are transsexual males. Dil states in the movie, that she has a blood condition that causes her to grow weak. There are several medications that she has to take for this condition. My interpretation is the blood disorder she is speaking of is HIV/AIDS. Dil does not have any family close to her. The closest, most stable relationship in her life is the bartender at the Metro. Dil is currently single because the love of her life was killed when he was a soldier in Ireland. Dil suffers from depression and loneliness and uses alcohol to cope. She also lives a very promiscuous lifestyle in search of love and acceptance. Dil’s weakness is men and she is often abused and manipulated by the men that she “loves”.
Description of the Problem
Dil displays symptoms that she wants to be perceived as a female. Although she still has a penis, she wants others to perceive and treat her like a female. If a man that she potentially wants to date or “mess around with” does not perceive her as a female she gets angry. However, she also blames the man if he does not recognize that she was born a male. At first, Dil would refuse to have sex with Jimmy; instead she preferred to perform oral sex on Jimmy. This was in an effort to keep him from seeing her penis. One night, after they had been drinking, Dil decided to disrobe and show Jimmy her penis. Jimmy was shocked and he hit her. Then he proceeded to vomit in the bathroom. This further sent Dil believing he would never love and accept her for who she was. Dil seemed to get really emotional when Jimmy threatened to leave her and refused to stay with her or show any type of affection toward her. The man Dil refers to as her true love did know that she was born a male and he accepted her for who she was.
Diagnosis
The appropriate diagnosis for Dil is Gender Identity Disorder in Adolescents or Adults (302.85).
A. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the opposite sex, frequent dressing as the opposite sex, desire to live or be treated as the opposite sex, or the conviction that he or she has the typical feelings and reactions of the opposite sex.
Dil was an adult male that chose to live his life as a female. Dil often stated that she was a lady and wanted to be treated as such. Mostly everyone around Dil (except Jimmy) knew that she was born a male. However, the still called her a woman and treated her like a woman. Dil dressed, talked, walked, and acted like a woman. Dil was a very emotional person and some may perceive that as acting like a woman. Most men would view Dil as a very attractive woman.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of their sex. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
Dil did not speak of wanting to have surgery to change sexes; however, she never went out without a padded dress or bra to make the illusion that there were breasts there.
C. The disturbance is not concurrent with a physical intersex condition.
Dil was not a hermaphrodite, he was simply born male and wanted to live his life as a woman. He did not state that he wanted to have surgery to change his genitals but he did want others to view him as a female.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if (for sexually mature individuals): Sexually attracted to males, sexually attracted to females, sexually attracted to both, sexually attracted to neither.
Dil lived in what seemed to be a low-income part of town; however, she worked as a hairdresser so she was able to pay her bills. She seemed to be liked by others such as her co-workers and people at the bar. Men especially found her very attractive and likeable. However, some men often took advantage of her low self-esteem and would physically abuse her. Dil was attracted to only males, especially males that told her they loved and cared about her.
Accuracy of Portrayal
The average person watching this film would not have guessed that Dil was born a male. They would have just viewed her as an attractive woman in the beginning of the movie. Most men could probably identify with the main character in being unaware that Dil was not a born female. First of all, there are many men that look for the large Adam’s apple first and if they do not see it, they assume that the female was born female. Dil did not have a large Adam’s apple or a deep voice; however, she did have very large hands and feet. People watching this movie could learn that not everyone that has Gender Identity Disorder, or feels that they were born in the wrong body wants to have surgery. Some choose not to undergo surgery and hormones and all of these things because of the side effects. Others choose not to have surgery because they are comfortable living as the opposite sex without making surgical changes. Dil was a person that was comfortable living as a female without seeking out surgery. The actor in this film definitely performed an accurate portrayal of Gender Identity Disorder. The emotion that was expressed throughout the film that Dil experienced seemed genuine. Anytime she felt jealous, scared or rejected that is when she would either seek attention from men or turn to alcohol.
Treatment
If I were a mental health professional and Dil walked into my office, I would first gather all of the proper background information and medical history and then proceed accordingly. One of the treatments for Gender Identity Disorder is hormones and surgery, but I do not think that would be a good fit for Dil because she has not expressed any interest in changing her biological sexual identity. Instead, I would recommend psychotherapy for Dil. I think Dil would benefit from psychotherapy because it would help her with gather and implement coping mechanisms to deal with her sexual identity. Also, empirical evidence supports that Dil would have better benefitted from psychotherapy if it was administered early in life but I think that she could still benefit from psychotherapy as an adult. The main purpose of psychotherapy in Gender Identity Disorder patients is to help them cope with their biologically determined sex and reinforce the behavioral patterns associated with those roles. However, with Dil the approach may be different because the role she is comfortable in is the role of the female. So as a professional, I would focus more on making her more comfortable with her biology and not trying to change her into becoming a male.