Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Wednesday, September 22, 2010
It's a Girl!
I'm on a New York Times streak....
In yesterday's paper, Jenny Norberg writes about families in Afghanistan who choose to raise their daughters as boys. Mostly, they do this because it erases the shame the family feels for not having a son, but it also gives the child and the family more freedom (you can't send a daughter to the store for a loaf of bread...do they have loafs of bread in Afghanistan?) and the child gets more educational and occupational options. Read Afghan Boys are Prized, So Girls Live the Part.
The cultural issues are fascinating, but that's not why this article caught my attention. In psychiatry we deal with issues of gender identity and we haven't fully figured out how much of gender identity is determined by unknown genetic influences versus cultural influences versus other factors-- intrauterine exposures, viruses, you name it: we don't know. It was interesting to read the article and read that some girls remained comfortable in the male role-- their 'conversion' to their biological gender with puberty, often heralded with an arranged marriage, was confusing and uncomfortable. One of the women continued to wear pants in private, while another girl was uncomfortable with the male role and wanted to be live as a girl, even though boyhood gave her more freedoms. I wondered, too, how much of the gender switching was random selection---did parents sense that a girl might blend into male life more easily and so pick her, rather than one of her sisters, to live a switched childhood? Does seem like this would make for some wonderful research into gender identity....
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I read about this in the newspaper yesterday. Fascinating (and rather sad). As for gender identity study, the major confounding variable would be the heavy price one pays for being a woman. Who wouldn't want to continue wearing pants? I can wear either and 99 days out of 100 I wear pants. So I'd love to see such a study done in a culture such as ours where the gender roles are more equal.
Be sure to see the excellent film Osama.
It reminds me of the institution of Albanian Virgins.
http://en.wikipedia.org/wiki/Albanian_sworn_virgins
An area I know a bit about....
I won't go into the reasoning (unless requested) but you can say that 1/3 of people are unalterably male, 1/3 unalterably female, and the final 1/3 can function with a greater or lesser degree of facility in either gender role.
Now that is altered significantly by the degree to which the roles are segregated.
In extreme cases, such as the Sambia in New Guinea, or the Pushtun in Afghanistan, the view that women are subhuman filth, morally corrupt by definition but regrettably necessary for procreation - or that semen is precious and must be held within the male community - leads to severe distortions.
In the Sambia, 5ARD syndrome, which can cause an apparent "natural sex change" from a feminised appearance at birth to a masculinised one later further perplexes the issue. See The sambia “turnim-man”: Sociocultural and clinical aspects of gender formation in male pseudohermaphrodites with 5-alpha-reductase deficiency in Papua New Guinea
Continuing controversy surrounding the Dominican Republic studies of 5-agr-reductase deficiency and the development of gender identity in male pseudohermaphrodites concerns the roles of culture and biology in determining the ambiguity of gender socialization in an unsophisticated population. The present paper provides a cross-cultural perspective on these problems through description of anthropological and clinical data for a sample (N= 14) of subjects suffering from 5-agr-reductase deficiency. Nine of these male pseudohermaphrodites were reared ambiguously as male and five as female. Female subjects changed from the female to male-identified role, but in circumstances of social trauma. The authors find ambiguity here related to the presence of a third sexual category available for sex-assignment and typing. Cultural valuation of the male role makes gender-switching from female to male pragmatically adaptive. The study concludes that social-experiential and cultural factors are significant in the formation of gender identity change in male pseudohermaphrodites with 5-agr-reductase deficiency.
Boys in the Sambia are taught from about age 8 to fellate their elders, the idea being to conserve the semen.
An analogous situation exists amongst the Pushtun in Afghanistan, where women are treated as literally subhuman. See Human Terrain Team AF-6's report on Pushtun Sexuality in Afghanistan.
An area I know a bit about....
I won't go into the reasoning (unless requested) but you can say that 1/3 of people are unalterably male, 1/3 unalterably female, and the final 1/3 can function with a greater or lesser degree of facility in either gender role.
Now that is altered significantly by the degree to which the roles are segregated.
In extreme cases, such as the Sambia in New Guinea, or the Pushtun in Afghanistan, the view that women are subhuman filth, morally corrupt by definition but regrettably necessary for procreation - or that semen is precious and must be held within the male community - leads to severe distortions.
In the Sambia, 5ARD syndrome, which can cause an apparent "natural sex change" from a feminised appearance at birth to a masculinised one later further perplexes the issue. See The sambia “turnim-man”: Sociocultural and clinical aspects of gender formation in male pseudohermaphrodites with 5-alpha-reductase deficiency in Papua New Guinea
Continuing controversy surrounding the Dominican Republic studies of 5-agr-reductase deficiency and the development of gender identity in male pseudohermaphrodites concerns the roles of culture and biology in determining the ambiguity of gender socialization in an unsophisticated population. The present paper provides a cross-cultural perspective on these problems through description of anthropological and clinical data for a sample (N= 14) of subjects suffering from 5-agr-reductase deficiency. Nine of these male pseudohermaphrodites were reared ambiguously as male and five as female. Female subjects changed from the female to male-identified role, but in circumstances of social trauma. The authors find ambiguity here related to the presence of a third sexual category available for sex-assignment and typing. Cultural valuation of the male role makes gender-switching from female to male pragmatically adaptive. The study concludes that social-experiential and cultural factors are significant in the formation of gender identity change in male pseudohermaphrodites with 5-agr-reductase deficiency.
Boys in the Sambia are taught from about age 8 to fellate their elders, the idea being to conserve the semen.
An analogous situation exists amongst the Pushtun in Afghanistan, where women are treated as literally subhuman. See Human Terrain Team AF-6's report on Pushtun Sexuality in Afghanistan.
The noise of the children caught the attention of our American interpreter, who returned and scolded them for their behavior. He attempted to shame them by asking “is this the way you would behave at home?” The oldest boy proudly answered that it was, indicating that his mother and sisters were treated with the same violence and disdain. While the encounter with the father hurt my wrist, the encounter with his sons broke my heart -- From HTT Personal Field Notes dated 15 May 2009.
It seems the cycle begins in isolation from the experience of women's companionship and the replacement of such companionship with men. Significantly, in the case of Taliban madrasas, many boys spend their formative years without even the influence of motherhood in their lives.[25] Women are foreign, and categorized by religious teachers as, at best, unclean or undesirable.[26] It is then probable that the male companionship that a boy has known takes a sinister turn, in the form of the expression of pedophilia from the men that surround him. Such abuse would most likely result in a sense of outrage or anger, but anger that can not possibly be directed at the only source of companionship and emotional support a boy knows, and on which he remains dependent. This anger may very well be then directed at the foreign object—women—resulting in the misogyny typical of Pashtun Islamism. Men and boys therefore remain the object of affection and security for these boys as they grow into men themselves, and the cycle is repeated.
In the Sambia, 5ARD syndrome, which can cause an apparent "natural sex change" from a feminised appearance at birth to a masculinised one later further perplexes the issue. See The sambia “turnim-man”: Sociocultural and clinical aspects of gender formation in male pseudohermaphrodites with 5-alpha-reductase deficiency in Papua New Guinea
Continuing controversy surrounding the Dominican Republic studies of 5-agr-reductase deficiency and the development of gender identity in male pseudohermaphrodites concerns the roles of culture and biology in determining the ambiguity of gender socialization in an unsophisticated population. The present paper provides a cross-cultural perspective on these problems through description of anthropological and clinical data for a sample (N= 14) of subjects suffering from 5-agr-reductase deficiency. Nine of these male pseudohermaphrodites were reared ambiguously as male and five as female. Female subjects changed from the female to male-identified role, but in circumstances of social trauma. The authors find ambiguity here related to the presence of a third sexual category available for sex-assignment and typing. Cultural valuation of the male role makes gender-switching from female to male pragmatically adaptive. The study concludes that social-experiential and cultural factors are significant in the formation of gender identity change in male pseudohermaphrodites with 5-agr-reductase deficiency.
Boys in the Sambia are taught from about age 8 to fellate their elders, the idea being to conserve the semen.
Getting back to 5ARD and the similar 17BHDD syndrome... here's a quote that details the situation when gender roles aren't quite so differentiated:
Individuals with 5alpha-reductase-2 deficiency (5alpha-RD-2) and 17beta-hydroxysteroid dehydrogenase-3 deficiency (17beta-HSD-3) are often raised as girls. Over the past number of years, this policy has been challenged because many individuals with these conditions develop a male gender identity and make a gender role change after puberty. The findings also raised doubts regarding the hypothesis that children are psychosexually neutral at birth and emphasized the potential role of prenatal brain exposure to androgens in gender development. If prenatal exposure to androgens is a major contributor to gender identity development, one would expect that all, or nearly all, affected individuals, even when raised as girls, would develop a male gender identity and make a gender role switch later in life. However, an estimation of the prevalence of gender role changes, based on the current literature, shows that gender role changes occur frequently, but not invariably. Gender role changes were reported in 56-63% of cases with 5alpha-RD-2 and 39-64% of cases with 17beta-HSD-3 who were raised as girls. The changes were usually made in adolescence and early adulthood. In these two syndromes, the degree of external genital masculinization at birth does not seem to be related to gender role changes in a systematic way.
-- Gender change in 46,XY persons with 5alpha-reductase-2 deficiency and 17beta-hydroxysteroid dehydrogenase-3 deficiency.
Although this kind of thing is fascinating (well I think it's fascinating) from the Olympian heights of the clinical researcher.... it's not exactly an easy situation to be in for the patient/experimental animal.
Boys in the Sambia are taught from about age 8 to fellate their elders, the idea being to conserve the semen.
In the Sambia, 5ARD syndrome, which can cause an apparent "natural sex change" from a feminised appearance at birth to a masculinised one later further perplexes the issue. See The sambia “turnim-man”: Sociocultural and clinical aspects of gender formation in male pseudohermaphrodites with 5-alpha-reductase deficiency in Papua New Guinea
Continuing controversy surrounding the Dominican Republic studies of 5-agr-reductase deficiency and the development of gender identity in male pseudohermaphrodites concerns the roles of culture and biology in determining the ambiguity of gender socialization in an unsophisticated population. The present paper provides a cross-cultural perspective on these problems through description of anthropological and clinical data for a sample (N= 14) of subjects suffering from 5-agr-reductase deficiency. Nine of these male pseudohermaphrodites were reared ambiguously as male and five as female. Female subjects changed from the female to male-identified role, but in circumstances of social trauma. The authors find ambiguity here related to the presence of a third sexual category available for sex-assignment and typing. Cultural valuation of the male role makes gender-switching from female to male pragmatically adaptive. The study concludes that social-experiential and cultural factors are significant in the formation of gender identity change in male pseudohermaphrodites with 5-agr-reductase deficiency.
Having problems posting... and these posts are two long anyway, so need breaking up.
Boys in the Sambia are taught from about age 8 to fellate their elders, the idea being to conserve the semen.
In the Sambia, 5ARD syndrome, which can cause an apparent "natural sex change" from a feminised appearance at birth to a masculinised one later further perplexes the issue.
See The sambia “turnim-man”: Sociocultural and clinical aspects of gender formation in male pseudohermaphrodites with 5-alpha-reductase deficiency in Papua New Guinea
(Abstract follows)
Continuing controversy surrounding the Dominican Republic studies of 5-agr-reductase deficiency and the development of gender identity in male pseudohermaphrodites concerns the roles of culture and biology in determining the ambiguity of gender socialization in an unsophisticated population. The present paper provides a cross-cultural perspective on these problems through description of anthropological and clinical data for a sample (N= 14) of subjects suffering from 5-agr-reductase deficiency. Nine of these male pseudohermaphrodites were reared ambiguously as male and five as female. Female subjects changed from the female to male-identified role, but in circumstances of social trauma. The authors find ambiguity here related to the presence of a third sexual category available for sex-assignment and typing. Cultural valuation of the male role makes gender-switching from female to male pragmatically adaptive. The study concludes that social-experiential and cultural factors are significant in the formation of gender identity change in male pseudohermaphrodites with 5-agr-reductase deficiency.
Here's a quote that details the situation when gender roles aren't quite so differentiated.
From Gender change in 46,XY persons with 5alpha-reductase-2 deficiency and 17beta-hydroxysteroid dehydrogenase-3 deficiency.
Individuals with 5alpha-reductase-2 deficiency (5alpha-RD-2) and 17beta-hydroxysteroid dehydrogenase-3 deficiency (17beta-HSD-3) are often raised as girls. Over the past number of years, this policy has been challenged because many individuals with these conditions develop a male gender identity and make a gender role change after puberty. The findings also raised doubts regarding the hypothesis that children are psychosexually neutral at birth and emphasized the potential role of prenatal brain exposure to androgens in gender development. If prenatal exposure to androgens is a major contributor to gender identity development, one would expect that all, or nearly all, affected individuals, even when raised as girls, would develop a male gender identity and make a gender role switch later in life. However, an estimation of the prevalence of gender role changes, based on the current literature, shows that gender role changes occur frequently, but not invariably. Gender role changes were reported in 56-63% of cases with 5alpha-RD-2 and 39-64% of cases with 17beta-HSD-3 who were raised as girls. The changes were usually made in adolescence and early adulthood. In these two syndromes, the degree of external genital masculinization at birth does not seem to be related to gender role changes in a systematic way.
A small critique there:
If prenatal exposure to androgens is a major contributor to gender identity development, one would expect that all, or nearly all, affected individuals, even when raised as girls, would develop a male gender identity and make a gender role switch later in life.
Why? I mean, in other Intersex conditions, cross-sexed gender identity occurs at different rates.
Those with 46XY cloacal extrophy have the same rate of male identity as the general population.
Those with 46XX CAH syndrome have 1 in 10 with a male gender identity, though they all show typical male playing patterns when young. Different parts of the brain are affected to different degrees, and while having one area cross-sexed usually increases the odds, sometimes greatly increases the odds, of other parts being cross-sexed, it's not always the case.
And I'm over-simplifying. What I call "masculinised" just means that a lot more men than women have a similar configuration in that area. There's overlap.
It's because it's biological, anatomical, and biology and anatomy is messy and fuzzy and not strictly binary that you'll find some people who are "bi-gendered" - able to adapt to either gender role, in different aspects - while some are unable to.
So why am I (unfortunately) dominating the comments with great screeds and tracts?
Because for some of us, this area is more than academic exercise.
When pediatricians surgically assign a sex to an intersexed child, it usually turns out alright.
2 times in 3.
Another way of putting it is that they permanently blight the lives of 1 in 3 children they "normalise", surgically inducing gender dysphoria, and often sterility and a whole host of lifelong medical problems. Insensate genitalia. Scarring. Urethral problems, which can lead to serious kidney disease, nephritis, even death.
This has led to a most unfortunate distrust of the medical profession, amongst Intersexed and Transsexual patients (for Transexuality is but neurological Intersex).
I'll leave with two videos. One is of two cases of 17BHDD in Jubayah, Gaza. Note the automatic assumption of the medics that they know which sex these kids "really" are. My own opinion, based on body language and other cues, is that one is definitely male, the other... not so much. But probably OK with it.
Gaza Conflict of Gender
The other shows that it's not just in Gaza that Social Pressures can lead to suboptimal outcomes. And it's a particularly egregious example of how IS people are treated by all too many in the medical profession.
Patrick's Story.
Disclaimer: I'm a "female pseudohermaphrodite" - one of the really rare IS cases, which involves a change from looking male to looking female.
Fortunately, my neurology, while distinctly non-standard, put me in the "Gender Identity Female, can't be anything else" category, so it was a blessed release from Gender Dysphoria, rather than a descent into it.
That's not always the case. See the court findings in RE: SALLY (SPECIAL MEDICAL PROCEDURE) [2010] FamCA 237
We now return you to your regularly scheduled commenting. I hope that you've found what I've written useful.
So why am I (unfortunately) dominating the comments with great screeds and tracts?
Because for some of us, this area is more than academic exercise.
When pediatricians surgically assign a sex to an intersexed child, it usually turns out alright.
2 times in 3.
Another way of putting it is that they permanently blight the lives of 1 in 3 children they "normalise", surgically inducing gender dysphoria, and often sterility and a whole host of lifelong medical problems. Insensate genitalia. Scarring. Urethral problems, which can lead to serious kidney disease, nephritis, even death.
This has led to a most unfortunate distrust of the medical profession, amongst Intersexed and Transsexual patients (for Transexuality is but neurological Intersex).
I'll leave with two videos. One is of two cases of 17BHDD in Jubayah, Gaza. Note the automatic assumption of the medics that they know which sex these kids "really" are. My own opinion, based on body language and other cues, is that one is definitely male, the other... not so much. But probably OK with it.
Gaza Conflict of Gender
The other shows that it's not just in Gaza that Social Pressures can lead to suboptimal outcomes. And it's a particularly egregious example of how IS people are treated by all too many in the medical profession.
Patrick's Story.
Disclaimer: I'm a "female pseudohermaphrodite" - one of the really rare IS cases, which involves a change from looking male to looking female.
Fortunately, my neurology, while distinctly non-standard, put me in the "Gender Identity Female, can't be anything else" category, so it was a blessed release from Gender Dysphoria, rather than a descent into it.
That's not always the case. See the court findings in RE: SALLY (SPECIAL MEDICAL PROCEDURE) [2010] FamCA 237
1 in 3 cases would be like this, unless in a society like the Sambia or Pushtun.
We now return you to your regularly scheduled commenting. I hope that you've found what I've written useful, and how the question of gender identity is, well, not always simple. I've tried to give a background to it, and why some bacha posh will want to retain a male role, while others gladly give it up, despite acquiring sub-human social status thereby.
A special Hi to ClinkShrink BTW, who must deal with such issues in a setting that really makes things difficult.
So why am I (unfortunately) dominating the comments with great screeds and tracts?
Because for some of us, this area is more than academic exercise.
When pediatricians surgically assign a sex to an intersexed child, it usually turns out alright.
2 times in 3.
Another way of putting it is that they permanently blight the lives of 1 in 3 children they "normalise", surgically inducing gender dysphoria, and often sterility and a whole host of lifelong medical problems. Insensate genitalia. Scarring. Urethral problems, which can lead to serious kidney disease, nephritis, even death.
This has led to a most unfortunate distrust of the medical profession, amongst Intersexed and Transsexual patients (for Transexuality is but neurological Intersex).
I'll leave with two videos. One is of two cases of 17BHDD in Jubayah, Gaza. Note the automatic assumption of the medics that they know which sex these kids "really" are. My own opinion, based on body language and other cues, is that one is definitely male, the other... not so much. But probably OK with it.
Gaza Conflict of Gender
The other shows that it's not just in Gaza that Social Pressures can lead to suboptimal outcomes. And it's a particularly egregious example of how IS people are treated by all too many in the medical profession.
Patrick's Story.
Disclaimer: I'm a "female pseudohermaphrodite" - one of the really rare IS cases, which involves a change from looking male to looking female.
Fortunately, my neurology, while distinctly non-standard, put me in the "Gender Identity Female, can't be anything else" category, so it was a blessed release from Gender Dysphoria, rather than a descent into it.
That's not always the case. See the court findings in RE: SALLY (SPECIAL MEDICAL PROCEDURE) [2010] FamCA 237
We now return you to your regularly scheduled commenting. I hope that you've found what I've written useful.
So why am I (unfortunately) dominating the comments with great screeds and tracts?
Because for some of us, this area is more than academic exercise.
When pediatricians surgically assign a sex to an intersexed child, it usually turns out alright.
2 times in 3.
Another way of putting it is that they permanently blight the lives of 1 in 3 children they "normalise", surgically inducing gender dysphoria, and often sterility and a whole host of lifelong medical problems. Insensate genitalia. Scarring. Urethral problems, which can lead to serious kidney disease, nephritis, even death.
This has led to a most unfortunate distrust of the medical profession, amongst Intersexed and Transsexual patients (for Transexuality is but neurological Intersex).
I'll leave with two videos. One is of two cases of 17BHDD in Jubayah, Gaza. Note the automatic assumption of the medics that they know which sex these kids "really" are. My own opinion, based on body language and other cues, is that one is definitely male, the other... not so much. But probably OK with it.
Gaza Conflict of Gender
The other shows that it's not just in Gaza that Social Pressures can lead to suboptimal outcomes. And it's a particularly egregious example of how IS people are treated by all too many in the medical profession.
Patrick's Story.
Sorry these posts turned out of order. We now really return you to your regularly scheduled commenting. I hope that you've found what I've written useful.
Wish i could wear a burka. Analyze that.
tracy the fact that you wish you could wear a burka means you have no idea about that which you speak.
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