Sunday, April 3, 2011

Can Integral Theory Account for Transsexual Experience?

integral theory

In my research on female-to-male transsexuals (FTM, transmen), one of the stories I read over and over again is how these men felt that being born in a female body was some form of mistake or accident.

Henry Rubin's Self-Made Men (2003) offers a great look at the issue of embodiment in FTM men - most of the men in his study offered different understandings of why they were born into the wrong bodies - some are creative, some are biological:
Whereas most individuals feel that they have bodies that adequately express their true selves, these FTMs all feel as if their bodies are erroneous expressions of their core selves. Their bodies fail to express their internal male identities. An expressive error occurred, severing the link between their body and their identity. The men in this study describe a variety of possible errors, ranging from the belief that God had made a mistake, to genetic mutations, to chemical imbalances, to underdeveloped or hidden male anatomy. One man believes he was reincarnated in a female body so that he could avoid the draft during the Vietnam War. This occurrence would be fortuitous, but most of the other men are less than thrilled with the mistakes of God or nature. They have always been men, albeit men whose bodies fail to express this to the world. (p. 150-151)
And it must be stated up front that I trust their experience - I do not believe trans people are mentally ill or suffering from gender identity disorder (GID), which I am not convinced is an actual valid diagnosis for anyone. Here is how the DSM-IV-TR defines GID:
DSM-IV-TR Diagnostic Criteria For Gender Identity Disorder

A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:

  1. repeatedly stated desire to be, or insistence that he or she is, the other sex

  2. in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing

  3. strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex

  4. intense desire to participate in the stereotypical games and pastimes of the other sex

  5. strong preference for playmates of the other sex

B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

C. The disturbance is not concurrent with a physical intersex condition.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

When the APA membership discussed the continued relevance and use of this diagnosis, members were split - but some would definitely like to see it revised or eliminated.

Katherine Wilson, Ph.D. said that DSM fails to acknowledge that “many healthy, well-adjusted transsexual people exist” or to distinguish between such individuals and those who would benefit from a medical treatment.

She would like to see GID replaced with a term such as gender dysphoria, which would describe someone who is persistently distressed with his or her physical sex characteristics or with the limiting gender-based roles that society often imposes on men and women. (Hausman, 2003)

More importantly, trans people suffer depression, anxiety, and addictions at about the same rate as the general population (an increased prevalence likely arises as a result of the social ostracism and discrimination they experience). When they come to see a therapist, they often are not coming for counseling around gender issues - it is often for all the same reasons other people go to therapy: family, relationships, work, depression, anxiety, substance use, and so on.

So if their experience is not pathological in the usual sense, how do we account for the discrepancy between gender identity and natal physiology? The term gender dysphoria is useful, I suppose, but in the absence of pronounced brain differences between trans and non-trans people (most likely based in genetics or epigenetics), we lack a solid understanding.

The deeper one gets into these men's lives, the more one learns that it really is not even about the penis for many transmen - their breasts are often a source or torment and their experience of menstruation, especially the first time, was traumatic.

Kristen Schilt and Elroi Waszkiewicz (2006) looked at the role of surgeries in transmen in their presentation to the American Sociological Association:
For most of our interviewees, hormone therapy, which gives transmen male secondary sex characteristics like thicker facial and chest hair, and chest reconstruction take priority over phalloplasty. Chest reconstruction involves a double mastectomy to remove the breasts, signifiers of womanhood,(7) and allows for the surgical construction of a male chest. The effects of testosterone, such as beard growth, create a male appearance. Having facial hair, no visible breasts, a low voice, and “men’s clothes” function as “cultural genitalia” for transmen, as they are assumed to have a penis based on their appearance.(8) Thus, even without a “real” penis, transmen can gain a male social identity that lines up with their personal gender identity.
For transwomen, the situation is a bit different - these women report that living with a penis, although they can pass as women in society, prevents them from fully adopting their internal gender identity - for them, the surgery is important.

Setting an Integral Foundation

In the integral psychology model developed by Ken Wilber, the human being grows and develops as a body, as a psyche, as an interpersonal being, and as a member of society. Each of those domains (the It, the I, the We, and the Its) shape the individual and determine her/his identity - and all of this occurs in an interrelated and interconnected manner.

Ken Wilber (Integral Psychology, 2000), explains the interaction of the quadrants with the now familiar phrase (at least it's familiar in integral circles) "tetra-evolve" (also: tetra-arising, tetra-interact, and so on) - the idea is that all quadrants interact in the creation of a holon:
It is not enough to say that organism and environment coevolve; it is not enough to say that culture and consciousness coevolve. All four of those "tetra-evolve" together. That is, the objective organism (the Upper-Right quadrant), with its DNA, its neuronal pathways, its brain systems, and its behavioral paterns, mutually interacts with the objective environment, ecosystems, and social realities (the Lower Right), and all of those do indeed co-evolve. Likewise, individual consciousness (Upper Left), with its intentionality, structures, and states, arises within, and mutually interacts with, the intersubjective culture (Lower Left) in which it finds itself, and which it in turn helps to create, so that these, too, coevolve. But just as important, subjective intentionality and objective behavior mutually interact (e.g., through will and response), and cultural worldviews mutually interact with social structures, as does individual consciousness and behavior. In other words, all four quadrants-organism, environment, consciousness, and culture--cause and are caused by the others: they "tetra-evolve."

(It does not matter "how" this happens; that "how," I am suggesting, is more fully disclosed at the postrational, nondual waves; at this point, it is only necessary to acknowledge that this interaction seems phenomenologically undeniable. Whether you think it is theoretically possible or not, your mind does interact with your body, your mind interacts with its culture, your mind interacts with the physical organism, and your organism interacts with your environment: they all "tetra-interact.") (p. 183-184)
Among those who accept the AQAL model (pronounced "aw kwal" - all quadrants, all levels, all lines, all states, and all types), this notion of tetra-evolving is taken as foundational. It is one of the primary assumptions upon which the whole model is built - to call it into question brings whole elements of the model into question.

Wilber goes as far as to say this tetra-evolution of the quadrants is essentially obvious: "this interaction seems phenomenologically undeniable." But is it undeniable? If we can't find an explanation that allows for the transsexuality in a non-pathologized manner, then we must question the extent to which body and psyche are inextricably linked.

So then how do we fit trans people into the model?

Trans men and women grow up with the awareness that they were born in the wrong body. In fact, trans people do not feel that they are transforming, for them its a transition:
Their goal is simply to become recognizable. Who they are at heart does not change during transition. Notice that they use the term "transition" rather than "transformation." Although they do have to make a social and physical changeover from one sex to another, they are not transforming, like caterpillars becoming butterflies. They are not changing their personality, only the physical package that houses the person inside the flesh. They are not transforming themselves from women into men. They are repairing the link between their bodies and their gender identity. (Rubin, 2003, p. 143-144)
From their experience and perspective, their body is all wrong for who they are as a gendered person. They would seriously question this assumed linkage that Wilber feels is unquestioned in its obviousness. I would suspect that intersex and other transgender people might also offer resistance to the idea that the body inherently shapes identity, especially gender identity.

The great gift of postmodern and poststructural views of gender identity is that these models break the 1:1 link between genitals and gender identity. The social construction model argues that (1) gender is constructed by each individual, (2) that it is based on conscious or unconscious acceptance or rejection of cultural norms (hegemonic masculinity, for example), and (3) that gender identity is not always equivalent to biological sex identity.

The flaw, for me, is that there is considerable evidence of the ways in which biology and brain structure impact our notions of male or female. The social construction approach tends to minimize or reject this research - but an integral approach cannot make that exception. We must find a way to account for the body in trans identity development.

I am going to propose a rather radical solution to this problem - but I am at a loss as to how to describe this phenomenon without pathologizing it - I can't offer the how or the why, only an attempt at explaining the what.

Subtle Bodies and Gross bodies

In 2003, Wilber posted a series of excerpts from what was to be (before his illness) part of the Kosmos Trilogy begun with Sex, Ecology, Spirituality - one of those postings was Excerpt G: Toward A Comprehensive Theory of Subtle Energies (Shambhala Publications website).

If you choose to read that article/excerpt, please keep in mind that Wilber comes from a Buddhist background, as well as transpersonal psychology, and association with various "nondual" gurus (some toxic, some not). Because of his own contemplative experience and due to the teachings he has received, Wilber accepts ideas about subtle and causal bodies with (it seems to me) little intellectual questioning.

He has talked frequently over the years about the three bodies - gross body (physical matter, the "outside" body), subtle body (contains - or can contain - the 3 levels of emotional, mental, and higher mental), and causal body (contains an overmental consciousness [Aurobindo's overmind], and is also the source for involution of archetypes - see Plotinus).

I've never entirely bought into this notion (it always felt metaphorical to me, even though I feel I can sometimes "read" bodies, which is probably picking up on the subtle body) - while there is considerable overlap on these ideas in the writings of various mystics coming from all of the major wisdom traditions, there has not been anything empirical for me to wrap my brain around.

Until now.

As I was thinking about the topic of trans identity and the lack of "fit" in their birth bodies, I decided to look back at Thomas Metzinger's The Ego Tunnel (2009). He had written extensively on out-of-body-experiences (OBEs) in that book, which he uses as a foundation for his self-model theory of subjectivity.

He lists ownership, agency, and location at three of the defining elements of "me-ness" in most people. While these and other qualities are important, he feels it has become increasingly obvious that . . .
ownership is closest to the core of our target property of self hood. Nevertheless, the experience of being an embodied self is a holistic construct, characterized by part-whole relationships and stemming from many different sources.[5] Phenomenal ownership is not only at the heart of conscious self experience; it also has unconscious precursors. Classical neurology hypothesized about a body schema, an unconscious but constantly updated brain map of limb positions, body shape, and posture.[6] (p. 78)
Ownership would seem to be a hard word for those who feel almost betrayed by their birth bodies. Interestingly, however, in finding a way out of the "location" issue so as to explain OBEs, he may have also given us a solution to the embodiment problem in integral self theory.

Metzinger offers a brief history subtle body thinking to create an intellectual, philosophical, and theoretical foundation for his idea OBEs - here is his list:
Examples are the Hebrew ruach, the Arabic ruh, the Latin spiritus, the Greek pneuma, and the Indian prana. The subtle body is a spatially extended entity that was said to keep the physical body alive and leave it after death.[14] It is also known in theosophy and in other spiritual traditions; for instance, as "the resurrection body" and "the glorified body" in Christianity, "the most sacred body" and "supracelestial body" in Sufism, "the diamond body" in Taoism and Vajrayana, "the light body" or "rainbow body" in Tibetan Buddhism. (p. 86)
He suggests that the idea of the subtle body may be the origin of our modern conception of the soul. More importantly to our work here, however, he tries to ground the idea of the subtle body in contemporary neurobiology (specifically body schemas).
My theory—the self-model theory of subjectivity—says that this subtle body does indeed exist, but it is not made of "angel stuff" or "astral matter:' It is made of pure information, flowing in the brain.[15] Of course, the "flow of information" is just another metaphor, but the information processing level of description is the best we have at this stage of research. It creates empirically testable hypotheses, and it allows us to see things we could not see before. The subtle body is the brain's self-model, and scientific research on the OBE shows this in a particularly striking way. (p. 86)
It's not too challenging to see Metzinger's model and Wilber's model as highly similar, at least as far as a general view is concerned.

For Metzinger, the subtle body is information, the brain's self-model; this is not all that different from Wilber's subtle body containing emotional, mental, and higher mental aspects of self.

Antonio Damasio offers a neurobiological model that can possibly account for this subtle body - and we leave the causal body to Wilber and the esoteric traditions.

In each of his last several books, Damasio has been refining his brain-based model of the self, most recently in Self Comes to Mind (2010). Arguing that the origin of the self and self-consciousness is in the upper brain stem and surrounding region, he posits a proto self, an organized and coherent, though temporary neural mapping of sensation and "primordial" feeling; a core self, a kind of stream of conscious that is modified whenever an object or experience "modifies" the proto self; and an autobiographical self that possesses knowledge of past (memory) and future planning. This third stage is social and spiritual in its construction and not directly connected to brain circuitry in the same way as the earlier stages.

Again, this autobiographical self is similar to Metzinger's and Wilber's versions of the subtle body - and he does a better job of explaining its origins than either Metzinger or Wilber.

So we have the gross physical body - the sexed body - and the subtle body that contains or holds our sense of self.

So is it possible that when these two do not match in terms of sex identity (female body, male self identity, or some other incongruous combination) that we have a transgendered person? Is this the child who grows up to be transsexual?

I think this may be an integrally-oriented explanation. And of course, how this dissonance is lived out will depend wholly on the developmental stage of the individual in question.
  • A mythic-authoritarian stage person, one who is religious, would likely not be able to face or "embody" the lived conflict between body and self.
  • A rational, self-expressive person might simply see gender reassignment surgery as the only obvious option.
  • A relativistic, communally oriented person might see variety of options from (assuming he has a female body) living as a butch female, living as a male with no surgeries, take testosterone, taking T and having chest reconstruction, all the way up to phalloplasty.
There is still much to think about around this topic - but I want to think out loud and maybe get thoughts from people who think I am off the deep end or on the right track or somewhere in between.

Stay tuned.

  • Damasio, A. (2010). Self comes to mind: Constructing the conscious brain. NY: Pantheon Books.
  • Hausman, K. (2003, July 17). Controversy continues to grow over DSM’s GID diagnosis. Psychiatric News, vol. 38, no. 14: 25-32.
  • Metzinger, T. (2009). The ego tunnel: The science of the mind and the myth of the self. NY: Basic Books.
  • Rubin, H. (2003). Self-made men: Identity, embodiment, and recognition. Nashville, TN Vanderbilt University Press.
  • Schilt, K. R. & Waszkiewicz, E. (2006, Aug. 10). I feel so much more in my body: Challenging the significance of the penis in transsexual men’s bodies. Paper presented at the annual meeting of the American Sociological Association, Montreal Convention Center, Montreal, Quebec, Canada. Accessed online: 2011-03-13 from
  • Wilber, K. (2000). Integral psychology: Consciousness, spirit, psychology, therapy. Boston: Shambhala Publications, Inc.
  • Wilber, K. (2003). Excerpt G: Toward a comprehensive theory of subtle energies. (Shambhala Publications website).

No comments: