Blanchard's transsexualism typology

Blanchard's transsexualism typology, also Blanchard autogynephilia theory and Blanchard's taxonomy, is a psychological typology of male-to-female (MtF) transsexualism created by Ray Blanchard through the 1980s and 1990s, building on the work of his colleague, Kurt Freund. Blanchard divided trans women into two different groups: "homosexual transsexuals", who Blanchard says seek sex reassignment surgery because they are feminine in both behavior and appearance, and to romantically and sexually attract (ideally heterosexual) men, and "autogynephilic transsexuals" who purportedly are sexually aroused at the idea of having a female body. Blanchard's model is unusual in that neither groups are considered "false transsexuals"; both autogynephilic and homosexual transsexuals are thought to benefit from transition. This distinction is a recurring theme in scholarly literature on transsexualism.[1]

Supporters of the theory include sexual behavior scientists J. Michael Bailey, James Cantor, Alice Dreger, and some openly transgender health care providers, Anne Lawrence and Maxine Peterson, and others who say that there are significant differences between the two proposed groups, including sexuality, age of transition, ethnicity, IQ, fetishism, and quality of adjustment. Criticism of the research and theory has come from trans activists, including developmental biology researcher Julia Serano, Jaimie Veale, Larry Nuttbrock, and some physicians, including Charles Allen Moser and John Bancroft, and others who say that the theory is poorly representative of trans women.[2]

In the transgender community, the theory has been the subject of controversy, which peaked with the publication of Bailey's The Man Who Would Be Queen in 2003.

History

The early history of the study of transsexualism is sparse; however, the concept of a categorization of transsexual people can be seen as early as 1923 with the work of Magnus Hirschfeld.[3] In 1966, Harry Benjamin wrote that researchers of his day thought that attraction to men, while feeling that oneself is a woman, was the factor that distinguished a transvestite from a transsexual.[4] In 1980 in the DSM-III, a new diagnosis was introduced, that of "302.5 Transsexualism" under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for gender identity disorders.[5] The diagnostic category, transsexualism, was for gender dysphoric individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status.[6] The subtypes were asexual, homosexual (same "biological sex"), heterosexual (other "biological sex") and unspecified.[5] This was removed in the DSM-IV, in which gender identity disorder replaced transsexualism. Previous taxonomies, or systems of categorization, used the terms classic transsexual or true transsexual, terms once used in differential diagnoses.[4]

The clinical literature of Freund, Blanchard, and others has consistently divided male-to-female transsexuals into two distinct groups - "homosexual transsexuals," people who are sexually attracted to (ideally heterosexual) men and supposedly desire a normative female body to attract them, and "heterosexual fetishistic transvestites" in which the transsexual purportedly finds the idea of having a normative female body sexually arousing but desires a heterosexual female partner.[1] Kurt Freund first distinguished between these two proposed types in a 1982 research article, theorizing that the "homosexual" transsexuals were qualitatively different from the so-called "heterosexual males" with gender dysphoria.[7] Sexologist Ray Blanchard coined the term "autogynephilia" in 1989 to describe this latter category of people.[1] He stated that while they lacked a specific term to describe the concept, there was evidence for the concept among clinicians of the early 20th century. Havelock Ellis used the terms eonism and sexo-aesthetic inversion in 1913 to describe similar cross-gender feelings and behaviors.[8] In a 2005 article on the concept by Ray Blanchard noted that Freund was probably the first author to distinguish between the erotic arousal due to dressing as a woman (transvestism) versus erotic arousal due to physically transforming into a more typically female form (autogynephilia).[8]

Development

Blanchard's observations at the Clarke Institute began by categorizing male-to-female transsexuals into four groups based off their supposed sexual orientations: "homosexual," "heterosexual," bisexual, and analloerotics (i.e. trans women attracted to men, women, both, or neither, respectively.)[9][10] Blanchard then conducted a series of studies on people assigned male at birth with gender dysphoria, including male-to-female transsexual people, and concluded that there existed only two distinct types.[9][10][11] Blanchard said that one type of gender dysphoria/transsexualism manifests itself in individuals who are exclusively attracted to men (Homosexual transsexuals averaged a Kinsey scale measurement of 5-6 and six is the maximum, or a 9.86±2.37 on the Modified Androphilia Scale[12][13]), whom he referred to as homosexual transsexuals, adopting Freund's terminology.[11] The other type he defined as including those who are attracted to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (analloerotic or asexual); Blanchard referred to this latter set collectively as the non-homosexual transsexuals.[14][15] Blanchard says that the "non-homosexual" transsexuals (but not the "homosexual" transsexuals) exhibit autogynephilia,[11] which he defined as a paraphilic interest in having female anatomy.[10][16][17][18]

Studies usually find that some number of non-homosexual transsexual report having no autogynephilia.[2] When developing the typology, Blanchard found that gynephilic gender identity patients who reported never experiencing arousal to crossdressing were still measurably aroused by autogynephilic stimuli, and that autogynephilia among non-androphilic trans women was negatively associated with tendency to color their narrative to be more socially acceptable.[19] This led Blanchard to conclude that non-homosexual trans women who reported no autogynephilic interests were misrepresenting their stories. This conclusion has been criticized for being unfalsifiable[2] and for being based on an incorrect way of measuring autogynephilia.[20]

Terminology

Within the typology, sexual orientation terms are usually used relative to biological sex. That is, "homosexual" refers to those attracted exclusively to men, while "non-homosexual" refers to those who are attracted to other people than men or who are attracted to neither men nor women. "Homosexual" is used this way partly because of the scientific precedent. One of the types of transsexuals described within the theory is known as homosexual transsexuals. They are thought to be fundamentally the same phenomenon as the most feminine gay men. This similarity between homosexual transsexuals and homosexual men is also part of the reason why "homosexual" is used relative to biological sex.[21]

The word "autogynephilia" refers to a propensity to be sexually aroused by the thought or image of one self as a woman. This paraphilia is related to transvestic fetishism.

Theory

The typology divides male-to-female transsexuals into two groups: homosexual and autogynephilic. Homosexual transsexuals are thought of as being extremely feminine gay men, while autogynephilic transsexuals are thought to be sexually attracted to the image of themselves as women.[21] Attraction to the image of oneself as a woman is called autogynephilia. The homosexual type corresponds to what is known as early-onset in other sources, while the autogynephilic type corresponds to what is known as late-onset in other sources. Homosexual transsexuals are proposed to be motivated by being very feminine in both behavior and appearance, and by a desire to romantically and sexually attract (ideally very masculine) men. Autogynephilic transsexuals are thought to be motivated by their sexual desire and romantic love for being women.[22]

Homosexual transsexuals are very feminine from a young age. According to Bailey and Zucker, non-transgender gay men are also often very feminine when young, but usually learn to live in a more masculine role when they grow up. They argue that homosexual transsexuals differ because they encounter early adversity that prevented them from defeminizing.[23] Gay men find the femininity of homosexual transsexuals very unattractive,[24] and the homosexual transsexuals themselves are very attracted to masculinity that they have trouble finding in gay men. As a result, homosexual transsexuals may be partially motivated by a desire to attract straight men.

Autogynephiles have sexual fantasies about being women. These fantasies may focus on a variety of things associated with womanhood, such as anatomy, clothing or behavior. Blanchard found that the specific form the autogynephilia takes on correlates with the likelihood of transition.[25]

Erotic target location errors

Ray Blanchard conjectured that autogynephilia is a misdirected form of heterosexuality, with the attraction to women being redirected towards the self instead of others. These forms of erotic target location errors have also been observed with other base orientations than gynephilia, such as pedophilia, acrotomophilia and attraction to plush animals. Anne Lawrence argued that these phenomena provide further support for autogynephilia theory:[25]

I believe that the existence of these analogs of autogynephilic transsexualism calls into question the most influential biological and psychoanalytic theories of nonhomosexual MtF transsexualism, because such theories should also be able to account for these analogous phenomena but cannot easily do so. For example: It is plausible that hormonal abnormalities during prenatal development could result in a male-bodied person with a brain that had developed in a female-typical direction. It is less plausible that a prenatal developmental disturbance could result in a male-bodied person with a brain that had developed like that of an amputee or a plush animal. [...]

I consider it more parsimonious to theorize that autogynephilic MtF transsexualism and the analogous conditions that exist in men who are sexually attracted to children, amputees, plush animals, and perhaps real animals, all represent manifestations of an unusual type of paraphilia in which affected men feel sexually aroused by the idea of impersonating or becoming whatever category of person or thing they find sexually attractive. Their paraphilic desires, in turn, often give rise to strongly held, highly valued alternative identities that ultimately become their dominant identities.

Autopedophiles have been found to be more likely than other pedophiles to have considered whether they would be better off as a child, and more likely to have considered hormones or surgery to look more like a child.[26]

Autogynephilic vs. homosexual transsexuals

By definition, autogynephilic transsexuals are autogynephilic while homosexual transsexuals are androphilic. However, a number of other differences between the types have been found. Under the theory, homosexual transsexuals are predicted to begin transitioning earlier in life,[27] generally before turning 30, which accounts for their supposedly better adjustment. They are also more likely to come from poorer, non-white or immigrant backgrounds,[28] have lower IQs,[29] as well as be by definition exclusively attracted to men. Autogynephilic transsexuals are either attracted to women, exclusively or not, or asexual.[27] They are also said under the theory to display more fetishistic or otherwise paraphilic arousal.[30]

Anne Lawrence has proposed that autogynephilic transsexuals are more excited about sexual reassignment surgery than homosexual transsexuals. She finds that homosexual transsexuals are typically ambivalent or indifferent about SRS, while autogynephilic transsexuals want to have surgery as quickly as possible, are happy to be rid of their penis, and proud of their new genitals.[22] Michael Bailey argued that homosexual transsexuals are unlikely to transition if their appearance as women would be very unattractive.[31]

Transsexuals who are active on the internet and in transsexual support groups are overwhelmingly autogynephilic.[32] The two kinds of transsexuals rarely interact with each other and don't show up in the same spaces.[21]

Autogynephilia

"Autogynephilia" (/ˌɔːtoʊˌɡaɪnəˈfɪliə/; from Greek αὐτό- ("self"), γυνή ("woman") and φιλία ("love") — "love of oneself as a woman") is a term coined in 1989 by Ray Blanchard, to refer to "a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman."[10] Alternative terms proposed for this notion include automonosexuality, eonism, and sexo-aesthetic inversion.[33] The DSM-IV-TR includes an essentially equivalent definition, and recognizes autogynephilia as a common occurrence in the transvestic fetishism disorder, but does not classify autogynephilia as a disorder by itself.[34] The paraphilias working group on DSM 5, which included Ray Blanchard, included autogynephilia and autoandrophilia as subtypes of transvestic disorder, a proposal that was opposed by the World Professional Association for Transgender Health (WPATH), stating the lack of empirical evidence for the theory.[35][36][2]

Autogynephilia is most notable for its use in Blanchard's taxonomy to explain the presence of gender dysphoria in "non-homosexual" (gynephilic) male-to-female transsexuals, in contrast to the gender dysphoria observed in "homosexual" (androphilic) transsexuals. Autogynephilia has also been suggested to pertain to romantic love as well as to sexual arousal patterns.[22]

Blanchard provides specific case examples to illustrate the autogynephilic sexual fantasies that people reported:[8]

Philip was a 38-year-old professional man referred to the author's clinic for assessment....Philip began masturbating at puberty, which occurred at age 12 or 13. The earliest sexual fantasy he could recall was that of having a woman's body. When he masturbated, he would imagine that he was a nude woman lying alone in her bed. His mental imagery would focus on his breasts, his vagina, the softness of his skin, and so on—all the characteristic features of the female physique. This remained his favorite sexual fantasy throughout his life.

Sexuality

According to Blanchard, "An autogynephile does not necessarily become sexually aroused every time he pictures himself as female or engages in feminine behavior, any more than a heterosexual man automatically gets an erection whenever he sees an attractive woman. Thus, the concept of autogynephilia—like that of heterosexuality, homosexuality, or pedophilia—refers to a potential for sexual excitation"[16] [emphasis in original].

Blanchard classified four subtypes of autogynephilic sexual fantasies, but noted that "All four types of autogynephilia tend to occur in combination with other types rather than alone."[16][37]

  • Transvestic autogynephilia: arousal to the act or fantasy of wearing typically feminine clothing
  • Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine
  • Physiologic autogynephilia: arousal to fantasies of body functions specific to people regarded as female
  • Anatomic autogynephilia: arousal to the fantasy of having a normative woman's body, or parts of one

Other authors have distinguished between behavioral autogynephilia and interpersonal gynephilia, with the latter being arousal to being seen or admired as a woman or having sex with men.[38]

There also exist male assigned at birth people who report being sexually aroused by the image or idea of having some but not all normative female anatomy, such as having breasts but retaining their penis and testicles; Blanchard referred to this phenomenon as partial autogynephilia.[39][40]

Autogynephilia has been linked to attraction to transgender women.[25][41] Autogynephilic men are usually attracted to women and not to men.[41] It has been proposed that autogynephiles who report being attracted to men are instead experiencing pseudo-bisexuality or pseudo-androphilia, an interpersonal autogynephilic desire for men as part of the fantasy about being a woman.[25]

DSM-5

In DSM-5, published in 2013, With autogynephilia (sexual arousal by thoughts, images of self as a female) is a specifier to 302.3 Transvestic disorder (intense sexual arousal from cross-dressing fantasies, urges or behaviors); the other specifier is With fetishism (sexual arousal to fabrics, materials or garments).[42]

Gender dysphoria

Blanchard found that anatomic autogynephilia was more associated with gender dysphoria than transvestic autogynephilia.[43][25] A different pattern was found in a sample of non-transgender autogynephilic men, where higher degrees of anatomic autogynephilia were associated with less gender dysphoria; here, it was instead interpersonal and physiological autogynephilia that predicted gender dysphoria. The men in this sample were significantly more gender dysphoric than the non-transgender male baseline.[38]

Autogynephilia in cisgender women

Two studies have tested the possibility that cisgender women can also experience autogynephilia. Veale and colleagues (2008) found that an online sample of cisgender women commonly endorsed items on adapted versions of Blanchard's autogynephilia scales.[44] Moser (2009) created an Autogynephilia Scale for Women based on items used to categorize MtF transsexuals as autogynephilic in other studies. A questionnaire that included the ASW was distributed to a sample of 51 professional women employed at an urban hospital; 29 completed questionnaires were returned for analysis. By the common definition of ever having erotic arousal to the thought or image of oneself as a woman, 93% of the respondents would be classified as autogynephilic. Using a more rigorous definition of "frequent" arousal to multiple items, 28% would be classified as autogynephilic.[45] However, Anne Lawrence criticized these studies' methodology and conclusions and asserted that genuine autogynephilia occurs very rarely, if ever, in natal women.[46]. Her comment was rebutted by Moser who said that she had made multiple errors by comparing the wrong items.[47]

One case of anatomic autoandrophilia has been reported in an adult male.[48]

Criticism

The concept received attention when sex researcher and trans woman Anne Lawrence described it on her website in the late 1990s.[49] In 2003, when Bailey published The Man Who Would Be Queen, in which he based his portrayal of male-to-female transsexual people on Blanchard's taxonomy, an enormous controversy resulted.[50]

Jaimie Veale gathered a convenience sample over the Internet of trans women's impressions of and opinions on Blanchard's typology.[51] Of the people answering the survey, 52.5% had a negative response. Of the 170 respondents, 33 said the typology was too narrow and restrictive, 15 said it did not apply to their experiences, and 5 that the typology was driven by questionable motives such as "to encourage 'elitist divisionism'." Other participants, however, said they did, in fact, experience autogynephilia.

Criticism of the theory of "homosexual transsexuals" is generally focused in two categories: the use of the terms "homosexual" and "non-homosexual" to refer to MtF transsexuals by their assigned sex[52][53] and the data underlying the theory itself.[45][44] Harry Benjamin, in his seminal work The Transsexual Phenomenon, opined that the question "is a transsexual homosexual?" had both "yes" and "no" answers depending on whether sexual anatomy or gender identity was prioritised, and in cases of post-operative male-to-female transsexuals, describing them as "homosexual men" was against "common sense and reason".[53] The terminology has also been described as confusing and controversial among transsexuals seeking sexual reassignment,[13] archaic,[54] and demeaning.[55] In 2008 sexologist John Bancroft expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women, and that he now tries to use words more sensitively.[56]

Charles Moser, a sexuality advocate, criticized Blanchard's theory, stating that it uses an overly-broad definition of autogynephilia, is not sufficiently relevant to MtF transsexual patients, fails to account for all information on sexual and romantic interests of homosexual and transsexual people, and lacks supporting data.[20] Jaimie Veale, a psychology academic, published an alternative theory in 2010 which proposes that variances in gender identity are driven by personality and social factors which determine whether psychological defense mechanisms are employed to avoid or repress gender nonconformity, resulting in the later expression of this gender nonconformity.[57]

Julia Serano, a trans activist, wrote that there were flaws in Blanchard's original papers, including that they were conducted among overlapping populations primarily at the Clarke Institute in Toronto without nontranssexual controls, that the subtypes were not empirically derived but instead were "begging the question that transsexuals fall into subtypes based on their sexual orientation," and that further research had found a non-deterministic correlation between cross-gender arousal and sexual orientation.[2] She said that Blanchard did not discuss the idea that cross-gender arousal may be an effect, rather than a cause, of gender dysphoria, and that Blanchard assumed that correlation implied causation.[2] Serano also stated that the wider idea of cross-gender arousal was affected by the prominence of sexual objectification of women, accounting for both a relative lack of cross-gender arousal in transsexual men and similar patterns of autogynephilic arousal in non-transsexual women.[2] Serano criticised proponents of the theory, claiming that they dismiss non-autogynephilic, non-androphilic transsexuals as misreporting or lying while not questioning androphilic transsexuals, describing it as "tantamount to hand-picking which evidence counts and which does not based upon how well it conforms to the model",[2] either making the theory unscientific due to its unfalsifiability, or invalid due to the nondeterministic correlation that later studies found.[2] Further criticisms alleged that the theory undermined lived experience of transsexual women, contributed to pathologisation and sexualisation of transsexual women, and the literature itself fed into the stereotype of transsexuals as "purposefully deceptive", which could be used to justify discrimination and violence against transsexuals.[2]

T. M. Bettcher, based on her own experience as a trans woman, has critiqued the notion of "autogynephilia," and "target errors" generally, within a framework of "erotic structuralism," arguing that the notion conflates essential distinctions between "source of attraction" and "erotic content," and "(erotic) interest" and "(erotic) attraction," thus misinterpreting what she prefers to call, following Serano, "female embodiment eroticism." She maintains that not only is "an erotic interest in oneself as a gendered being," as she puts it, a non-pathological and indeed necessary component of regular sexual attraction to others, but within the framework of erotic structuralism, a "misdirected" attraction to oneself as postulated by Blanchard is outright nonsensical.[58]

Misgendering language

According to Leavitt and Berger (1990), "Transsexuals, as a group, vehemently oppose the homosexual transsexual label and its pejorative baggage (Morgan, 1978). As a rule, they are highly invested in a heterosexual life-style and are repulsed by notions of homosexual relations with males. Attention from males often serves to validate their feminine status."[13]

Trans man Aaron Devor wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive."[59] Still other transsexual people are opposed to any and all models of diagnosis which allow medical professionals to prevent anyone from changing their sex, and seek their removal from the DSM.[60]

Accusations of misconduct

Trans activist Lynn Conway blogged extensively about the publication of Bailey's book by the United States National Academy of Sciences and along with other activists accused Bailey of misconduct. Northwestern University investigated Bailey, but did not reveal the findings of that investigation and did not comment on whether or not Bailey had been punished.[61] According to a summary of the controversy written by Northwestern University bioethicist and historian Alice Dreger, the accusations were unfounded and comprised an attempt by those activists to silence Bailey for expressing views that contrasted with the public image they wanted. The accusations themselves did not hold up to scrutiny, according to Dreger's analysis. For example, two of the four transsexual women who accused Bailey of misusing their stories in the book were not actually mentioned in the book at all.[50]

Dreger studied the reactions of trans activists and other controversies in her 2015 book Galileo's Middle Finger.[62] She argued that although the science appears correct that eroticism is behind the typology of transgenderism, activists in the trans community preferred the simpler narrative of literally being one sex trapped in the body of the other. Dreger says, "Autogynephilia is perhaps best understood as a love that would really rather we didn’t speak its name",[62] in reference to the famous expression the love that dare not speak its name formerly used to refer to homosexuality or pederasty.

See also

References

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