The concept of stability in Tina's transsexualism

From a strictly DSM III standpoint Tina met all the criteria for a diagnosis of transsexualism. She exhibited a profound sense of gender discomfort and believed that she should have a male body. Indeed, she wished to be rid of her breasts and to have phalloplasty. Her disturbance was chronic and she had lived full time as a male for over three years. She was erotically attracted to females and had had several relationships with women. While she refused to label these relationships as homosexual, her behavior and fantasy suggested (from my standpoint) a homoerotic preference. There was no evidence of a physical intersex or genetic disorder; nor was there overt evidence from clinical inter viewing of another mental disorder. Tina's past history and current behavior were less chaotic and impulsive than for most male transsexuals. At first glance her case seemed to illustrate the first proposition concerning female transsexuals: that they had a prior homosexual history and a stable course to their disorder.

What does it mean to call someone's disorder "stable" when the person craves to have her sex changed and threatens to commit suicide unless this is done? From a psychological perspective "stable" seems to refer either to the patient's subjective view or to the therapist's evaluation of her "successful" level of adaptation and coping style, including social-vocational adjustment, and an absence of sociopathy (embracing such complicating social factors as arrest record, prostitution, and drug addiction). The assessment of "stability" may also refer to those psychological factors which are embedded in the evaluation process: that is, cooperative behavior; a lack of impulsivity; an ability to delay gratification; and the capacity for frustration tolerance. It was for these reasons that female transsexual patients were viewed as less difficult to work with than their male counterparts. Moreover, the absence of a manifest affective disorder, in conjunction with an apparent lack of what Kernberg (1975) has called "non specific ego weaknesses" (capacity to bear anxiety, tolerate frustration, and delay gratification), made these patients seem as if they were "stable" aside from their gender dysphoria. (see PROPOSITION 1: THE SO CALLED "STABLE" COURSE OF FEMALE TRANSSEXUALISM PART III)