Social and Economic Aspects of Transsexualism

¹ Professor of Psychiatry, Memorial University, St. John's, Newfoundland
² Senior Lecturer in Clinical Psychology, University of Manchester
³ Psychiatric Social Worker, Royal Infirmary, Manchester

1. An unselected and untreated group of 60 transsexualists is reported with particular emphasis on social, economic and educational factors. Since therapeutic efforts are mainly directed towards helping the patient to achieve a better social adjustment as well as greater tranquillity therapeutic success will mainly have to be assessed on the social dimension. Our report is hoped to provide the baseline for future assessments of treatment.

2. Certain differences in sex distribution, marital state, social class, sexual propensity, etc., between the series reported in the literature by various authors must make comparisons guarded. It is almost certain that the patients approaching different doctors are each a highly selected group.

3. Our patients show a high incidence of concomitant other psychiatric disorder, which undoubtedly impedes social adjustment in its own right quite apart from the difficulties caused by the transsexualism as such. On the other hand, the home background was found 'abnormal' in 30 per cent, and this figure does not seem to differ from that found in the general population.

4. In spite of the early onset of abnormalities educational adjustment does not seem grossly impaired. 13 per cent of our patients obtained higher tertiary education.

5. Work adjustment on the whole is poor. 50 per cent had an unsatisfactory record either in terms of prolonged unemployment or in terms of downward drift on the social ladder.

6. Antisocial or frankly criminal behaviour was widespread and occurred in 47 per cent of the patients. Only one-fifth of this was entirely linked with the psychosexual abnormalities.

7. Prostitution was very common, but only in the male patients. It had occurred in 31 per cent of the patients.

8. Assessment of therapeutic results must be in terms of comparisons with the pre-treatment situation, and this must be kept in mind particularly in relation to the high incidence of promiscuity and prostitution in that type of patient.

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