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SILVERMAN OPENED THE PANEL WITH a history of the psychoanalytic study of early male gender disturbances. Research began in the 1960's as part of an effort to understand the origins of homosexuality. Investigators such as Bieber et al. (1962) and Socarides (1968), (1970) expanded on Freud's observations of bisexuality and his hypotheses about the role of early childhood experiences in shaping the final form of sexual interests, attitudes, and preferences. The early studies described a particular constellation of factors (the seductive and dangerous mother, the unavailable father, the overly timid boy), but we now know that many constellations may be antecedent to homosexuality in adulthood. While about two-thirds of the youngsters with gender identity disorders (GID) do grow up to be homosexual adults, not all gay men suffer in childhood from GID. Young children who are brought to treatment for GID tend to be extremely unhappy and anxious, and often have serious ego disturbances. Their problems go well beyond the cross-dressing and wishes to be a girl that bring them to treatment.
Gender identity is complex, appearing to derive from the confluence of innate biological factors and the shaping effect of psychosocial influences. Money and the Hampsons (1955a), (1955b), and Money and Ehrhardt (1972) pointed to the possibility that hormonal influences beginning in utero may contribute to "masculine" and "feminine" attitudes and self-perceptions, though it is hard to demonstrate this objectively. Studies by Stoller integrated their findings into psychoanalysis (1966), (1968), (1975), (1976). The effects of environmental influences are easier to observe. From pregnancy forward, parents impose their own attitudes and expectations, conscious and unconscious wishes, demands, and conflict derivatives on their children.