Earlier this week while on an elliptical trainer at the gym, I watched a portion of The Doctors airing on the TV monitor above me, all about a 33-year-old man, Toby Sheldon, who has spent more than $100K for plastic surgery to make him more closely resemble Justin Bieber. A desire to look like Justin Bieber seems to me like prima facie evidence of mental illness; sarcasm aside, I find his behavior deeply disturbing. People who voluntarily and repeatedly go under the knife to change their appearance have always struck me as painfully confused, trying to fix something wrong within them by changing their exterior. Toby admits to being “obsessed” with having a youthful appearance (and many people want plastic surgery for the same reason), but given his relative youth when he underwent his first surgeries, it seems likely that age is a stand-in for something else. My guess is that he felt badly about himself, “ugly” on some profound level, and he “explained” that feeling with reference to hair loss and the age-related droop of his flesh.
In numerous other interviews, Toby has insisted that it’s not so much about looking like Justin Bieber as having the same youthful features. This seems like a distinction without a difference: if you want only to appear more youthful, why not strive to reclaim a younger version of your own features? Toby has also said that when Justin Bieber first burst on the scene to enormous acclaim, he, Toby, felt extremely envious of Bieber’s success. This statement seems closer to the mark. Toby seems delighted to tell reporters that he is occasionally mistaken for the star. If only he could become Bieber’s identical twin, then maybe he wouldn’t feel so ugly inside. In the other interviews I’ve watched, Toby is always talking about how happy with his appearance he now feels. The TV segment regularly cuts to shots of Toby consulting his own image in the mirror, endlessly examining his features and arranging his hair. This preoccupation with his looks doesn’t convey a sense of well-being, at least not to me. It seems obsessive: Am I really okay? Do I still look young? Maybe I was wrong — I’d better check again.
It will come as no surprise that I view this as a shame-related issue. As I’ve often said, core shame is an extremely painful experience of internal defect or damage, often consciously felt as “ugliness.” For people like Toby Sheldon who suffer from Body Dysmorphic Disorder, the shame is displaced from the inside onto their appearance. The search for a “solution” to shame then focuses on altering one’s features — losing weight, getting fit, or in extreme cases, finding a plastic surgeon to “fix” you. In one interview, Toby spoke in ecstatic terms of seeing his own reflection after one of his latest surgeries: “That’s who I’m supposed to be!” Like all narcissists who escape from shame into an idealized false self, Toby has shed his damage by taking refuge in a new-and-improved Justin Bieber self, one that “disproves” all that unconscious shame. Now he has become the perfect undamaged person he was always meant to be.
At the risk of offending the politically correct LGBT crowd, I will state my personal view that Gender Identity Disorder involves the same process. The experience of profound shame (resulting from an emotionally catastrophic infancy and early childhood) is equated in the person’s unconscious mind with her anatomical gender. This usually occurs at a very early age, often before language develops; it is for this reason that the transgender person will argue that she has “always felt that way.” For all intents and purposes, she has. On an unconscioius level, she early on came to believe that she was actually a boy trapped in a girl’s body; in later life, she convinces herself that surgically altering her body is the solution to her psychological pain, her depressive feelings, her sense of being an outsider. Gender transition is the solution to shame, just as plastic surgery is the solution to shame for people like Toby.
My views on this subject aren’t purely theoretical, though I confess I am no expert in transgender psychotherapy. One of my long-term female clients was very male-identified and in her early 20s had a long-term sexual relationship with another woman. My client often felt as if she were an angry little man trapped inside a woman’s body; she tended to idealize men to an extreme degree, believing that the possession of a penis meant they had no problems of any significance. She often wished she were a man and at least in the beginning of our work, often came across as a caricature of one: gruff, swaggering, aggressive. Over time, we came to understand that she had identified her shame with her more physically vulnerable gender, especially her vagina — that smelly black festering wound in her body. Helping her to address the real source of her shame and rehabilitate her femininity was the work of many years.
Also, on a factual basis, there is no scientific evidence to substantiate the theory that people are “born into” bodies with genders that don’t match their emotional, psychological genders. I accept that many transgendered people have “always felt that way,” at least for as long as they can remember. These defensive identifications occur at a very early age, much earlier than what we see in someone like Toby. You know I don’t put much stock in diagnosis, but using the DSM labels currently in vogue, I would say that Gender Identity Disorder is a specific, severe form of Body Dysmorphic Disorder. Core shame drives them both, with gender re-identification functioning as a powerful defense against it.