Black female transsexuals and schizophrenia: a serendipitous finding?

While increasing numbers of individuals have identified themselves as transsexuals and requested sex reassignment surgery, the number of black female applicants is grossly underrepresented. Indeed, only 3% of the patients applying to the Case Western Reserve University (CWRU) Gender Identity Clinic (5 of 174 patients) were black females; and in one survey of nine gender identity clinics, only 1.1% of the applicants were black females. In this study, all five black female applicants who applied for transsexual evaluation to the CWRU Gender Identity Clinic served as subjects. The patients' characteristics, their psychological test results, clinical interview material, and psychological and psychiatric diagnoses are presented. All patients had severe psychopathology; three were schizophrenic, one was a schizophrenic character, and the last diagnosed as either a psychotic character or borderline personality. Among the hypotheses, it was suggested that black women may be "inoculated" against severe gender identity pathology and only exhibit such pathology as a consequence of a schizophrenic illness or severe borderline schizophrenic state. The data also suggest that more attention should be placed on investigating the family and cultural dynamics related to transsexualism. The implications of these findings for developing a comprehensive theory of transsexualism are presented.