Conflicted gender. The case of a woman who believed she was half male and half female.

The author presents the case of a middle-aged woman who had a fantasy that she was half male and half female, which did not emerge until she was well into her analysis. Initially, the analytic work focused on issues of attachment and trust, as the patient was mute and despairing, and unable to verbalize affects or put together a coherent story of her life. Gradually over the course of her analysis, a history of severe emotional neglect and trauma was pieced together--she had been left at the hospital as a newborn because her mother had not wanted a girl. It was only after the establishment of more comfortable and stable connection to the analyst that the conflicts around gender and the boy/girl fantasy came into focus. Two masturbation fantasies, a primitive, non-visualized sensation of sexual insatiability with abdominal throbbing, and a more traditional beating fantasy were also analyzed. The fantasy of being both male and female, which was conscious since childhood, was both a result of and a solution to more basic issues. It was a sign of problems in integration of internal parental identifications, a shaky maternal attachment, and difficulties in dealing with affect. The fantasy reflected a profound sense of being unwanted and unloved and became a narcissistic solution for these troubling feelings. The author details the interplay of constitutional, familial, and psychological factors that contributed to this solution. Because issues of gender were highlighted in this case, their complex relationship with other underlying factors could be appreciated.