Studies in Gender and Sexuality

ISSN: 1524-0657 (Print) 1940-9206 (Online) Journal homepage: http://www.tandfonline.com/loi/hsgs20

Trans Bodies and the Failure of Mirrors

S. J. Langer LCSW-R
To cite this article: S. J. Langer LCSW-R (2016) Trans Bodies and the Failure of Mirrors, Studies
in Gender and Sexuality, 17:4, 306-316, DOI: 10.1080/15240657.2016.1236553
To link to this article: http://dx.doi.org/10.1080/15240657.2016.1236553

Published online: 30 Nov 2016.

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Date: 30 November 2016, At: 09:13

STUDIES IN GENDER AND SEXUALITY

2016, VOL. 17, NO. 4, 306316
http://dx.doi.org/10.1080/15240657.2016.1236553

Trans Bodies and the Failure of Mirrors

S. J. Langer, LCSW-Ra,b
a

Private Practice; bSchool of Visual Arts

ABSTRACT

This project applies and expands Gallaghers (2005) theories concerning body
image and body schema to the concept of gender in general and in particular
how understanding gender through this lens can be used to aid transgender
people in understanding their own gender. In addition, the paper discusses the
effects of gender-incongruent mirroring for transgender and gender nonconforming persons ability to know their own feelings and its role in the development of shame. In furthering the understanding of gender and selfknowledge, the concepts of tacit knowledge and phantom limbs reveal how
one comes to know gender as a fundamental aspect of the self.

Our body is not simply one object among the many in the world but is part of the background that presupposes
our understanding of the world [Borrett, Kelly, and Kwan, 2000, p. 263].

What are the effects of gender-incongruent mirroring on trans persons and their embodied
cognition? The implications of poor mirroring and incorporation of the others gaze are well
documented for general psychic development but the effects and consequences for transgender
and gender nonconforming individuals have not been considered fully, particularly through the
lenses of psychoanalysis, developmental psychology, neuroscience, and philosophy (Winnicott, 1971;
Pines, 1985). Early self and ego development are established during the mirror stage using Lacans
(1966) theory where the child learns about his or her self in the reflection of a mirror with the others
help or through the gaze of the other. Winnicott expanded on Lacans theory to include bodily
experiences of mirroring by the caregiving other (Winnicott, 1971). Drawing from both of these
theories this paper develops a new theory about mirroring and transgender.
The term trans is used here to include those people in the community who find they need to modify
their body in some gendered manner, so this could include those individuals who identify as
genderqueer or anyone along the gender spectrum. When I refer to trans children, that includes
those who already know and those who have not yet identified as trans but who will when they are
older. This paper also develops a theory of the process of how one understands ones gender from an
interdisciplinary position and provides examples from clinical practice within the trans communities.

Psychic architecture of body image and body schema

Shaun Gallagher is an American philosopher who works on embodied cognition and the philosophy of
psychopathology. His writing is unrelated to gender but many of his concepts are particularly well
suited to understanding gender because they come from an embodied cognition position that
challenges a mind/body split of the self. Therefore, applications of his theories to gender are my design.
If throughout conscious experience there is a constant reference to ones own body, even if this is a recessive or
marginal awareness, then that reference constitutes a structural feature of the phenomenal field of consciousness,
part of a framework that is likely to determine or influence all other aspects of experience [Gallagher, 2005, p. 2;
italics added].
CONTACT S. J. Langer, LCSW-R
2016 Taylor & Francis

slangerlcsw@gmail.com

138 West 25th Street, New York, NY 10001.

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Gallagher refers to this field as prenoetic consciousness, which affects our consciousness but is not
in our awareness. In psychoanalytic terms, it is similar to Freuds preconscious (Freud, 1900).
Gallagher argues for an embodied self. This embodied self is constructed through an interplay of
body image and body schema. When thinking about the premedical transition trans body, this
constant reference is the dark undercurrent that becomes the seat of discord within the body, which
is one of the hypotheses this paper aims to prove.
The first part of this project is to apply Gallaghers theory of body image and body schema to how
one understands gender. Body image pertains to the appearance of the body in the visual field and
the accompanying beliefs and attitudes (Gallagher, 2005). It is perpetually and actively affecting our
perceptions. It is a reflexive intentional system according to Gallagher, which facilitates one to feel
that this is my body, an ownership over ones own body and sense of self (p. 28). Body image in this
form arrives later in development whereas body schema exists earlier. Body image is built up by
experience even though it acts as if it were innate (Gallagher, 2005).
Body schema consists of proprioceptive information and proprioceptive awareness (Gallagher, 2005).
These proprioceptive processes channel and interpret various sensory input (from every muscle, tendon,
and joint) and movement, orientation and kinesthesis, conscious and nonconscious, but are primarily
unconscious. When the body schema is working well, it archives for the individual a higher degree of
integration between body and environment (Gallagher, 2005, p. 57). Because proprioception is awareness from internal signals, it can be a more accurate means of identifying oneself (Gallagher, 2005). This
paper is adding to body schema the phenomenon of interoceptive sensitivity, which is defined by
perception of sensation from all internal viscera, our bodily reactions, that is, hunger, respiration, sexual
desire, gastrointestinal, headaches, heart rate, and so on. Higher interoceptive sensitivity has been
correlated with deeper and more intense feeling of emotions. This is determined by a correlation between
an individuals ability to accurately perceive his or her heartbeat and the depth of their experience of their
emotions; a good detector of heart rate had more intense emotions (Wiens, Mezzacappa, and Katkin,
2000). This confirms William Jamess hypothesis that we need the body to fully feel our emotions, as
James argued that we need the body to feel our gender as well (James, 1884; Pollatos, Gramann, and
Schandry, 2007; Langer, 2014). Interoception is about self-perception, which is why I propose that it is at
the core of how a transgender person understands their gender.
These body schematics are the information a gender nonconforming person needs to tap into and
listen to for self-knowledge. Body schema is present to a certain degree prenatally to birth due to
evidence of neonates ability to imitate whereas body image is created in later infancy between 6 and
18 months, the time of the mirror stage (Lacan, 1966; Gallagher, 2005). This is demonstrated by
hand-to-mouth coordination, which begins in utero (de Vries, Visser, and Prechtl, 1983). Imitation
by infants, such as sticking out their tongues, suggests there is at least a basic body schema at work in
the early months of life because there is proprioceptive awareness of the face illustrated by the fact
that the infants can move their mouths in imitation of another (Gallagher, 2005).
Body image is not innate but is developed through the intermodal and intersubjective interaction
between proprioception and the vision of the others face, a succinct definition of mirroring
(Gallagher, 2005, p. 73). Body image also includes the individuals perceptual, conceptual understanding and emotional experience of the body (Gallagher and Meltzoff, 1996). Mirroring is key in
the development of body image and a recognition of a self and thus the earlier self is more of an
embodied self than a purely psychic process (Kleeman, 1971; Winnicott, 1971). Whereas body image
comes out of the visual field (external world), body schema receives its signals from proprioception
(an internal process) and interoception as added in this work (Gallagher, 2005).
There can be a translation problem between these two languages, the internal and external body
(Gallagher, 2005). My theory is that this translation problem is the disconnect one feels when felt
gender does not match the material body. There are the visual disconnects between the experienced
gender and the body and then there are the experienced gender feelings that do not match other
interoceptive sensations. It also seems there are different aspects of gender that reside within these
two fields of image and schema, some of which have never been named, such as how one would

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describe the proprioceptive or interoceptive feeling of masculinity or femininity. One example of felt
sense dislocation is ones locomotion and sense of body changes when muscle density changes, either
thickening with testosterone or softening with feminizing hormone treatment. Our largest organ, the
surface of our bodies, changes through hormone treatment and feels different and one senses the
world differently. This can feel more gender congruent when it comes into alignment with ones
experienced gender; that is an interoceptive sensation in the body schema. It appears as if the
relationship between physical sensation and gender identity is consistently reciprocal. Cisgender
individuals cannot experientially understand the deep body schematic feelings of gender incongruence, which is why they focus on the image of the body. This is why applying Gallaghers (2005)
image/schema is important to more deeply understand the trans persons experiences of gender.
There are so many more aspects of gender perceived through organs other than the eyes.
Freud said the ego is a body ego, a mental projection of the surface of the body (Freud, 1923). The
child moves through Lacans mirror stage by taking in the image of the body, acquiring imaginary
mastery over it, and thus is the foundation for the development of the I (the ego) through the real
mirror and interactions with the primary caregiver (Lacan, 1988, p. 79). The first mirror is the mothers
face (Kleeman, 1971). Furthermore, mirroring includes how the infant is held, spoken to, played with,
and so on (Winnicott, 1971). Observation and research support how these interactions are played out
along gendered lines between caregivers and infants such as by throwing a boy up in the air more and
cuddling a girl or that girls are talked to more than boys (Brooks-Gunn and Matthews, 1979). Condry
and Condry (1976) found that adults attributed different feelings to a 9-month-old infant based on what
gender the infant was labeled, that is, crying was identified as fear for girls and anger for boys. The famous
baby X experiment, where adults were told a child was a boy, girl, or did not know the gender, found that
unknown gender determined how much the adult physically handled a childmen handling the
children less and women handling the infants more (Seavy, Katz, and Zalk, 1975). Parents act on an
illusion of what they expect from a boy or a girl child and modify their behavior accordingly in implicit
and explicit ways (Kleeman, 1971). At 7 months disapproval-approval mirroring cues are responded to
by the infant and at 1 year the childs gender in the parents mind is established (Kleeman, 1971).
The importance of good-enough mirroring cannot be understated and has far-reaching lifelong
implications from infant affect regulation to adult sexual life (Scharff, 1982; Gergely and Watson, 1996).
Without it, the childs own creative capacity begins to atrophy (Winnicott, 1971, p. 2). The childs
survival depends upon being seen. The gender nonconforming (GNC) child looks and looks but his or
her sense of themselves is usually not reflected back as many of our clinical experiences have shown.
The trans child has a unique experience of misattunement. This gendered misattunement leads
children to have a more difficult time understanding their own proprioceptive/interoceptive sensations (aspects of body schema) perceptions, some of which are related to gender identity.
Mirroring and identity development
Lemma has also theorized about transgender identity formation and mirroring effects (Lemma, 2012,
2013). Drawing from interviews and a long-term psychotherapy case, Lemma describes the transsexuals (her word for those who seek surgery) recalled experience in childhood of the painful
nonrecognition of their experienced gender by their parents, that their feelings of incongruity were
not accepted. Lemma interprets this poor mirroring as exposing the child to conditions to developing an alien self and that this may lead to the search for the right body (Lemma, 2012, p. 272),
thus concluding that needed gender-affirming medical interventions are not just about aligning the
body with experienced gender but as a disruption in identity coherence, further pathologizing
trans identities (Lemma, 2013, p. 272).
We are in agreement that there is an impact on the trans childs psyche from repeated failures in
misattuned mirroring and that an alien self becomes introjected as a result of the misattunement. We
also agree that the universal developmental task of owning the body one has is doubly complicated for the
trans person because their embodiment is felt to be confusing and painful (Lemma, 2012, p. 279).

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Yet we diverge after this point. Lemma interprets the need to seek medical intervention to resolve
incongruity felt by the self as a false solution to repeated mirror failings. The theory in this paper is
in fundamental disagreement with Lemmas (2012) characterization of poor mirroring as causality
for trans identity and need for medical intervention. If poor mirroring were a cause for transgender
identity, then it would be extremely prevalent.
This paper argues that the poor mirroring exacerbates the childs difficulty connecting to a body,
which is already complicated to him or her. This inability to connect disrupts the individuals
understanding of their interoceptive and proprioceptive sensations. If the childs body image is being
developed out of incongruently gendered mirroring, it runs in contrast to their body schema, the
internal felt sense of self.
The Winnicottian false self or alien self is the transgender identity for Lemma (2012), whereas
argued in this work, the false self is the childs effort to conform to the gender assigned at birth
(Winnicott, 1965). The child assigned male at birth who feels feminine but who is mirrored maleness
submits to the false maleness in order to survive under the others gaze, dissociating them from
their own feelings. This tension is exasperated into an unbearable rub when misattunement (internally and socially) of gender is part of the constellation of experiences. Children quickly learn that
their awareness of their gender in private is at odds with how vigilant their social self-awareness
needs to be in terms of gender. This is an incomprehensible and unarticulated process for most trans
children. These children begin to consciously or unconsciously manipulate their behavior away from
their body schema and to a body image (and expression) that matches others expectations.
However, another conclusion from these interviews is that the core of the experience of the
transsexual is indeed located in the visual order (Lemma, 2012, p. 278). Lemma conceptualizes trans
experience as only belonging to the image. She actually reports feeling the transpersons (nonpassing
in her opinion) image being forced upon her (Lemma, 2012). She uses this word six times in
reference to her patients gender presentation, which seems to possibly say more about Lemmas
unprocessed transphobic countertransference than about her patients identity.
This project does not minimize the crucial aspect of the visual field but gives weight to the impact
of the body on the body; one needs to take into account all the other senses as well. The visual is not
the only means of gender recognition. All of our senses need to be considered; for instance, scent
plays a role in masculinity and femininity as ones body odor shifts with hormone treatment as well
as the feeling of ones skin; aspects of body schema (Coleman et al., 2011). These gendered
differences could explain how only weeks after commencing hormone treatment, patients report
being correctly gendered by strangers. There have not been any visual changes but what one smells
like has changed. Additionally how one senses smell is gendered and must affect a cascade of
behavior, from food preferences to sex, because how one experiences smell affects ones preferences
(Garcia-Falgueras et al., 2006; Burke, Cohen-Kettenis, Veltman, Klink, and Bakker, 2014).
The trans essence has aspects that are rooted within the body schema and later within body
image. These sensations are foundational and make up the beginning of ones gender identity.
Lemmas use of the individuals and/or others inability to recognize the childs gender incongruity to
pathologize that identity is misguided and harmful to the trans communities.

Mirroring and shame

We now consider incongruent mirroring throughout childhood and its role in the development of
shame. Winnicott said it this way: Any minute the mothers face will become fixed or her mood will
dominate, and my own personal needs must then be withdrawn otherwise my central self may suffer
insult (Winnicott, 1971, p. 2). Muller said, The mirror phase establishes the framework for
intersubjective illusion insofar as it enables the child now to mirror the mothers desire, to be what
the mother wants so as to please her (Muller, 1985, p. 238). Trans and gender nonconforming
people remember when the disgust or disapproval in their parents eyes registered with them. It is a
potent childhood memory. There are also the people for whom no memory exists, because the

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message was communicated through the earliest mirroring. Subsequently the core gender body
schema is foreclosed and the false body image and self (the gender assigned at birth) take residence.
A parents inability to properly mirror may be due to the childs gender nonconformity, which
triggers parental rejection for transgressing gender norms. This results in parentchild interactions
at worst of total rejection or at best, in poor mirroring. The rejection by parents of their gender
nonconforming childrens behavior is still the cultural norm. Almost anyone who has transgressed
gender norms as a child can immediately recall a moment of being explicitly or implicitly shamed for
that behavior.
Adults react more positively to children who they see as imitating their behavior, such as: their
walk, facial expressions, and gestures. This positivity is shown through responsive nonverbal cues,
more face-to-face interactions through talking and facial expressions. The adults also see the
imitating child as having superior characteristics when it comes to social and intellectual traits
(Bates, 1975). This is accepted and praised by both parents when the gender of the adult matches the
material body of the child, but for the child who is GNC there are consequences.
Gesture [is] the origin of language (Gallagher, 2005, p. 107). Gesture springs from body schema;
it is an unconscious action. It is also the first communication of gender nonconformity. The looks
given by adults and other children penetrate with disapproval to disgust when a gesture or walk is
embodied in the wrong gender. Here lies tacit shame and the commencement of body modification
based on mortification, such as trying to walk, talk, gesture in a manner conforming to the gender
assigned at birth. This modification takes shape as the child hiding who he or she is and how they
behave in front of others. We know the long-term price of gender transgressions later in childhood
are higher rates of physical and verbal abuse (Grossman et al., 2005) and proposed here is that the
aftermath for suppressing the self particularly related to childhood abuse is shame.
This is observed in many adults who come to understand their (trans)gender later in life. The
process of self-recognition for them initially is to connect to this false self, to profoundly feel it, in
order to connect to the body; to develop a more complex connection to ones body schema. Only
then will one know if some body modification is warranted. Only the individual can know this truth;
the clinician cannot know it for them.
Due to the gender trauma, trans individuals have a difficult time connecting to caregivers due to
their own alienation from their bodies and having to act in an incongruent gender role. Gender
trauma could be defined as the profound and consistent disruption of the self by the misattunement
of the body and society. In addition, gender trauma includes the emotional burden bearing upon the
individuals psyche due to the internal dissonance.
When the other systematically disconfirms the subjects state of mind particularly in strong
affective states the individual mistrusts their own sense of the self and reality. Dissociation becomes
the most adaptive solution to preserving self-continuity (Bromberg, 1998, p. 11; see also Laing, 1962).
This individuals ability to cope with this dislocation is dependent on his or her personality structure.
As there are neurotic trans people, so too are there psychotic trans people whose gender is no less
essential but for whom the process of understanding themselves will express itself differently. This is
important to appreciate because historically trans identities have been seen as a production of a
psychotic or perverse psychological process.
As Saketopoulou (2014) explicates through the case of one of her trans child patients, the massive
gender trauma of being raised in an incongruent gender can be too great and a psychically fragile
child may have a psychotic defensive reaction. She emphasizes that being trans is not the psychotic
formation but a reaction to the pressure surrounding identifying as a gender other than the one
assigned at birth. If the gender trauma is not addressed early, the psychotic compromise can become
ensconced. These individuals, as adults, may need more time and exploration to understand the
signals their bodies are giving them concerning their gender. The shame is compounded by the
gender being associated more explicitly to mental illness. The therapist, in general, must call upon
the better mirrored aspects of the patient to help repair the poorly mirrored aspects, but this

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becomes more problematic when there are few to no positively mirrored aspects of the individual,
which can occur with our most fragile patients.

With the help of phantoms

If we look at trans experiences through the example of aplasic phantom limbs, it will illustrate this
point of how it takes time to develop awareness within ones body and then the understanding of
what that awareness means about the body. Aplasic phantoms are phantom limbs, which occur in
people born without the limb, not from removal of a limb one was acquainted with from birth
(Gallagher and Meltzoff, 1996; Price, 2006).
Most aplasic phantom limbs occur between 5 and 8 years old (Gallagher and Meltzoff, 1996;
Gallagher, 2005). This suggests the individual needs time to understand that his or her internal felt
sense of their body does not match their outer image of the body. They need time to develop the language
to express this to others. This mirrors the range of the experience of many young trans people. Children
become able to recognize and assert through language what they know to be true for themselves. Many
times people forget that they do not have the limb and venture to use it (Gallagher, 2005). The
phenomenon of forgetting the missing limb implies aspects of the limb are still part of the body schema
and body image (Gallagher, 2005). This parallels the experience of many trans people who report
momentary surprise when a certain gendered body part or feature is missing when they catch themselves
in the mirror, which I have observed in my practice with trans patients (Langer, 2014).
Research comparing trans identified people with cisgender people who have genital surgery due
to disease reaffirms the power of phantoms. One finding showed 60% of transmen reported feeling a
phantom penis over the course of their lifetime. In addition, 10% of transmen experience breast
phantom postmastectomy surgery as opposed to one third of cisgendered women. Thirty percent of
transwomen report phantom penis postvaginoplasty as opposed to 58% cisgendered men with
penectomy due to illness (Ramachandran and McGeoch, 2008). Whereas some people born without
arms have phantom sensation of arms, similarly trans people have phantoms of their missing body
parts. Ramachandran and McGeoch (2008) explain how remarkable it is that these phantoms in
trans persons have survived despite years of no reinforcement visually or socially. This addresses the
power of body schema for holding much of what we call gender.
These numbers are not absolute because some trans people did or did not experience a phantom;
similarly neither did the cisgender people. The phantoms prove both variety of body schema and
probably how our brains experience gender. It again reinforces listening to the individuals and that
they are the experts of their own bodies.
In the medical model perspective on transgender experience, there is the language of early and
late onset of gender dysphoria (GD), usually in the tone that early versus late indicates a kind of
severity. First of all, we should be using the words early and late awareness, particularly in light of the
phantom metaphor. Early awareness GD is a picture of strength and good enough mirroring; late
awareness signals not less necessary or strong GD but a delay in recognition of ones gender
impacted by consequence the experiences of gender trauma, poor mirroring, and poor body
integration. This moves transgender away from a diagnostic category (another aspect of misunderstanding by the other and shame) and recognizes it as its own unique phenomenon.
The way to direct treatment related to gender diversity (dysphoria) is by working toward creating
attunement within the body. This is accomplished through nonjudgmental inquiry, knowing how to
inquire about the body, and by exploring how to connect with ones body with emphasis on the
identity being foundational instead of dialogue about proving ones gender experience.
Trans persons may need to work over these mirror failures before becoming fully who they are in
terms of gender. Psychotherapists need to have a nonjudgmental stance that gender may not present
itself in the beginning of treatment, but it does not make gender any less important or essential to
that human being. And conversely, gender may be the first aspect of personhood the individual

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presents with and our work in therapy is to help develop the self in support of his or her gender
while we are concurrently working through other mental health issues.

How do we know that we know?

There is a condition resulting from infectious mononucleosis that damages the myelinated large
fibers below the neck. The patient suffers from acute sensory neuropathy. The individual loses
proprioception and thus has no sense of his or her body schema. When one depends only on bodyimage, it results in awkward and inexact movements (Gallagher, 2005). One would need to think
about every movement and see the body in the visual field in order for it to function, such as for
walking. There is a disruption in the communication between the body image and body schema
resulting in a lack of a felt sense that my body is my own. This type of split can help explain why
some trans people feel and/or appear very awkward in their own bodies. There occurs a separation
between the body image and body schema for the trans person who needs gender-affirming medical
intervention(s). To the cis-community this may seem like a leap to understand because they usually
see trans-related interventions as reversing or overcoming the gender assigned at birth. In reality the
reason medical interventions work so well and efficiently is that they are aligning internal (unseen
but felt in the body schema) gender aspects with the observable, public gender.
One patient had begun treatment with me when she was still presenting as male. She was
extremely awkward in her manner of walking and even sitting in the office. She had taken a break
from therapy a few months before beginning hormone treatment. When she returned, there was a
marked difference in how fluid her movements presented now. She carried herself more upright,
confident, possibly because she was now presenting as a woman, but there was coordination in her
body, which even she noticed as something internal, which she could not easily explain. It was as if
she was not working against herself anymore.
Equilibrium between body and environment, allows us to be more attentive to the world and our
surroundings than to our body (Gallagher, 2005, p. 34). Once body image and body schema are
brought into alignment, the mind is freed to think of other things. Many patients in treatment have
expressed this sentiment when they have undergone some aspect of medical transition. It can explain
the incredible increase in mental space. It could be argued this is because the person is relieved that
the decision is over and they are less stressed. My clinical experience has shown people who may be
coping with even more stressful circumstances due to the commencement of transition feel a greater
capacity in mental processing. They feel as if they have access to another part of their brain and
harmony has set in or the mental pressure from living incongruently eases. A recent study, which
compared MMPI-2 scores of transmen pre-testosterone and three months post-hormone treatment,
supports clinical and lived experience. These transmen showed steep increases in psychological
functioning post-hormone treatment (Keo-Meier et al., 2015, p. 148). Patients, postsurgery or
hormone treatment, describe an experience of their body being in sync or coming into alignment
on a profound level; their internal and external selves were out of step with each other before, but
postintervention, there is a smoothness within the body and with the body. Many patients in my
practice have said to me there is no need to get used to their body postsurgery; it is the body being
returned to itself, as supported by the phantom research.
When another bodily process changes, that is, metabolism or respiration, it affects perception.
They are not just physiological processes but prenoetic ones, which affect consciousness (Gallagher,
2005). We do not know the full extent of how many processes are affected by hormone treatment,
but this fact supports the experiences of individuals on hormone treatment who describe seeing the
world differently. As an example of the body schema exerting itself on the psyche alone, after only a
few weeks of beginning on hormone treatment, many trans patients have reported a sense of settling
into themselves. Even before visual (body image) changes, clinical observation has seen a striking
contrast of calm in the room. The person is more present in His or her own body. One patient
expressed it as I feel like more me.

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As stated earlier, this is before any visual (body image) changes have occurred, but dramatic body
schema changes must be happening to provoke this stunning a change on a measurement such as the
Minnesota Multiphasic Personality Inventory (MMPI), which is assumed to be fixed for life. Meier
et al. (2011) have also shown how hormone treatment further improves transmens mental health.
We do not yet know the full extent of what is happening in the brain and body but this new
research is only confirming that we should trust the individuals experience of gender. The breakdown of gender into perceptible body image elements is more easily identifiable, but the percepts of
gendered body schema elements are more difficult to describe in language; it is more intuitive.
The theory proposed in this paper is this: certain elements of gender begin their residence in body
schema even though they are discussed in general through body image. It is these unknown
coefficients of gender that are retained when the body image is not reflective of the individuals
felt experience. Are some aspects of proprioception or interoception gendered? It appears so, but
how do we define them and measure them? How does one describe feeling these feelings to someone
who has not experienced this fundamental incongruence? How do people know what aspects of
transition will be right for them? For a portion of trans people, the entire answer occurs posttransition intervention, for instance, when the improvement in psychological functioning occurs, as
validated by the MMPI study.
Knowing gender is a tacit knowing through the process of subception. Subception is a perception
that occurs out of consciousness, similar to the unconscious percepts of body schema. The example
Polanyi (1966) uses is, we know how to recognize one face out of millions, but we cannot say how we
recognize it. Another example he uses, which connects to mirroring and shame, is research subjects
were quickly shown a series of nonsense syllables and given an electric shock when certain ones were
shown. Eventually the subjects would anticipate the shock, even though they could not articulate
which syllable connected to the shock. Furthermore, a similar study found the same results when
subjects were exposed to shocks when they verbalized associations to certain shock words yet
avoided those associations without conscious knowledge. The subjects were able to avoid the shock
without being aware of how they knew how they were avoiding the shock, similar to trans children
who know which gestures to avoid in public.
There are various aspects of tacit knowing. The shock syllables and shock associations are part
of the first term, whereas the shock is the second. We know the first term only by relying on our
awareness of it for attending to the second term (Polanyi, 1966, p. 10). Polanyi explains the two
terms of tacit knowing as divided into proximal and distal terms. Proximal are the particulars, which
are unconscious. Distal terms are the actual comprehension.
For instance, the proximal elements of gender are the texture of my skin, the distribution of fat to
muscle, the way my voice feels in my throat, the way I smell, the atrophy of my estrogen receptors and the
awakening of my androgen receptors, and so on. The comprehension of this combination as masculine is
the distal term. These are some of the quiet coefficients of gender that act as unconscious percepts as well
as conscious knowledge. A trans person may feel these elements as discordant when they are still
incongruent but have no means to articulate it; one must trust ones gut. One study has proven through
a similar nonconscious fear conditioning that those participants who had higher interoceptive sensitivity
also had better unconscious predictive behavior and thus could rely on their guts (Katkin, Wiens, and
Ohman, 2001). This reinforces the point that improving ones connection to the body improves the
ability to know what is happening in it in order to know what ones true gender is (Langer, 2014).

Gender as music: Embodied metaphor

Another approach to gender and tacit knowledge is via a gender-as-music metaphor. We can tell
when music is out of tune or dissonant, but only a trained musician can understand why the
architecture of the chord or phrase is uncomfortable to hear. Moreover, everyone can sense when
instruments in a band are disjointed but few of us know how to correct the players to be in harmony
(sharp vs. flat) and rhythm (dragging vs. rushing or accenting the wrong downbeat).

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Most people take for granted their own gender as congruent but cannot tell you how or why it
feels in harmony. Imagine your life has been lived out of tune and posthormone treatment, you
suddenly have perfect pitch to play the instrument of your body. You never felt that feeling in your
body before, but you needed to make the attempt toward transition to fully comprehend what your
body and mind were communicating to you.
The visual field of gender is what most analysts (and general public) consider, but there needs to
be an awareness of the felt elements and body schematics belonging to the other senses. My process
in psychotherapy, when working with gender, is to develop the equivalent of an ear for the gendered
music of our bodies. Helping patients understand how complicated gender is can bring some relief
in treatment that it makes sense that understanding this aspect of oneself takes time.
Gender-conforming people know their gender but not how they know it. When asked, they often
point to physical manifestations in their body image yet may take for granted all the body
schematics. Trans people may not be able to articulate how they know they will feel better without
breasts or with fuller hips; they just know it. It is essential for us (clinicians, theorists, society) to
mirror this back to them.
These perceptions become clearer postmedical intervention. One patient who was an exceptional
surfer grew up competing in male and female categories. He took pride in the fact that he was female
bodied; he could surf like a dude. His transition took place in his mid-30s, which was partly due to
the fact he felt that much of his body felt and passed as male. Posttestosterone for about a year, he
began surfing after a break, due to top surgery. He spoke about how he was able to shred the wave
with much more intensity. Although he had not gained any weight, his body felt denser and heavier,
a sensation he did not know would feel natural to him but was more congruent. This allowed him to
shred the waves in a manner he was unable to before. Similarly, many transwomen describe feeling
their bodies as softer and lighter and experience it as a relief. There are multiple manners in which
gender is identified and expressed in our psyche and our bodies.
Gender does not have an objective measurement. We cannot rely on the material body; it does
not reveal the person. The historical weightiness of body image in considering gender in the
literature requires a balancing to the importance of body schema in the discourse on gender
proposed in this project. Understanding gender with a dual-attention focus using body image and
body schema conceptualizations is a nuanced approach that can capture more of what can be
considered within the gender spectrum.
Winnicott (1971) talked about how to work in session with someone who experienced traumatic
failures in mirroring. As analyst I have had to displace this mother in a big way in order to enable
the patient to get started as a person (p. 4). These mirror failures imprint distinct grooves into the
psyches of the gender-nonconforming person. In conclusion, the aim was to show how subtle,
intuitive, and in some ways immeasurable a process it can be to discover and understand ones
gender and to truly get started as a person.

Notes on contributor
S. J. Langer, LCSW-R, is a writer and psychotherapist in private practice in New York City. He is faculty in the MPS
Art Therapy Department at School of Visual Arts and on the Executive Committee for the Psychotherapy Center for
Gender and Sexuality at the Institute for Contemporary Psychotherapy, where he supervises and created their Surgery
Assessment Project. His published articles and presentations cover a range of interdisciplinary interests such as
trauma, gender studies, transgender health, and clinical practice.

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