The born identity: Can online gaming help people with gender dysphoria?

About a year ago, my colleagues and I published what we believe is the very first study of the helping role that video gaming can play in the lives of transgender individuals. Before I get to that, it’s probably worth noting that there have been studies of how gamers and fans play with sexuality, gender, and the video game Minecraft on YouTube as well as papers discussing whether the gaming industry should cater for marginalized groups and develop games for groups where there is little representation within games (e.g., gay and transgendered characters). For instance, there is now a short autobiographical game by Auntie Pixellante called Dys4ia. This is a WarioWare-style game, played only with the arrow keys, chronicling the experiences of a trans woman rectifying her own gender dysphoria. Such videogames raise interesting questions about how those individuals with gender dysphoria utilize gaming as part of their identity.

In a previous blog I briefly looked at gender swapping in online video games including some of my own research. For instance, in 2003 I published a paper in the journal CyberPsychology and Behavior using secondary poll data from online gaming forums. The paper reported that of 10,350 players at the Everlore fan site, 15% had swapped the gender of their main in-game playing character. We also reported a similar finding among 8,694 players at the Allakhazam fan site with 15.5% reporting that they had gender swapped their main in-game character (and more specifically, 14.5% males and 1% were females who had changed the gender of their lead character). In a 2004 follow-up survey among 540 Everquest gamers (again in the journal CyberPsychology and Behavior) my colleagues and I reported that 60% had swapped their online in-game characters. The prevalence of gender swapping was probably much higher in this study because the question related to the gender swapping of any online game character not just their main playing character.

In a small exploratory study I published in 2008 with Dr. Zaheer Hussain in the International Journal of Mental Health and Addiction, we examined why people engaged in gender swapping in a self-selecting sample of 119 online gamers (mean age of 28.5 years). We reported that 57% of gamers had engaged in gender swapping (any character not just their main character), and that males adopting an online female persona believed there were a number of positive social attributes to becoming female characters in male-oriented gaming environments. The study also reported that significantly more females than males had gender swapped their character – mainly to prevent unsolicited male approaches on their female characters. Some females appeared to gender swap purely out of interest to see what would happen in the game (as a personal experiment), while others claimed that they were treated more favourably by male gamers when they played as a male character. Others reported that gender swapping enabled them to play around with aspects of their identity that would not be possible to explore in real life. Other reasons for gender swapping were that (i) female characters had better in-game statistics, (ii) some specific tools were only available with female characters, (iii) the class of character was sometimes only available in one gender, (iv) they played for fun, and/or (v) they did it to so something that they would not normally do in the game (i.e., they did it for a change in their usual playing behaviour).

Outside of online gaming, a 2002 paper by Hegland and Nelson in the International Journal of Sexuality and Gender Studies noted that the Internet more generally can be used as a tool for expressing gender identity because it allows identities to cross cultural boundaries instantly and without regard for real physical space. They examined 30 cross-dressing websites and argued that for most cross-dressers that visited such websites, the online forum was their primary medium of expression. The users of the website used the Internet to nurture the ability to create a feminine identity, and helped them to pass as a woman in the offline public world. More generally, cross-dressers used the Internet to participate in the larger cultural dialogue of gender.

For an adult to meet current criteria for a diagnosis of transsexualism, the World Health Organisation’s International Classification of Diseases (ICD) reports they must express the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the desired sex through surgery and cross-sex hormones. This transsexual identity must have been present persistently for a minimum of two years and not be a symptom of another mental disorder or a chromosomal abnormality. The latest (fifth) edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association uses the term gender dysphoria to describe people who are uncomfortable and/or distressed regarding their assigned gender, their physical sex characteristics and/or their associated social roles. Depending upon the intensity of this distress, some individuals may wish to transition from one point on a notional gender scale to another. The most common direction is from a man to a woman (individuals known as trans women), or from a woman to a man (individuals known as trans men). The distress intrinsic to gender dysphoria may be focused around anatomy, physiology, and/or being perceived and treated as someone of a gender with which the person does not identify. However, these diagnostic labels do not apply to all trans individuals for a multitude of reasons because some people will not identify themselves as a man or as a woman

The World Health Organisation working group has recommended that the latest ICD replace the term Transsexualism with Gender Incongruence) and remove it from the mental and behavioural disorders chapter. Gender incongruence denotes the incongruence between a person’s gender identity and their assigned sex and/or congenital primary and secondary sex characteristics. The terminology in this field has changed over the years and the terms ‘transgender’ and ‘trans’ have been used in the literature as umbrella terms to cover a wide variety of atypical gender experiences and expressions which may lead to permanent change of social gender role but does not necessarily involve treatment with cross-sex hormones or surgical intervention. A recent study has reported an prevalence for transsexualism of 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men, which is primarily based on studies looking at individuals attending clinical services. (However, it should be noted that recent population studies have reported a significantly higher prevalence rate of atypical gender experiences and expressions).

The study we published in the journal Aloma originated from initial observations made by Dr. Jon Arcelus that a number of gender dysphoric clients presenting at the national (UK) gender dysphoria clinic admitted that they gender-swapped while playing online games. After I met with Dr. Arcelus I suggested he revisit his case files and and to write them up as case studies (as no study in the gaming field has ever examined online gaming among those with gender dysphoria). The main objectives of our study were to use exemplar case studies to highlight that gaming – in some circumstances – appears to be a functional way of dealing with gender identity issues, and that gender swapping in gaming may help such individuals to come to terms with their gender dysphoria.

Our paper featured four case studies who attended an assessment at the National Centre for Gender Dysphoria in Nottingham. All four individuals described in our paper were given pseudonyms and the content of their histories were anonymised (and included ‘Mary’ a 26-year old natal male who fully transitioned to the female social role six months prior to our study; ‘Mark’ a 20-year old natal female who first attended for an assessment in the female role; ‘Paul’ a 31-year old natal male who would like to be female, but still living full-time as a male; and ‘Harry’ a 23-year old natal male who presented for an assessment as a male). If you want to read about each case in detail, the paper can be downloaded for free from here).

The four case studies outlined in our paper are only a selected sample of the number of cases attending a national clinic for people with gender dysphoria. However, they were in no way unusual to the other clients that have sought help at the Centre. However, these individual accounts were specifically selected to demonstrate the different ways that video gaming may help people with gender dysphoria come to terms with their gender identity. For example, gaming can be used among trans people as a psychological tool to increase one’s awareness of gender identity and/or as part of the self. Gaming may therefore be a useful way to express one’s experienced gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. This appears to mirror other the findings of other studies outside of the online gaming environment.

Articles published in the mass media have reported that online games such as World of Warcraft provide a creative space that allows gamers that might be questioning aspects of their identity to explore their lives as different individuals. Some have even gone as far as to argue that this could help gamers transform their ‘offline’ identity, as is the case with some trans gamers. This was also demonstrated in the case studies described in our study. Other authors have asserted that the online medium offers an infinite space for development and resistance to traditional gender roles, and that online interaction enables a transgression of the dichotomous categories of male and female, constructing trans (or even genderless) social identities and relationships. However, although such anonymous online communities may provide trans individuals with the power to subvert their physical sex.

Our case studies also demonstrated the different functions of gaming in trans people (e.g., the function of “testing out” their gender feelings). For instance, using gaming to ‘come out’ to other people, by initially coming out in the online community, which is perceived as a safe environment, and then gradually coming out in real life. Gaming, as for many non-trans individuals, can derive psychological benefits and a sense of escapism. This is even more relevant among trans people as it may be the only time that they feel they can be themselves, allowing them to feel happy, relaxed, and achieving a sense of completeness. This could develop into a powerful coping skill substituting unhealthy behaviours, such as self-harming behaviour. This is particularly important in this population as research shows a strong association between being trans and mental health problems, particularly depression and self-harm as a way to manage one’s trans feelings. This is not surprising as the discomfort and distress about assigned gender and body dissatisfaction may lead to a sense of hopelessness, which can bring low mood, self-injury and even suicide.

Although gaming appears (at least initially) to be a positive and beneficial activity for many trans people, there is also the risk that staying in the game becomes too much of a secure and safe environment. This can create a vicious circle where the trans person does not wish to move out of the secure online world, and back into reality. Spending an increasing amount of time in online gaming carries the risk of developing a gaming dependence or addiction. This may not only affect one’s personal relationships, work and/or study, but may also impair real life social gender role transition, as in many cases, the individual is expected to socially transition before they can be considered for treatment.

Obviously our paper only included four participants and may be perceived by some researchers as ‘anecdotal’ because the data were not collected for this specific study but were retrospectively collated. However, our findings showed that for a trans individual, the online gaming environment was perceived as “safe” but further research is needed to establish what the distinctive elements of online gaming are that help to raise gender awareness (or not as the case may be). With the rates of gender dysphoria attending clinical services increasing significantly, future research should investigate (i) the rates and severity of gaming among this population as well as its function, and (ii) the rates of gender dysphoria among game addiction as coming out may help their addiction. The game industry may also want to consider how they can use games as a way of helping trans people being more accepted within society by developing game industry may want to co-observe how their games can prepare and assist individuals to socially transition. Online games also provide a safe environment that provides people access to a platform where individuals can discuss and experiment with gender identity.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Arcelus, J., Bouman, W. P., Witcomb, G. L., Van den Noortgate, W., Claes, L., & Fernandez-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30, 807-815.

Arcelus, J., Jones, B., Richards, C., Jimenez-Murcia, S., Bouman, W.P. & Griffiths, M.D. (2017). Video gaming and gaming addiction in transgender people: An exploratory study. Journal of Behavioral Addictions, 6, 21–29.

Dale, L. K. (2014, January 23). How World of Warcraft helped me come out as transgender. The Guardian. Retrieved from http://www.theguardian.com/technology/gamesblog/2014/jan/23/how-world-of-warcraft-game-helped-me-come-out-transgender

Griffiths, M.D., Arcelus, J. & Bouman, W.P. (2016). Video gaming and gender dysphoria: Some case study evidence. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 34(2), 59-66.

Griffiths, M. D., Davies, M.N.O. & Chappell, D. (2003). Breaking the stereotype: The case of online gaming. CyberPsychology and Behavior, 6, 81-91.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychology and Behavior, 7, 479-487.

Griffiths, M. D., Kiraly, O., M. Pontes, H. M. & and Demetrovics, Z. (2015). An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.27-55). Oxford: Oxford University Press.

Fahs, B., & Gohr, M. (2012). Superpatriarchy meets cyberfeminism: Facebook, online gaming, and the new social genocide. MP: An Online Feminist Journal, 3(6), 1-40.

Hegland, J. E., & Nelson, N. J. (2002). Cross-dressers in cyber-space: Exploring the Internet as a tool for expressing gendered identity. International Journal of Sexuality and Gender Studies, 7(2-3), 139-161.

Huh, S., & Williams, D. (2010). Dude looks like a lady: Gender swapping in an online game. In Online worlds: Convergence of the real and the virtual (pp. 161-174). London: Springer.

Hussain, Z., & Griffiths, M. D. (2008). Gender swapping and socialising in cyberspace: An exploratory study. CyberPsychology and Behavior, 11, 47-53.

Lewis, A., & Griffiths, M. D. (2011). Confronting gender representation: A qualitative study of the experiences and motivations of female casual-gamers. Aloma: Revista de Psicologia, Ciencies de l’Educacio i de l’Esport, 28, 245-272.

McLean, L., & Griffiths, M. D. (2013). Female gamers: A thematic analysis of their gaming experience. International Journal of Games-Based Learning, 3(3), 54-71.

Osborne, H. (2012). Performing self, performing character: Exploring gender performativity in online role-playing games. Transformative Works and Cultures, 11. doi:10.3983/twc.2012.0411.

Potts, A. (2015). ‘LOVE YOU GUYS (NO HOMO)’ How gamers and fans play with sexuality, gender, and Minecraft on YouTube. Critical Discourse Studies, 12(2), 163-186.

Shaw, A. (2012). Do you identify as a gamer? Gender, race, sexuality, and gamer identity. New Media and Society, 14(1), 28-44

Taylor, T. L. (2003). Multiple pleasures women and online gaming. Convergence: The International Journal of Research into New Media Technologies, 9(1), 21-46.

Todd, C. (2012). ‘Troubling’ gender in virtual gaming spaces. New Zealand Geographer, 68(2), 101-110.

A gender setting: Inside the world of pandrogyny

In a previous blog I briefly examined the extreme art and music of Genesis P-Orridge and Throbbing Gristle. In the last decade P-Orridge began a performance art series called “Breaking Sex” with his partner and second wife Lady Jaye (who died in 2007 of heart failure complications arising from stomach cancer). The culmination of this art project can be seen in the documentary film The Ballad of Genesis and Lady Jaye (directed by Marie Losier).

Most of you reading this will be well aware of ‘androgyny’ (i.e., the condition of having both male and female characteristics in either bodily appearance, attitudes and/or behaviour). Those who describe themselves as androgynes often claim they don’t fit into society’s gender roles. Genesis P-Orridge has taken this one stage further and developed the concept of ‘pandrogyny’. According to a posting on the CrossDressers.com website:

“Pandrogyny is the conscious embracing of gender roles, sexual orientations, or cultural traditions so as to render the person’s original identity completely indecipherable. It is the ‘third gender’…a type of gender-neutral living being more akin to the OTHER…a pandrogyne is [about] making one’s life (a brief existence) into an art form. Is [pandrogyny] transvestism, transgendered behavior, or transsexuality? None of the above, as it turns out”

Along with Lady Jaye, Genesis P-Orridge decided to create a third being as both an artistic expression and statement (i.e., life – quite literally – as “a work of art”). They fused their psychological identities and underwent radical and irreversible plastic surgery to look more like each other (including reconstructive facial surgery [cheek impants, rhinoplasty, lip pumping], liposuction, and breast augmentation). In an interview with Tamara Palmer about Lady Jaye and the Pandrogyne project, Genesis said:

“We started out, because we were so crazy in love, just wanting to eat each other up, to become each other and become one. And as we did that, we started to see that it was affecting us in ways that we didn’t expect. Really, we were just two parts of one whole; the pandrogyne was the whole and we were each other’s other half. DNA is really the new battleground for evolution. If we want to survive as a species, if we want to hopefully colonize space and do incredible things, we have to completely reassess how the human body works and realize that it’s not sacred, it’s just stuff”.

The underlying philosophy of pandrogyny is about creating similarity, unification and resolution, rather than difference and separation. Genesis explained the concept further:

“When you consider transexuality, cross-dressing, cosmetic surgery, piercing and tattooing, they are all calculated impulses—a symptomatic groping toward the next phase. One of the great things about human beings is that they impulsively and intuitively express what is inevitably next in the evolution of culture and our species. It is the ‘Other’ that we are destined to become.”

In a different interview he went on to further outline what the pandrogyny project was all about.

“We are not trying to look like twins, though we wouldn’t mind that if it were possible. We are seeking to give an initial impression of visual similarity as far as we can. As a 56 year old biological male who is 5 foot six inches with a 30 inch waist, I can never reasonably expect to look identical to Lady Jaye who is a biological female who is 35 years old and 5 foot 10 inches high with a 24 inch waist. [However] we are committed enough to surrender our bodies to surgeries even if we end up not liking how we look. That is not what we are concerned with. We have no urge to try and ‘look better’, or younger, or more ‘glamourous’. Nor are we changing gender. Pandrogeny is about neutralising gender in order to REPRESENT a future possibility for thee species”

One of the central themes of their work is the “malleability of physical and behavioural identity”. P-Orridge’s work has been influenced by the ‘cut-up’ techniques of both William S. Burroughs and Brion Gysin (a technique popularized by David Bowie in the 1970s). As P-Orridge explained:

[Burroughs and Gysin] began to cut-up and, incorporating random chance, re-assembled both their own and co-opted literature…They referred to the phenomena of profound and poetic new collisions and meanings that resulted from their intimate collaborations as the ‘Third Mind’. This was produced with a willingness to sacrifice their own separate, previously inviolate works and artistic ‘ownership’. In many ways they saw the third mind as an entity in and of itself. Something ‘other’, closer to a purity of essence, and the origin and source of a magical or divine creativity that could only result from the unconditional integration of two sources”.

Genesis first met Lady Jaye in the early 1990s and eventually fused their separate (art)works before combining their individuality. They have literally cut up their bodies to create the pandrogyne, a third body that is the sum of their two bodies and minds subsuming each other. Genesis says that the way that he and Lady Jaye look relates directly to the internal dialogue that describes themselves to each other. In an interesting interview with Douglas Rushkoff in the Believer magazine, Genesis was asked what the difference was between pandrogyny, transvestism, and transgnder. He replied that:

“The main difference is that Pandrogeny is not about gender, it’s about union. The union of opposites. One way to explain the difference is very easy: with transgender people the man might feel that he’s trapped – the person feels they’re a man trapped in a woman’s body, or a woman trapped in a man’s body – whereas in Pandrogeny you’re just trapped in the body. So Pandrogeny is very much about the union of opposites, and, through that reunion, the transcendence of this binary world and this illusory, polarized social system…When people have an orgasm together that’s a moment of Pandrogeny. And when people have a baby, the baby is pandrogynous, sexually. Because it is literally two people becoming one”

Genesis and Lady Jaye have both taken body modification to the maximum, but unlike most people that engage in extreme body modification, they have done it in the name of art, not beauty or vanity.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ford, S. (1999). Wreckers of Civilization: The Story of Coum Transmissions and Throbbing Gristle. London: Black Dog Publishing.

Frederique (2011). You’ve heard of androgyny, but what about PANdrogyny? CrossDressers.com, September 13. Located at: http://www.crossdressers.com/forums/showthread.php?159912-You%92ve-heard-of-androgyny-but-what-about-PANdrogyny

Palmer, T. (2008). Genesis P-Orridge: The Body Politic. Current.com, December 29. Located at: http://current.com/1lkam4c

P-Orridge, G, (2002). Painful but Fabulous: The Life and Art of Genesis P-Orridge. Soft Skull Press.

P-Orridge, G. (2011). Pandrogyny and the overcoming of DNA. Sex, Gender, Body. Located at: http://sexgenderbody.tumblr.com/post/11588285014/pandrogeny-and-the-overcoming-of-dna

Rushkoff, D. (2012). In conversation with Genesis Breyer P-Orridge. The Believer. Located at: http://believermag.com/exclusives/?read=interview_p-orridge_rushkoff

Wikipedia (2012). Genesis P-Orridge. Located at: http://en.wikipedia.org/wiki/Genesis_P-Orridge