Relationships with Gender Dysphoric People

Alice Purnell


Issue 7
August 1999

This essay is based on an edited and amended talk I gave at the Northern Gender Dysphoria Conference in 1997. I read Zoology at University, later became a nurse and now am a postgraduate counselling psychologist, so I have brought all these strands into my presentation. I propose to first give an overview and examine the reasons why there is gender, to look at different types of personal relationships and the challenges and responses that often arise in a counselling context and elsewhere. The first consideration in most work concerning gender dysphoric people, who I will give the overall term GD, has usually been the GD person and his or her search for her or his own gender identity. For that person there has to be information, recognition, a reconciliation, action, which may include no action, reconstruction and dealing with the consequences. In this essay I will look at those people who are affected by a diagnosis of gender dysphoria besides the GD person, and how society, stereotypes, poor information, lack of clear thinking, false fears and seemingly impossible dilemmas can evolve.

We hear a lot about the cliché of a woman trapped in the body of a man, about the tomboy who hated her periods and fancied other girls, about the boy who says he longed to play with dolls and the woman who goes to her doctor asking for her healthy breasts to be removed.

There is no doubt that the struggle, the inner turmoil, the fear and guilt, the searching for an answer, takes a shocking toll in energies and grief for the GD person, and, do not let us forget, those who are close to them, who love them or care about them.

There seems to be a psychological driver that is so strong in the GD person that it goes against most peoples cognitive perceptions to comprehend it. It is seen and felt as "against common sense", "against nature", it is "their fault". It seems to be so strong that even in a person who may never pass, and who will always look or sound like a man in a dress, or another person who is prepared to be a man without a penis, will still want to go ahead and seek to change their public image and body as near as to that of the so called opposite sex.

We hear of the almost obsessional drive towards achieving the goal of self fulfilment, the apparent self-centredness of the GD person once she or he has recognised the situation, which is often seen as "made that choice".

We hear about the middle aged successful father of three losing his wife, family, work, friends, all so that he can say he is a woman who likes flower arranging, although in fact he never did much about looking after the children, or doing any house work.


The longer childhood lasts in a species the greater the influence of parental, particularly maternal, then paternal and peer group, the teaching of a child now extends later to the young adult. A large portion of play is to reinforce and prepare for adult life, particularly for the predicted gender role by that society of their young. Both parent and child are affected by this process, based on how things "should be"..

A boy's only doll is usually Action-man. Girls are not generally given toy soldiers to play with. Gender stereotypes are constantly reinforced throughout childhood.

However with fewer children there is a greater investment in the one or two, "He will take over the family business when I retire", or "She will get married and give me grandchildren".

There is a tendency for the unfulfilled wishes of parents to be placed as their child's responsibility. However against those types of dynamics of behaviour reinforcements and aspirations, there is more room for the individual to develop as an individual personality with his or her own agenda. This may or may not conform with parents aspirations, and rebellious youngsters, teenagers, have emerged.

But what of the fifty year old who suddenly seems to rebel against the dynamic and need to conform, and now says he has always been a woman?

A sense of self

develops partly as a reflexion of other people, and is interactive. But what of brain sex; are people born with a brain sex, are there sometimes brain intersexes with the wrong sort of brain in the wrong sort of body?

What of Gender Identity?

When a wife says "My husband says he feels like a girl, but he is a big man, a forty year old father of our three children?" Is it surprising that she feels challenged by this "apparent nonsense?"

Who after all knows what being a woman or a man feels like? In a sense, the feeling simply is there in terms of gender identity. Does a mind or a soul have gender? Before males realised it was sperm which caused children, goddess worship prevailed in the ancient world, now we have a patriarchal society with God portrayed as a bearded man, who, in my church is served by celibate male priests in long robes, but that God has a human mother who is a virgin. I must ask God if She invented gender as a challenge to us all or is it a game people play?

The instant a child is born, with, "It is a boy", or "It's a girl" there are expectations as to its identity and future, with assumptions that it will be normal in terms of sex, gender identity and sexual preference. Normal is seen as good. Abnormal is shameful and bad. So where does that leave natural variation? Nature provides us with variation, but difference is perceived as perverse and an undesirable aberration.

Immediately a child is born, parents subconsciously give different messages to baby boys or girls. Work at Sussex University has confirmed that if you tell someone that they are holding a baby boy, they bounce him and tickle the baby, whilst if they believe it is a baby girl they are handed, they talk gently, cuddle and stroke her, irrespective of the actual sex of the baby they are given to interact with.

It has been said that in many ways your genes are your destiny, but it is no longer true that your genes or your genitals define exactly what your life course will be. Intellect has overcome the selfish gene. Humans are the only animal that can chose not to reproduce, and people, even in this country, may feel they can also expose their sense of self, including gender identity free of this chemical dictatorship, if they dare risk being seen as challenges to mainstream society. Those close to them become engaged in this emotional battle.

Both parents and society as a whole do all they can to reinforce the idea of gender in a child. There is no room for blue for girls or pink for boys. Men and women behave and are treated differently.

Once you have different roles for the sexes you tend to get stereotyping. You begin only to see males or females, men or women, masculine or feminine, heterosexual or homosexual.

Each of the elements that help identify an individual personality such as sex, gender, and sexual preference are separate dynamics, are variable continua, not fixed "black or white" and need not be in phase. In the majority of cases of course they are.

However, in personal thinking and constructs and in society, whatever that is, it all becomes black or white, instead of the wonderful technicolour rainbow spectrum that nature, and/or a Creator, has provided us with.

Imagine the confusion felt by a parent who says,"I am the father of a son, now he says he is a woman"; or a wife who says, "I'm married to a man who has become a woman, I love the person, but I'm not a lesbian".

Gender dysphoria

is a complete challenge to behaviourists and psychological developmentalists. It seems to derive at a very basic level, and possibly has a genetic aetiology. It is I would maintain a natural variation. To an extent we are all victims of gender stereotyping and gender tyranny. It acts in our minds and the minds of others. Not only is the GD person a victim of that oppression but so are those around him or her, and their reactions are largely influenced by a black or white view of gender, sex and most other matters.

So long as society is patriarchal there will be more shame about the MTF GD person, than the FTM. The "normals", those who see themselves as not only the majority but the moral majority, involve themselves in seeing variation as abnormality, as wrong, laughable, shameful, to be hated, feared, mistrusted, legislated against, ridiculed, denied, or at best kept at arms length, it will be hard for those who care about a GD person to allay themselves to her or him.

This paradox of muddled collective thinking is constantly reinforced by the media. It is ignorant, anti-humanistic, cruel, and dare I say it un-Christian and wrong. We all remember the fat child in the playground who was ridiculed and bullied, who we actually may have liked. We also remember the tomboy we admired and the sissy we kept well away from.

The group tends to be less tolerant than the individual, and society does not approve of lose cannons, or boys who become women. It challenges the very fragile constructs of sex and gender that we all have. Perhaps it is time that humanity not only recognises difference, but rejoices in it.

One to one humanistic counselling, sorts out some of the "oughts" and "musts" and allows for the "What if". It allows not only the GD person to tell her or his own story, but those around that person to find ways of coping and ways of being. Essentially it allows for personal development.

This above all is needed as an approach whereby "Survivors of GD challenges", brought about by their loved ones condition, can find ways to avoid being victims of the label trap, the need to conform, the need to blame, the need to be stereotype victims. It allows for the development of evaluation, identification of primary needs, strategies and creation of acceptance or rejection of the situation. Hopefully it enables people to cope.

Parents of GD People

Freudian psychology looks for psychological reasons for behaviour. It was seen by the general public as providing a reason for "aberration" and so someone to somehow blame. If early parental (maternal) influence is the reason for learned gender behaviours then it could be seen as being "big on blame", as the Americans might say. It has put mothers in particular under the microscope of "Whose fault is it?" I maintain this is an outmoded patriarchal, misogynistic oversimplification.

Society still sees GD as a matter of choice, "Why doesn't he just go on living as a man, it's his responsibility. He was born a man?"

I believe mothers give birth to babies, not adults. Nobody is born a man or a woman! That wouldn't bear thinking about!

In psychology and counselling individual values have more chance of expression. As we approach this millennium, and ideas about the life course are less couched in a behaviourist pattern there is some hope for the future. This post-modern humanistic view of the individual and his or her personal identity has given an opportunity to be less prescriptive in a way in which society as a whole has not yet adopted.

When a mother rejects her son because that person now says she is a woman, on a psychological level the mother is suffering from wounded narcissism. Her reaction has much to do with her own personal pathology because she produced an "imperfect child", and she can not allow or bear this. She may also believe she is an imperfect mother.

This pathological reaction is insecure and will not let others exist in their own right.

If a mothers protective instinct is stronger than her personal narcissism then she feels able to try to understand her child and will work towards that goal.

Some 85% of GD children cross-dress before they are 18 years old.

Parents go through a process after they find out or are told.

There is
Bewilderment, "There was nothing wrong with him as a baby".
Recognition, "So that is why there were so many problems at school".
Denial, "There is nothing wrong with him, it's just a phase".
Blame, "It's his mothers fault, she was always too soft with him".
Shame & Fear, "What will the neighbours say, We will have to move".
Bereavement, "I've lost my son".
Reconciliation, "At least she's happy now".
Concerns, "What about family gatherings, weddings and so on, What is her role now? "How will it affect the children?"
Support, "Whatever she's still my child".
Acceptance "She was a great little boy and I'm glad she is my daughter now."

It is hard for parents, especially of adult GD people to remember the new name always, especially if they don't like it, and to remember to use "he" or "she" correctly. There are dangers in it becoming the family secret, the shameful spectre at the family party, or a constant source of embarrassment.

Parents of young diagnosed GD children will have to sort out problems with education, other children and any bullying. Should they move? Should they be open about the problem? Are they doing the right thing? When should he or she start hormones to prevent hated secondary sexual characteristics from being established? How can they balance all this attention on one child when another may feel left out? In the past these children could not talk to their parents about this sort of thing. If they hinted they would be punished, sent to see the doctor, who might tell them to take up rugby, have sex with a few girls and settle down. Parents would be concerned their child was homosexual, mad or bad.

Parents might fear that it was somehow their fault. Was mother too kind or hard? Was father absent or violent? "Is it because I had to raise him on my own?" Was there any abuse? Often there is denial, "Perhaps it will all go away when he gets married", the dressing up was "only a phase."

Against the opprobrium of society, there is a tendency to become protective and defiant. It is a devastating problem for a parent or guardian. A child deserves to be happy and become a realised and contented adult. Children and educational psychologists, teachers, social workers, counsellors, psychiatrists all become involved.

Often the child is profoundly self absorbed, insecure, and depressed. Who knows the right answer? It is such a big step to take, parents need help facing the particular responsibilities associated with the child in their care. They might say,"My child right or wrong", but how can a child make these sorts of decisions? There is a profound need for help and appropriate care of this medical condition. Counselling the whole family and all individuals concerned can be a great help in these circumstances..

There are ethical problems in medicine and surgery about providing suitable but irreversible care to a person who is not yet an adult. They have to get it right.

Parents of younger children now have Mermaids as a support group to turn to.

The problems are rather different for them compared to parents of an adult daughter or son who was married, had children, and an established role in society. There are questions of loyalties to the daughter or son in law, concerns about the grandchildren. It is a big adaptation for an elderly parent to make.

Counselling can help a parent deal with all these elements and fears, to accept that it is the result of natural variation, not their fault, that their child should do better in life once he or she has got this difficulty sorted, that this person is not dead, but a more complete version of the same person they loved and reared.

Siblings and Extended Families of GD People

Reactions are variable among siblings of GD people. Brothers of an FTM may fear they will also somehow be "Infected" by it. They may have looked up to an elder brother who is now a big sister, they may feel it is eccentric, brave, irresponsible, shocking, or none of their business.

They may ban the GD person from their household for fear of it confusing their children, or if they are rather Bohemian or arty they may be delighted by this bizarre turn of events.

In Moslem, Sikh and Orthodox Jewish families the position of a son, especially an eldest son, is of vital importance, and families can be totally disrupted by the GD situation. I know of a Saudi parent who wanted his GD son killed rather than bear the disgrace. There are many GD people who totally lose contact with their families.

Sometimes, as with parents, siblings are divided in terms of acceptance or rejection. Sisters seem to find it less challenging than brothers. Mothers can be more supportive than fathers, but it all depends on whether the individual family member is able to take on board recognition of the person as she or he is, or wants to be, rather than as an icon of their own making.

Sometimes it is a learning experience and family members use it as a cue to assert their own secrets, a sister who comes out as a lesbian, a brother who admits he hates his job. Honesty can be catching. It is an opportunity for a learning experience and can draw a family closer, or rip it apart..

One mother wrote for the book I am in process of preparing for Parents & Partners, that when her son was at university she had wondered if he might be homosexual, since he did not seem overly interested in sex with girls. However he eventually became suicidal and told his horrified parents that he had always felt that he should have been a woman. His mother found it incomprehensible as he was masculine, with hairy limbs, receding hairline and a muscular body. His father felt betrayed by his son. The mother was saddened by the fact her child had suffered all those years. She remembered that at five the child had said that he wanted to grow up to be a lady. She of course had replied that was impossible, that he would grow up to be a "lovely man like Daddy". The subject had never been mentioned again.

The psychiatrist suggested that things would get better over time. As their daughter emerged and looked more convincing and so much happier and less withdrawn, both parents found it less challenging. The parents adopted a strategy of being truthful to anyone who asked about their son. They lost no friends and were somewhat surprised by friends saying how brave their daughter was "to undergo all that".

Another mother wrote "I have to be strong, to help others to understand, to cope with neighbours and friends who mention the topic. I'm drained by the constant explanations. It exhausts me. How do other parents cope?"

This mother seems to have taken on her child's pain and isolation, although she hopes to have a mother daughter relationship with this different person in the family, she misses her son. There is a sense of helplessness, like seeing someone you love with terminal illness. The new daughter may, we can only hope, help her mother realise she did her best, and nobody can do better. She needed to grieve for her son and get to know and love her daughter. A life has changed not been lost.

Partners of GD People

Partners all behave as individuals, with varying personal reactions to their loved one being GD. They do however fall into various categories:

Partners of An MtF GD Person

  • Existing partners of a MTF person (Those women who met and may have married the GD person before Real Life Test & surgery
  • Young heterosexual women, with or without young children.
  • Middle aged or elderly women, with or without adult children.
  • Men who see themselves as heterosexual.
  • Men who see themselves as homosexual.
  • Women who see themselves as Lesbian.
  • Women or men who see themselves as bisexual.
  • Celibate partners.
  • Those who met the GD person after change over & surgery

Our research suggests that 68% of the over 50 group we surveyed are married and 25% stay together.

In what was previously a heterosexual relationship the wife or partner is placed in a difficult situation regarding her own definition of herself. "I love this person but now she is a woman, does that make me a lesbian?" "I thought I had married a

man". "I can't stay with him, I don't fancy women" "What will the neighbours say? I just want to get away". "How can I tell my mother, she never liked him?"

There are issues of betrayal: "After 26 years of marriage he never trusted me enough to tell me. All those lies, secrets, all that money on clothes, the double life, how can I trust him?" "I hate the bastard, after all those years I gave him, the best years of my life". "Now he says he is a woman, but she dresses like a tart and is looking for a boyfriend and he expects us to be sisters!"

Self blame: "If only I'd been a better lover , then maybe I could have cured him."

Sexual issues (25% of those GD people we surveyed say they are asexual). There are sexual issues for a partner. "She looks ridiculous, where's the man I married?" "I feel sick when I think of his shaved legs" "I'm attracted to men. Not this strange woman".

Practical issues: "He's lost a good job, now I have to support her" "I think we will have to divorce, we can't have two women in the kitchen" "I don't like her calling herself Mrs. I'm the wife here."

Resentment "I thought it was another woman. There was, it was him!" "Her breasts are better than mine." "Why can't he just dress up sometimes like before?"

Concerns for the children: "How will it affect the children? They need a father." "The children can never see him like that"

Loyalty "I feel sad that she didn't trust me enough through all those years to tell me. It must have been dreadful for her". "I can't make love with her, but I will stand by her". "It's too late for me to start a new life".

Bereavement "He's disappearing before my eyes, I'm losing him."

There is a catalogue of betrayal, anger, bewilderment, fear, concerns for the children, shock, bereavement, need for revenge, hate, disgust, mistrust.

Safety has gone out of the window and a lot of work needs to be done to restore this. "He lied to me".

Fear of the future "I go with her to the clinic, but I'm so frightened I don't know what to expect."

Fear of solitude "I will stay with her, but if she finds someone else, so will I". "I can't bear the idea of growing old alone, we shared so much, and I never did enjoy sex much anyway".

Pragmatism "It's nice to have a best friend and do things together". "I'm glad to say those awful depressions are gone, she seems a nicer person". "Perhaps now she understands how hard it is to be a woman".

Regrets "If I'd only known earlier, maybe things would have been different". Even when the couple face the problems together there can be problems, however the payoff is sometimes better if both stay together, especially after a life where much of their emotional, physical and financial worlds were shared

How, what and when a wife or partner is told, or finds out, has a lot to do with their reaction. A great deal of mutual consideration is needed and I'm sorry to say is not always apparent. If safety isn't an issue then the positives may outweigh the negatives in staying together, or at least remaining good friends. Losing a home, financial considerations, issues of loneliness, being aware of having had a shared past and seeing a sharing future, not caring what others might think all helps these relationships to survive.

Sometimes it is possible to look at the positive side of things. A younger wife said, "The children love her, now they have two mums. I can go out to work again at last". An older partner said "Now at last I have a real best friend" A woman writes "After over 50 years of marriage suddenly I'm in limbo, What am I now?" She wonders how she should describe her status, she says she's "not married, not divorced, widowed, separated or single somehow". It has affected how she sees and defines herself as well as her partner. She goes on to explain how hard it still is for her to always use the female name that has been adopted, after so many years with someone whose name is part of her life. "It is hard to remember to say she instead of her when describing her." She adds, how do I explain or introduce this woman or myself, our relationship? Are we sisters, in-laws, friends, is she a lodger?"

The problem seems to be that no strategy had been satisfactorily resolved to deal with this, and after many years of marriage, she could not alter her perception of herself as the wife of a man who is now no longer visible. She is not a lesbian, so how is it they (now two women) are close, together, partners? The problem arises because we often define ourselves in relation to others, "his wife, her mother, old school friend" or whatever. Eventually she decided to describe themselves as partners and "bloody-minded people can make of it what they want" She asks how others cope with being partners instead of a wife. What she doesn't say is how it has affected her sexually, albeit they are an elderly couple. Clearly after so many years together companionship was the priority and a break-up would only add to the trauma, more so than making a go of the situation.

Younger couples, indeed some elderly ones might well feel the changed physical situation creates a barrier to their physical expressions. Some chose to live in celibacy under one roof as "sisters". However, some find it opens doors and they switch to an open relationship, or enjoy the new sexuality of being two women together.

Loneliness is often a threat greater than staying together for many, "I love this person not simply the outside appearance. Perhaps it is a little like staying with someone whose appearance has changed because of cancer". I guess what we are looking at is the different ways in which we view love for that significant other, is it dynamic or fixed, is it physical, spiritual, psychological, or a habit?

Besides these issues there are often financial considerations, which may be exploited because of the guilt the reassigned spouse may feel and the sense of betrayal her wife feels. Add to this the fears of the possible effect on any children and you may realise how difficult it is to stay together. However our survey indicates that a third of couples surveyed do remain as partners.

Sometimes there is humour in it "Now I will wear the trousers, literally" "She has the breasts of a fifteen year old, but I'm better at being a woman"

The lesbian who meets and gets close emotionally to a post op woman may feel challenged once she knows the history.

"I spent thirty years getting used to the fact I am a lesbian, now people tell me I love someone who was a man" "When they told me she was born a male I had a nervous breakdown" "She has so many qualities which make her more self sufficient than other women I have known, but now I know she isn't a real woman after all".

Gay boyfriends can also feel challenged by a post op partner. "It was great knowing she was a boy in a dress when we went out together". "If I'd wanted a woman I'd have gone with one, now she's had surgery it isn't the same" Gay male relationships often end once surgery is complete. Some heterosexual men feel shocked and confused once they are told. "It must have been so hard for her, but it's hard for me too, she can't have children, and I don't know how to tell my family". "If anyone found out they might think I'm a poof, I'm not". "I hate it when she fixes the car, that's my job."

In the April Ashley case according to April, the divorce took place because the transvestite husband was angry that she wouldn't let him dress up, which caused the initial breakdown of their relationship.

Some transsexuals seek other GD people as partners, perhaps subconsciously to avoid all this sort of problem.

Partners of an FtM GD Person.

Almost all FTM people come from a lesbian or bisexual background, although a few married and had children. I have not yet counselled anyone who is a man and was a mother.

The lesbian partner in a couple who had lived together for 13 years said "I hate her body becoming more male, the beard, hairy chest, the male smell. Her voice is deep now, and her original voice was a real turn on. We can't stay together. Who will get custody of the dogs, we can't separate them?

Some post-op FTM people become gay men, I realise it is ideologically unsound to say this, but I can not imagine how they cope with initiating or maintaining a sexual relationships with other men who essentially like a sexual partner with a willie. Unfortunately as yet phalloplasty does not provide an erectile penis, and relatively few FTM men go for this option.

If a partner can see that the person they value and love is happier, often less depressed or angry and more complete, it may be that this enables the relationship to go forward, but there has to be safety, honesty, trust and caring as two way components in the relationship.

Getting rid of stereotypes and unfounded fears is often useful. The sexual side of expression may improve or disappear altogether, and if this is the case other values need to come into focus. It seems to be less fraught if there are no children or if they are grown up.

Children of GD People

There is absolutely no evidence that gender dysphoria is inherited or catching. There have been cases in the West Indies where a familial trait towards androgen insensitivity syndrome has been dominant, but research by Richard Green and others has demonstrated that children of transsexuals are not profoundly affected in terms of their own sense of personal gender by their parents syndrome (Any more than children of gay parents become gay, or Tory parents become Torys)

Children are affected by a messy divorce, by a parent transferring their hate of a partner for having failed them, by being asked to take sides.

Daughters are often close to their fathers, and their sense of loss can be great.

Reassurance that it is still the same person is essential.

Even an adult child of a GD person will find problems, which may be irreconcilable, but it can sometimes draw them closer.

They say things like "I am sorry I have lost my Dad". "Who will give me away at my wedding?"

Young boys may at first feel their own masculinity is challenged "Does that mean I will be gay?" "Will I become a woman?" "Dad always was eccentric." "Now, who will go fishing with me?"

Problems arise with friends. "What can I tell them at school?" "I don't know whether to call her Dad or Mum or Auntie."

Often use of merely a first name will help, it is safest rather than being asked to lie, or calling the woman with them Dad. Strangers do not need to know. But it is important that a child has someone to talk to, and counselling can help.

When children get older there comes the problem of telling the boyfriend or girlfriend, best friends, sweethearts and their families.

There is often a variable level of acceptance among the children of GD people, which can sometimes divide a family.

I knew a case of a fifty year old son of a transsexual, who when his post-op father died, burnt all evidence of her existence, and placed a headstone on the grave in the original male name.

There are also families which rally and learn to live with and accept the situation. So much depends on individuals, how things have been handled, how much acrimony was involved and how much they actually care about one another. But, with the best will in the world it is not easy.


What divides humans can be so much less than what unites us. Counselling individuals on a one to one basis can more easily help them make this the case. I suggest that fear of what others might think is one of the major problems that not only the GD person fears, but it is also one of the major stumbling blocks in all unconventional relationships. This includes the family and partners, neighbours, employers and society as a whole.

A second observation is that the urge towards claiming their natural or actual gender identity - and therefore gender image, may be so focused as to make those who care about the GD person feel that there is no room for them, the children or anything else. It can be seen as not only an existential act, but a very selfish one.

My third conclusion is that whilst things are in flux for the GD person there are conflicts of hope that things may not go all the way (surgery), that they will turn out all right in the end, and hopelessness, for those close to them. "It feels like being on a train dragging the carriages over a cliff", a wife said. Another showed her distress and said "It's not knowing what to expect".

The insecurity brought about by such a fundamental change in their relationship, from being a couple to being "sisters" is overwhelming.

My fourth observation is that whilst the GD person is engaged in the real life test, when they most need support, the GD person is less likely to sustain or maintain a relationship. It is a time of extreme stress and is very difficult for a partner to feel safe and a part of it.

It is important for the GD person to take into account the views and needs of loved ones. It helps if good qualified counselling be available if requested, to enable parents, partners, children, siblings and extended family to understand and adjust, accept or go separate ways, with damage limitation.

Often once a parent, partner or child of a GD person is accurately informed and evaluates the situation over time, it is possible for them to realise that the person they love remains the same person who wishes to be as close to them, but in a different wrapping, which more clearly says who they feel they are.

Time is a balm, once life and the emotions have given people a chance to get used to things, they can, and often do, improve. Sometimes there will never be a reconciliation. The platitude "Blood is thicker than water" is not always the case. A sense of injury and bloody mindedness is easier than enquiry and understanding for the GD person and those related to him or her. All people are different, so no single phrase of advice will suffice to help deal with the intense emotions in either the GD person or relatives; nevertheless I believe that the best relationships depend on honesty in both directions, however painful. Taking responsibility, rather than feeling guilt or blame, evaluating and communicating, consideration and clarification will often be helpful to all concerned in coping with the almost inevitable problems that arise in this sort of context.

I must thank those who have provided material for this work. The figures I use in this presentation are derived from my research and original survey report, see GENDYS Conference Report 1992, and my work in GENDYS Conference Report 1996, and the Northern GD Conference Report 1997.

N.B. This paper will form part of a Parents and Partners book I am in process of researching and writing. I hope this will become a useful resource for them. I would be most grateful for any articles, comments and personal accounts (anon) from parents or family members or partners of GD people to include in this publication. Copyright Alice Purnell July 1999.

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