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'Gender disappointment' is the feeling of sadness when a parent's strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents' pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether 'gender disappointment' represents a unique diagnosis. We argue that 'gender disappointment' does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents' distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level.
Is ‘gender disappointment’ a unique mental illness?
Tereza Hendl1, Tamara Kayali Browne2
Medicine, Health Care and Philosophy
To cite: Hendl, T. & Browne, T.K. (2019). Is ‘gender disappointment’ a unique
mental illness? Medicine, Health Care and Philosophy (online 21/12/19). DOI:
1 The Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-
University in Munich, Munich, Germany.
2 School of Medicine, Faculty of Health, Deakin University, Geelong, Australia.
‘Gender disappointment’ is the feeling of sadness when a parent’s strong desire
for a child of a certain sex is not realised. It is frequently mentioned as a reason
behind parents’ pursuit of sex selection for social reasons. It also tends to be
framed as a mental disorder on a range of platforms including the media, sex
selection forums and among parents who have been interviewed about sex
selection. Our aim in this paper is to investigate whether ‘gender disappointment’
represents a unique diagnosis. We argue that ‘gender disappointment’ does not
account for a unique, distinct category of mental illness, with distinct symptoms
or therapy. That said, we recognise that parents’ distress is real and requires
psychological treatment. We observe that this distress is rooted in gender
essentialism, which can be addressed at both the individual and societal level.
Key words: gender disappointment, sex selection for social reasons, mental
disorder, gender essentialism, mental illness diagnosis
This article discusses the phenomenon of ‘gender disappointment’ that is
increasingly gaining traction in debates about sex selection for social reasons and the
parental drive to pursue it. In September 2015, a seminar was held in Sydney with Dr
Potter, a leading American fertility specialist and sex selection provider. The aim of
this seminar was to recruit Australian procreators for sex selection in the US. The event
was organised by Gender Selection Australia, an Australian company “dedicated to
helping Australian and NZ [New Zealand] couples choose the gender of their baby”
(Gender Selection Australia 2014, n.p.) which facilitates sex selection overseas. The
company director began the seminar by saying that ‘gender disappointment’ is a real
issue and ‘gender selection’ is the solution. Procreators who desire a child of a
particular gender were then referred to Dr Potter’s clinic for IVF. This anecdote
suggests that the concept of gender disappointment is being used by providers of
prenatal sex selection, framing sex selection as a treatment for a unique psychological
The phenomenon of ‘’gender disappointment’’ is also increasingly being used in
online debates about procreation. A Google search for the term generates
20,700,000 results and many of these pages advise parents on how to cope with sadness
that their children are of the ‘wrong’ gender. Furthermore, several online forums, such
as GenderDreaming and In-Gender, provide a platform for (prospective) procreators to
discuss their desire for children of a particular gender, including their feelings related
to ‘gender disappointment’. The most frequented of them - GenderDreaming - has
currently 140,491 participants (GenderDreaming 2019a) and the community is
growing. The discussion forum focused on ‘gender disappointment’ involves 492
threads and 5,790 posts (GenderDreaming 2019b).
Furthermore, ‘gender disappointment’ as a phenomenon is often spoken about as
a mental disorder in a range of contexts: in sex selection forums, media and among
parents who have been interviewed about sex selection. This paper builds on accounts
of ‘gender disappointment’ provided in a small 2013 study (Hendl 2017) with
Australian procreators who have undertaken or desired to undertake sex selection for
social reasons. In this study, procreators compare ‘gender disappointment’ to
depression or mental disorder. In our paper, we investigate whether ‘gender
disappointment’ represents a unique separate diagnosis. We argue that in the case of
‘gender disappointment’, as articulated in sex selection forums, media and among
parents who have been interviewed about sex selection, a parent’s sadness at not having
a child of the ‘right’ sex stems from a belief, inculcated by society, that one cannot
enjoy the same activities and relationship with a child of any sex. Such beliefs, which
constitute gender essentialism, are not based on factual evidence.1 The problem,
1 In this paper, we limit our discussion of ‘gender disappointment’ and motives for it to the sample of
parents’ articulations from sex selection forums, media and empirical study. We recognise that there can
be other articulations of ‘gender disappointment’, some that may not be directly grounded in gender
essentialism. We are grateful to an anonymous reviewer of this paper for alerting us to the case of parents
therefore, is primarily with society, not the individual. In our view, it is paradoxical to
medicalise parents whose fixation on the sex/gender binary is a logical result of
prevailing dominant gender normative views reinforced in society and through its
structures. That said, as we discuss below, parents’ distress deserves attention and
psychological treatment.
Gender disappointmentis the feeling of sadness at the conception and/or birth
of a child of the undesired sex. This feeling is experienced by procreators who have a
strong preference for a child of a particular gender and their desire is not realised
(Monson and Donaghue 2015; Whittaker 2012; Duckett 2008). 2
In a 2013 study with Australian procreators who have selected or desired to
select their child’s sex for social reasons (Hendl 2017), all participants speak of their
disappointment at having only had sons as well as their long-standing desire for a
daughter. While the participants do not use the term ‘gender disappointment’ to
describe their feelings, their descriptions nevertheless fall within the concept. For
example, Olivia describes her feelings of disappointment when she learned that she was
expecting her third son at a 20-week sonogram:
[...] he said it’s another boy. And I just felt not very happy and I feel
I still feel jumpy about that today because I love him, he’s the best and it
who might be disappointed when having a child of a particular sex because children of that sex face
specific hardship or discrimination in society. As such, this case is not grounded in parental prejudice
against the child but reflects on societal attitudes towards children of that sex. Yet, some might still argue
that even this case involves some aspects of gender essentialism, such as the assumption that the child
will (keep) developing) as a child of a particular gender, who will fit into the gendered group that the
particular society will stereotype in a particular way.
2 A moderator from a sex selection online forum defines ‘gender disappointment’ as
“simply when the sex of your baby is not what you desired. For me, it is having my heart hurt so bad,
because I knew that my dreams would never come true. It is the loss of a dream child” (Whittaker 2012,
wasn’t really about him, it was about oh, that was my last shot for this. I
thought oh, well, I was only going to have three and that means I’m never
having a daughter. So it was more, I suppose, grieving what I was going
to miss out on [...]3
Olivia was particularly disappointed as she tried the Shettles method of natural
swaying (based on the timing of intercourse) in order to have a daughter.
Similar expressions of disappointment about not having the child of the
preferred gender are found on online forums discussing sex selection and parenting
websites (Duckett 2008; Whittaker 2012; Monson and Donaghue 2015). Whittaker
cites a woman sharing her feelings about carrying a girl while she desires a son:
I was told I will be having a girl, this is my first child and I really wanted
a boy. I am only 15 weeks pregnant and I still feel as if the doctor made a
mistake. I couldn’t stop crying when I found out and now I am so dis-
appointed, I know it’s wrong to feel this way, I am supposed to be happy…
(Whittaker 2012, 153)
In all the instances cited above, a gendered mother-child bond plays a central
role in women’s longing for a child of a particular gender. In the Australian empirical
study, the participants’ main motive for sex selection is a desire for a strong mother-
daughter bond. The women expect that establishing a long-lasting familial relationship
is only possible with a daughter, not a son. One participant says about her desire for a
3 All materials stemming from the Australian study have been collected as part of a PhD project (Hendl
2015). Most citations from this study have not been published (Hendl unpublished data).
I have a very close relationship with my mother and I would like to have
the opportunity to have that with a child and obviously, my children are
my boys are still little but my perception is that you don’t have that
same … like boys … though let’s go really stereotypical but boys grow
up and fly the coop and make their own lives, have their own families
kind of thing, whereas girls, my perception is that they stay a little bit
more closely aligned with their family. Girls are more family-oriented
than boys necessarily. So I feel that I am … with my boys, I’m raising my
children to have them leave me and I feel that a girl would … that I would
have the opportunity, because you’re the same sex essentially, have the
opportunity to have more in common with them.
Duckett finds similar sentiments expressed in debates about ‘gender
disappointment’ on online forums. She cites a woman describing her longing for a
I think a lot of women on this board aren't disappointed in their actual
children, but disappointed in what comes with the specific genders. For
me, I'm not disappointed my son has a penis, I am disappointed in the
things that come with having a son. I'm disappointed I won't be able to put
hair bows in his hair or dress him up in girlie dresses. I'm disappointed I
won't be able to shuffle him to ballet class or play pretend makeup. I'm
disappointed that I will have to suffer through football games and soccer
games and all the other types of games that have balls. (Duckett 2008, 95)
Participants in online forums also “cite wanting to either replicate the
relationship bonds which they experienced in their families or wanting to create bonds
with a future child which they did not experience themselves” (Duckett 2008, 95). Both
these sentiments were also expressed by participants in the Australian study.4
Some of the participants in the Australian study say that they have always
wanted a daughter. They emphasise the strength and depth of their desire. Alice says:
“I've always wanted a daughter and I always thought that I would have one, I always
thought that would be my future, you know, that I would raise a daughter.” Hannah
reports that she always felt that a daughter was her destiny, hence she was “going to the
extreme” of sex selection. It is evident that these women feel that they are in some sense
destined to have daughters. At the same time, this sense of entitlement is unjustified as
procreation offers no guarantees that parents will have a particularly gendered child.
Not having a child of the desired gender leads to a feeling of incompleteness in
the women. Several women talk about the impact of these strongly held feelings. Jodi
says: “… it’s like a feeling of desire that sort of just doesn’t go away, like it just sort of
lingers around”. She describes this feeling as a “true” and “genuine” feeling that is
“always there” and while it can get weaker when another son is born, it always comes
back. Similarly, Hannah describes the strength of her longing: “it’s not just about oh, I
want a baby girl and that’s it, there’s a lot of ingrained psychological reasons for it and
it’s something that haunts you every day.” She speaks about her uneasiness when
encountering people with daughters and the negative effect that her feelings have on
her family as she spends a lot of time researching sex selection instead of being with
her sons.5 Furthermore, Olivia talks about the lack of understanding for women longing
4 While we choose to use the gender neutral term “parents” when referring to procreators with ‘gender
disappointment’, it seems important to acknowledge that all participants in the Australian study and
parents discussing ‘gender disappointment’ online in studies by Duckett (2008); Whittaker (2012) and
Monson and Donaghue (2015) are women.
5 It is noteworthy that these findings contrast with a study with American procreators desiring sex
selection. While parents in the American study express various degrees of ‘gender disappointment’, they
nevertheless rarely express unhappiness with their immediate family situation (Sharp et al. 2010).
for a child of a particular gender. She says that most people have children of two sexes
naturally and hence “they have peace because they’ve never known what it was like to
have that desire ‘cause they’ve got it.”
Some women frame the distress from not having a child of a desired gender in
terms of mental disorder. Matilda says:
I think it’s a bit like a depression, it’s a bit like depression. I think it’s a bit
like for some people, not myself, but I think for some people it can be a bit
like post natal depression or some other kind of mental illness. It’s real and
people get really depressed, people are really miserable and I just think if
you can fix that, why, why not?6
Similarly, Hannah speaks of emotional distress experienced from not having the
desired child. She reveals that she takes pharmaceutical drugs that help her cope with
her emotional state: “I actually am on medication to help the way I’m feeling.”
These quotes suggest that the feelings of longing exert a strong negative impact
in the lives of some women who are unsuccessful in having a child of the gender they
desire. They point to their negative emotions to support their contention that ‘gender
disappointment’ is a real phenomenon.
However, this could be caused by the fact that participants in the American study were interviewed
during their attempt to gain access to prenatal sex selection and do not want to appear overly gender
6 Interestingly, Duckett notes that members of online forums distinguish between ‘gender
disappointment’ and post partum depression. She cites a participant who says: "I know that GD and PPD
are 2 different things, but I have to think that the emotional side of things are somewhat similar" (Duckett
2008, 92).
Some scholars observe that the feeling of gender disappointment is
medicalised in debates about desire for particularly gendered children. As Whittaker
(Whittaker 2012, 151) observes, “Desires for children of a particular sex, which in the
past would have remained unspoken or, if said, unable to be acted upon, now are
pathologised as a syndrome.” Duckett (2008) also describes the medicalisation of
gender disappointment, arguing that the way it is framed in online forums resembles
the way chronic illnesses are framed. Both gender disappointmentand chronic
illnesses are described as going unrecognised unless disclosed to others, and that
persons who have not experienced the condition cannot relate to the experience or its
severe nature. The framing of gender disappointmentas a medical problem serves at
least two purposes: first, it legitimises feelings related to having a child of the undesired
sex and second, it justifies appeals for treatment.
First, the framing of desire for a child of a particular gender as a medical
condition serves to justify socially sanctioned feelings related to ‘gender
disappointment’. Duckett (2008, 85) argues that: By associating a medical frame to
potentially discrediting events, individuals attempt to reduce the risk that a morally
disreputable interpretation may be applied to the behaviour.” She provides quotes from
online forums, which illustrate that women who desire a child of a particular gender are
aware that their preferences tend to be seen as violating traditional normative
assumptions about motherhood, particularly the commitment to unconditional love of
one’s children.7 In this sense, the label of a medical condition attached to ‘gender
7 It is worth noting that according to Duckett, most members of online forums analysed by her state that
they did not know about the concept of ‘gender disappointment’ before joining the forums. Duckett
(2008, 86) quotes a participant named Kate: "I did not have a name for this [GD] until I came across the
website [GDI] after the birth of my third son. I could not believe that there was an actual term and support
for women who experience this." In contrast to this, Monson and Donaghue (2015) who analysed
discussions about ‘gender disappointment’ on three Australian parenting websites observe that the term
‘gender disappointment’ is used without further explanation which according to them suggests that it is
a “recognisable emotional response” (16).
disappointment’ helps to reduce stigma associated with parental preferences regarding
their future children’s gender.
This construction ofgender disappointmentbuilds on parents’ emotions which
are framed as out of control and distinct from reason (Monson and Donaghue 2015).
Monson and Donahue argue that participants in discussions about ‘gender
disappointment’ on Australian parenting websites emphasise the strength and depth of
their emotions. The scholars (Monson and Donaghue 2015, 18) claim: “Lack of control
is an important aspect of both the construction of the experience of the desire to sex
select and the reasons behind the desire; the posters are not making a choice to feel a
certain way.” They note that longing and grief are seen in Western cultures as
overwhelming emotional experiences, which require psychological effort to overcome.
Nevertheless, parents in online forums frame their condition as something, which can
be temporarily managed but not resolved.
Second, the construction of gender disappointmentas a mental health issue
helps to strengthen the appeal to access treatment. Duckett (2008, 86) argues that, “The
ability of a sufferer to attach a label to one's experiences is of significant importance,
as individuals transition from an "unorganized" state of illness to one which involves
order and a course of action.” The framing of gender disappointment’ in terms of
uncontrollable emotional suffering does not necessarily mean that the only effective
treatment for the suffering is the birth of a child of the preferred gender, yet this is how
it is being framed. As women with gender disappointmentalready naturally conceived
a child/children of the undesired sex, the argument goes that prenatal sex selection is
the major reliable treatment for ‘gender disappointment’.8 Similarly Whittaker (2012)
8 Furthermore, prenatal sex selection using PGD and IVF is also considered the most ethically acceptable
form of sex selection as it does not involve abortion. Although in Australia, sex selection via abortion is
allowed whereas sex selection via PGD is not (National Health and Medical Research Council 2017).
argues that the construction of a medical condition legitimises the use of reproductive
technologies to alleviate the particular condition.9
However, sex selection via IVF followed by pre-implantation genetic diagnosis
(PGD) is prohibited by regulation in Australia (National Health and Medical Research
Council 2017). Participants in the Australian study question the ban on sex selection as
they see it as a solution to their emotional struggles. For example, Hannah says about
sex selection: “it’s going to help me psychologically for the rest of my life.” The
expectation that sex selection will serve as a treatment for gender disappointmentis
taken by participants to legitimise parents’ freedom to use sex selection if they wish.
One particular story, which received considerable coverage in Australia is the
case of Ms Cornwill who undertook sex selection in the US after having 3 sons (The
Guardian 2014; Daily Mail 2014; News 2015) She describes gender disappointment
as “mourning the loss of a child you never had” (Daily Mail 2014, n.p.). She holds that
‘gender disappointmentis like post traumatic stress disorder, leads to depression and
is a real problem. She argues (Daily Mail 2014, n.p.): “There are many women I know
who survive now on antidepressants and therapist to get through ‘gender
disappointment’ but if there is a solution like PGD I don't understand how anyone can
deny them the help.” Clearly, Ms Cornwill portrays sex selection as a treatment for
gender disappointment, which she constructs as a mental health issue. Yet no
reasoning has been presented thus far as to why sex selection is a better ‘treatment’ for
gender disappointment than antidepressants or therapy. Perhaps the unstated logic
9 This medicalisation of ‘gender disappointment’ could also potentially open the door for demanding
access to sex selection on gender grounds for “medical reasons”, i.e. with respect to the parent’s
proclaimed ‘medical condition.’ Usually, sex selection for medical reasons is available to prevent the
birth of a child with a genetic condition that would significantly limit the child’s wellbeing. However,
parents who request sex selection based on their parental gender preferences could use the medicalisation
of ‘gender disappointment’ to reframe the understanding of “medical reasons” via shifting the focus from
the child’s wellbeing to the “wellbeing” of the parent.
behind this ‘solution’ is that being depressed as a result of having a child of the
undesired sex is understandable. To react in such a way is then a normal reaction to an
unfortunate event. If one can then alter the event, or ensure that it does not happen
again, one would be treating the root cause of the distress. Yet such reasoning would
rely on a conceptualisation of ‘gender disappointmentas patently not a mental illness
but a normal and understandable reaction to unfortunate events.
The framing of ‘gender disappointment’ as a mental health issue and a specific
diagnosis is also adopted by some psychologists. The article about Ms Cornwill (Daily
Mail 2014, n.p.) cites Dr Di McGreal, a senior psychologist from Melbourne, who
claims that there is a “common occurrence” of ‘gender disappointmentin Australia.
She allegedly sees six patients with gender disappointmentevery year and the
numbers are increasing. She is quoted as saying that gender disappointmentcan cause
postnatal depression, problems with bonding with a child of an undesired sex and grief
for the rest of the woman’s life.
There is a range of psychologists cited in popular articles about ‘gender
disappointment’. For example, the British publication, The Telegraph (2010) cites
Graham W. Price who holds that women usually desire daughters and men sons and
gender disappointment can impact all parents. Similarly, the UK Sunday Express
(2010, n.p.) quotes psychologist Linda Blair: “As a woman produces children she
realises how extraordinarily heavy is the burden of being a mother and she feels an
increasing urge to share that with someone: who better than a daughter?” By describing
gender disappointmentas a common occurrence, or that the urge to have a daughter
in order to share the burden of mothering (which not only assumes that mothering, but
not fathering, is a burden, that such an urge is common and also that such burdens
cannot be shared with a child of another sex) these psychologists appear to play on the
notion that being disappointed with the sex of one’s child is a normal and
understandable reaction. Pointing to the other problems that this leads to also provides
justification that something needs to be done about it. However, none of these reasons
provide justification for ‘gender disappointment’ as a mental illness.
The appearance of psychologists in the media invoking a diagnosis of ‘gender
disappointment’ and speaking about its negative impact on parents’ wellbeing aims to
add credibility to the acceptance of gender disappointmentas a mental illness, but the
reasoning underlying their comments implies the opposite namely, that it is a normal
and understandable reaction to an unfortunate event rather than an abnormal one
indicative of a mental illness. Further, one’s distress should not need to be classified as
a mental illness in order to be taken seriously and treated.
Gender essentialism appears to lie at the heart of ‘gender disappointment. At
least in our sample, involving parental articulations from online forums, media and
interviews, parental desires for a particularly gendered child are grounded in socially
produced gender stereotypical and binary beliefs about future children. We will later
argue that the grounding of ‘gender disappointment’ in socially produced gender
ideologies undermines the claim that ‘gender disappointment’ is a unique separate
mental diagnosis. The source of their distress is their strong adherence to a problematic
social belief. Their adherence to it is so strong that it causes them distress. It thus seems
there are two “faulty” elements here the problematic social belief (gender
essentialism), and that they adhere to it so strongly. There are two approaches we could
then take we could either say that the root of the problem is the unfounded social
belief, so if the individual were to see that the belief is unfounded, they may no longer
hold it, and their associated distress (i.e. the ‘illness’) may then disappear. If apprising
an individual of the state of current evidence is enough to ‘treat’ their illness, it does
not seem reasonable to have called it an illness in the first place.
However, it is possible that the individual’s belief is not rational, such that even
after learning that gender essentialism is unfounded, they nevertheless continue to hold
that belief. Some may also argue that many people hold the same gender essentialist
beliefs (whether rational or not) yet do not experience such strong reactions at the birth
of a child that is not the sex they prefer. In such cases, we might consider that there is
an element of the problem which resides in the individual, not just society. Yet it is still
not clear that the phenomenon qualifies as a standalone diagnosis because:
1. From a theoretical standpoint, there are different definitions of mental
disorder, so it is not clear whether ‘gender disappointment’ would qualify
as a unique, standalone diagnosis; and
2. From a practical standpoint, there is no distinct aetiology or unique
treatment,10 and the nature of the harms have much in common with other
mental illnesses, so it is not clear how classifying it as a standalone diagnosis
would serve a useful purpose.
In debates about gender disappointment, a parent’s desire for a particularly
gendered child is often grounded in gender essentialism. The longing for a child of a
particular gender is rooted in a gender essentialist conviction that only children of a
particular sex are capable of certain actions (Mudde 2010; Whittaker 2012; Fine 2010).
10 Sex selection does not treat the mind, so it cannot be considered a legitimate treatment for a
mental disorder.
This conviction leads parents to believe that they can secure a child with a particular
gendered personality through prenatal sex selection. The gender essentialism in a
selector’s outlook on children takes at least one of three forms: there is a conflation of
sex with gender, second, that sex and gender are binary categories and third, that gender
roles are essentially heteronormative. We argue that gender essentialist beliefs such as
these are problematic because they are not empirically grounded.
First, parents who experience gender disappointmentdo not appear to
recognise the distinction between sex and gender. Sex is “the different biological and
physiological characteristics of males and females” whereas gender is “the socially
constructed characteristics of women and men such as norms, roles and relationships
of and between groups of women and men” (World Health Organization 2011, n.p.).
Parents who experience gender disappointment do not appear to recognise a
distinction between chromosomal sex and gender. For example, Hannah describes how
she arrived at the decision to select for a daughter:
So I’ve got two young boys, they’re five and three. When I was
pregnant with my second boy I found at the gender scan that he was a
male and we decided pretty much straight after that we’d go the gender
selection route.
In this quote, Hannah implies that gender can be determined in utero, which
suggests that gender is essentially tied to sex.
The conflation of sex and gender is also prevalent on sex selection forums.
Women who discuss gender disappointmentdiscuss sex and gender as though they
are the same and focus on the presumed (lack of) particular character traits and
behaviours associated with a child of a specific sex. As shown above, the women
assume that children with XY chromosomes and/or (traditionally understood) male
genitalia will be inclined to play football instead of ballet and mothers will not be able
to enjoy activities with their sons which would include hair bows, dresses and make-
up. As such, a parent’s desire for a child of a particular sex is grounded in gender
Parents who experience gender disappointmentassume that a child with the
male karyotype is essentially different (psychologically) to a child with a female
karyotype, rendering him more inclined towards stereotypically boyish likes, dislikes,
character attributes, propensities, social roles and sexuality, or other factors which sit
within gender, not sex. The same goes for a child with the female karyotype. Yet there
is no sound evidence that sex determines fixed gender differences or a “male brain” and
a “female brain” (Fine 2010; Fine et al. 2013; Rippon et al. 2014).
First of all, biological sex is a complex category. Sex traits develop on multiple
levels, including 1. chromosomal sex, such as the combination of X and Y
chromosomes; 2. gonadal sex, the development of testis or ovary; 3. foetal hormonal
sex, the production of sex hormones; and 4. internal and 5. external morphologic sex,
which refers to the development of internal and external sex organs or genitalia (Fausto-
Sterling 1995). The sex that results from this development is a combination of all the
different sex traits, which can combine in a variety of ways. Despite the complexity and
multilayered character of sex, a specific sex is usually assigned to a person on the basis
of the appearance of the external genitalia at birth (Fausto-Sterling 2000; Hausman
2000; Gilbert 2009). In prenatal sex selection using IVF, sex is associated with sex
However, recent evidence shows that the relationship between sex
chromosomes and sex is not so simple and straightforward (Ainsworth 2015). For
example, the sex chromosome aneuploidy (an ‘atypical’ no. of X and Y chromosomes)
occurs in 1 in 400 pregnancies. Yet even the presence of a ‘typical’ set of sex
chromosomes either XX or XY does not guarantee the presence of the ‘usual’
female or male genitalia in a particular newborn. The rate of intersex (that is, those born
with variations in physical, genetic or hormonal sex traits) is estimated to occur in 1.7%
of live births (Blackless et al. 2000), which is similar to the proportion of red haired
people (United Nations 2015b).
Moreover, recent evidence suggests that variety also manifests on a cellular
level. New technologies in cell biology and DNA sequencing show that almost every
human is a “patchwork of genetically distinct cells, some with a sex that might not
match that of the rest of the body” (Ainsworth 2015, 288). And if this is not enough to
challenge the notion of a fixed binary sex, researchers have also identified the ‘SRY
gene’ which can switch the gonad’s development from ovarian to testicular (Sinclair et
al. 1990; Berta et al. 1990) and a range of genes which activate ovarian development
while suppressing the testicular (Jordan et al. 2001; Tomaselli et al. 2011). This
empirical evidence shows that the process of sex development is complicated and that,
indeed, chromosomes play a less deterministic role than previously thought (Ainsworth
If the relationship between chromosomes, genes and sex is complicated, the
relationship between sex and gender is perhaps even more complex. While the latest
research in sex development challenges a direct and unmediated causal relationship
between sex chromosomes and sex, it also calls into question the notion that two
respectively dichotomously ‘paired’ genders unambiguously follow from sex
chromosomes - a notion that requests for sex selection on the grounds of ‘gender
disappointment’ are built upon. At the very least, parents with gender disappointment
appear to over-emphasise the role of sex chromosomes and under-emphasise the role
of a child’s social environment in the acquisition of gender roles and attributes.11
The types of role models, activities and information to which children
categorised as boys and girls are exposed help to create and reinforce differences
between them. As Eliot (2012, 7) explains:
Obviously, boys and girls come into the world with a smattering of
different genes and hormones. But actually growing a boy from those
XY cells or a girl from XX cells requires constant interaction with the
environment, which begins in the prenatal soup and continues through
all the choir recitals, football games, secondary school science classes,
and playground politics that ceaselessly reinforce our gender-divided
However, recent empirical evidence (Stryker and Whittle 2006; Richards et al.
2016; Losty and O’Connor 2018) shows that despite such gender socialisation, a
significant percentage of the population comes to self-identify with genders outside one
of the binary categories assigned to them at birth based on ‘biological markers’.12 Losty
11 There is a plethora of studies, which show how gender differences are created and entrenched by
society. Stereotype threat, for instance, is a phenomenon whereby people who are members of a
stereotyped group underperform at certain tasks simply because they are aware of their membership of
that group. For instance, in a study by Cadinu et al. (2005) showing the effect of stereotype threat on
math performance, 60 women were divided into two groups. One group was told that research shows
clear differences between men and women in their math performance (the stereotype threat condition),
and the other group was told that there are no such differences (the no-threat condition). The women
were instructed to note their thoughts during the course of the test. Women in the stereotype threat group
noted twice as many negative thoughts about maths and the test compared with the no-threat group.
There was also a marked difference in scores. In the first half of the test, both groups achieved a 70%
average of correct answers. However, in the second half the score dropped to a 56% average for those in
the stereotype threat group, whereas the average score rose to 81% in the no-threat group. As Fine
explains, “the deadly combination of ‘knowing-and-being’ (women are bad at maths and I am a woman)
can lower performance expectations, as well as trigger performance anxiety and other negative emotions”
(Fine 2010, 32).
12 Richards et al. (2016) list a number of recent studies, which map the prevalence of gender variant
identities in Western countries. For example, a study (Kuyper and Wijsen 2014) with a large sample of
the Dutch population found out that 6% of individuals assigned male gender and 3.2% of individuals
assigned female gender at birth reported an ‘ambivalent gender identity’ (they identified equally as male
and female) and 1.1% of individuals assigned male and 0.8% of individuals assigned female at birth
and O’Connor (2018, 41) observe that over the last 50 years individuals with gender
identities “falling outside of the ‘nice little binary box’” assigned to them at birth have
gained more visibility in Western societies. To them, this suggests that these forms of
self-identification are being more socially accepted.
Given the influence that culture and society are shown to have on gender
differences, and the contrasting lack of strong evidence for something like a “male
brain” and a “female brain”, many scholars argue that the assumption that particular
sex chromosomes will unambiguously produce a particularly gendered person with
respective gender character traits from birth and attributing gender to the foetus based
on chromosomal sex is a form of gender essentialism (Mudde 2010; Seavilleklein and
Sherwin 2007; Bhatia 2010). Moreover, contemporary neuroscience suggests that
gendered (psychological) behaviour and characteristics are not ‘hardwired’ into the
brain but that biological factors are ‘entangled’ with social environment and presumed
fixed gender differences can be modified or reversed by particular social context (Fine
2010; Fine et al. 2013; Rippon et al. 2014; Rippon 2019). From this point of view,
assuming specific gender character attributes to children prior to their birth and without
consideration of their particular development and self-determination is problematic. In
this regard, it is also problematic to assume that preconception sex selection will
unambiguously produce a child of a particular sex, with particular gender identity and
gendered characteristic traits desired by their parent(s).
reported an ‘incongruent gender identity’ (they identified more strongly with the ‘other’ gender than the
one assigned to them at birth). Furthermore, Van Caenegem et al. (2015) conducted surveys with 1832
Flemish individuals and 2472 with ‘sexual minority individuals’ in Flanders, Belgium, with ‘gender
ambivalence’ or non-binary gender reported by 1.8% of male assigned individuals and 4.1% female
assigned individuals. With regard to LGBTQ population more specifically, a recent UK study (METRO
Youth Chances 2014) with LGBTQ youth found that 5% identified as neither male nor female and a US
study (Harrison, Grant, and Herman 2011) found that 13% of trans people in the sample identified with
a gender not listed in the survey and a Scottish study (Mcneil et al. 2012) exploring trans mental health
reported that over a quarter of participants identified as gender non-binary.
Secondly, gender disappointmentis grounded in a binary view of sex and
gender. At the core of this view is the postulate that humans come in two genders,
female and male, and men and women are essentially different and therefore suitable
for different tasks and activities. Participants in the Australian study (Hendl 2017) and
in ‘gender disappointmentforums (Duckett 2008; Whittaker 2012) talk about children
as either masculine males or feminine females.
This binary view of sex and gender is problematic because it disregards the
diversity of human sexed embodiment and gender. As we have discussed above, sex is
a complex and multilayered trait. Even prior to the latest discoveries in sex
development, many scholars have argued that the normative two-sex model is deficient
given there is evidence of variety in human sexed embodiment (Romao, Pippi Salle,
and Wherett 2012). In this regard, Fausto-Sterling (1993, 24) argues that instead of
reflecting nature, the classification into two strictly delineated sexes is a product of a
cultural urge to “maintain clear distinctions between the sexes.” This view is shared by
several other scholars (Germon 2014; Butler 2008; Davis, Dewey, and Murphy 2016).13
Hence, assuming that all children will fit into rigid binary notions of appropriate sexed
embodiment effectively marginalizes those who ‘deviate from the norm’, such as
individuals with intersex variations and non-binary bodies.
Furthermore, the assumption that children assigned with male and female sex
are binary opposites with polarised characteristics is troubling. Parents with ‘gender
disappointment’ commonly presume that daughters will be family-oriented,
understanding of emotions and capable of confiding conversations with their mothers
while sons will be independent, lacking in emotional intelligence and the capacity to
13 Some of those affected by the rigid two-sex model are people with intersex variations, who tend to
be diagnosed with ‘disorders of sex development’ (Parliament of Australia 2013; United Nations
2015a; Human Rights Council 2013; Australian Human Rights Commission 2009) and are often
subject to irreversible clinical interventions (Blackless et al. 2000).
build close bonds with their mothers. These gender essentialist views involve gender
stereotyping, assuming certain behaviours only from children of a specific,
dichotomously understood, sex (Seavilleklein and Sherwin 2007; Kane 2009; Hendl
2017; Whittaker 2012). However, recent studies in neuroscience reject the presumption
that when it comes to psychological characteristics, “the sexes cluster distinctively and
consistently at opposite ends of a single gender continuum” (Rippon et al. 2014, 3) or
have uniquely ‘feminine’ and ‘masculine’ characteristics.14 Rather, this research shows
that there is in fact no evidence to support the assumption that the gender variety we
see fits into strictly binary categories.15
Finally, parents’ gender essentialist views involve heteronormative
assumptions. Participants in the Australian study (Hendl 2017) assume that their
children will have relationships with members of the opposite sex. The idea of
normative heterosexuality has been called into question. Many scholars have argued
that human sexuality is more diverse than the model that normative heterosexuality
proposes (Ahmed 2006; Butler 2008; Stone 2013; Scott and Dawson 2015) argue that
heterosexuality is a social norm, which is reinforced to maintain the binary sex-gender
roles. However, human sexuality reaches beyond the boundaries of normative
14 Recent studies in neuroscience (Fine 2010; Rippon et al. 2014) show that gender variables are
characterized by at least four aspects. The first aspect is overlap because all humans tend to express traits
and behaviours stereotypically framed as ‘feminine’ and ‘masculine.’ Hence, there are no two distinctive,
mutually exclusive male and female personalities. The second aspect is mosaicism, which means that
human psychological characteristics differ in continuous rather than categorical dimorphic ‘sex specific’
ways. The third aspect is contingency, as gendered behavior is created by complex factors, such as time,
place, affiliation with a specific social or ethnic group etc. The fourth aspect is entanglement, owing to
the fact that behaviour is modified by the environment.
15 Vincent and Manzano (2017) argue that the Western notion of a gender binary is relatively new and
only one of a wide range of perspectives. According to them the dichotomous conceptualisation of gender
was not so distinct only a hundred years ago. They show that there has been a long history of gender
variance around the world, offering examples from Eastern Europe, Asia, South America and Indigenous
communities in the US and Canada as well as pointing to known examples from Africa and the Middle
East. They emphasise that particular socio-historical contexts can generate “highly varied articulations
of gender” (25) and reflect on the systemic suppression of gender diversity in non-Western societies
under Western colonialism.
heterosexuality and sexual preferences and behaviour can change over one’s lifetime.
Thus, many (Offord and Cantrell 1999; Rupp 2002; Butler 2008; Ahmed 2006) argue
that human sexuality is complex and fluid in that it is shaped by a range of personal and
socio-cultural factors, particularly societal gender norms and politics. The active social
shaping of sexual expression can be clearly observed for example in the increased
voluntary visibility16 of queer people in societies that lift oppressive sanctions on
homosexuality (Rupp 2002; Walsh 2016). Hence, by showing the social dimension of
human sexuality and its diversity, these scholars’ work challenges the assumption that
heterosexuality is a natural norm. As such, this work also calls into question the
selector’s assumption that prenatal sex selection can provide a child who will conform
to heteronormative gender roles. As human sexuality is not determined by
chromosomal sex but by a multitude of complex individual and socio-cultural factors,
the assumption that children will necessarily embody heteronormative gender roles is
therefore empirically unsubstantiated.
To conclude, a large body of contemporary research in sex, gender and sexuality
problematises the gender essentialist beliefs that seem to be at the core of many parents’
desire for children of a certain sex. This scholarship challenges the societal assumptions
underlying ‘gender disappointmentand contrasts them with evidence of existing
variety in human embodiment, gender and sexuality.17 This body of work needs to be
taken into account when discussing the concept of gender disappointment and its
framing as a form of mental illness.
16 We acknowledge that not all queer visibility is empowering or voluntary. For example, Stella (2015)
shows how the ‘new’ visibility of queer people in post-Soviet Russia is perceived by many as a threat to
‘tradition’, which leads to the targeting of ‘visibly’ queer people with oppressive state politics and
17 In consequence, the real existing diversity calls into question the ability of sex selective technologies
to deliver a child gendered according to parents’ preferences (Ryan 1990; Mudde 2010; Seavilleklein
and Sherwin 2007). This is a significant issue regarding sex selection, nevertheless, we do not have the
space to explore it in depth in this paper.
As we have observed, parents with gender disappointment and some
psychologists hold that at the core of ‘gender disappointment’ is psychological distress.
This distress appears to have two facets. Women who experience gender
disappointment’ and who feel guilty about their desires for a child of another gender
feel such guilt because it is not how the idealised ‘good mother’ is expected to feel.18
A mother is expected to love whatever child she has, regardless of its gender. The guilt
results from the contradiction between the gender essentialist beliefs promoted by
society on the one hand, and the unconditional love and acceptance that society expects
of a mother on the other hand.
This guilt appears to be a phenomenon associated with gender disappointment
but not all of the associated distress is due to feelings of guilt. In fact, much of the
content of their distress, as shown by earlier quotations, appears to be a feeling of loss
associated with not having a child of the desired gender. Yet these feelings of distress
are the result of having internalised society’s ‘lessons’ in gender essentialism much too
well. At the very least, these parents are underestimating the degree of influence that
they and society can have on the acquisition of gender and overestimating the influence
that biological sex has, given the current state of the evidence. We have a great deal of
robust, replicated studies demonstrating how society contributes to the association of
gender traits, norms and roles with sex. For example, various studies have shown how
children learn what is considered appropriate and inappropriate gender behaviour by
18 Although it is of course possible for men to be disappointed with the sex of their child, those who talk
about ‘gender disappointment’ appear to be almost exclusively women. This could be due to the
internalisation of societal stereotypes of what can be expected from sons and daughters combined with
an adherence to the belief that “unconditional love” is a trait that mothers, but not necessarily fathers,
should have. It could also be that the men who are disappointed with the sex of their child are reluctant
to talk about it due to a sexist perception that it is not masculine for a man to talk about his feelings.
reward and punishment from their parents, by imitating their parents and other children,
by learning from books and the media, and by experiencing stereotype threat (Fine
2010; Cadinu et al. 2005; Eliot 2012).
It should be apparent from the above discussion that there are some societal
beliefs and norms with which it is best not to conform as not only do they lack solid
foundation, but they result in distress for parents who accept them. It should not be
surprising that a society which continuously portrays humans within a sex/gender
binary, with males and females portrayed as vastly different from each other, leads
parents to believe that their children, and hence their parenting experience, will be
vastly different depending on their child’s sex. If they have their heart set on a certain
type of child or parenting experience, then such beliefs will understandably leave them
open to distress if they do not have a child which society tells them will grant them that
experience. Added to this is the discourse around ‘balanced families’, which is
increasingly being presented as an acceptable reason for pursuing sex selection. It is
therefore somewhat paradoxical that this distress, which is a logical extension of
societal norms and beliefs, should be framed as a mental disorder. In other words,
holding too firmly to beliefs which society propounds could result in one being labelled
as mentally ill.
Even if parents do not hold gender essentialist beliefs themselves but feel just
as constrained by social pressure to ensure that their child conforms to gender
stereotypes, the disappointment they then have at feeling that they must raise a child in
gender-conformist ways lest they be ostracised still indicates that the root of the
problem lies within society, not within the individual. There are, therefore, very
problematic social factors which lead to the beliefs, which cause the suffering of
gender disappointment’ in the first place. These are social factors, which allow sexism
to persist and must be addressed.
If society relinquished its heteronormative, gender essentialist beliefs, then
parents may lack reasons to assume that their parenting experience would be vastly
different with a child of a different sex, and may come to share
‘feminine’/’masculine’/gender non-specific activities and bonds with a child of any sex.
In other words, if it were not for unfounded societal assumptions about gender, there
would be less importance attached to their child’s sex and ‘gender disappointment’ may
become a thing of the past. The crux of our argument is that the root of the problem lies
in society, not the individual.19 What is required, then, is a host of interventions to take
apart the sexist social structures and messages that both promote, and result from,
gender essentialism, and are grounded in a sex-gender binary.
A much better approach would be to try to undo the damage caused by gender
essentialism both at the individual and the societal level. Counselling may be effective
to help parents understand that they can have a variety of parenting experiences with a
child of any sex and the scope of these experiences might not be determined by sex or
gender but by the child's individual personality. Yet we should not focus our efforts
solely on the individual parent(s).
All this does not ignore the fact that the distress these parents experience is real
and ought to be treated. Jane Cornwill, who selected for a daughter and advocates for
sex selection, states that “Telling someone to get over it is like telling an anorexic
person to just start eating, it isn't that easy. It is like post traumatic stress disorder - just
19 Having said this, the individual still has some responsibility in the matter. Although the root of
the problem lies in society’s beliefs about gender, that fact does not give a parent license to force
their child not to conform to those beliefs. For example, a parent should not force their son to wear
a pink tutu if he does not wish to (or force him to wear trousers if he does not wish to) and claim
that it is society’s fault, not the parent’s, if the child is upset. (Thanks to Edmund Horowicz for this
because you can't see it doesn't mean it isn't real” (Daily Mail 2014, n.p.). Similarly,
women’s feelings associated with gender disappointmentshould not be overlooked,
and simply telling them to overcome their feelings is much easier said than done. Their
distress may even involve some form of pathology. However, we should not need to
label distress as a symptom of mental illness in order for it to be taken seriously and
It might be argued that those who suffer such distress seem to react
disproportionately to learning that they will not have a child of the sex they desire
compared with others in society who hold the same gender essentialist beliefs. For this
reason, we might consider seeing ‘gender disappointment’ through the lens of some
form of mental illness such as adjustment disorder or depression. Adjustment disorder
refers to those who respond to a stressful life event with more distress than would
normally be expected, and who do not adjust to it within a few months (American
Psychiatric Association 2013). Treatment for adjustment disorder is usually
psychotherapy rather than medication (Lal and Mackinnon 2017). In relation to ‘gender
disappointment’, one might consider the ‘stressor’ to be having a child of the undesired
The American Psychiatric Association states that depression (major depressive
disorder) “causes feelings of sadness and/or a loss of interest in activities once enjoyed.
It can lead to a variety of emotional and physical problems and can decrease a person’s
ability to function at work and at home” (Parekh 2017, n.p.). It is usually treated with
medication and/or psychotherapy, and electroconvulsive therapy can be used for severe
depression. Although the DSM makes no mention of the relevance of the context of
one’s depression, depression can be triggered by a variety of reasons - the death of a
loved one, divorce, job loss, and so on. Similarly, having a child of the undesired sex
might be viewed as one of the many circumstances that may trigger depression,
depending on the individual.
However, there are risks involved in medicalising distress such as this. It may
be argued that this form of distress, as well as other manifestations of ‘depression’ in
response to a trigger (such as bereavement, divorce, etc.) are understandable reactions
to life events. In other words, they are normal and understandable forms of sadness
which should not be medicalised and classed as mental illness (Horwitz and Wakefield
2007). In the case of ‘gender disappointment’ we may consider it understandable to
hold gender essentialist beliefs given how strongly society promulgates them, and that
those beliefs would result in a sense of disappointment (at having a child of the
undesired sex) proportional to how strongly those beliefs are held and how much one
desires to share certain experiences and bonds which are considered exclusive to the
another sex. Women’s distress is in particular danger of being medicalised as the
differences between men’s and women’s lives mean that women experience much
higher levels of stress and trauma compared with men, which unsurprisingly results in
higher levels of distress (Ali, Caplan, and Fagnant 2010; Cabral and Astbury 2000;
Belle and Doucet 2003; J. M. Stoppard and McMullen 2003). The ‘women’s-lives’
approach to depression explains that although everyone is impacted by patriarchal
society, it affects women more than men given the power imbalance in society (J.
Stoppard 2000). This, in turn, is one of the factors contributing to the diagnosis of
depression at much higher rates in women than men. Given this context, and the fact
that most of those who say they experience ‘gender disappointment’ are women, we
must be careful not to fall into a similar trap and over-medicalise distress which is, at
its root, a result of sexism within society.
The danger of medicalising what could be considered an understandable
reaction to having a child of the undesired sex (given gender essentialist beliefs) may
be minimised if the context of the parent’s life and the extent of their reaction are taken
into account. DSM-5 states that for a diagnosis of adjustment disorder to be made, the
symptoms must be “clinically significant, as evidenced by one or both of the following:
1. Marked distress that is out of proportion to the severity or intensity of the
stressor, taking into account the external context and the cultural factors that
might influence symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of
functioning.” (American Psychiatric Association 2013, n.p.)
This point is crucial, but there would still be a degree of subjectivity involved in
assessing what sort of reaction is proportional to the stressor and what is not. This factor
could mean that although in theory only distress that is disproportionate would be
diagnosed as mental illness, in practice there is the potential for over-medicalisation.
There are a number of different definitions of mental disorder we could consider
in assessing whether ‘gender disappointment’ qualifies as a stand-alone diagnosis.
There are fact-based (naturalist) accounts of disorder, value-based accounts, and
accounts that incorporate both facts and values. Boorse’s definition of disorder is an
example of a supposedly fact-based account which relies on a statistical definition of
normal function. According to Boorse, “diseases are internal states that depress a
functional ability below species-typical levels (relative to age and sex)” (Boorse 1997).
It is not clear whether, on this definition, ‘gender disappointment’ would qualify as a
mental disorder because it is not clear exactly what functional ability (if any) is at issue
here, let alone what its species-typical level is or how to measure it. We could, however,
be generous and propose that perhaps, there is some level of contentment with your
child’s sex (the ‘functional ability’) that is typical of the human species, and that parents
with ‘gender disappointment’ seem to go beyond this to an extent that may be
statistically measurable.
However, one criticism levelled at Boorse’s account is that the decision
regarding where to draw the statistical line itself relies on a value judgment of where to
place the appropriate distinction between normality and abnormality. For example, if
anything beyond two standard deviations of the norm is considered abnormal and
therefore diseased, this is itself a value judgement. The definition also potentially
encapsulates features which are simply different/variations from the norm but do not
have a harmful element - i.e. it does not distinguish difference from disease. It also
seems clear to us that social and cultural norms and ideas influence what is considered
normal and abnormal thinking and behaviour, and hence what is considered a mental
illness and how it is classified. Whether the phenomenon is physical or mental, what
we consider to be the problem, and whether we consider the problem to be medical in
nature or not, involves a value judgment, and value judgments are inextricably linked
to social norms and values. This is why we find purely fact-based accounts of disorder
In contrast, value-based (normative) accounts maintain that what constitutes a
mental disorder is based solely on judgements about whether a particular state/trait is
valued or not. In other words, illnesses are entirely social constructions. According to
this definition, ‘gender disappointment’ may well be considered a mental disorder since
it is disvalued by society. However, value-based accounts would also permit
masturbation, drapetomania and political dissidence to have been considered mental
disorders in the past (among other examples) since they were also disvalued (Powell
and Scarffe 2019). Thus, a purely value-based account of disorder seems implausible
as well.
To avoid the problems inherent in both the fact-based and value-based
accounts, hybrid models of illness have been proposed. Wakefield’s ‘harmful
dysfunction’ account provides a well-known example of a definition of disorder that
incorporates both facts and values. According to this account, “a condition is a disorder
if it is negatively valued (‘harmful’) and it is in fact due to a failure of some internal
mechanism to perform a function for which it was biologically designed (i.e. naturally
selected)” (Wakefield 2007, p.1). While purely fact-based accounts fail to address the
value component of the definition of disorder (as we argue above), purely value-based
accounts do not provide a means of separating conditions in life which are negatively
valued, but may not be disorders. For example, the symptoms that can accompany grief
place one in a state which is negatively valued, and the distress that is experienced may
even be clinically significant, but most of us would not consider grief to be a disorder
because it does not seem to constitute a failure of some biological or psychological
mechanism to perform a function for which it was designed. It seems only natural to
grieve if one loses a loved one. Like every definition of mental disorder, Wakefield’s
definition also has its fair share of criticisms - the main one being its reliance on
evolutionary theories of natural functions, which are not always well substantiated.
Regardless, we find a definition of mental disorder which explicitly incorporates both
facts and values (which may or may not be specifically Wakefield’s definition) more
plausible than definitions of disorder which claim to be purely fact-based or purely
If we apply Wakefield’s account to ‘gender disappointment’, some might say
that such a disproportionate reaction to the birth/conception of a child of the undesired
sex indicates the failure of a psychological mechanism somehow. Yet if it does, what
exactly is the mechanism that has failed in this case? Is there a mechanism that is
specifically designed to not care about your child’s propensities and the kind of
parenting experience you will have? After all, this is essentially what the parent is
disappointed with. It seems implausible that the dysfunction (if there is one) would be
so specific. There would need to be a function which is specifically concerned with
adjusting to the sex of one’s child (and not even with other physical or psychological
aspects of one’s child) to justify a harmful dysfunction specific enough to be called
‘gender disappointment’. Psychological examination of the parent may bring to light
extreme disappointment with other aspects of their lives that have not gone according
to plan, or difficulties in adjusting to changes, and so on, or rigid thinking that may
indicate some other form of mental illness. In summary, from a theoretical standpoint,
it is not clear whether ‘gender disappointment’ would qualify as a standalone diagnosis.
From a practical standpoint, without a unique treatment for their mental distress
or a distinct aetiology, we do not see the point of classifying it as a stand-alone
diagnosis. Likewise, in considering whether Internet Addiction should be considered a
unique, stand-alone mental disorder, Ronald Pies suggests that:
A constellation of related signs and symptoms - essentially, a syndrome - may
ultimately be understood as a specific disease entity when at least one of the following
criteria are met:
1. A pattern of genetic transmission is discovered, sometimes leading to the
identification of a specific genetic locus.
2. The syndrome’s etiology, pathophysiology and/or pathologic anatomy become
reasonably well understood.
3. The syndrome’s course, prognosis, stability, and response to treatment are seen
to be relatively predictable and consistent across many different populations.
(Pies 2009, 35)
None of these criteria have thus far been met by ‘gender disappointment’.
Further, psychiatry should aim to be acutely aware of when social norms are
exerting more influence on the classification of a mental illness than, for example,
concerns about harms, and should attempt to minimise such influences if we are to
avoid the social biases that cause classification to be discriminatory rather than helpful.
Arguably, allowing social norms to exert too much sway over the classification of
mental illness, rather than a concern about harms and whether sex is consensual or not,
resulted in the classification of homosexuality as a mental disorder until 1973. A similar
problem appears to underlie the controversial classification of other phenomena as
mental illnesses currently.
In order for ‘gender disappointment’ not to fall prey to the same problem, we
believe the focus should be on the nature of the harms inherent to the phenomenon. In
the case of ‘gender disappointment’, the harms are in the mental suffering and
depression that the individual experiences when they do not have a child of the sex they
want, and the obsessive yearning that can be associated with it. However, intense
sadness and obsession are not unique to ‘gender disappointment’ but can be
experienced within other mental illnesses, such as depression. That the suffering is also
socially mediated is also not unique to ‘gender disappointment’. If we do not distinguish
between reactive and endogenous depression,20 let alone different reasons for reactive
depression (e.g. bereavement, depression due to divorce or job loss, and so on) then we
fail to see why depression due to ‘gender disappointment’ should be singled out.
20 One of the authors of this paper argues that perhaps we should. See [reference will be added after
the blind review].
Regardless of whether we consider ‘gender disappointment’ a form of
depression or adjustment disorder (or another disorder) or simply an understandable
and foreseeable outcome of strongly inculcated social beliefs, we should give the
individual some tools for the mind to tackle their mental suffering while we deal with
the root of the problem which is societal.
Whether parents long for a girl in order to dress their child in pink frilly dresses,
take her to ballet classes or walk her down the aisle at her wedding; or whether they
seek a boy in order to watch him kick a football with his father, maintain the family
surname or inherit the family business; or whether they simply feel there is something
essentially different (psychologically) about males compared with females (and
presumably compared with intersex people), parental desires for a child of a particular
sex, and feelings of sadness at not having that desire realised, are grounded in the
acceptance of gender essentialist beliefs which are all too-prevalent within society. The
individuals presented in this paper describe feeling a great deal of sadness and distress
as a result of their belief that the child they have will have different gender traits, roles
and behaviours to those they desire. However, we argue that these parents’ gender
essentialist attitudes are not based on sound evidence. There is no guarantee that
children with a particular set of sex chromosomes or genitalia will lack or express
certain gender traits and characteristics. In this respect, it is important to acknowledge
that given the evidence we currently have21, gender disappointment is grounded in
21 There may be causes of a parent’s disappointment with the sex of their child, which may not be
strongly related to gender essentialism. More studies may reveal such causes. Our paper can only address
what we know from studies, forums and the media thus far, and the reasons articulated by parents for
their ‘gender disappointment’ thus far have centred on gender essentialist beliefs.
socially reinforced gender ideologies, not in facts about the ‘essence’ of children of a
particular chromosomal or physiological sex. As such, the root of the problem lies not
in the individual, but in society.
To say that gender disappointmentshould not be considered a unique stand-
alone mental illness has no bearing on the reality (or otherwise) of the individual’s
distress. An individual can experience distress, and this distress can even be clinically
significant, without needing to be classified as a mental illness in order to be addressed.
Rather than focusing on whether and what mental illness with which to label the
individual, it is time to recognise the sexism within society as disordered and to focus
our attention on dismantling sexist social structures and attitudes. Once the gender
essentialism propagated by society disappears, the reasons many parents articulate for
‘gender disappointment’ may also dissipate, since so far those reasons are based on
gender essentialism.
Ahmed, S. 2006. ORIENTATIONS: toward a queer phenomenology. GLQ: A Journal
of Lesbian and Gay Studies 12 (4): 543–74.
Ainsworth, Claire. 2015. Sex redefined. Nature 518 (7539): 288–91.
Ali, Alisha, Paula J. Caplan, and Rachel Fagnant. 2010. Gender stereotypes in
diagnostic criteria. In Handbook of Gender Research in Psychology, Vol. 2:
Gender Research in Social and Applied Psychology, ed. Joan C. Chrisler and
Donald R. McCreary, 91–109. New York: Springer.
American Psychiatric Association. 2013. Diagnostic and statistical manual of mental
disorders: DSM-5, 5th ed. Arlington, Va.: American Psychiatric Association.
Australian Human Rights Commission. 2009. Surgery on Intersex Infants and Human
rights-2009. Accessed 13 January 2019.
Belle, Deborah, and Joanne Doucet. 2003. Poverty, inequality, and discrimination as
sources of depression among U.S. women. Psychology of Women Quarterly 27
(2): 101–13.
Berta, Philippe, J. Boss Hawkins, Andrew H. Sinclair, Anne Taylor, Beatrice L.
Griffiths, Peter N. Goodfellow, and Marc Fellous. 1990. Genetic Evidence
Equating SRY and the Testis-Determining Factor. Nature 348 (6300): 448-450.
Blackless, Melanie, Anthony Charuvastra, Amanda Derryck, Anne Fausto-Sterling,
Karl Lauzanne, and Ellen Lee. 2000. How sexually dimorphic are we? Review
and synthesis. American Journal of Human Biology 12 (2): 151–66.
Boorse, Christopher. 1997, “A Rebuttal on Health”, in What Is Disease?, James
M. Humber and Robert F. Almeder (eds.), Totowa, NJ: Humana Press, 1134.
Butler, Judith. 2008. Gender trouble: feminism and the subversion of identity. New
York, London: Routlege.
Cabral, Meena, and Jill Astbury. 2000. Women’s mental health: an evidence based
review. Geneva. Accessed
15 February 2019.
Cadinu, Mara, Anne Maass, Alessandra Rosabianca, and Jeff Kiesner. 2005. Why do
women underperform under stereotype threat? Evidence for the role of negative
thinking. Psychological Science 16 (7): 572–78.
Daily Mail. 2014. Mother so depressed by having three boys she spent $50,000 to make
sure fourth child was a girl.
went-ensure-girl.html. Accessed 16 May 2018.
Davis, Georgiann, Jodie M Dewey, and Erin L Murphy. 2016. Giving sex:
Deconstructing intersex and trans medicalization practices. Gender & Society 30
(3): 490–514.
Duckett, Alison J. 2008. Gender dreams: the social constructions of gender
disappointment as an affliction in online communities. The University of Guelph.
Eliot, Lise. 2012. Pink brain, blue brain: How small differences grow into troublesome
gaps-and what we can do about it. Oxford: Oneworld.
Fausto-Sterling, Anne. 1993. The five sexes. The Sciences 33 (2): 20–25.
———. 1995. How to build a man. In Constructing masculinity, ed. Simon Berger,
Maurice; Wallace, Brian; Watson, 127–35. New York: Routledge.
———. 2000. Sexing the body: Gender politics and the construction of sexuality. New
York: Basic Books.
Fine, Cordelia. 2010. Delusions of gender: The real science behind sex differences.
London: Icon Books.
Fine, Cordelia, Rebecca Jordan-Young, Anelis Kaiser, and Gina Rippon. 2013.
Plasticity, plasticity, plasticity...and the rigid problem of sex. Trends in Cognitive
Sciences 17 (11): 550–51.
Gender Selection Australia. 2014. About gender selection australia. Accesses 17 May 2018.
GenderDreaming. 2019a. Community stats.
Accessed 28 March 2019.
———. 2019b. Gender disappointment. Accessed
28 March 2019.
Germon, Jennifer. 2014. Norrie’s gender win brings us closer to knowing who we are.
The Conversation.
closer-to-knowing-who-we-are-25250. Accessed 14 October 2018.
Gilbert, Miqqi Alicia. 2009. Defeating bigenderism: Changing gender assumptions in
the twentyfirst century. Hypatia 24 (3): 93–112.
Harrison, Jack, Jaime Grant, and Jody L Herman. 2011. A gender not listed here:
Genderqueers, gender rebels, and otherwise in the national transgender
discrimination survey. LGBTQ Policy Journal at the Harvard Kennedy School 2:
Hausman, Bernice L. 2000. Do boys have to be boys? narrativity, and the John/Joan
Case. NWSA Journal 12 (3): 114–38.
Hendl, Tereza. 2015. The Ethical Aspects of Gender Selection for Non-Medical
Reasons. Macquarie University.
———. 2017. Queering the odds: The case against ‘family balancing.’ IJFAB 10 (2):
Horwitz, Allan V., and Jerome C. Wakefield. 2007. The loss of sadness how psychiatry
transformed normal sorrow into depressive disorder. Oxford: Oxford University
Human Rights Council. 2013. Report of the special rapporteur on torture and other
cruel, inhuman or degrading treatment or punishment. Geneva.
n22/A.HRC.22.53_English.pdf. Accessed 22 November 2018.
Jordan, Brian K., Mansoor Mohammed, Saunders T. Ching, Emmanuèle Délot, Xiao-
Ning Chen, Phoebe Dewing, Amanda Swain, P. Nagesh Rao, B. Rafael Elejalde,
and Eric Vilain. 2001. Up-regulation of WNT-4 signaling and dosage-sensitive
sex reversal in humans. The American Journal of Human Genetics 68 (5). Cell
Press: 1102–9.
Kane, Emily W. 2009. ‘I Wanted a soul mate’: gendered anticipation and frameworks
of accountability in parents’ preferences for sons and daughters. Symbolic
Interaction 32 (4): 372–89.
Kuyper, Lisette, and Ciel Wijsen. 2014. Gender identities and gender dysphoria in the
Netherlands. Archives of Sexual Behavior 43 (2): 377–8.
Lal, Rachna, and Dean F. Mackinnon. 2017. Adjustment disorder. Johns Hopkins
Psychiatry Guide.
e/787068/all/Adjustment_Disorder. Accessed 29 March 2019.
Losty, Mairéad, and John O’Connor. 2018. Falling outside of the ‘nice little binary
box’: A psychoanalytic exploration of the non-binary gender identity.
Psychoanalytic Psychotherapy 32 (1): 40–60.
Mcneil, Jay, Louis Bailey, Sonja Ellis, James Morton, and Maeve Regan. 2012. Trans
mental health study 2012.
content/uploads/2014/08/trans_mh_study.pdf. Accessed 25 March 2019.
METRO Youth Chances. 2014. Youth chances summary of first findings: The
experiences of LGBTQ young people in England. London.
Monson, Olivia, and Ngaire Donaghue. 2015. ‘You get the baby you need’: Negotiating
the use of assisted reproductive technology for social sex selection in online
discussion forums. Qualitative Research in Psychology 12 (3): 298–313.
Mudde, Anna. 2010. ‘Before you formed in the womb i knew you’: Sex selection and
spaces of ambiguity. Hypatia 25 (3): 553–76.
National Health and Medical Research Council. 2017. Ethical guidelines on the use of
assisted reproductive technology in clinical practice and research. Accessed 28 March 2018.
News. 2015. Mum Jayne Cornwill’s dream of a daughter realised through gender
selection via IVF in the USA.
of-a-daughter-realised-through-gender-selection-via-ivf-. Accessed 17 August
Offord, Baden, and Leon Cantrell. 1999. Unfixed in a fixated world. Journal of
Homosexuality 36 (3–4): 207–20.
Parekh, Ranna. 2017. What is depression.
families/depression/what-is-depression. Accessed 23 March 2019.
Parliament of Australia. 2013. Involuntary or coerced sterilization of people with
disabilities. Canberra: Community Affairs References Committee.
_Affairs/Involuntary_Sterilisation/Sec_Report/index. Accessed 17 February
Pies, Ronald. 2009. Should DSM-V designate “Internet Addiction” a mental disorder?
Psychiatry (Edgemont) 6 (2): 31-7.
Powell, Russell, Scarffe, Eric. 2019. Rethinking ‘disease’: a fresh diagnosis and a
new philosophical treatment. Journal of Medical Ethics (online first): 02 July
2019. doi: 10.1136/medethics-2019-105465.
Richards, Christina, Walter Pierre Bouman, Leighton Seal, Meg John Barker, Timo O.
Nieder, and Guy T’Sjoen. 2016. Non-binary or genderqueer genders. International
Review of Psychiatry 28 (1): 95–102.
Rippon, Gina. 2019. The gendered brain: The new neuroscience that shatters the myth
of the female brain. London: The Bodley Head.
Rippon, Gina, Rebecca Jordan-Young, Anelis Kaiser, and Cordelia Fine. 2014.
Recommendations for sex/gender neuroimaging research: Key principles and
implications for research design, analysis, and interpretation. Frontiers in Human
Neuroscience 8: 1–13.
Romao, Rodrigo L. P., Joao L. Pippi Salle, and Diane K. Wherett. 2012. Update on the
management of disorders of sex development. The Pediatric Clinics of North
America 59 (4): 853–69.
Rupp, Leila J. 2002. A desired past: A short history of same-sex love in America.
Chicago: University of Chicago Press.
Ryan, Maura. 1990. The argument for unlimited procreative liberty: A feminist critique.
Hastings Center Report. 20 (4): 6–12.
Scott, S., and M. Dawson. 2015. Rethinking asexuality: A symbolic interactionist
account. Sexualities 18 (1–2): 3–19.
Seavilleklein, Victoria, and Susan Sherwin. 2007. The myth of the gendered
chromosome: sex selection and the social interest. Cambridge Quarterly of
Healthcare Ethics 16 (1): 7–19.
Sharp, Richard R, Michelle L Mcgowan, Jonathan A Verma, David C Landy, Sallie
Mcadoo, Sandra A Carson, Joe Leigh, and Laurence B Mccullough. 2010. Moral
attitudes and beliefs among couples pursuing PGD for sex selection. Reproductive
BioMedicine Online 21 (7). Reproductive Healthcare Ltd.: 838–47.
Sinclair, Andrew H., Philippe Berta, Mark S. Palmer, J. Ross Hawkins, Beatrice L.
Griffiths, Matthijs J. Smith, Jamie W. Foster, Anna-Maria Frischauf, Robin
Lovell-Badge, and Peter N. Goodfellow. 1990. A gene from the human sex-
determining region encodes a protein with homology to a conserved DNA-binding
motif. Nature 346 (6281): 240–44.
Stella, Francesca. 2015. Lesbian lives in Soviet and post-soviet Russia: Post/socialism
and gendered sexualities. New York: Palgrave Macmillan.
Stone, Amy L. 2013. Flexible queers, serious bodies: Transgender inclusion in queer
spaces. Journal of Homosexuality 60 (12): 1647–65.
Stoppard, J.M., and L.M. McMullen. 2003. Situating sadness: Women and depression
in social context. New York: New York University Press.
Stoppard, Janet. 2000. Understanding depression: Feminist social constructionist
approaches. Oxfordshire, England; New York: Routledge.
Stryker, Susan, and Stephen Whittle. 2006. The transgender studies reader. New York:
Sunday Express. 2010. Parenting: For mothers of sons, ‘gender disappointment’ is a
guilty secret.
mothers-of-sons-gender-disappointment-is-a-guilty-secret. Accessed 25 May
The Guardian. 2014. Gender selection: Australian couple spent $50,000 and travelled
to US to have baby girl.
Accessed 30 January 2018.
The Telegraph. 2010. ‘Gender Disappointment’: coping with the ‘wrong’ baby.
Coping-with-the-wrong-bay.html. Accessed 18 March 2018.
Tomaselli, Sara, Francesca Megiorni, Lin Lin, Maria Cristina Mazzilli, Dianne Gerrelli,
Silvia Majore, Paola Grammatico, and John C. Achermann. 2011. Human
RSPO1/R-spondin1 is expressed during early ovary development and augments β-
catenin signaling. PLoS ONE 6 (1): e16366.
United Nations. 2015a. Ending violence and discrimination against lesbian, gay,
bisexual, transgender and intersex people.
t_ENG.PDF. Accessed 27 October 2018.
———. 2015b. Intersex: Fact Sheet. Accessed 16 February 2019.
Vincent, Ben, and Ana Manzano. 2017. History and cultural diversity. In Genderqueer
and non-binary genders, ed. Christina Richards, Walter Pierre Bouman, and Meg-
John Barker, 11–30. London: Palgrave Macmillan.
Wakefield, Jerome C. 2007. The concept of mental disorder: diagnostic implications of
the harmful dysfunction analysis. World Psychiatry 6: 149-56.
Walsh, Fintan. 2016. Queer performance and contemporary ireland: Dissent and
disorientation. London: Palgrave Macmillan UK.
Whittaker, Andrea. 2012. Gender disappointment and cross-border high-tech sex
selection a new global sex trade. In Technologies of sexuality, identity and sexual
health, ed Lenore Manderson, 143–64. London: Routledge.
World Health Organization. 2011. Gender, equity and human rights: Glossary of terms
and tools. WHO.
rights/knowledge/glossary/en/. Accessed 26 February 2019.
In a western context, little is known about the term ‘gender disappointment’, which describes feelings of despair around not having a child of the desired sex. This study aimed to explore the lived experiences of British women who identify with the concept. Six mothers with only sons, who also desired a daughter, participated in a semi-structured interview via an online platform. An interpretative phenomenological analysis identified themes related to pity, societal expectations of unfulfillment, and concerns relating to the future mother-son relationship, feelings of guilt and shame, barriers to seeking help and the benefits of talking. The study concludes that there is a need for greater awareness of gender disappointment and the negative impact it has on maternal wellbeing. In addition, mothers who identify with gender disappointment would benefit from support from health visitors to enable them to access the help they need.
George F Winter explains the meaning of gender dissappointment and why midwives need to be aware of it
Despite several decades of debate, the concept of disease remains hotly contested. The debate is typically cast as one between naturalism and normativism, with a hybrid view that combines elements of each staked out in between. In light of a number of widely discussed problems with existing accounts, some theorists argue that the concept of disease is beyond repair and thus recommend eliminating it in a wide range of practical medical contexts. Any attempt to reframe the ‘disease’ discussion should answer the more basic sceptical challenge, and should include a meta-methodological critique guided by our pragmatic expectations of what the disease concept ought to do given that medical diagnosis is woven into a complex network of healthcare institutions. In this paper, we attempt such a reframing, arguing that while prevailing accounts do not suffer from the particular defects that prominent critics have identified, they do suffer from other deficits—and this leads us to propose an amended hybrid view that places objectivist approaches to disease on stronger theoretical footing, and satisfies the institutional-ethical desiderata of a concept of disease in human medicine. Nevertheless, we do not advocate a procrustean approach to ‘disease’. Instead, we recommend disease concept pluralism between medical and biological sciences to allow the concept to serve the different epistemic and institutional goals of these respective disciplines.
Women are particularly vulnerable to depression. Understanding Depression provides an in-depth critical examination of mainstream approaches to understanding and treating depression from a feminist perspective. Janet Stoppard argues that current approaches give only partial accounts of womens’ experiences of depression and concludes that a better understanding will only be achieved when womens’ experiences and lived realities are considered in relation to the material and social conditions in which their everyday lives are embedded. The impact of this change in approach for modes of treatment are discussed and solutions are suggested. Understanding Depression offers new insights into the problem and its treatment. It will prove useful to those with an interest in depression and gender as well as mental health practitioners.
Depression is widely recognised as the leading disability worldwide. Though classified as a medical condition, depression also contains very personal and social aspects which are integral to the experience - as those who have experienced it know all too well. Drawing on research interviews with women who have experienced depression, this psychological study elucidates experiences of depression and the meanings attached to it. In so doing, Browne challenges current understandings of depression as a chronic and endogenous illness and stresses the importance of the perception of authenticity among depression sufferers. Written in plain language accessible to non-specialists, Depression and the Self argues that in depression, perceptions of control and the self are intertwined - and that this has important implications for diagnosis and recovery. Read more at
This chapter will discuss different ways gender has been understood historically, and across different cultures. Historical data is reviewed using the case study approach. Identity categories are analysed, illustrating how relatively recently gender was not commonly or instinctively binarised. Pre-dating contemporary language, variation in gender expression (sometimes related to sexuality) is explored through examples of English Mollies, Italian Femminielli, Roman eunuchs, and Albanian Sworn Virgins, who were all positioned as “other” from men and women, without necessarily being marginalised. The chapter will also explore the range of North American two-spirit people, the Buginese people of Indonesia who have a five-gender system, and other examples including the South American Machi and Indian Hijra.
The non-binary gender identity has recently emerged on the landscape of gender variance. It captures individuals who may experience a gender identity that is neither exclusively male nor female, is a combination of male and female or is between or beyond genders. The availability of literature exploring the non-binary gender experience is somewhat limited. Consequently, our understanding of the development of ‘self’ amongst such individuals seems to lag behind that of other gender variant identity, in particular the binary transgender identity. A psychoanalytically informed qualitative research design was used to explore the psychological realities of 6 individuals, aged between 19 and 29 years, who identified as gender fluid, genderqueer, polygender, non-binary Trans person, non-binary trans guy and non-binary gender. Analysis focused upon the integration of conscious and unconscious material in order to provide some insight into the participants’ internal world and object-relating. Three core themes emerged from the data: ‘A developing gender identity’, ‘Correct and incorrect language’ and ‘Being seen and unseen’. These themes, as well as the heterogeneity and complexity of non-binary gender identity, are explored within the discussion, with some implications around our clinical and wider cultural response to people who identify themselves in this way.
In this paper, I investigate the ethical aspects of sex selection for "family balancing." Advocates of the practice make two claims: first, that it is ethically permissible because it creates gender diversity and entails no harm from sexism; and, second, that it benefits families, as gender diversity offers richer experiences. I test these claims through an empirical study with Australian sex selectors. I argue that the claims are flawed because they are grounded in a narrow understanding of sexism that disregards gender essentialism. As family balancing is based on the selection of children to fit preconceived binary gender roles, it denies diversity and reinforces sexism. © IJFAB: International Journal of Feminist Approaches to Bioethics 2017.
This book examines the surge of queer performance produced across Ireland since the first stirrings of the Celtic Tiger in the mid-1990s, up to the passing of the Marriage Equality referendum in the Republic in 2015.
The surge of queer performance produced across Ireland since the first stirrings of the Celtic Tiger in the mid-1990s, up to the passing of the Marriage Equality referendum in the Republic in 2015, forms the focus of this book. While unprecedented economic expansion stimulated the growth of certain aspects of LGBTQ culture during this time, as the case studies examined here reveal, a great deal of queer performance illuminated the darker social consequences of frenzied capitalism, systemic state failings and pernicious cultural crises. Tracking scenes of dissent and disorientation across diverse sites and contexts, the book foregrounds performance that animates interactions between gender and sexuality, and issues relating to migration, religion, place, age, economics and class, ethnicity and national identity. It considers how performance engaged with same-sex partnership and marriage debates, but perhaps queerer still, offered some remarkably nuanced perspectives on interpersonal intimacy, social support, public participation and cultural belonging, with the capacity to inspire and provoke beyond an Irish or LGBTQ context.