Is gender dysphoria considered a mental illness?

[ReluctantCamper]

I've had an offensively lightweight word salad of a reply from my MP. Among the 'I welcome progress against transphobic bullying' (this is the basic standard I would expect from a sentient human, so fucking what?) anodyne crap, is the statement ' I am also encouraged that gender dysphoria is no longer considered a mental illness'.

Is this true? Being so unhappy with your body that you are prepared to undergo treatment that may well remove much of your sexual function is not considered a mental illness? Really??? If it isn't how the hell do sufferers access therapy?

I need to construct a reply to him, but I'd like him to engage his brain and not take immediate offence so need to simmer down a bit before writing it!

The probably agp twat is a conservative!

The more enraged Cluster Bs are, the less they can control themselve, and the more they reveal to the greater public exactly who they are. To someone who studies tactics of engagement, that suggests a certain path of activism.

It absolutely is. But anyone engaging in it needs to be very careful that they don’t put themselves at risk unless they are sure they can afford to do so. It also requires a very clear mind because if the non-cluster B person gets wound up instead, then they will be made out to be the bad guy. Gaslighting and making other people look bad is their favourite tactic.

Well if it’s not a mental illness then on what basis can NHS treatment such as hormones and surgery be accessed?

This is the bit I don't get. I sort of understand what the MP is trying to say when he expresses satisfaction that all of this isn't considered a mental illness any more. I think he means that society sees trans people's aspirations to transition not as delusional but valid expressions of 'who they really are'. But if that's really what's going on (I'm not saying it is) then surely the cash-strapped NHS can't be paying for it?

The TRAs are backing themselves into a corner and creating this paradox.

On the one hand gender dysphoria cannot be seen as a mental illness because they want to compare 'transphobia' to the homophobia of years ago, where people thought that fancying someone of the same sex was a mental illness and carried out 'conversion therapy'. So the schtick would go that any attempt to try and give people with gender dysphoria, including kids, therapy to try and accept their perfectly healthy body as it is (in the same way you would for someone with anorexia) is a type of conversion therapy and wrong.

On the other, if gender dysphoria isn't a recognised medical condition, then how can you access surgery, hormones etc? I can't just say that I self id as 20 years younger and get Botox or a face-lift on the NHS?

And this is, once again, where the comparison with being gay collapses. Being gay never needed to be classed as a mental illness, because you don't need to actually take anything or do anything to 'become truly gay', you just are. You are not believing you are something you are not, 'gay' is just a descriptor for what you are sexually attracted to.

And Jane Fae seems to be barely holding it together in the face of Man Friday.

It’s true. I only saw bits of CBB, but India too.

In Cbb India said she had gender dysphoria didn't she? I think she actually referred to it as a mental illness actually.

I am also encouraged that gender dysphoria is no longer considered a mental illness
This is part of the standard response from Tory MPs. I doubt they even read it before pressing send. The same phrase is in the OP of these threads:
www.mumsnet.com/Talk/womens_rights/3107024-Response-from-MP
www.mumsnet.com/Talk/womens_rights/3189503-Received-a-reply-from-my-MP
and in a post in this one:
www.mumsnet.com/Talk/am_i_being_unreasonable/2926418-Labour-gender-identity-equality-law?messages=100&pg=1

Nobody knows what causes someone to be gender dysphoric. You might assume it is a mental illness or delusion. I fully understand why you would. But it is still an unproven assumption.

It was what doctors thought in the past and, you might be surprised to hear, most trans people seeking treatment or who got treatment years ago did too.

Surely is the first thing anyone would think of as it is obvious that reality is what it is so if you powerfully believe that reality is wrong with you then something maybe has gone awry.

They tended then only to assist medically those who approached doctors fully aware of reality and biology and the limitations of what could be done to merge perception of either but after thorough testing who still insisted that for some reason something was wrong.

Hormones or surgery was very much used as a last resort and - you might think paradoxically - only recommended if a person was considered mentally stable enough to understand the realities and consequences and cope with them.

This resulted in lots of analysing and testing and a search for causes that still goes on. There has been some recent sophisticated testing of gene groups and mapping of areas in the brain that are hinting at evidence there that might lead to finding a cause one day.

But we do not know right now and there might be psychological factors involved as yet untraced outside obvious personality disorders or other well diagnosed conditions which the gatekeeping before legal recognition is there to try to discern.

But not all trans people are the same in how they identify or see reality or labels or whether they want to change their body at all .

To get legal recognition today many find it hard to follow the rules so want to remove the barriers such as medical assessment preventing them.

That, of course, is the main problem for those outside looking in.

It is a question of balancing these two needs together somehow.

For me common sense is to be cautious and sure before taking such a major step in life. And seeing a doctor ought not to be an imposition but a sensible first step. But I am out of step in thinking that with a lot of people trans today who regard it as a choice.

It never was for me. Just a way to survive in the best way recommended by the many doctors I saw over several years.

To answer an earlier question I do not think the talk of 'de-medicalisation' would mean getting hormones or surgery without this. These checks and balances would remain for going that route.

But fewer would be seeking to physically transition if it made no difference to the ease of access to legal recognition (it is not necessary now but does make proving status harder and so rejection of recognition sometimes happens without it).

Plus they could probably access them abroad or off the net and by pass all UK checks.

Gender dysphoria is a form of body dysphoria IMO. No different from anorexia really.
I don't get why one is a mental illness, but not the other

I know I'm skipping back a bit but I've seen transgenderism equated with eating disorders before.

The two are very different.

Not least because if one is indulged to it's fullest the sufferer tends to become happier, less distressed and to all intents and purposes "cured".

If the other is indulged to it's fullest you die.

Hope this helps.

Not least because if one is indulged to it's fullest the sufferer tends to become happier, less distressed and to all intents and purposes "cured".

Like Nathan Verhelst, for example?

www.telegraph.co.uk/news/worldnews/europe/belgium/10346616/Belgian-killed-by-euthanasia-after-a-botched-sex-change-operation.html

I did say "tends to".

The argument would be of course that sometimes other conditions present as trangenderism, but only in "true" transgenderism does replicating the other sex as far possible bring relief.

...not accounting for botched operations of course!

Nobody knows what causes someone to be gender dysphoric. You might assume it is a mental illness or delusion. I fully understand why you would. But it is still an unproven assumption.

But surely gender dysphoria is by definition a mental disorder, in the sense that gender dysphoria is merely a label for a state of thinking that psychiatry currently judges to be a mental disorder - regardless of its causes or associations which, like you say, are little understood. Whether it will always be considered a mental disorder is to be doubted. But it's not an 'unproven assumption' that gender dysphoria is a mental disorder.

Maybe I misunderstood you, maybe you are saying that perhaps it's not only a mental disorder, perhaps it ultimately has some physical cause? Perhaps then one day there may be a simple treatment for it without the patient having to undergo intrusive surgery. Who knows what sophisticated laser brain treatment might become available one day to help people align their sense of self with the physical reality of their bodies?

The larger issue here, though, is that - whatever its causes - do we believe that it's a sign of a health problem of one kind or another?

Not least because if one is indulged to it's fullest the sufferer tends to become happier, less distressed and to all intents and purposes "cured".

My recollection is that the largest study of success of SRS was very ambiguous as to whether this was the case partially due to the fact that 75% of the participants dropped out - usual drop out rates are between 10%-25%.

Gender dysphoria is a form of body dysphoria IMO. No different from anorexia really.
I don't get why one is a mental illness, but not the other
Gender dysphoria is more like Body Integrity Identity Disorder, where people identify as disabled.
Sufferers from BIID experience a mismatch between their physically healthy body and the body with which they identify. They identify as disabled. They often desire a specific amputation to achieve the disabled body they want: for example, the left leg below the knee. The analogy with Gender Identity Disorder is clear: someone with Gender Identity Disorder experiences a mismatch of some kind between their chromosomal and genital sex and the sex they identify with.

Maybe I misunderstood you, maybe you are saying that perhaps it's not only a mental disorder, perhaps it ultimately has some physical cause? Perhaps then one day there may be a simple treatment for it without the patient having to undergo intrusive surgery. Who knows what sophisticated laser brain treatment might become available one day to help people align their sense of self with the physical reality of their bodies?

It's interesting to think about isn't it archery. I was wondering this myself, and came to the notion that perhaps the physical cause of the disorder is quite simply the "wrong" body. I know that sounds nuts, but what you go on to say about being able to laser the brain and align it with the body, aren't we closer to being able to laser the body to align it to the brain?

And even on on that, it got me to thinking how I would feel if my mind and my body were somehow seemingly misaligned; would I be more inclined it was my whole internal self that was "wrong" or somehow sick and needed treatment, or would I think it was my physical body? I don't think I'd want someone messing with my sense of self - I think I'd rather consider my "self" to be exactly who I am, thank you very much! Feels a bit like lobotomising to mess with that...

...whereas treating the body with surgery or hormones or whatever seems far more palatable.

The larger issue here, though, is that - whatever its causes - do we believe that it's a sign of a health problem of one kind or another?

I think the more pertinent question is whether or not we consider it a problem of the mind - a mental health problem - or whether we consider it one of the body - a physical health problem. Given that we only have an apparently effective treatment for one and not the other (in most cases I think) that's probably why it seems to be being pushed into the physical category.

I don't think we know enough about the long term outcomes of transgender people to know if changing their body to present as the opposite sex is a long term effective treatment.

I do wonder if such a treatment would get past an ethics committee today. Imagine someone proposing that treatment. Asking everyone to to be complicit in what is a deceit. The treatment is changing the body and face of a person as much as it takes to make other people not realise what sex that person was really born as. It's passing that relieves the dysphoria -so more and more extreme measures are taken (feminising facial surgery) to make that person look as though they have never been the sex they were born as.

At a basic level I find it incredible that this was ever allowed as a treatment. I believe it is reported in the medical literature as a last resort, desperate measure - just because no other treatments were successful, in some cases, at the time. The only way this treatment could be deemed ethical is if there is absolute proof that one can be born in the wrong body and that has never been the case.

I don't think I'd want someone messing with my sense of self - I think I'd rather consider my "self" to be exactly who I am, thank you very much!

But if you could retain your sense of self and come to terms with your body the way it is, don't you think that would be an even better outcome?

I do agree with you ifonlyus, and you Juzza.

Personally Oldcrone, yes I do think that would be better. But then again the choice has never been mine to make.

RatRolyPoly

Neither this:

Not least because if one is indulged to it's fullest the sufferer tends to become happier, less distressed and to all intents and purposes "cured".

If the other is indulged to it's fullest you die.

Nor this

I think the more pertinent question is whether or not we consider it a problem of the mind - a mental health problem - or whether we consider it one of the body - a physical health problem. Given that we only have an apparently effective treatment for one and not the other (in most cases I think) that's probably why it seems to be being pushed into the physical category

Are supported by what little good research we actually have.

Long-term follow-up studies show that SRS does not alleviate suicidality.

Furthermore, we have many highly effective treatments for mental illness. It is untrue to state that we can only effectively treat physical illness and not mental illness. I'm not exactly sure what you are getting at with the last paragraph, there; if you're only referring to trans people or are speaking more generally of treating mental versus physical illness.

But it's also inaccurate to state that only "medical" - physical transition only - are effective for trans people The long-term follow up studies simply do not support that.

What's needed are effective treatment protocols backed up by research. The research isn't there.

I do think that would be better.
So why have you been arguing against it?

Juzza that Swedish study is a little controversial. I believe one of the authors later discredited it. But it is widely cited.

I think it possibly also might be date dependent to a degree. In that there were very few cases of trans regret under the old regime where only a few were put through for transition. These do seem to be on the rise now there is less assessment.

You might expect that if you put less care into checking who is an appropriate case for this complex approach that you will sometimes put through cases that were possibly in need of other care first.

Anyone who is trans will have lived with it for some time before they see a doctor and if that has not impacted them in some other significant ways before they get there I would question how deeply dysphoric they are.

Living with real gender dysphoria is not like having a bit of tummy ache that goes away if you forget about it. It is ever present and insidious. You would be very fortunate to reach adulthood not somehow destabilised by that.

And such complications arising from it should be dealt with before you transition or they will probably still be there.

That is why you see a doctor and then psychiatrists and psychologists. If you do not then it is no surprise that the whole problem is not effectively treated.