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!

So why have you been arguing against it?

Because it's not my choice to make, or yours, so I'm offering reasons why people might choose differently from you and I. Just trying to offer another perspective for consideration.

Luna, no, not talking generally, just about transgenderism. Do you have research links? I don't doubt what you're saying at all, I'm just interested. I don't claim to be informed in this area as I perhaps am in others.

Do you think that the small cohort of transpeople for whom transition appears to be a total cure (such as Jaycee on this thread) are suffering from the same thing as those for whom it doesn't help? Could the key be being better able to tell between those who are truly transgender (ie transition = cure) and those who are not? Or do you think everybody could (or should?) have treatment to their mind only and never to their body?

Only just seen your post Jaycee, sorry, will read now. Hope I haven't stepped on your toes.

In the 70s they tried all sorts of wonder cures. Surgery and hormones - both unknown factors then - were not done out of some mystical sense of righting wrongs. They were last resorts. And the dangers and risks of then long term consequences were real as there was no record to judge against.

That was why they were cautious as to who they put through this. It certainly was not common. 90 cases a year or so.

Methods tried otherwise were all psychological and psychoanalytical and all of us had much of that first anyway. Including in patient stays in a psychiatric unit with many tests and studies.

So all sorts of therapy of that kind was tried, alongside more contentious methods such as high dose testosterone to try to reinforce natal sex. Or electro shock therapy. Or aversion therapy.

This never was doctors walking blindly into treating it this way and shunning any approach involving a mental illness.

Any hint of that in the testing and nobody was put forward for transition.

That was then, of course. Today it is likely rather different. You might think that not irrelevant. And, of course, my direct experience informs my view that psychiatric assessment is a necessity for all with gender dysphoria.

Even though my saying that is not well received by many. It is simply my honest opinion.

Jayceedove

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

The controversy surrounds the finding that trans women crime rate is the same as men's. Not the finding about suicidality.

Johns Hopkins found the same thing with their patients regarding mental health outcomes following SRS. That's why they stopped doing the surgery until they were pressured into offering it again.

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.

Yes, I agree with the rest of what you said. This is complex.

We need more research. "Gatekeeping" - aka medical due diligence is a good thing. Treating any underlying psychological issues before fully embarking on physical interventions is a good thing. Treating individuals according to their need is a good thing.

The current push of affirmation only and being put on puberty blockers/hormones then to surgery as quickly as possible is harmful.

Or do you think everybody could (or should?) have treatment to their mind only and never to their body?
I think Jaycee and others have said that they had extensive psychiatric evaluation, and surgery was only used as a last resort when the psychiatric help was not adequate to alleviate their distress.

That is quite different from the current view that 'being trans' is similar to being gay, and anyone who says they are trans is trans without any diagnosis/evaluation, and should have hormones and/or surgery as a first step rather than a last resort. Psychiatric evaluation and talking therapies are now viewed as conversion therapy and doctors and psychiatrists are prevented from using them.

RstRoly - not at all.

I would not presume to say that you are right. Because we do not know what causes anyone to be trans. So it is wrong really to think in terms of their being real trans people and not so real ones.

There may well be multiple causes. There may well be different ways of expressing it and of choices of how to deal with it. And there may well be different degrees of consequence and side effects that being trans brings to your mental health and, sadly, if not addressed by yourself early enough in life, by those family around you.

But the reality of who you are and how you express and the undeniable conflict that will always exist between biological reality and your own reality and the ease with which it is possible to accommodate that difference within society is the same for us all.

None of us should argue the 'more trans than someone else' line.

There will - though - I agree be differences in how successful transition proves as a cure for dysphoria. It worked amazingly for me. I have never regretted it for one second. It may not do for others.

We need to minimise that disparity and I do think that the more care is taken as to who should transition with help and who maybe should pause and take it slowly until certain it is the right step is at least more likely with psychiatric gatekeeping than without.

The research isn't there

Nor is it likely to be in the current climate where questioning = bigotry.

www.theguardian.com/education/2017/sep/25/bath-spa-university-transgender-gender-reassignment-reversal-research

Old crone, psychiatric evaluation is certainly not in my perception conversion therapy. It is a common sense first step if you are arguing that your mind is out of step with your body.

I was arguing that this is how it felt, whilst totally aware of the biology of reality. Almost by definition that implies that something is wrong somewhere either in body or mind.

So to get doctors to check out both and advise on the best route forward is only viewed as a positive for me. How can it be a negative.

Who would refuse to see a doctor if you had a pain in your head, say. on the grounds that you know the pain should be there and seeing a doctor risks them telling you it is a brain tumour.

If something is wrong you want to know why. It was. I did.

It was that simple.

Today, though, gender has become an expression of self identity for many. So regarded as part of you and not a glitch somewhere.

I appreciate that means you will approach this from a whole new direction and might fear that someone is trying to take away a valid part of your identity.

I guess there are two possibilities here:-

That in the past half century what once was a simple question of sex and biology going awry has become more socially understood as an expression of self through gender. Meaning solutions and control of these solutions has shifted from medicine to your self.

Or what was called being transsexual, where you know your sex and know your gender and feel that the sex has somehow been misaligned and so this needs fixing as far as possible has a different cause from those who simply feel they want to express themselves more effectively through the clothing and activities of the other gender. These being called transgender.

I do not know myself if these are the same or different. Others will have to decide that once we have the science to do so.

Dysphoria is pathologising trans people and so could be transphobic.+if you are to justify transing young children then you have to come up with a way to justify it.
So - born in the wrong body is no longer a feeling people have but a full on medical condition that has to be treated.

This article is worth a read to bring yourself relatively up to date on current thinking in this field: www.ncbi.nlm.nih.gov/pmc/articles/PMC5077108/

Research into why people detransition - something that used to be unknown but is now looking to be more common - is pretty obviously to anyone who cares about the people going through this to be entirely justified and to be welcomed.

I cannot imagine why anyone would argue otherwise.

Seems very selfish as just because I, for instance, have never even thought about it for one second in 45 years I am very upset that some have and the numbers might be increasing.

Finding out why would be beneficial as it might stop it happening to others in future.

Anyone arguing differently would seem very selfish and short sighted.

RatRolyPoly

There is very little research available. (That fact alone should be enough to give any medical or psychological professional pause).

There's the famous Dhejne et al:

journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885%20

This one found mixed results; improvement for some and worsening for others:

www.ncbi.nlm.nih.gov/m/pubmed/26479779/

And this one I found very interesting.

www.researchgate.net/profile/Griet_Cuypere/publication/247335377_Long-term_follow-up_Psychosocial_outcome_of_Belgian_transsexuals_after_sex_reassignment_surgery/links/5a7c1468aca27233575bb713/Long-term-follow-up-Psychosocial-outcome-of-Belgian-transsexuals-after-sex-reassignment-surgery.pdf

Positive outcomes, when "gatekeeping" is used.

Our multidisciplinary gender team has adopted a cautiuous policy. We advise a dual-phase hormonal schedule, with a first reversible part in which sex-specific features are suppressed, together with the start of a real-life test. Not until in the second part, cross-hormones are given that result resulting in irreversible feminization or masculinization (T’Sjoen et al., 2000). Our data confirm that our policy is recommendable and that psychiatric counseling throughout the sex change is not an additional luxury. Even post- operative psychotherapy is sometimes needed. If there is a positive relationship with the psychiatrist pre-operatively, he or she finds it easier to return to this psychiatrist.

Do you think that the small cohort of transpeople for whom transition appears to be a total cure (such as Jaycee on this thread) are suffering from the same thing as those for whom it doesn't help? Could the key be being better able to tell between those who are truly transgender (ie transition = cure) and those who are not? Or do you think everybody could (or should?) have treatment to their mind only and never to their body?

So, we have a group of people with similar symptoms. One treatment protocol seems to help some people within that group and not others. Yes, this would suggest to me that there are different underlying processes going on. Look, say you have someone come into the ER with coughing, fever and shortness of breath. Just from the symptoms, that looks an awful lot like pneumonia. Empirically, that person would be given IV antibiotics in the ER, because that's the most effective treatment for pneumonia, and even if the person doesn't have pneumonia a dose of antibiotics isn't going to cause any long term damage (allergies will of course be checked first, before administering any medication). However, that person will also have a chest x-ray, blood work and a sputum sample sent. Because it could also be lung cancer, or an asthma or COPD exacerbation with an underlying viral illness. Antibiotics won't help that; and not effectively treating the underlying cause will not help them and could be fatal. That person will not just be given antibiotics without further diagnostic testing. Furthermore, that person will not just be given antibiotics without the docs also monitoring follow-up chest x-rays and lab work to ensure that the antibiotic we are giving them is actually helping and they don't need to be switched to a different one. Same symptoms, but different underlying causes mean different treatments. Same symptoms, same disease, but different bacteria causing the disease means different treatments, too.

So yes, differentiating between who is actually going to benefit from a certain treatment is vital to effectively treating people. This is one of the principles modern medicine and psychology are based on.

And no I don't think that people should have only either medical or psychological intervention - the more variety of treatments available, the better. The better able to offer people the most effective the better. Having treatments that are less invasive, the better. Only offering highly invasive and life-altering treatments to those who will truly benefit, much better. The better able to differentiate who will benefit from a certain treatment protocol (like the clinic I quoted in my last link) the better.

We need research. We need gatekeeping. The current push is affirmation-only with no exploring of other underlying causes is harmful. Unfortunately in the current political climate differentiating between people who would benefit from a certain treatment protocol - i.e. those who are "truly transgender" versus those who are not - is seen as transphobic bigotry.

This appears to be the crux of the matter for diagnosis: The desire to destigmatize gender incongruence and the importance of securing access to care has been described as the central dilemma in both the DSM-5 and ICD-11 revision processes [3].

In the proposed diagnosis, the person will not be required to experience serious distress or functional impairment (e.g. inability to function properly in their job or social life) as a consequence of their gender incongruence in order to fulfill the diagnostic criteria. Formerly, people would only be eligible for the diagnosis, and therefore treatment [3,4], if they experienced serious distress from their gender incongruence or were unable to function properly because of it. Since most health insurance systems use a classification code as a requirement to offer healthcare, it is only when a person has a diagnosis that treatment can be provided. The proposed change entails that people who experience discomfort with their birth assigned gender but who do not experience significant distress or impaired ability to live a functional life (work, socialize, etc.) will now meet the diagnostic criteria and as result, be entitled to access to treatment in many countries.
www.ncbi.nlm.nih.gov/pmc/articles/PMC5077108/

RatRolyPoly

Yes those are interesting thoughts. It's all science fiction for the time being, of course. My guess is that the less intrusive option would have a lot going for it, from the patient's point of view.

psychiatric evaluation is certainly not in my perception conversion therapy. It is a common sense first step if you are arguing that your mind is out of step with your body.
I agree, but sadly, the BACP doesn't. Did you see this thread a couple of weeks ago about the letter to them from Stephanie Davies-Arai and their apology for publishing it?
www.mumsnet.com/Talk/womens_rights/3182187-Support-for-Transgender-Trend-Stephanie-Davies-Arai

Gender dysphoria became a by itself diagnosis relatively recently, it changed during the late '90s/early '00s due to both research as well as the political & social factors. For the decades before that it was studied and applied more like a symptom with various possible root causes. Gender Identity Disorder was pretty much used when no causes like delusion or trauma could be found. With GID basically thrown out, gender dysphoria became a stand alone which has had its pros and cons.

I find the move to push out of mental health into "Conditions Related to Sexual and Gender Health" is likely going to affect funding and the mental health care element which is already abysmal with people getting less and less face time as it is. What is and is not a mental illness has always had some flexibility and social pressures to it but I don't think it is appropriate to categorize distress at one's sex characteristics and people recognizing one's sex as mentally healthy and there is plenty of research that hormones and surgery without mental health care as well has far worse results for a person's wellbeing.

I find it very confusing to read in Chanelprincess's link about the move to remove the distress element with around half agreeing that "people who do not experience distress from their gender incongruence but who do wish to receive treatment will be able to get a diagnosis and become eligible for treatment", I mean, should people be able to get hormones and surgeries and a diagnosis just because they want to? These are powerful medications and procedures with serious potential side effects which to me seems pretty ridiculous to hand out at will because someone wishes to receive treatment - I really don't think that is going to happen but I don't think it should be idealized either - while most countries are currently undertreating chronic pain because of the fears of people wanting painkillers and the risks of those. I'm kinda struggling to get my head around that something I've gone to years of therapy for should be treated as a "if you want it you can have it" sort of thing particularly as someone who has tried to transition against medical advice and it did not go well. As most here have said, it needs research and a structured medical procedure but that will go against the current tide which views such things as cissexist gatekeeping bullshit as I've been told quite a few times and I am not sure what it will take to go against that when there is financial benefit to going with it.

My gender dysphoria is a mental illness rooted in trauma, I pretty much view it as part of my PTSD and treat it as such. I know others who are similar as well as other dysphoric people who experience it very differently. Brains are complex things, much like the bodies they are part of, and it would be nice to have a more holistic approach but I do not think that is what the end result of this is going to be. I hope I am wrong, but I'm very cynical of this and do not think the current way things are going is going to help dysphoric people at all, however any of us identify or view our dysphoria.

Jayceedove
Just picking up on something you said earlier in the thread
But fewer would be seeking to physically transition if it made no difference to the ease of access to legal recognition
This is something I really don't understand. I understand that some people feel their body is 'wrong' and are cured by taking steps to change it. But why would you want legal recognition if you do not feel the need to change your body? If you are happy with your body and not dysphoric, why would you want legal recognition - in what way are you transgender? The only reasons I can think of are bad reasons, such as men wanting access to vulnerable women.

Oldcrone. I imagine for some it would be self validation,. if they need it for confidence day to day. And for others simply a protection against what might happen if they ever get into trouble with the law or have a dispute with an employer as it is a visible sign of legitimacy.

So there are all sorts of reasons beyond the nefarious why someone might.

Not sure it would be at all likely that someone would acquire one for perverted reasons. But that does not mean the possibility should not be guarded against in some way. As one that could have been prevented would be too many.

Though in truth a GRC is not under present circumstances policed in any way so having one or not is rarely a factor in day to day living.

Might change, of course, given current concerns.

At present the majority who have one have physically transitioned. So it seems to matter more to someone who has done that than to those just expressing a different gender identity. Though physical transition makes access to a GRC easier right now - even though surgery is not required - because the person has gone through the medical assessment currently required to reach that point.

That doesn't really answer my question. If someone doesn't have gender dysphoria, in what way are they transgender?

Transgender is such a wide term that it can really only means gender non conforming. You then have to drill down further but I don't think the TRAs have appropriated sufficient language yet to enable us to sort out the different types of transgender issues and individuals. I'm sure when they do so, women will be the last to know.

In slighly more reassuring news however the Pentagon has banned people who suffer from gender dysphoria from serving in the US military on the basis that it is a mental health condition but allows transgender individuals to serve as long as they have not transitioned or have not been diagnosed with gender dysphoria.

The outrage over this drowns out the actual report from the Pentagon which clearly highlights concerns about cost, the impact of biological reality in troop fitness, needs and health issues, social cohesion and unit morale. The end result is that you can be transgender and serve but you can't transition and serve as transition changes the nature of the condition. Not quite the headlines of a transgender ban that transactivists have claimed.

So simply feeling like a woman in man's body is not an illness and therefore doesn't, in itself, qualify an individual for therapy or costs of medical transitioning in the US but allows them to enter military service. Needing to transition or experiencing distress on the otherhand is considered a mental health issue in the US thus opening up the world of insurance cover but negating entry into the US military on the grounds of mental health.

It would appear that the transactivist lobby have tried to argue that dysphoria is not a mental health condition but have used all the mental health flags such as suicidal ideation, anxiety and distress to gain a sympathetic hearing whilst arguing that it's not an illness or condition, just a true authentic experience of self . The US military has, on the other hand, quite simply recognised the logic that a civilised society does not train people with mental health conditions in armed combat and provide them with access to guns, explosives and warfare. And if you don't have a mental health condition then you'll have no problems in understanding that you can consider yourself a woman but that you need to meet the parameters that the US military sets down on the basis of biology, science and research and that this requires men to be recognised as men and women as women.

I can't do the mental gymnastics required to sympathise with someone who may suffer so greatly that suicide is considered whilst at the same time being required to accept that they do not have mental health issues. It is beyond dishonest for TRAs to lobby for the erosion of women's rights simply to validate their gender nonconformity and indefensible for them to do so to accommodate mental health conditions whilst denying those mental health conditions exist. It leaves those needing help being undertreated while the system and society focus on the few whose only need is for attention.

This is the real reason for #nodebate: its more than that their arguments are illogical: it’s that, emotionally, they can’t keep control during what they perceive as an attack, and they don’t want anyone to see that; some of the TRAs, anyway, are at least self-aware enough to know their titanic rage is self-defeating.

YYY.

I can't do the mental gymnastics required to sympathise with someone who may suffer so greatly that suicide is considered whilst at the same time being required to accept that they do not have mental health issues. It is beyond dishonest for TRAs to lobby for the erosion of women's rights simply to validate their gender nonconformity and indefensible for them to do so to accommodate mental health conditions whilst denying those mental health conditions exist. It leaves those needing help being undertreated while the system and society focus on the few whose only need is for attention.

Exactly. Great post, Blistory. I don't think any grounds should be accepted for legally claiming EA "gender reassignment" protections other than medically diagnosed gender dysphoria.

Oldcrone I cannot answer your question because, like you, I would presume the two have to go hand in hand in some way.

If they don't then it would be more like just changing the expression of your personality.

Which might be why some feel this is not a medical condition. For them it isn't. Whilst mine certainly felt like it was.

As my posts elsewhere have indicated I can only view it from a transsexual perspective. I find it as hard as some of you to understand this sense of just feeling or wanting to behave differently.

Not denying it happens, just that mine was entirely what I know was an illogical (yet real) physical sense of mismatch.

I have enough difficulty putting that into words. But it was focused over needing to adapt the body as far as possible. As a child I was literally praying to God at night to correct the mistake not secretly cross dressing. Very hard to explain.

I think it might be the difference between a dissonance of body and one of expressing gender identity. The former having a sense of physical necessity and the latter being more of expression.

But that really is only a guess and I know doesn't explain much.

All I know is that in my case and other transsexuals I have met this feels like a physical necessity - there is no choice involved. You know from childhood - well before puberty - and there was no prospect at all of putting off getting help to later life as it is overwhelming.

Nor any thought of involving others in my problems so I decided early to delay all relationships until I resolved this first as anything else would have been unfair.

I cannot even imagine how I would ever have been able to live a normal life as an adult, get married, have kids, and in late middle age decide to transition and involve them in the problem.

I know it happens and I am sure it is not meant to hurt others. But that is just not a thing I could have done. I was seeing doctors whilst at school and asking for help. And my life could not start until this problem was resolved.

But it is easy to create an impression of difference when there might be none. It might just be how we as individuals deal with such a huge and baffling thing in your life.

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 .

Then what is the definition of trans?

I'm not sure that trans can really be equated to gender non conforming, although that might once have been true. Some people are indeed rejecting the gender expectations that come with their sexed body, but some are whole heartedly embracing and performing gender stereotypes just of the opposite sex where others are claiming to be of the opposite sex (usually female) while continuing to behave in a way that is very recognisably of the sex they have apparently rejected (in particular I'm thinking of the violence in speech and action of some TRAs). Plus many women reject both female gender stereotypes and trans ideology so I don't believe that they should be classified (especially by other people) as trans.

To be honest I think the term has become fairly meaningless. I wish we could return to the days when we used trans only in reference to transsexuals. These are the people who should be supported. The MRA inspired agitators and fetishists should return to their own categories and be treated as the people they are not encouraged to appropriate the experiences of the transsexuals or of women to the detriment of both. There would I think still be things to figure out in order to heal all the rancour that has been stirred up and I'm not sure how single sex spaces could be restored to single sex plus 'honorary people' as has happened in the past. Hard to put any genie back in the bottle especially when there are so many one misogynists cheering away on the sidelines.