We Need To Depathologize Trans* Identities

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The past couple of weeks have been quite hard for me in terms of sustaining the bubble I’ve created for myself to live in without wishing to become an anti-social being (with glorious armpit hair so kudos to me for that anyway) who only meows and communicates on fanfiction threads. But let’s take it from the very beginning.

The comment section

This January’s National Geographic issue that was released on the 27th of December is featuring a trans person on its cover for the first time in its history. Avery Jackson is a nine-year old openly trans girl from Missouri, with a YouTube vlog series called “Avery Chats”, that gives insight in the experiences of a trans person who has come to terms with their identity at such a young age.

January’s National Geographic focuses on the different issues that young people have to face because of gender roles that indisputably affect their lives. The stories shared with the public are really diverse and offer a valuable insight in the lives of children around the world. National Geographic went to 8 countries and shot portraits of 80 both cis and trans nine-year-olds who talked about the way their gender influenced their lives.

One of these children was a nine year old Muslim girl, Nasreen Sheikh, who lives in a slum in Mumbai, talked about how she wants to be a doctor, and believes that if she was a boy she would have the chance to earn money more easily to help her family.

Another girl was Avery, the girl featured in the cover, who has lived as an openly trans girl since she was 5 years old.

As Robin Marantz Henig says in a story of the issue: we are surrounded by

evolving notions about what it means to be a woman or a man and the meanings of transgender, cisgender, gender nonconforming, genderqueer, agender, or any of the more than 50 terms Facebook offers users for their profiles. At the same time, scientists are uncovering new complexities in the biological understanding of sex. Many of us learned in high school biology that sex chromosomes determine a baby’s sex, full stop: XX means it’s a girl; XY means it’s a boy. But on occasion, XX and XY don’t tell the whole story.”

Editor in Chief Susan Goldberg points out in the editorial of the issue that all of us carry labels that have been applied by others for us without us. “The harsh ones,” she says, referring to those labels, “can be lifelong burdens, indictments we try desperately to outrun.”

To take that thought a bit further, this means that we are constantly defined without our consent by different societies that construct the identities of its members in ways that support different social needs and/or requirements and are presented as essentialist even though they might be socially constructed on a great degree.

Gender is such a label that is assigned at one person’s birth, based solely on some biological characteristics – that may greatly vary and are not as binary as we think. In fact sex, as well as gender, is a spectrum.

Reading the editorial of National Geographic, I greatly appreciated the initiative and looked forward to a look at the issue. It felt warm and nice: to finally have trans people represented, to see a cover that might have, under different circumstances, shown some of my most beloved people as children, giving publicity and normalizing the struggles trans people have had to endure for decades in order to be able to identify as their real selves. Reading this editorial marked a bright day.

Well, bright I say, until I scrolled down on the comments section.

Seeing the amount of bigotry, dismissiveness and uneducated smugness under the picture and the words of a proud, brave, nine-year-old girl, shattered my heart. I refuse to go back on that comments page or quote any of them here – it hurt too much the first time, I was intensely triggered and yes, I admitted both of these things that bigots try to undermine all the times.

People have feelings that can get devastatingly hurt, people get triggered in ways that impair them from living their lives decently, and no, we are not refusing to live in the real world, because the world you describe is not the real world. The real world includes trans people who have every right that you have to live their lives properly and in decency, without being discriminated in almost every part of their lives, harassed, abused and represented as abnormal.

The thing is that, when people feel uncomfortable with something that they don’t understand, they often use strong and heavy systems of beliefs to doubt it. Religion is one and science is another. The National Geographic comment section was full of comments that claimed that trans identities is nothing but a mental disorder. Transphobes often use pseudo-scientific or outdated scientific data to try and prove that the trans reality is in fact a mental disease. And while mental illness is not something that should be stigmatized, and many trans people are mentally ill, claiming that the entire condition of being trans equals mental instability, is more often than not used as an argument to deny trans people their basic human rights.

The bioethics article

Around the same days I read the National Geographic comment section, I also received in my inbox an article found on the Bioethics Observatory page of the Catholic University of Valencia.

The academic article titled “Transsexuality diagnosis and treatment” was so ideologically biased, outdated and problematic that it made me physically sick, not to mention extremely disappointed by the person who forwarded it to me – assuming of course they have read it and agree with it, since we haven’t discussed it yet, but judging by our previous discussions, I can almost safely assume that they might actually agree with it.

This article is starting with the claim that “transsexualism” (an outdated term) is a diagnosis based on medical and psychiatric findings, based on criteria that appear on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association (APA) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10).

However, little do such classifications say about the nature of a human state or identity as a mental disease, especially considering that homosexuality was in the DSM and was declassified as a mental illness by APA only in 1973, and it was explicitly stated in the ICD-10 (2016) that “sexual orientation by itself is not to be considered a disorder”. This happened after long-lasting battles pulled by LGB activists.

Conceptions of mental health and illness, sexuality and gender are fluid and constantly changing, however for trans people progress is unfortunately taking much longer. Up until 2012, trans people were in the DSM as suffering from “gender identity disorder”, while today this is not the case anymore.

APA now classifies “gender dysphoria” in the DSM. APA’s Jack Drescher said that the goal of the declassification was to end the pathologization of trans people simply because their existence made others “uncomfortable”. The scientific community has not given a definitive answer on how trans identity is shaped even though there have been numerous recent researches that redefine the way that we view gender.

Still, the ICD-10 still classifies “Transsexualism” as a mental disorder, so the fact that gender identity disorder per se has only been declassified in the DSM doesn’t get us anywhere near the amelioration of the bigger picture, considering that many psychiatrists around the world follow the ICD in first place.

However, let’s return to our article from the Bioethics Observatory of the Catholic University of Valencia (even though believe me I really wish I wouldn’t have to do that again). According to that article, karyotyping should be performed in order to rule out a chromosome condition that might affect the person’s gender identity.

This shows that the author confuses intersex variations with trans identities (which are two very different things, one having to do with sex characteristics and the other with the ways a person experiences their gender), so his arguments are fundamentally misled.

He then proceeds to suggest the failure of current “ treatments of transsexuality” (by which he means the process of transition that – some of the – trans people who wish to align the appearance of their body in ways that feel more appropriate to them undergo) to change the chromosomal sex. As the author of the article says:

[transition only masks it so that it is outwardly what the transsexual — or their family in the case of children — desires.” (*start of sarcastic brackets * Because obviously not only are all parents of trans children hella supportive, but trans children become trans because their parents make them. Like the person who forwarded the article once asked me in a conversation, isn’t the cause of a trans girl identifying as such, that the same parents who kicked her out of the house because she wore a dress, obviously forced her into wearing that dress in the first place? *end of sarcastic brackets*).

For some reason, the author of the article along with countless other people who have an essentialist, limited picture of gender as a binary, and the thought of anything that doesn’t fall strictly into it upsets them greatly, believe that the real threat is that people’s gender should be strictly aligned to their chromosomes –as if any of us or them are ever going to know anything about their chromosomes or be in any way socially affected by them. He continues, extremely problematically: “It [transition] does not solve the transsexual tendency which, as already mentioned, might perhaps be the result of a possible cerebral abnormality.”

He closes his article with an alarm call about how hard trans people have it – both in terms of health and mental health – but he fails to acknowledge that the reason trans people’s mental stability is so often affected, is in most cases people like him who refuse to allow trans people in ways that help them feel true to themselves and their identities.

The actual harmful consequences

History has shown that the danger of trying to medically and psychiatrically convert identities that people don’t understand at a certain age and social context can have extremely harmful consequences. Countless stories on conversion therapies that were still legal only decades ago (and still are in several parts of the world), performed on gay and bi people show how dangerous the effects of ideologically biased science can be when performed on people whose life is at stake.

Article such as the aforementioned encourage the conservative, outdated and harmful notion that trans people are sick people – not because they might be trans and sick but because they are trans – that need to be cured, in the same way that LGB people were thought to be sick in need of a cure, and were submitted to horrific, dangerous and humiliating procedures.

In addition, this article points out several ways – and there are more – in which pathologizing trans identities gives legal paths for conservative politics to enforce systemic discrimination against trans people, such as vetoing against transgender bathroom bills in the US and legally forcing trans people in more than 30 European countries to undergo sterilization in order to be able to apply for legal gender recognition and have their documents changed.

What’s more, the pathologization of trans identities not only adds to the discrimination, stigma and social exclusion, bullying and abuse that trans people face anyway because of the transphobia in our societies, but also makes access to mental healthcare which is often necessary – especially because of all these things – traced with huge obstacles, such as finding a therapist that is well educated on trans issues and won’t cause you inordinate harm instead of helping you out.

This is alarming, considering that trans people do need easy access to mental healthcare, not only because they are at greater risk for developing anxiety disorders, depression, social phobia and adjustment disorders, substance abuse, eating disorders, suicide ideation and attempts, but also because in many countries trans people need to be diagnosed by a psychiatrist in order to proceed to the change of their legal documents.

Many trans activists and advocates think that we still have a long way to go. With gender dysphoria still classified as a mental disorder in the DSM-V and even worse, gender identity still pathologized by the ICD-10, trans identities are still pathologized. Some people argue that complete removal of gender dysphoria from Psychiatric Manuals would prevent its treatment for people who suffer from it. Others believe that what has changed is progress, because gender dysphoria is not a synonym for trans identities, and not all trans people experience it. Rather, gender dysphoria “is a clinical term used to describe the symptoms of excessive pain, agitation, restless, and malaise that gender-variant people seeking therapy often express” (Lev, 2004, p. 910), and some trans people who experience dysphoria themselves want it to stay classified in order to simplify their access to its treatment when it impairs them from having a lifestyle of the quality that they need.

Also, many trans people who are mentally ill as well wish to get rid of the stigma of mental illness that most LGBTQIA+ mentally ill people are facing. According to this position, complaining that the classification of gender dysphoria “makes us look mentally ill and we don’t want it because being mentally ill is a bad thing” is slightly different from “we don’t want our identity to be treated as mental instability”, and the first one is contributing even further to the stigmatization of mental illness against which we’re fighting.

But this is not our debate here. Our demand is that trans identities are not pathologized anymore. It is vital that we educate ourselves and stop feeding into the problematic notion of treating trans people’s existence as if it is up for debate, and denying them their basic human rights simply because we are ideologically prejudiced against them and think we can use science to prove our misinformed, bullshit point.

Trans people are in need of mental healthcare just as everyone is, and considering the stigmatization and discrimination have to go through, for trans people especially it is important to make health care accessible while reducing the stigma of mental illness.

So if you act like you want trans people to be ok, like many of the people who use this rhetoric do, instead of trying to cure an illness that does not exist, respect them, hear them out, and give them voices in the way that National Geographic did, losing many of its subscribers who simply hate on everything that they cannot understand.

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If only the world was as “open-minded” as us… Alas, matters of sexual identity and equal love, often cause so much friction in the rest of the world. Here, find an open dialogue on the issues facing our LGBT community.

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