The medicalisation and pathologification of being transgender, an exploration

Wow, with a title like that it seems like I am ready to write a Master’s thesis at least! All kidding aside, this is a serious post, so brace yourselves.

There are some inherent contradictions within our community and within our own minds. Many trans people (rightly) object to the idea that being trans is some sort of mental illness in need of treatment. It may be surprising to some that as recently as 2012 ‘gender identity disorder’ was a recognised mental illness. The definition has since changed to reflect that ‘gender dysphoria’ rather than ‘gender identity’ is the condition that needs treatment. This accords closely with my own experience. I personally do not see my non-conforming gender identity as a disorder. I see it as a difference that I celebrate rather than seek to treat. I am quite happy being me and I do not think that being trans causes me mental anguish nor do my relationships suffer as a result of it. I am able to manage myself reasonably well in most instances.

I do however acknowledge that some trans people experience varying degrees of dysphoria. In some cases the dysphoria is mild and results in some discomfort. In others it is a serious condition that results in a great deal of unhappiness and depression. I am no psychologist and I do not know what causes the dysphoria, but it clearly exists. It is clear that it is the dysphoria rather than the gender identity that is the problem.

Nearly all trans people are concerned with the need to be perceived and accepted by society as ‘normal’ people. We do not want to be seen as sick, perverted, strange or anything else. At the same time the dysphoria seeks many of us to seek medical help to ‘fix’ our bodies.

This is an inherent contradiction. How do we assert our fundamental normality and at the same time assert our need for medical treatment? By definition medical treatment (cosmetic procedures aside) are designed to fix medical problems, treat diseases and cure illnesses. Trans people mostly argue that gender dysphoria is a real illness and will not be cured through cosmetic procedures. This is an important argument as it moves treatment from an elective medical procedure (that usually needs to be paid for by the patient) to a medical condition in need of treatment (and thus to be paid for by state or private mutual medical funds). However how do we reconcile this argument with the one that says that we are not ill? We need to distinguish between the erroneous belief that transgenderism is a mental illness that needs to be cured and get society to realise that it is the gender dysphoria that is pathological and needs medical intervention.

Unfortunately, the belief held by a number of both trans and cisgender people that the only ‘real’ trans people are those that are transitioning and that ‘transitioning’ requires some sort of medical intervention; medication (hormones) at the very least and more aggressive medical interventions (surgery) at the more extreme levels exacerbates some confusion in society. At least some people believe that if you aren’t (at least) on hormones, then you aren’t really trans and you are ‘just crossdressing’.

This attitude leads at the very least to divisions within our community and (I believe) some serious emotional problems in others. Some people I have spoken to in recent months seem to think that the only way for them to validate their transgender identity is to start to transition. They often do so without properly appreciating the side effects and risks associated with this course of action. It is not always clear what is motivating the desire to transition. Is it a deep seated need to eradicate dysphoria or is it a need to more closely identify with the trans community or what?

The trans experience is an intensely personal one. There is no one way to be trans and the definition of ‘transgender’ is necessarily broad. No one should be defining anyone else’s identity other than the individual (and perhaps a trained psychologist). Certainly no member of our community should be telling others that they need to seek medical help unless that need is truly justified. Of course the medical profession have an interest in medicalising us. On the one hand transitioning is a long-term process resulting in the need for lifelong medication and ongoing medical care. It is a wonderful opportunity to make money. On the other, medical professionals want to help people. If you come to them asking for help they will want to help you, and the way they help people is through medication, surgery and other treatments. If you arrive at a doctor’s office, don’t be surprised when he or she starts to treat you.

All people have the right to express themselves fully in the way they see fit without being made to feel marginalised by other members of society. We need to give all members of our community the latitude to do so without being pressured into seeking treatment. Conversely, the medical professions needs to act as more of an enabler than a gatekeeper. But to do so, we need to assist them. We should not be seeking medical treatment when we are not really in need of it. We should not be pressuring others into seeking treatments that they do not really need. This will allow medical professionals the ability to more readily believe those of us who come to them saying they need help and will also reduce the chances of a serious error being made with potentially disastrous results for the individual trans person, the doctor and indeed the broader community. Every mistake that is made results in fewer trans people being able to seek treatment.

In conclusion, being transgender is not an illness (mental or otherwise). Some of us experience gender dysphoria, this may need medical intervention. If it does please seek medical help, if it does not then we should stay well away from the medical profession and respect the person’s right to be themselves and live their life without being dictated to by others. Nobody is any more or less trans we are all on our own unique and personal journeys. We need to support each other. Let’s do that.

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4 Comments

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  1. Well said. I have bumped into a few people who have haughtily declared themselves the only “real” trans people. It gets doubly sad when you see them posting on radfem sites trying to express solidarity, overlooking the glaring fact that the majority of radical feminists do not see medical transition as conferring an iota of validity… At the end of the day, though, being trans should be about being true to oneself, and not about being in competition with others.

    Liked by 1 person

  2. Some thoughts this inspires:
    There are categories within the bible of American psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, now in volume five, that are not listed as chronic disorders (the word disease is not used with any frequency). They may however be items that require intervention. The old Gender Identity Disorder was dropped due in part to research showing that transgender persons do not have more or less mental disorders than the regular population. However, it is my conjecture that the rate of traumatic based problems is high! There are varieties of problems in humans that may require, at this time, some kind of medical or medically related intervention. People sometimes have congenital problems that would not normally interfere with “reproduction,” work, recreation, etc. but if they work with the public or deal with it regularly, what if the congenital problem gets in the way because the their appearance? This is not the best example, but I imagine some might feel enough distress and get enough discrimination that they might seek plastic surgery. Gender dysphoria is in some ways similar to other issues, but is unique in that it deals with gender, something that most people have a built in sense of by age four to eight, and is fundamental to a sense of identity.

    Dysphoria is real and in some individual so intense, that it can trigger depression, or even stand in as depressive or anxiety related symptoms. I think the very high rate of suicidal thinking, attempts, and completed suicides in the trans community is in part due to this dysphoria, and the fact of stigma and discrimination, if not outright physical or verbal assault. If one experiences dysphoria, and gets nothing but roadblocks to what is and should be, and is more than a social construct to my knowledge, I think a sense of helplessness and hopelessness develops. These secondary problems may very well require therapy or medical intervention. That it should happen with a person’s consent is something I agree with strongly, though there are civil laws that allow for mandated intervention in cases of imminent self harm in all states from what I have heard….

    Though we are indeed unique in many respects, being transgender and transsexual gives people a lot of common problems. Some seem to be sheltered from these problems to some extent, most of us do have common problems and solutions that can be solved in common. Thanks!

    Liked by 2 people

  3. Well, the paragraph regarding the definition, by some, of what it takes to be a “real” transsexual certainly got my attention. Of course, I’ve seen this stated so many times over the years.

    I have been vocal over the years, on my very neglected blog, as to why I have not transitioned and why I have not begun HRT. Although I have crossdressed for about as far back as I can remember, and mostly in my early years, I get absolutely nothing out of it. I’ve never crossdressed in public. I always refer to it as window dressing and I don’t have the window to dress, so why even do it?

    Have I absolutely ruled out transition or at least HRT? Absolutely not. I need to always see a light at the end of the tunnel, even if I never reach it.

    Yes, I am a transsexual, mired deeply in the dysphoria. I keep myself very busy to fight off depression, but it did get the best of me last night. Just a bit of weeping, but that’s what I live with and deal with in the male body I live in…..all for the sake of family.

    Anyway, Daniella, nice post and I did feature this on T-Central.

    Calie xx

    Liked by 1 person

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