About a year and a half ago a new condition was added to my medical record, “Gender Dysphoria.”
For those who aren’t aware, “Gender Dysphoria” is a diagnosis in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-V). “Gender Dysphoria” replaced the older diagnosis of “Gender Identity Disorder” that was present starting in the DSM-III released in 1980. This change was prompted by the recognition that transgender people are not automatically disordered. In fact, according to the DSM-V, it is only the distress and pain that can sometimes accompany transgender identities that can be said to be a disorder.
By the time I was labeled as having “Gender Dysphoria,” I had been experiencing distress and pain regarding my gender for over 24 years.
As a result, “gender dysphoria” seemed like the perfect term to describe my feelings at the time. The term recognized and validated my experiences. On top of that, having “Gender Dysphoria” on my medical record had a real practical benefit: I could finally pursue medical transition with the support of a professional.
Medical transition, even if I didn’t fully admit it to myself when I first talked to my therapist, was my ultimate goal in finally talking to someone about my feelings. Getting emotional support was beneficial, but I had known for a long time that my difficulty wasn’t about my emotions, but rather the fact that my gender and my sex did not align. Talking to a therapist was simply how I had to go about getting access to the things that would help me solve that underlying issue.
When I finally got the diagnosis of “Gender Dysphoria,” I was both uncomfortable with the fact that I was being labeled with a “mental disorder,” and elated to be given access to hormone replacement therapy (HRT).
This mixed-bag of emotions came from the fact I was familiar with what are now called the WPATH Standards of Care outlining “best practice” in the treatment of trans people starting in the early 2000s. So, I understood that reducing a foundational part of who I am to a disorder was a necessary evil if I was going to get access to medical interventions. In order to get what I needed, I knew I had to navigate the system—a system based on transphobia and gatekeeping—even if it meant bearing an inaccurate label.
However, the closer I get to solving the the underlying cause of the dysphoria I experience, and having “Gender Dysphoria” removed from my medical record, the angrier I get that getting access to the things I and other trans people need requires being labeled with a mental disorder.
I do not have a mental disorder.
I do not say this out of some sort of mentalism, which often arises in situations like this when people think that having a mental disorder makes you “lesser” than someone without one. I have a great empathy for those who have mental disorders. In being labeled with one, I have come to understand—to some extent—what it is like for others to think of you as “crazy,” or “mentally ill,” and for them to use those labels to disparage, insult, and devalue you.
No, my issue is of a more technical and philosophical nature.
With regard to “Gender Dysphoria,” I have to say that if the pain and distress that I have experienced related to my gender and sex has ever reached levels at which it could be considered a mental disorder, it is not because of any intrinsic fact about me.
Almost all the pain and distress I have experienced related to my gender and sex has been the result of society systematically discriminating against people like me. Had I grown up in a society that embraced me, I would not have found myself at age four sobbing and praying to god that I was a girl—because I would have been empowered and supported in self-advocacy long before then. Additionally, my discomfort with the sex characteristics of my body would have been mostly prevented—because I would have been given access to the medical interventions and resources necessary to ensure my body developed correctly earlier.
In this context, the distress and pain that has led me to be labeled with a disorder can be put down almost entirely to the fact that I am a minority in a majority culture that has a rich and varied history of hating people who are different. So, if anyone can truly be said to suffer from “Gender Dysphoria,” it is society at large.
Further, even though “Gender Identity Disorder” is no longer present in the DSM-V, it is important to note that the bare fact of being trans—regardless of the presence of distress—does not mean that you have a mental disorder.
Continued research has failed to show that there is any chemical imbalance or dysfunction present in the brains of trans people who otherwise have no health concerns (either mental or otherwise). What the research does show is that being trans is likely an issue of genetic and congenital variation related to sexual development that causes the sex characteristics of trans brains and bodies to be out of alignment.1
Given this, labeling trans minds (or more specifically, trans brains) as disordered as opposed to anything else relies on nothing more than cissexism—the belief that cisgender people and identities are better than transgender people and identities.
Now, some within the trans community might object to my statement that trans people do not have a mental disorder—either due to distress or the bare fact of being trans—because such a position might jeopardize access to the healthcare many of us need and want
To this I have two responses.
First, treatment has been shown to improve the health (both mental and otherwise) of trans folks. Tying this treatment to a mental disorder is ultimately unnecessary, and only serves cissexist beliefs through gatekeeping. Trans people should be given access to the care they need and want because it helps to ensure their continued health, not because they have been labeled with a mental disorder.
Second, for those of us who do feel strongly that our bodies are at odds with our brains, I see no reason that such a state couldn’t be classified, if absolutely necessary, as a physical disorder or something similar to a disorder of sexual development. After all, that’s where the research points, and such a diagnosis agrees with the issue as experienced and expressed by trans folks.
I personally tried for 24 years to fix my mind until I finally realized that my mind and my identity was never the problem. And, it is only when I accepted this fact that I was able focus on the actual problem—my body’s sex characteristics—and make progress.
1For a high-level introduction to this research, see “Between the (Gender) Lines: the Science of Transgender Identity” and the poorly named “Causes of Transexuality” page on Wikipedia, both of which do a good job of discussing the complexities of transgender brains and current research into the physical causes of transgender identities.