Making the Case, Part 9
Nearing the end of this series which is designed to equip the reader to make calm, rational, convincing arguments in the ongoing debate concerning the legitimacy of trans people in our society, we come to the hardest point you’ll likely try to make. Not that the case itself is hard to make, but in a culture that is for many increasingly anti-intellectual, many people are more and more willing to simply hand-wave away the stated findings of scientists, researchers and experts. So in many cases, even when you direct the conversation towards these published findings the opponent will simply dismiss them as untrustworthy, or attempt to refute them with the claims of some pseudo-science religious source such as Dr. Paul McHugh or NARTH.
Nevertheless, it’s a public good to put the accurate information into the conversation. As always it’s as much about widely publicizing the truth as it is convincing the single individual you might be debating.
The “hard” part of the debate to which I refer is the “mental illness” claim. It generally breaks down into one of four angles that the critic might take. Let’s consider them separately.
The first and most prevalent is the simple claim that trans claims are a “delusion” generally in conjunction with offering some lame analogy like “if my kid thinks he’s a cat should I buy him a litter box” or the somewhat more sane “anorexic people think they are fat when they clearly are not and we do not respect their delusion.” As I’ve explained previously, science has established plenty of evidence necessary to dispute flawed analogies like the former, since we are aware of the processes which establishes gender in the brain, but self evidently there’s no natural process which distinguishes the brain of a human fetus as a human brain or a cat brain or whatever. That is conclusive evidence that thinking one is a different species (or other silly things like being an alien or a chair) have no root in developmental disorders. On the latter, the counter-argument is pretty clear: reversing mental disorders like bulimia and anorexia is done to reduce self harm, likewise transition in trans people is an effort to reduce the possibility of self-harm. The validity of each treatment may be evaluated by the outcome of the treatment. Moreover, trans identities have never been described in medical or psychological literature (other than that which is religion-in-the-robes-of science) as “delusion.”
Following on their train of thought that being trans is a delusion, they point out that being trans is “by definition” a “mental disorder” but this is manifestly not the case. The DSM-V lists the designation of “gender dysphoria” but it doesn’t mean what they assume it means because all they really know is that it’s in there. The reality is that gender dysphoria describes the mental distress that arises in reaction to being trans and it’s sociological impact. In other words, being trans is a physiological state of being in and of itself, not a “mental condition” as the term is commonly used. To make a comparison to another disorder of the brain, one might bring up epilepsy. One may have a negative reaction to such a condition, depression for example, but the depression is not in and of itself the condition, it is the response to or effect of the condition. If a person became depressed because they were epileptic, and they sought the services of a mental health professional, that person is tasked with addressing depression – that would be the diagnosis – not epilepsy. In the wording found in the DSM:
It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.
The distress in question arises, typically, both from the incongruity of the physical body with the gender identity, and also from the consequent social interactions that are based on that appearance. In this sense, it’s important to note, that the treatment for dysphoria which has been found successful is to reduce the sources of distress by modifying the appearance and thereby, hopefully, also modifying the social interactions.
Which brings me to the third angle, the persistent refrain that trans people should “get help” – which is a really short answer response – getting help, real professional scientifically supported help, generally leads to transition. Anything short of that is simply a coping mechanism for living with the distress, not a method for removing it. There is no known “cure” to reverse gender dysphoria. So when they say “you (they) need to get help” the answer is “I did, which is what transition is. Help.”
Finally, they will point to the suicide rate as proof that trans people are “mentally ill.” The foundational response here is that suicidal ideation arises from dysphoria, as we’ve discussed, and that a major part of dysphoria arises from sociological interaction with people and circumstances which reject their gender identity. By logical implication, the very sort of conversation you’re involved in, with people who insist on denying the validity of trans person’s gender identity claim, is an example of the mentality on the part of non-trans people that increases that risk. They are helping to create the problem they claim proves their point.
Let me wrap up by adding this: our opponents seek to stigmatize us by applying the “mental illness” tag and in response, many advocates seek to “de-pathologize” trans identities by lobbying for a removal of any reference in the DSM. This can lead to serious unintended consequences for insurance coverage for transition related care, both before and after the fact. A better solution, in my view, is to focus on the physiological aspect of being trans and stop denying that we’re dealing with a medical condition. The diagnosis of significant dysphoria in relation to a medical condition is perfectly valid but we need a firmly established diagnosis of the physiological condition itself. Those among us who feel stigmatized by that shouldn’t, it’s no more logical to deny reality because of societal stigma than it would be if we denied the existence of, for example, autism because of desire to not be stigmatized. Rather, let’s work towards a culture where no one is ever stigmatized because of a medical condition they can’t help.
Photo credit: Marie L.