Are Transsexuals Mentally Ill?

Cecil's Columns/Staff Reports
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Link

I actually wish I knew which thread this was referring to (though I don’t know the average turnaround time between question and answer, for all I know this letter was sent a year ago and the thread is loooong dead).

I used to be (as in, before 5 minutes ago before I read this) a very, very staunch supporter of transsexuals. And to a degree, I am, I’m casually acquainted with a couple post-ops, I refer to them as “she” (both MtF), never gave them a degree of shit about it and I never will.

However, this point has kind of got me stuck and I’m starting to become shaken. At least as far as transitioning between “transsexuals are mentally okay, you bigot!” To “I’m so sorry about your severe body dysmorphia with regards to your genitals, what a terrible affliction!” I’ll never start hating transexuals or anything. Heck, even if it is a “mental illness” I’ll still vote to support trans rights.

But either way, what say you, Dopers? What is the flaw here? I can’t really figure out what the difference is between somebody who wants to alter their penis because they feel like a woman and a person who wants to chop off the bottom half of their legs because they’re totally a hobbit. Or that guy I know from college who had a dragon fleshlight and wouldn’t shut up about his “draconic habits” (sexual and non-sexual) because he’s a dragon “inside”. Or maybe this just means there’s absolutely nothing wrong with the hobbit and the guy who is convinced he’s a giant lizard trapped in a human’s body and I should accept them.

Heck, after reading this, an apt comparison almost seems like anorexia. Where they just don’t feel right in their body because it’s NOT THIN ENOUGH. And they HAVE to stop eating because they MUST become thinner.

I’m really having a crisis of… something here, can anyone help me out?

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For me the issue isn’t body modification. It’s believing something that is just not true.

Sex is a defined biological characteristic. You are male or you are female, or you have a birth defect that leaves you with something else. If you are male, however, you are male. If you are male and you think you are female, you unquestionably have a mental disorder.

Not only that, but isn’t the very concept sexist? Genders don’t have defined roles anymore. How would one know if they should be one or the other in the absence of such roles?

This story here drives me nuts:

Richard refused to swim topless, always wearing a shirt in the pool. By age two, he became clearly jealous of his sister’s “girl” things – her toys, her pink drinking cups, and especially her clothing.
“We were getting dressed, and he wanted to wear a dress. He wanted to be pretty like his sister,” said Stephanie. “He was saying, ‘I want a dress. I’m a girl, Mommy, I’m a girl.’ And I’d say, ‘No, honey, you’re a boy. You have a penis, you’re a boy. Allie’s a girl.’”
No, RICHARD, you are a boy who likes dresses and pink. There’s nothing wrong with that. So stop trying to cut off your own penis!

3

I’m guessing “you are now right, and were previously wrong” isn’t the kind of help you were looking for, but that would be my response.

Personally, I have no problem whatsoever with people who do not conform to gender sterotypes. If a man likes pink and raising kids and is sexually attracted to men, more power to him.

I disagree with transsexuals (and the otherkin you mention) for the same reason I disagree with the religious. If you make statements of fact about the world that are at odds with reality, I’m not going to agree with you just because you want me to.

I dislike transsexuals who view it as my obligation to act in accordance with their incorrect worldview. If an otherkin was offended every time I referred to him as a person and not a dragon, or a religious person was offended because I do not show proper subservience to his god, I would view them with contempt.

4

Now that I’ve calmed down a bit, perhaps you’re correct. I’ve been in an environment where it’s heavily, er… suggested that you see trans people as the same as homosexuals. No problems. But I just can’t poke a hole here.

That doesn’t mean they’re not still people deserving of respect, that doesn’t mean a boy can’t like pink and dresses, it just means that their mind is in conflict with reality in a way that is very sad, and can be very damaging to their psyche. This still kind of sounds to me like Christians who say “look, I still love gay people like Christ wants, I just think they’re sinners, but it’s okay, everybody is! And they can fix their sin by thinking right!” But I don’t know, the comparison to the guy who thinks he’s Napoleon is just too strong.

And I was trying to avoid using the term “otherkin” for the dragon guy, but I guess there was really no reason to in hindsight.

5

Huh. Really thought you were going to go the opposite way with that argument.

Believing you’re a hobbit, as in the OP, is something that’s clearly untrue.

In terms of gender, I doubt that there are many transsexuals that are under any illusion about the gender of their bodies.

Because such “roles” are not entirely a product of society. Also note roles is a bit loaded here as it implies what someone should be doing. It’s less loaded to just talk about dispositions and what someone wants to do.

There’s plenty of evidence that certain behaviours are, instinctively, more prevalent in one gender than the other, as with pretty much every two gendered species.
Indeed there are differences in thought patterns (on average) that can be seen using techniques such as functional MRI. And I’ve seen studies that have indicated the “wrong” gender’s thought patterns in transsexuals. I’ll google it later (when I’m not technically at work).

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That is easily established for members by simply doing a search on the quote. Here is the post in question.

I don’t quite see the problem. There isn’t really any significant difference difference. The only minor difference is that getting a sex change won’t stop you from holding down a job or doing whatever you like aside from sexual acts. Transgenders aren’t considered physically handicapped. Chopping your legs off does tend to have an effect on other areas of your life.

But yeah, the main point is obviously true. When the ideas in your head don’t match consensus reality, the problem is with your head, not in reality: you have a mental problem. The difference between someone who thinks they are another sex and someone who thinks they are a space man is practically non-existent.

What always mystifies me is that it is such a huge issue. It’s impossible to say of course, but I have always thought that if I woke up tomorrow and found out that, as a result of a well studied biological process, I was in a woman’s body I would come to accept it. I would be freaked out to hell initially of course, and the doctors may have to explain to me what has happened and that there is no way to change it a lot of times before I would believe it.

But I also totally believe that I would come to accept that as the simple truth. I am sure I would be a lesbian because I have no sexual interest in men, but i can’t imagine that I would possibly “reject” my body as being rightfully mine because it had become something that I didn’t want it to be.

And by that I don’t mean thinking it’s unfair or being unpleased. I am sure I would feel that way, just as I would feel that way if my body were to develop some disfiguring illness or quadriplegia or similar. But people with cancer or paralysis don’t normally reject their bodies. They may be angry with their bodies or depressed with what has happened, but I have never heard of someone with quadriplegia or psoriasis making the claim that their body isn’t theirs.

And that to me is the most mystifying thing about BID, and the clearest sign that it is primarily a mental illness, albeit one with a likely biological cause. People’s bodies become things that they don’t want them to be all the time. People get disfigured, they get paralysed, they get old. But people don’t go around declaring their body to be “wrong” and “not theirs” just because it doesn’t fit with their mental image of how they think their body ought to be and what it ought to be able to do.

Yet that attitude is at the core of BID. The attitude that, despite the objective fact that in the reality you have a perfectly functional body of sex A, you *can not *accept that fact and must have a body of sex B. Even if the best you can do is a weak impersonation that fools nobody. Even if you have to have parts amputated and render yourself sterile an unable to achieve orgasm in order to do make a more realistic impersonation that is still just an impersonation, not a functioning body.

To me that is as clear an indication of mental illness as a person who is 4’9" insisting that their “real” body is 7’5", and walking around on stilts for years in an attempt to “pass” for a tall person, and then eventually having their legs chopped off and having the stilts surgically bolted to their stumps.

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However, they think that inside they are something else, and desire society to view them as something they are not. If this is something society should do, then shouldn’t we also honor people’s wishes to be a different race than they are, since race is a much less well defined characteristic?

Now personally I think everyone should just be who they want to be, but much as my right to swing my arm ends at another person’s face, your right to pursue a different identity ends where it requires another person to accept something that is false. We have 100% freedom to view ourselves as we wish, but by the same token everyone else has the freedom to view you as you actually are.

8

Yes, it’s not as if the person I mentioned who thinks he’s a dragon inside is under any strange hallucinations that he’s a dragon outside, and yet I don’t think I’m going to get many calls to humor him. I mean, I guess there is a difference to be made that dragons aren’t real, and people of <opposite gender> are, but then if some guy from Maine was walking around insisting that inside he was really German, despite his thoroughly American geneaology, we wouldn’t be starting a movement to give Transgermanics native German citizenship, regardless of country of origin, so they can finally be who they REALLY are.

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:confused:

Society does do that, doesn’t it? I mean, if a fair skinned blonde man told you that he was a Negro, you wouldn’t tell him he wasn’t, would you?

This woman says she is an Aborigine. Would you seriously tell her that she isn’t?

I really think that height or weight are much better traits to use as a comparison, rather than race.

If I as a 6’ tall 75kg man were to claim to be 350kg and 4’3" tall, the police or my employer would still put my *biological *height and weight on any records. They would not be obliged to provide me with access to facilities reserved for midgets or the morbidly obese. And nor should they.

But if I want to be called a woman, for some reason everybody, including the police and my employer are obliged to act as though my mental divergence from reality was true. They are obliged to provide me with access to all the facilities and programs reserved for women. They are obliged to record my sex as female on all paperwork.

It’s bizarre. If my mental state is incongruent with reality, I don’t see why anyone should be obliged to provide reinforcement to my divergence. No do I see why I should be offended when someone point out the fact that I am a tall, skinny man and not an obese female dwarf.

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Let me put it this way:

Imagine everyone is given a cat or dog to look after. And say virtually all men prefer dogs and virtually all women prefer cats so historically they’ve been distributed on gender grounds.

Now, if you were a man in this society, but liked cats more, does that make you mentally ill? No, of course not by any conventional definition of the term.

What about if you inform society: you request to be given a cat rather than a dog? No, still not mentally ill.

Now say in this society it is not just a matter of cats and dogs but what colour pen you write with, whether you have tea or coffee, whether you paint or wallpaper your walls etc. And for whatever reason many of your affinities line up with what is expected of the other gender.
Would it be wrong to say “Hey society, by default treat me like the other gender please”?

Now obviously our society and our treatment of gender is not as black and white as in this hypothetical. But it’s also far from the case that our society treats both genders the same.
And in any case, if we did treat both genders the same “Treat me like a woman” would still not be sexist; it would just be a pointless request.

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However, gender roles are loose enough that there’s nothing wrong with being a girl who likes to play football and toy guns and a boy who likes to play with dolls and watch Hannah Montana.

Society should accept that boys and girls will do whatever they want. What society cannot accomodate is boys wanting to use female facilities even though they have a penis. At some point, you’re just denying reality. Even if you insist you are a female inside, if you’ve got male parts then you need to use facilities made for your parts. And use them with people who also have your parts.

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Which is where it all falls down of course.

Firstly, transgenders don’t say “Treat like a man/woman”. They say “I *am *a man/woman”. And they (or the ones I have met or heard of) become offended and irate if anyone says “Sure I’ll treat you like a woman, but you’re really a man with his penis amputated.”

Secondly, most people don’t specifically treat women/men in any way. “Society” may do that, but “people” treat an 18 year old woman very differently to an 18 year old man. They treat a conservative professional man very differently to the way they treat Charlie Sheen. The point being that people don’t treat people “as women” they treat them as a type of woman. But transgenders, especially younger ones, very often don’t fit into any type for obvious reasons. As such it’s impossible to actually treat them “as women”. All anyone can do is treat them as a type of woman which they are not, rather than treating them as a transsexual man.

Thirdly, you are asking people to go out of their way to reinforce your divergent view of reality. You aren’t asking people to treat you as a transsexual male, which you are and what they will naturally treat you as. You are asking them to constantly check the behaviour they are comfortable with and that conforms with reality in order to reinforce your fantasy that is at odds with reality. That is pretty damn rude.

If I asked people to treat me like a fat person by, for example, not walking within 6 inches of my skin because they will be bumping into me, I would be told to go take a jump. Nobody is going to constantly go through mental gymnastics of that sort just to cater to my delusions. Yet by asking people to pretend you are a woman when they can see you are a man, that is precisely what you are doing.

And finally, while it is not wrong to say “Hey society, by default treat me like the other gender please”, it is also not wrong to say “Hey, individual, accept your biological sex please”. Neither of these positions is inherently more right or wrong. They are both just asking people to act in a certain way. Whether people will agree to the impost is entirely a personal choice. Under some circumstances it would be reasonable for wither party to say “No, sorry, I wont”.

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Nor is there anything wrong with asking to be treated like the other gender, unless we’re holding transsexuals to a higher standard of gender-less language than the rest of us. I presume you’d have no objection to someone saying “Many of my affinities / dispositions would be typical for a woman, but atypical for a man. Where differences exist, please treat me like the other gender”.

Someone wandering into the mens toilets in women’s clothes, maybe with makeup, fake boobs etc is going to get a lot of funny looks and may feel uncomfortable.
Depending on their specific appearance they may get funny looks in the womens toilet too, but they’ve got to go somewhere.

And it sounds to me like it irks you that this might happen.
Why is it so important that they go to the right toilet?

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Funny looks is one thing. Actually causing females to feel threatened by a male is a case where women’s rights and transgendered rights come into conflict.

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I disagreed with Cecil’s conclusions in this column. He and I had very many conversations over how to interpret the problem of high drop-out rates. I believe there is a preponderance of evidence, despite the dropout rates, to err on the side of “hormones/SRS are good and proper treatment.” Later on I intend to post some of my citations to support my position.

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If it affects your sensibilities so much, maybe we should publically request that they say “I feel as though I am a woman; my affinities are typical for a woman but atypical for a man”.

But personally I don’t care. The distinction seems clear cut now while we don’t have clear models for how this works in the brain. If we later find a gender identity switch in the brain, and find some people have the wrong switch, then for at least one aspect of gender their gender is the opposite one: the aspect of which gender identity switch.

Agreed. But this still doesn’t invalidate the request “treat me like a woman”. It’s asking you to try to treat me like a woman, rather than having any expectation that you can 100% succeed.

Yeah they’re so in your face with it. The number of times I’ve had a transsexual get me in a headlock and refuse to let go before I acknowledge that they are biologically the other gender, it’s appalling.

I don’t know what accepting one’s biological sex actually means in this context. If you mean accept what your chromosomes and physiology are then the vast majority of transsexuals are there already.

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Agreed.

If you’re transsexual and have dressed like the other sex, have hormone treatment and maybe some of the ops, then you’ve got quite a problem when it comes time to use the toilet. I doubt many relish the prospect.

And when I said funny looks I actually meant feeling threatened also. So you’ve got a choice between feeling threatened and making someone else feel threatened. I guess you could say that one difference is that the transsexual knows that they are not going to harm anyone, whereas they do not know that someone in the gents toilet will not harm them; so they choose the physically safer option.

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I have no problem with someone saying that.

Do you have a problem with someone saying “Many of my reactions / dispositions towards you would be typical of my reaction to a a man and atypical for your identity as a a woman. Where differences exist please respect my socially and biologically derived reactions.”

This is, IMO, the heart of the matter. The respect has to go both ways. While its fine to ask someone to treat you in a manner that is at odds with reality, it is must also be fine for them to treat you in a manner consistent with reality. Nobody should be obliged to reinforce someone else’s fantasy or be labelled a bigot.

Wouldn’t good manners dictate that they *not *make others feel uncomfortable by breaking social mores if it can be avoided?

Imagine, for example, I took a plastic bucket into the toilets and shit into it in the middle of the floor rather than in a cubicle, all the while proclaiming in a loud monotone “They live in the sewers. The horror, the horror”. That would be perfectly legal, but you would sure feel uncomfortable if I did it. You would have every right to ask me not to, and while I could certainly say “no”, I think we’d all agree I was being rude for doing so.

Humans aren’t machines. People breaking cultural norms in an attempt to deny reality makes us feel uncomfortable. It’s not the mark of a jerk to ask one individual not to do something that makes a majority feel uncomfortable.

While I certainly have every right to say “I’ve gotta shit-in-a-bucket-while-muttering-about-the-eldricth-horrors-in-the-sewers somewhere”, it’s not really much of a response for what is a purely volountary action.

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Assuming for the sake of this discussion that transsexality is a mental illness, for me the question then becomes how can we best alleviate this person’s suffering?

Can we cure this mental illness? No.

Can we dispense some medication that will put this mental illness into remission? No.

Then the question becomes “does sexual reassignment treatment result in happier/more functional mentally ill human beings?” Note I said treatment, not surgery. While the surgical treatments tend to attract a lot of attention a lot of transsexuals stop at hormone treatments or something else.

I honestly don’t know if this results in happier long term results. It seems to in many cases, but perhaps those happiest talk most about it and those who it doesn’t help don’t talk much, attempt to get it reversed, commit suicide, or something.

It seems from my very much an outsider’s viewpoint that SRT (sexual reassignment treatment) that is successful enough that society starts to react to/view the person as their believed gender is what is most important for the transsexual. They want to be regarded as that gender in social contexts as much (or perhaps more) than a sexual context. If that actually improves outcomes - as I said, people happier, more functional, less depressed, etc. - then it would be cruel to deny it to these people for which we can no nothing else to alleviate their condition.

Getting back to believed-to-be-Napoleon: if the wannabe Napoleon, when deigned his costume, hat, etc. is a very unhappy, agitated person, attempts suicide on occasion, etc. but when allowed to dress as Napoleon becomes calmer, happier, more cooperative, able to hold down a steady job, stops self-harm then I would argue it’s less harmful to allow the costume and call the person “Nappy” than to force the person to live in a continually agitated and miserable state. It may not be the ideal situation but we don’t live in an ideal world.

So I would argue that SRT is needed for harm reduction.

That said, I’m not entirely convinced this is a mental illness. I’ve known several transsexuals who were born intersex, but weren’t in the habit of informing everyone they met that they were born with ambiguous gender. Nor should someone be forced to issue a full disclosure of any and all medical problems/issues every time they meet someone. It’s no one else’s business. I’m aware not ALL transsexuals were born intersex but it one reason some people want SRT and you can’t tell at a glance who falls into that group.

I also want to point out that a boy/man who likes to dress as a woman is NOT automatically a transsexual. He’s a transvestite. He may be straight or gay. Most of them are perfectly happy being men and have no desire to be a woman.

20

Nobody mentioned offended sensibilities, but hey, if you need to find some snarky way to imply that I’m a prude for refusing to agree with statements of fact about the world that are at odds with reality, go for it.

When a poster has to resort to this sort of ad hominem, his position has become pretty damn weak,

Agreed, and the request is precisely as valid as my request that you live according to the word of God. It’s asking you to try to accept Jesus, rather than having any expectation that you can 100% succeed.

I think we all agree that people have the right to make *requests *of this type.

Where the disagreements starts is that some will immediately label me a bigot if I respond to the request with “No, your beliefs are at odds with reality and I have no intention of acting as if they are real.”

Yep, your position is so weak that you have to resort to this sort of garbage in response to perfectly cogent arguments.

I point out that it requires effort for people to pretend that someone who they know is a man-in-a-dress is really a woman. No reference whatsoever to anyone being "n your face ". And you come up with this crap.

Nice. Well done.

So you believe that most transsexuals with XY chromosomes and a penis and testicles accept that they are men?

Cite! Because the link adaher posted earlier, the story here and thousands of other stories all say differently.