Are Transsexuals Mentally Ill?

Cecil's Columns/Staff Reports
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In theory, we can project some future date where brain function is so well understood that the nature of identity can be mapped and analyzed. With that level of understanding of things like self identity and what makes us think this way and that, it might be reasonable to start asking the question of how does gender dismorphity arise. It might be possible to assess a person early, figure out where a hormonal path goes left when it should go right, or where a gene missed a cue and didn’t fire, or whatever. When we have that detailed level of understanding, we can reevaluate what it means to be trans, and what the best solution to the problem is.

Right now, we do not have the kind of information to assess the problem to that degree. We have a condition - people’s self-identity does not match their gonads. We have clinical history of trying to approach it via therapy and retraining to alter the self-identity. That is very low success, poor outcomes, and generally unhappy patients. We have an alternate approach - use hormones and perhaps surgery to alter the body to our best ability to match the self-identity. The statistical results are far better for this course of action.

How is it really a burden on society for us to recognize people have a problem, recognize a solution that gives the best outcomes with the information and techniques we currently have, and allow people to choose their outcome?

Most rejection of the concept comes from ignorance and fear.

Fear that the person might “pass”, that somehow you’ll wake up one day and be in bed with a penis you didn’t see coming. The Crying Game effect.

Fear that somehow someone going against “biology” will cause the downfall of society.

Simple pigheaded ignorance that another person’s genitals are more important to me than what is in their head.

I can say that I sympathize with stevenova. I’ve been there, I’ve had those thoughts. What I’ve come to realize is that my personal comfort is really not relevant to that person’s life.

Seriously, we’re able to get over race and color, we’re able to get over dwarfism, we’re able to get over homosexuality. Get over transgender, too.

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Your post raises good questions but I don’t see how the bolded part is relevant. This thread is about sexual identity, not sexual orientation. Conflicts in one or the other or both may exist in a given person.

I myself do have a hard time imagining how sexual identity could be so important to warrant surgery. I think: suppose I woke up one day with my genitalia swapped. An alien announces to me that the conversion is perfect, and my new equipment works as well as anyone’s. Further, the brains of my friends and family have all been subtly altered such that not only do they accept my new identity, but they believe my identity is what I have always been. My SO still loves me and I am told that childrearing will not be a problem (via unmentioned means).

About the only emotion I can conjure up is supreme annoyance. But I’m pretty sure after a while I would just go with the flow. It wouldn’t take that long to figure out which bathroom to go to. I doubt I could ever be a “girly girl”, but I’m fairly certain I could pass easily enough and quickly reach the point where I no longer thought about it much.

Of course, I’m not trans, so I just can’t really say. I just wonder if there’s a spectrum of how tied people are to sexual identity, and that trans people require not only a mental/physical mismatch, but a very strong sense of identity that amplifies this mismatch. Perhaps not everyone has this strong sense of identity.

I also wonder how this would manifest in a world where boys doing “girl things” wasn’t looked at so harshly. For some reason, girls can act as tomboys without too much problem, but the reverse doesn’t seem to be true.

Disclaimer: I’m fine with treating trans people however they wish. But it’s just out of politeness and humanity, not out of any kind of understanding of their mental state.

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I agree with others that this truly is a fascinating thread. I’m learning quite a bit, but I’m not there yet in really understanding this.

If the transgendered members and others in the know would indulge me by answering some questions, I would appreciate it. I have always been the inquisitive type, so I am curious about getting to the base of this.

  1. What specifically makes you think you are the opposite sex? Is it about wanting to dress certain ways, feel, act, look?
  2. Given that gender roles have relaxed in the last few decades, especially for women, why do you feel you need to become the opposite sex (as opposed to the gender that your body says you are) and take on a whole new identity in order to be the person you want to be?

And a question for those who know the stats (forgive me if I missed it): are there more male to female transgendered or more female to male? And if there are far more of the former than the latter, do you think that says anything important?

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If there were a pill that would correct the defect and made your mind accept the physical reality, would you aprove of it as a method (not necessarily in your case) but as a general rule.

“People like you” is an interesting term full of ignorance, you know nothing about me. At least ask before accusing, especially on a thread that’s supposed to be about tolerance.

If surgery help the outcome of a person’s life (while not correcting the underlying problem) I agree it has to be considered. However it is telling that for everything elese in the body image department surgeries are considered only last resort or unnecesary. Also telling how you dismiss eating disordes as simply fear.

Would you recommend surgery (implying cutting out parts or modifying them sinficantly) on all cases were the outcome would be positive? Even if it means amputatin, let’s say, properly workin fingers?

“Unchangeable” is, at most, a present reality.

If surgery works to improve outcomes, then it should be considered. The problem is that the underlying condition is not treated. We alleviate the symptoms.

Ignorance? No, not in my case at least.
Fear?
“Waking up with..” is as likely for me as being named starting QB of Montréal Alouettes and at the same time receiving the Nobel Peace prize for giving my kids a schedule to use the Wii.
By the way, public bathrooms aren’t a fear either.

“Downfall of society” is always a silly argument. Slavery was a reality of basically all societies in the world for thousands of years and didn’t cause ther downfall. And even if you said “US Civil War” I’d say that a result 4000 after the fact is “never” for all practical purposes.

Aside from my wife and my kids, other people’s genitals are usually none of my business

I don’t have to get over transgendered people even if this thread is about transsexuals.

In the end, I see a lot of posturing about sex/gender while still using the only biological reality: men and women. This dychotomy is only real in biology and if gnder is a persona construct, it should not be bound by it.

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This is also true of eye glasses, anti depressants and all other psych drugs and a whole buncha other stuff. What’s your point?

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I dare say, but as long as we don’t have magic gender/identity/orientation pills to do experiments with, Occam would seems to suggest some kind of linkage.

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There’s a linkage, no doubt, but the concepts are still orthogonal. This is even more obvious now that homosexuality is fairly accepted in many places–a biological male may well pass as a homosexual until such time as they come out as a heterosexual trans woman.

Even without magic pills, we could learn more if there were more cases like that of David Reimer. The evidence certainly indicates that *some *people have a very strong sense of sexual identity separate from external characteristics and rearing. But I don’t think there’s enough data to suggest that the effect is as strong in everybody.

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Short-sighted people do not have an identity problem. They do not have a birth defect that says “people tell you things are not blurry, your mind tells you different, ergo they are wrong and judgemental”. They also not locate their identity with their wrong-working eyes.

People with clinical depression, have a problem with reality. We correct the biochemical problems that cause that, we don’t lobotomise them or whatever so they can live better while being depressed.

209

You are writing English words but they make no sense strung together in this fashion. What are you saying?
Powers &8^]

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Our society also doesn’t have different restrooms for near sighted folk. It DOES have different restrooms, clothes, and cultural expectations for men and women. Hell, before ultrasound, the first question parents would ask about their newborn child was ‘Is it a boy or a girl?’

No we don’t lobotomize them- anymore. We used to. Then we learned a lot more about depression. Just like we used to try and force tranpeople to conform to their genitalia until we learned more about the condition.

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Stats on the occurence of transsexualism vary widely; the most-accepted stats are about 1 in 10,000 for male-female, and 1 in 35,000 for female-male. That same 1:3 to 1:4 ratio seems to hold mostly true regardless of the absolute numbers.

A common theory is that the number of diagnosed transmen is much lower than transwomen due to the fact that a woman can be very masculine, wear masculine clothes, have only male friends and do “guy stuff” and no one bats an eye. So some transmen are just very masculine-acting women who are in stealth mode.

However, thanks to the crippling hysterical homophobia which makes up a foundation of American culture, men can’t be “stealth” women nearly as easily.

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Very simple, sorry to have used big words.
Sex - Biology: Men - Women
Gender: Even though it’s supposed to be a personal construct it is always experessed along the man-woman comparison or a continuum. Why would gender nned to be along those lines?

Bathrooms are not a cultural expectation.
“It’s a boy or girl?” is not a cultural expectation, it’s a biological reality.
Different bathrooms, clothes are cultural but based on biology
Lobotomy is closer to sex-reassignment surgery than pills.
If you mind interprets reality incorrectly, changing reality doesn’t chane your mind (and the mind is the problem).

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Why do you insist that genitals are the end all be all of sex? Why do you ignore the cases of ambiguous genitalia, the intersexed, and the neurological evidence for a sexually dimorphic brain?

I may have asked this before but-

If I transplanted your brain into the body of a woman, what would you be?

If I transplanted your brain into a chimpanzee, what would you be?

If I kept your brain alive in a jar, what would you be?

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I have no idea, but if you have to resort to these examples, I must be doing something right.

Hey, if I did a hemispherectomy on your brain and transplanted one part to a bonobo, are you know two people?

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If ignoring evidence and dodging questions is ‘doing something right’, then you sure are!

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“Female” is the default human form – all human fetuses start out with a female body plan and it requires the input of a functional Y chromosome to convert the body to male (this does happen very early in the pregnancy). If the input does not occur the physical form remains female, which is what happens in complete androgen insensitivity where a person with XY chromosomes does not reaction to androgens: an outwardly completely female form that contains some internal anomalies that, until the 20th Century, weren’t detectable outside of autopsy.

Since male development requires input in addition to the default there are more odds of it going wrong. Also, it seems easier to drop something out of the program than to have something additional accidentally find its way in (which tends to be what happens with the girls, where many defects seem to arise from input of male hormones in excess of those normally found in human females). Thus, when it comes to problems of sexual development I would expect to see more problems with the boys than the girls.

For other types of body image problems alternatives to surgery have a much higher chance of alleviating suffering, thus, surgery is not justified. It is perfectly justifiable to attempt less invasive interventions before more invasive.

There would have to be one hell of a benefit to amputating working fingers to justify such an action. It’s all about risk and benefit. No one here is recommending surgery for transsexuals because surgery is such a wonderful thing, it’s because there are few or no viable alternatives for some people.

Once again, there is too much focus here on genital surgery. MANY transsexuals never get their genitals altered, and it is most certainly not required. ALL transsexuals contemplating gender reassignment therapy must undergo extensive counseling (at least they do in western nations) so it’s not like anyone is proceeding directly to the operating room. Quite a few undergo counseling and hormone therapy, learn to pass in clothing, and are able to be content with that even if it’s still not a perfect situation. No one is forced to undergo genital surgery. It is an option, not a mandate for treating a distressed transsexual. If an individual wants to stop short of that – and there are people who fall into that category – they are welcome to do so and should be supported in that decision.

One reason female to male transsexuals are less likely to undergo genital surgery is because the outcomes for constructing a penis are less wonderful than those for constructing a vagina. Thus, there is less benefit for the risks involved.

If we can’t cure or even alleviate the underlying condition then symptom control is entirely appropriate. If, in the future, we come up with alternatives we’ll revisit the question, I’m sure, but right now all we have is symptom control. As I mentioned, surgery is NOT the first thing considered or offered, even for transsexuals.

We can’t cure arthritis, we treat the symptoms. We can’t cure asthma, so we treat the symptoms. We can’t cure multiple sclerosis, so we treat the symptoms. We can’t cure diabetes, so we treat the symptoms. We can’t cure transsexuality, so we treat the symptoms.

Actually, there is still a role for surgery in the treatment of mental illness. It is rare, and there are tons of hoops and red tape to get through for approval these days, but in severe, intractable, and life-threatening cases it can be considered as an option. You have to exhaust all other options first, of course. It does help some people but the risks are high. Also, these days it’s not an icepick through an eyesocket, it’s much more finely targeted.

Keeping in mind that untreated transsexuality may have a suicide risk of 1/3, extreme measures might be justified.

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I’ve been highly disappointed in the anti-trans commentary on this message board, in this thread and innumerable others. For the most part, it comes down to self-described “smartest folks in the room” reacting with textbook Freudian castration anxiety. “OMG these freaks want to cut off their wangs! But…but…having a wang and being a man is the greatest thing in the universe! We gotta do sumptin’ to stop it!”

I really don’t see anything but backhanded and grudging admission that “yeah, them thar’ trannies might be unhappy,” but all the while that being an intro to “OMG! Someone save the wangs! If I don’t save the wee wangs, who will?”

I want to share something I posted elsewhere for those who are still reading here.

In the book Whipping Girl, Julia Serano wrote of a conversation she had with a straight male friend, who was seemingly trying to trick her into confessing she herself, as a transsexual lesbian, would never dream of having relations with a transsexual – only to be rebuffed by Serano, which leads to a much bigger exposition of trans women in general. I thought this dialogue was touching and inspiring.

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Serano may be showing pride in transwomen, but she sounds like she hates men and maleness (“lame-ass Y chromosomes” for one). That I don’t find touching, especially if one starts out as male. There are times I wonder if some of the body dismorphia “pathology” (for want of a better word) of at least a m-to-f transperson is because they hate being a man (if not initially, then eventually) and all that they believe it entails in society.

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Well since of the two of us, I’m the one who read her 400+ page manifesto/book, you’ll have to take my word for it that she doesn’t hate men and maleness (before she discovered she was trans, she had many sexual and other relationships with men). The whole point of her book is that lack of acceptance of transsexuals is driven largely by a combination of male hysteric homophobia and female self-hatred of femininity. Her rant which I quoted is in the context of a celebration of femininity, and rebuffing a fairly transphobic friend (which begs the question of why they were her “friend” in the first place, but some are just gluttons for conflict, I guess) who was trying to use verbal judo on her to convince her that transsexuals are just “dudes in skirts.”

Where do you read her characterization of her own Y chromosomes as reflecting on you? This morning I thought my lame-ass thighs looked big; are you now offended?

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That argument isn’t really going to work on those that believe that transexuality is just a severe form of body dysmorphic disorder or body integrity identity disorder (a population which, for now, does not include myself). One might equally imagine that dialogue from the perspective of a voluntary double leg amputee: that he is not merely equal but superior to those born without legs, because his act was more brave; and because he has fully embraced his amputeeness, while those born with the handicap take it for granted; and further, that voluntary amputees a simply badass for their courage.

The analogy might fall apart had the author not likened femininity itself to a handicap–but that view seems required for the dialogue to be compelling in the first place. I don’t see how it’s supposed to work on the “unconverted masses”.