Are Transsexuals Mentally Ill?

Cecil's Columns/Staff Reports
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The question or dilemma of fixing the mind versus fixing the body with the transgendered is one which I recently discovered is quite old. I have read about a dozen books and twice that many journal papers on transsexual history over the last 3 months, and have come across numerous accounts from psychiatrists and physicians from as far back at the late 1800’s, where many times they note the extreme “resistance to cure” of a certain subgroup of “cross-dressers” – namely, cross-dressers who identified as female. In the early 20th century some attempt at pharmacology was attempted to “cure” transsexuals. After Swedish Dr. Jan Walinder found 28% of transgendered persons had “abnormal” EEGs, he came up with the potential for Dilantin use as a “cure.” While he found that one patient who had suddenly developed transsexual impulses after a brain injury was “cured,” US Dr. Harry Benjamin found that Dilantin only seemed to “cure” cross-dressers, not “true” transsexuals. Antidepressants generally do very little to cure the transsexual drive and gender identity, nor does ECT.

The philosophical question is both interesting and troubling from some standpoints. Allow me to provide my interpretation of it. In effect, what we’re saying is this:

  1. Transsexuals typically require lifelong hormonal treatment and often major surgery to lead mostly happy lives.

  2. This is a negative thing, and it would be better if the mental gender could be aligned more with the body gender.

  3. Therefore, a hypothetical pill which did such would be a net positive.

Now a very closely-related hypothetical situation involves that of lesbians and gays, especially as there has been some recent evidence that the potential for lesbianism might be prophylactically preventable in the womb. In past discussions on the SDMB the argument is made that being lesbian and gay is not a negative thing, and that to have a “magic pill” or other means to “cure” homosexuality is at best misguided and at worst a eugenics program.

The argument changes, however, when transsexuals are considered - lesbians and gays generally do not need any hormone treatment, nor any surgery, (barring incidental cosmetic surgery they may desire) to be happy. Whereas transsexuals will almost always need hormone treatment to be happy, and very often will need surgery. Despite that difference, however, it still begs the question of whether the “cure” pill does become a eugenics program to remove “undesirable” elements from humankind. Some may argue that it’s no different than if one was able to cure diabetes.

I know a lot of transsexual and transgendered persons. As in, scores of them. I talk to them every day – I’ve been messaged by 4 girls this morning alone. And I’m known as “that lady” who keeps bringing up these deep questions, and I’ve asked what transsexuals would think of a “cure” pill. More than half think it’s immoral and demeaning to consider their transgendered selves to be needing of being removed that it must be “cured.” Many fear that the presence of a cure would remove any choice in the matter – that our hystericalyl transphobically-terrified society of 2012 would make it not an option, but would force, by court order if needed, this eugenics program. A large majority feel that transgendered persons are intended to exist, despite the anti-evolutionary implication, and that transgendered persons give a wonderful variety and have a unique cultural significance which is valuable. Maybe a quarter of the transsexuals I speak to are just very uncertain. And a significant but small number are of the attitude “I don’t care what gender I end up as, I want to be happy as that gender. I’m a female assigned male and I want to be female. But if I was male and assigned male, sure, I’d have been very happy.”

My personal opinion is I oppose “cure pills” in principle, and would never take one myself, but also very well understand the incredible inconsolable sadness of being transgendered, and can well understand why some – maybe more than think they would – would actually embrace a quick and painless “cure.” Being diverse is one thing; a lifetime of suffering is another.

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The thing that bugs me about all of this is that, if transsexuality* is a mental illness, it is not the difference between one’s sex and gender that makes it so. Think about how mental illnesses are defined. There are two different types of mental illness, those defined by thoughts that, while they don’t cause distress, cause harm to others, and the one defined by distressing thoughts that one cannot cope with. transsexuality does not harm anyone, so only the second definition can hold.

But which thoughts are the distressing thoughts? It’s not the thought of what gender they believe they are. It is the thought of their sex not matching their gender. That’s the distressing thought. So what would the purely mental cure be? It would be to stop feeling that one’s sex should match one’s gender. It would be that our idea of gender and sex roles are wrong as a society.

Yet, when we talk to people that consider transsexuality a mental disorder, what do they always think the problem is? They think the problem is that these people really are the gender their sex implies. That makes no sense if they thinking it is a mental disorder. What they want to do is change the identity of the person to an identity that the onlooker is more comfortable with. When do we do that in any other circumstance?

It all boils down to “I want to change who someone is at a fundamental level because I am not comfortable with them.” You think you have the right to change others. you want to brainwash people into completely different identities because their very existence causes you problems. How is that different than wanting to paint a black person white because their dark skin offends you?

One thing that is apparently unique about me is that, even back when I was a homophobe, I still respected trans people. The idea of not respecting them seems so weird. These are people in such mental torment that they modify their own genitals, the second most precious organ on their bodies, to fix the problem. They take hormones opposite their sex, which I know from experience make you feel like crap. Someone who is hurting that bad who finds something that solves the hurt without harming anyone else–how in the world can I be down on them for that?

I mean, at least they were honest, unlike transvestites, who, at the time**, I thought the Bible commanded me to hate.

*Because there are dueling terms, and I’ve found that someone is always offended whatever term I use, I’ve decided to use transsexuality for its literal meaning. Trans- means change, and sexuality is what is being changed. Using transgenderism would imply that you are changing your gender, which is not what I am discussing.

**Please notice the bolded, underlined italics. I don’t think that way anymore.

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There was a person on another site who was a MtF transsexual pre/post operation who fielded questions on the subject.

IIRC it works like this, up to a certain point in the womb all foetuses are female (which is why men have nipples), then hormones come into play and the genitalia grows outwards (male) or inwards (female), and that males have XY in their DNA and females have XX in their DNA.

However it is possible for an XY to be born with full or partial inversion of the scrotum and penis, giving them female genitalia and feminine gender. And the same can happen with a XX being born with full or partial meat’n’two veg genitalia and a male gender.

(I hope I got that the right way around!)

Upshot was, you can be born into the wrong body [genitals] for your chromosomes.

Also I saw a programme on TV years ago about people who were of indeterminate sex, having neither fully male or fully female genitals. Basically they lived as either male or female depending on whether they were raised as, or what they chose to be later in life. They were all infertile, and could have operations to “sort out” their genitals so they appeared to be whatever sex they said they were (or wanted to be)

It’s not the same as body dysmorphia - and I’m thinking particularly of a woman who hates her legs so much she’s been trying for years to get a surgeon to amputate them - IIRC the transsexual had to undergo years of testing, and psychotherapy, as well as having to live as a woman for a year before she was considered suitable for the operation.

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It seems to me that transgenderedness is an obvious handicap. You went through the reasons yourself. Whether it is a defect in the brain or body is irrelevant to this point.

For most handicaps, the questions surrounding a cure don’t even come up. No one suggests that a cure for paraplegia is a eugenics program, even though paraplegics have a robust community and some or many have internalized their handicap so that it’s a part of them. It’s still obvious to most that a cure is desirable.

Then again, there are situations like with the Deaf community. I don’t know that any hearing person is able to view deafness as something other than a handicap and that a cure is immensely desirable. But at least some that identify as Deaf believe that it’s not a handicap at all, just an alternative way of living. These people are welcome to their opinion, but it’s not really a supportable statement.

As you say, homosexuality is a bit different in that it’s possible for them to live perfectly normal lives in the right situation. In some times and places it is a serious handicap, but today it is not and there’s little reason for a “cure”.

At any rate, I think the question will be resolved once medical technology reaches a certain level. We’ll detect transsexuality at or before birth, and resolve it one way or another: physically or mentally, whichever technique is developed first. There won’t be any transexuals; only people that had a small birth defect that was corrected immediately, just like people with cleft palates or other defects. Hopefully we can treat the existing transexuals well in the meantime.

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I don’t know how many people on this Board are actually Transexual themselves. But I read and see alot of posts and some of them have some good points to it. All I can say Is, I’m just a girl,thats all,a girl. All I want out’ve life is to just live normally and do the things normal people do,thats all. I’d like to have a job,have a relationship and go out to movies,maybe a resteraunt here or there. I’m just a Normal Person and thats all I want,to be treated normal. I’m a human being,I still have feelings just like everybody else,I bleed like everyone else,I cry like everyone else.I’m not different then any other girl there is. Yeah I understand that cisgender people have a fascination on the genitals. But honestly there’s more to being a woman then just your genitals,lets be real. Anywhere I go people see a woman, nobody really knows any different unless they were to see me naked. So I really don’t know why people make such a big deal about transexualism,I wish they didn’t but cisgendered peoples fascination with it and insistance that its a big deal is actually ruining my life

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I think you’re wrong. First, lots of hearing people are able to view Deafness as more of a cultural signifier than a handicap; not surprisingly, these tend to be hearing members of the Deaf community, like children of deaf adults (CODAs) and interpreters.

Second, it is supportable. Many Deaf people value silence highly, and rebel against the notion that to have the ability to hear is more desirable than to be able to shut out all noise. And of course, due to the communications difficulties between Deaf and hearing communities, Deaf people have developed their own culture, which is at risk if deafness becomes vanishingly rare.

That’s not to say I support some of the more extreme views, such as those that compare getting one’s deaf child a cochlear implant to intentionally inducing deafness in one’s hearing child.
Powers &8^]

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Fair enough. But I hope you’ll agree that they’re a special case. What about those with no prior connection to the Deaf community?

I can shut out all noise if I want. A deaf person has no choice.

To be honest, I’m never impressed by these strange side benefits that people trot out in conversations like this. I’m sure many paraplegics gain massive upper-body strength by wheeling around all day, too. It just seems like a non sequitur.

Yes, but cultures develop all the time around handicaps. Lepers developed a culture. That doesn’t mean it wasn’t right to cure them.

Deaf culture deserves to be recorded, and it currently still has a place in society. That doesn’t mean its existence outweighs the negatives of deafness, and that we shouldn’t cure it once we have the ability. Same as transexuality or any other handicap.

BTW, obviously I don’t support imposing a cure on someone that doesn’t want it. There are some for which the cultural, social, or mental displacement would be too hard. I’m only saying that the existence of a culture should not stop us from developing cures, and we certainly shouldn’t think of a cure as a kind of eugenics program.

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Many interpreters have no prior connection before choosing to go into that line of work. They learn, so there’s no inherent reason why other hearing people cannot do the same.

Not really, or at least not without a lot of expensive preparation and limited mobility. Noise-cancelling headphones are not perfect, and sensory-deprivation chambers are stationary.

It’s not. To them, it’s not a strange side benefit; it’s a way of being. They literally cannot comprehend being assaulted with constant noise all day and all night. They extoll the virtues of silence because it’s their natural state.

Would they feel differently if they had the experience hearing people have with sound? Very possibly. I can’t say I’ve ever put much stock into the argument. (I once had many a discussion about whether deafness was a disability or not, with me taking the side that it is, simply by definition, but I’ve never seen the word ‘disability’ as inherently pejorative.)

But it’s important to recognize that Deaf people simply don’t see it that way. If anything, they see hearing as a disability. (Or claim to; I suspect most such claims are rhetorical, but sometimes I wonder.)

This is a difference of degree. Plus, lepers were forced into the fringes of society by others, not by choice.

And you’re going to have to support the “all the time” claim. There is no “amputee” culture or a “blind” culture… not anything close to resembling the scope and importance of Deaf culture, at least. The closest possible analogue is actually GLBT culture (though I hope we’re agreed that those aren’t really disabilities), though GLBTs don’t have the language component to help define their culture.

Deaf culture has formed around a shared language that separates them from the larger culture around them. That makes deafness unique among disabilities, and puts Deaf culture in a unique position that can’t really be compared to other disability communities.

Well that takes us back to what this thread was originally about. =)

Anyway, I tend to agree that a cure is probably desirable, but it’s not as clear-cut as you seem to think.
Powers &8^]

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http://news.yahoo.com/blogs/abc-blogs/transgender-student-womens-locker-room-raises-uproar-221516308--abc-news-topstories.html

As sad as the article is, the comments are worse. They clearly illustrate just how far we have to go on this important issue.

The big question for me is this: How is it that I, as someone who has never had any real exposure to any transgendered person, am capable of understanding why we need to accommodate transgendered folks, while so many many others are not?
Powers &8^]

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That does raise an interesting question: just what is the purpose of having sex-separated locker rooms? Is it to prevent the separate groups from being exposed to the alternate genitalia? Or is it to prevent others from staring at your genitalia?

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I think the latter. Especially as men are recorded as committing more sexual assaults. As a child I always changed in a curtained segment of the changing room. I remember once my father didn’t come to the swimming pool and I was taken by my mother into the woman’s changing room, so I hid in a corner.

I guess the comfort scale is from “getting changed in front of a fellow woman” to “my young daughter changing in front of a strange man”. Female changing rooms probably have other facilities too, like additional hair dryers. The solution is probably to have a communal changing room with many additional segmented zones for the young and neurotic (like me :)).

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I won’t comment on the story you linked to; I wrote a technical paper analyzing that specific issue and don’t want any cross-linking between online and professional life. But it’s basically the usual “transgendered toilet threat,” driven partly by people who are trans-unfriendly, and partly by the innate squeamishness of America society for anything nudity-related.

Well…playing Devil’s advocate here, it is possible your opinion could change when faced with an actual transperson…

However, IME in most cases a person who is trans-unfriendly is faced with a real life living, breathing transperson and can see how serious they are, and talk to them, and maybe understand a bit more of what they have had to go through (and what still lies ahead for them), the experience has been positive and resulted in greater understanding, in some cases a sea-change to complete acceptance. Once folks realize that these are real people who are dealing with an enormous fuckton of shit and doing the best they can - and not sex deviants trying to peek under their toilet stalls or grab guys penises and spirit them away - then understanding and acceptance usually follows.

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I would assume both…? For example, I personally don’t want anyone of either gender who I’m not intimate with, or not working in a doctor-patient relationship with, to see my naughty bits. I’m an old prude on that subject. Am I offended by seeing others? No, not in the least, although I would politely turn away if I accidentally saw someone, unless I knew they were cool with being seen - just out of being polite for their feelings.

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Again, it’s partly just what one is accustomed to. I never had a pet growing up, so it happened that I was twenty-two the first time I undressed in front of a cat, and that felt strange at first.

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All I think it takes is having felt like an “other” before and being able to generalize that experience. Sure, they may not understand as deeply as someone who actually is friends with a trans person, but it’s not that hard of a concept, once you assume that they have a right to be different than you and thus you need to consider what they say. The arguments trans people make make perfect sense if you aren’t predisposed to not believing them.

As for the locker room or bathroom thing, I think it all boils down the same fear of rape. Nudity equals sexuality, thus looking at you naked is sexual. And someone who looks at you sexually is a potential rapist.

Then again, I think homophobia is partly (an irrational) fear of rape, too. Guys feel uncomfortable with the idea that other guys might find them sexually attractive, which is rape related due to the reason above. That’s not a mainstream position, so take my opinion for what it’s worth.

(The other part is fear that they themselves might be gay.)

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It’s not? What is the mainstream position?
Powers &8^]