Mental illness is a fine term here on the forums but has no real meaning technically. I don’t bring it up typically in discussions like this because I don’t have any specialist knowledge but after retiring from the Army I worked for the Virginia DBHDS for five years (Department of Behavioral Health and Developmental Services), I worked more at a program / operations management level mostly dealing with things like resource allocation and Federal grant writing. To do that I had to get familiar with the lingo but I’m totally not a specialist with any special knowledge in that field.
I only bring it up now because in terms of treatment, my department and similar departments in most States have by and large mapped major treatment service groupings into AXIS I and AXIS II diagnoses. By and large people with AXIS I diagnoses receive “mental health services” and AXIS I diagnoses are mapped typically to the sort of thing random people think of when they hear the word “mental illness.” (Basically psychotic disorders like paranoid schizophrenia, mood disorders like bipolar disorder, anxiety disorders like OCD, sleep disorders like narcolepsy etc.)
You can quibble about whether a given AXIS I disorder is a mental illness or not, for purposes of services that distinction is not made and the DSM-IV doesn’t distinguish some AXIS I disorders as “mental illness” and others as “something else.” The DSM-IV to my knowledge (and while I’ve never read it cover to cover I have probably read every page in multiple times) never defines the term either.
Technically, gender identity disorder falls under the category of “sexual disorders” although even in my time no one really knew if it better fit there or fit under “somatoform disorders” with things like body dysmorphia. If you read the definitions of those categories and the definition of the diagnoses you can easily make the argument either way. I actually was not surprised to hear the DSM-V was moving GID to be more akin to a body dysmorphia disorder since the criteria for being classified as a sexual disorder is supposed to include sexual dysfunction and lots of people with GID do not actually have sexual dysfunction at all, but all of them have dysmorphia.
I’d need multiple scientists across a large number of studies with significant peer review that handle a large sample size of persons stating that holistically they found no significant deviations in an M2F brain and a normal, healthy female brain. Anything else and you’re just talking garden variety brain abnormalities or deformity which aren’t so uncommon that we need to throw out biology 101 and start denying the biologic reality of someone’s genitals.
Hell, even if you prove the M2F brain is identical to a healthy female brain (which I do not believe it is, and don’t act like we’re even close to that, do you know how small the BSTc is? A lot more is going on in your head than the stuff in that little speck) I’m still not sure that what makes you male or female really has anything to do with your brain, to me it seems that biologically it is all about your reproductive system.
I am confused here, it is definitely the scientific consensus that gender identity disorder is an AXIS-I DSM-IV diagnoses and falls under the category of “sexual disorders.” We can quibble over the term “mental illness” but most people would use that term for most AXIS I diagnoses in the DSM-IV. When I said I was happy that Cecil had reflected this, I meant I was happy he acknowledge that (however you use the term mental illness) GID is basically accepted as a mental illness.
He went on to basically say he was unsure about the efficacy of SRS and long term happiness rates, which seems reasonable if the studies he was able to scrounge together had low participation rates etc. I see the eighteen cites you posted appear (based only on their titles) to basically deal with treatment of GID. Do any of them actually make conclusions about whether GID is a “psychiatric disorder” or not? If so let me know and I’d be happy to look into that specific citation. But it seems to me the citations you listed, at least based on their titles, aren’t relevant to my point that I was glad to see Cecil reflect scientific consensus on whether or not GID is a mental illness.
Eh, if a study came out tomorrow that the bad effects of certain kinds of depression could be eliminated by removing the subject’s appendix, everyone would be happy and all for the surgery.
But somehow, removing a penis makes everyone go all weird.
The question raised by Cecil’s column is, I think, whether removing the penis does, in fact, cure a certain kind of depression. And the answer seems to be: unclear.
In other words, the appropriate treatment for these individuals is to allow them to transition socially and legally and empower them with the medical resources they consider sufficient to do so.
Something tells me Martin Hyde is unconcerned with what qualifies as a mental illness or the latest iterations of DSM:
Keep in mind, something abnormal isn’t necessarily a mental illness.
Also, I’m pretty sure if it was removing a hand, or grafting some strange alien appendage onto their forehead a lot of people would still be saying “woah woah woah… are we sure there’s not something better here?” The appendix<->penis comparison isn’t really apt, IMO.
Though people have made a good point that the physiological brain is closer to the other gender in trans cases. And that hey, if it works as treatment (which is up in the air), why knock it?
Surgery to correct a deformity, or make a person more functional if it can’t be corrected, has a long history. We don’t tell someone born with misshapen feet they must accept the reality of being deformed, we attempt to either give them functional feet or, in some cases, perform an amputation to make it possible for them to use a prosthesis. We don’t tell someone born with a metabolic disorder they must accept the reality of a dysfunctional body chemistry, we attempt to help them.
So yes, there is a “basic reality” of someone’s genitals, but a person is more than just their reproductive organs. If gender is all about reproductive organs then a woman who has a hysterectomy is not longer female - and that would be outrageous to the overwhelming majority of people in our society.
Castration anxiety.
That’s why some many arguments about this subject get littered with phrases like “amputation” and “cutting off the penis” when, as I have pointed out, many transsexuals never get the genital-alteration surgery. Transsexuals seem much more concern with altering their appearance to trigger a response socially and can be content with looking like their “brain gender” in clothing than what is or isn’t in their pants. Cissexuals focus in on OMG GENITAL SURGERY!!!
Also, saying “chop off his penis” is ignorance at work. These days, it’s much more like they turn the penis inside out, retaining as much of the sexual nerves as possible so the transsexual can potentially enjoy having sex.
On top of which - you can see the fear because this all focuses around the penis - no mention of breast implants, feminizing the face with surgery, and so on. Nor do these folks seem overly concerned with the “bearded ladies”/transmen. Apparently no one gives a damn if a woman “turns into” a man, but it’s the horror of a man becoming a woman!..
Let’s just say lots of people have some issues about sexuality, and not just transsexuals.
Julia Serano writes about this and other things in detail in her book Whipping Girl, a nearly 400-page transwoman’s manifesto. Summarizing her arguments about why men find transsexuals icky and scary and threatening:
Masculinity is the greatest thing in the world. It’s awesome to be a man and cloak yourself in the majesty of manhood. MEN are the most sacred creature ever to grace the earth with the imprint of their size-13 foot.
Transwomen, being (most of them) born XY, have also been granted this gift of manhood from God or Nature.
Transwomen have directly and contemptuously insulted God, Nature, and all men on the planet by rejecting this gift, throwing it to the ground and digging their stiletto heel into it.
In addition, the rejection of the superhuman gift of manhood by an XY male makes other men question the value of this awesome manhood and its associated God-given penis, and it terrifies them.
The fact that a MAN would reject manhood means that they are either crazy, or contemptuous towards men, and either way they should be ostracized or punished. Punishments for transwomen should include verbal abuse, economic and social exclusion, sexual abuse, beatings, “corrective rape”, and murder.
The second line of reasoning why men hate transwomen goes:
Transsexuals might just pass “too well”, and it’s possible that a MAN would be attracted to one of these “freaks.”
This causes the man to question his heterosexuality, and most men are terrified of doing that. Thus, punishment is needed for the transwoman. See above for punishment suggestions!
Gay men dislike transwomen for similar but not the same reasons.
Of course while straight and lesbian women tend to be more accepting of transsexuals, some (many?) have a specific hate towards transwomen. The two prongs of that hate, from Serano, are:
Women have had to form a sisterhood in society to provide them the benefits of emotional, moral, and physical support as an oppressed majority under the thumb of the MAN. Transwomen are a way for MEN to intrude into that last bastion of privacy and support which women have formed. In short, men not only have everything else, they want to take from women one of the last bits of exclusivity that they have. They are interlopers who are stealthily exerting their male dominance over women in their most personal societal constructs, and thus must be opposed.
Transwomen are sexual deviants who could not have a normal relationship or be close to women in a normal way, and thus they are abusing medicine to try to satisfy their deviant urges to be near women in lavatories, etc.
IME everyone I’ve met who is transphobic has ultimately had their argument fall into the above lines. They are no more concerned about the physical or mental well-being of a transsexual and surgical outcomes than they are about what dental floss to buy. Opposition to transsexuals as I’ve witnessed it focuses on either hysteric phallocentric homophobia, or in the case of women fear of “men” in their toilets.
That fact that you believe homosexuality is a mental illness (quoted above), despite what the current DSM-IV says, means that you are in opposition to established practice in the psychological field, doesn’t it?
Why does it have to be so similar? You seem to be placing male and female brains into binary physical states, which I not believe is true even if transsexuals never existed. There isn’t a template for a brain which you can hold up to an MRI or dissection and say “male” or “female.”
And the DSM has been wrong in the past, changing the classification of homosexuality. Relying on the DSM for this argument is starting on a shaky foundation.
I already did the legwork and forked out the cash and conducted more than 40 hours of research on this subject. Perhaps you should read the subset I posted above before we go any further.
I have nothing to add but I would like to thank **Una Persson ** for her contributions to this thread. A lot of well presented information information here. Thanks.
That’s fair enough, but why assume that the mental one is right? Why is clinical depression an issue of errant brain chemistry, but gender dysphoria isn’t?
As I said already, the DSM-IV doesn’t define mental illness, mental illness is not defined by the DSM-IV. I believe homosexuality is a mental aberration consistent with most pop cultural definitions of mental illness. The DSM is about giving physicians the ability to diagnose something, almost overwhelmingly for billing purposes and reimbursement purposes. Since homosexuality does not have any accepted medical treatment and most have come to not view it as a problem it makes sense it wouldn’t be in the DSM.
Obviously the only reason for the DSM isn’t financial, it’s a diagnostic manual, but a psychiatrist really only uses the DSM codes to get justification for the treatment and drugs he’s going to prescribe. A practicing psychiatrist for example knows that a person with “schizophrenia” is going to fall within an extremely wide spectrum and the DSM is really just a rough way of saying “he’s roughly under this category, and people under this category are customarily treated in this way.” The DSM doesn’t actually define the condition, the condition existed before the DSM was ever created.
I’d agree with that, actually. I’d be shocked if there was a template for “male” and “female” brains, but I’m not the one who wants to say a variation in trans men’s BSTc means “they are men with female brains.” Do you think there might be a reason none of the researchers who have looked into the BSTc abnormality in M2F transexuals has ever stated “the subjects appear to have been men with female brains?”
The DSM-IV doesn’t define what is an illness and what isn’t, it just establishes diagnostic codes that psychiatrists are permitted to use when it comes to following accepted treatment techniques and getting the treatment paid for (the overwhelming majority of people treated for conditions described in the DSM receive most or all of their treatment through State or Federal funds.)
Homosexuality falling off the DSM isn’t necessarily proof that it isn’t a mental disorder, but only proof that it is not treated by accepted medical practices as it isn’t seen as a problem.
Now, I think homosexuality is a problem as many homosexuals have a variety of problems. Namely they clearly have sexual dysfunction and delude themselves that various acts with people of the same sex is a form of sexual intercourse when we’ve evolved to reproduce by having sexual intercourse with the opposite gender. Homosexuals also often have various emotional and mood problems along with depression. I think we should be looking into treatments and cures for homosexuality or at the very least let’s understand what combination of genetic or developmental conditions leads to the affliction so we can eventually eliminate it in future generations.
However for political reasons it became unacceptable to try and treat homosexuality, and part of that of course is because the treatments people were using back when it was in the DSM-III were crude, ineffective, and based on grave prejudice. That isn’t a reason medical researchers (away from a clinical setting) shouldn’t be looking for solutions that could make their way back into medical practice.
I have no problem with paying money to get access to research works, I do it all the time and have expensive subscriptions to several databases of such works as well. However you refuted my specific statement that “I was glad to see Cecil acknowledge GID as a mental illness” by saying “I think he was too pessimistic and my eighteen research articles show this.” But upon actually reading the post in which you linked those articles, and the titles of those articles, it appears those articles have nothing to do with whether or not GID is a mental illness. Instead they suggest efficacy rates of treatment options for GID patients.
It’s simply not a honest position to tell me “well, what I’m asserting might be in one of those articles which are superficially about treatment but not about the definition of GID as a psychiatric disorder, but I’m not going to indicate which ones might hit on that and instead insist you fork over money and read all eighteen articles.” I’m sorry but no, you presented those arguments to support a claim before I ever posted in this thread: that Cecil was pessimistic about success rates of treatment for GID. If you now want to say those articles also support another claim, that GID isn’t a psychiatric disorder then you need to actually give some justification for that and specify exactly which articles support that assertion.
Now further, I have actually not specifically said we should never perform SRS. I have said nothing on that topic in this thread, in the past I’ve had different opinions on it but basically ultimately have concluded if nothing else works then it should be used. However I don’t view it as a “solution” anymore than I view a wheel chair as a solution. A wheel chair provides mobility, absolutely, but I still want people looking into a solution for various afflictions that put people in wheel chairs so that some day they can be fully ambulatory without wheel chairs.
What I would actually like to understand is why people do not think it is a psychiatric disorder, what do you think GID is if it is not a psychiatric disorder? Do you think a normally functioning human brain will tend to believe, and truly feel that something about their body is “wrong” and that they are “really” something else? Do you really believe it is more likely that the body is somehow “wrong” (even though its function is perfectly normal) and the brain is right?
For virtually every other scenario like that, except when talking about people who believe they are a different biological sex, there is no controversy: the brain is wrong and objective reality is right. Only when people are believing things in contravention to reality about their sex do we say objective reality is wrong and the mind is right.
Biological sex is not based on feelings or thoughts, it is based on your genetics and your physical attributes. The whole concept of biological sex exists to describe all the physical differences in species with multiple sexes. These differences are almost entirely all physical and relate to physical capabilities and aptitudes.
Humanity is the only species we know of with cognition and rational thought on par to even have issues like this come up, but in human society we have “gender” which isn’t quite the same as biological sex. “Gender” is essentially the acceptable roles and behaviors for people of the two sexes in their given society/culture. Since it is defined socially it isn’t really a biological feature, although just like in some species the female is more likely to raise the children and etc human societal definitions of gender have mapped to some of the behavioral impulses of the different sexes. (And those behavioral impulses are why I say the differences in the sexes when looking at different species are almost entirely physical the behavioral aspect is obviously not strictly physical.)
I think it entirely possible for a healthy human brain to have a gender self-identity in contrast to the social normal. But I do not believe a healthy human brain will insist and believe, against all evidence, that their physical body is of the wrong sex because the whole concept is ludicrous. There isn’t a right or wrong sex, you are the sex you were born as.
It’s weird and strange for a man to dress and act as a woman, but if a man does that because of their gender self-identification, and has no desire or belief that they are “really a woman” then I don’t necessarily think that person has a brain abnormality or a disorder. They’re weird, a little out of sync with society, but it doesn’t “seem” intrinsically abnormal in and of itself. But those people are a far cry from the ones who insist the only way to be normal is to mutilate their genitals.
The hallmark of psychiatric disorders is they cause functional problems, and that is why I can see someone who just likes to dress as a woman being fine and someone who wants to have their penis removed and their pubic region mutilated to give the illusion they are women as having a disorder.
There is a long history of homosexuals being subjected to cruel treatment, abuse, and even being sent to prison for their actions. That is wrong, homosexuality while I believe it should be considered a sexual disorder in the DSM to this day, does not harm outsiders and appears to be mild enough that people with the disorder can mostly live productive and happy lives if allowed to do so. For that reason mistreatment of homosexuals is wrong, but because of this historical mistreatment homosexuals have formed a “community of the oppressed” and have extended that community to include people with GID.
Because homosexuals (understandably) are hyper-sensitive to mistreatment and abuse and discrimination, the ones who are active in “LGBT” issues will be prone to insist that under no circumstances can you think of someone with GID as having something “wrong” with them. These people (and you are obviously one of those people) would probably rationally recognize GID is a psychiatric disorder but you feel that doing so is somehow incompatible with your view on rights for all LGBT people.
I have no such bias, I think it is clearly a psychiatric disorder but I also don’t feel any of these people should be mistreated or discriminated against. It is not a violation of anyone’s rights as an individual to tell them the truth: they are not a woman, they are a man. It isn’t a violation of anyone’s rights or even immoral to say “I hope we can find a cure for this affliction some day.” Especially since I’m not saying “deny them SRS”, I’m saying I consider SRS to be like a wheelchair. It works, but it’s not ideal.
I spent a decade in the S.F. Bay area, so I saw a fair number of transgendered folks, pre- and post- The ones that were happy were the majority. They talked about being women (just didn’t meet many F2M) and how they loved it. They rarely talked about their pre-condition. The unhappy ones almost always talked about being transgendered, even post-op. They were obsessed with being transgendered and I doubt anything could have made them happy. Yes, those folks had a mental problem.
I don’t understand this one. First of all, let me say that I wouldn’t automatically feel threatened if a man entered the ladies room while I was in there. My first assumption would be that he had made a mistake. My second assumption would be that the mens room was unavailable and his need was urgent. I would only feel threatened if there was something in his demeanor that suggested a threat.
That being said, if I as a woman see another person who appears to be a woman, who is acting like a woman (whatever that means!), then I’ll accept that person as a woman. I don’t know what that person might have in his or her underwear and I don’t want to know. Any more than I know whether this female-appearing person has intimate relations with a man or a woman. It’s none of my business.
Why would I feel threatened unless the other person was holding a weapon and giving me a menacing look? And if that was the case, I’d probably feel threatened regardless of their real or assumed gender.
If there’s a continuum of brain morphologies, then when do you stop feeling comfortable referring to someone’s brain as female?
They “delude themselves” that they’re having sexual intercourse? Really?
So do cisgendered people. There is no compelling reason I’ve seen to treat it differently in LGBT folks.
So basically, a roundabout eugenics program to eliminate LGBT?
No. Please review the thread. You posted this, and my refutation is contained in the quote below, from Page 1.
[QUOTE=Una]
[QUOTE=Martin Hyde]
I also most say, it was quite the surprise to see a quote of mine end up in a question someone asked. I am glad my post from that original thread got someone thinking about things, and I’m also glad “Cecil” looked at the evidence without bias and correctly answered the question to the best consensus of current science.
[/QUOTE]
It’s your opinion he looked at it without bias. My opinion is he was overly pessimistic. I offered 18 citations in a post up above which provide support for my opinion.
[/QUOTE]
The brunt of Cecil’s answer was with respect to treatment of transsexuals, not the cause or validity of GID et al.
So on the subject of treatment, I’ve more than addressed that with my lengthy post. I’m not researched enough to debate the root cause and existence of GID at this juncture. Thus I referred you to the articles because I don’t have the time to review all of them again and focus on the cause/validity of GID. That’s not dismissal of you, that’s saying before I get into that subject I need to do some more legwork, and perhaps you can look into it yourself. I believe the topic is addressed in at least a few of the papers, but it is not a primary focus of them.
I’m sorry, but no right back at you. Where did I make the assertion? I quoted what you and I posted above. My post only addressed treatment success, which was the key point of Cecil’s column.
Yeah, I’m inclined to agree. It’s more consistent to make a hard and fast rule that body dysmorphia and identification with the “other” is, well, nuts–whether it’s cross-phylum, cross-species, cross-race, or cross-gender–then to say some cases are OK and some aren’t.
But it’s like Cecil said. Someone who undergoes sex reassignment surgery is not harming themselves to the same degree as someone who cuts off their forearms for some loony reason.
But here’s an analogy for you: Someone who has surgery to change his eyelid shape, or bleaches his skin, out of identification with another ethnicity or race, isn’t even doing himself as much physical harm as SRS would. But, there’s a difference between saying, metaphorically, “I was a Norwegian trapped in a Vietnamese body,” and actually believing that you were always a literal Norwegian trapped in a “false” Vietnamese body. At some point, yeah, there’s some break with reality, and that should be acknowledged, even if it makes some people unhappy.
The concepts of “mind” and “brain” have been used interchangeably in this thread and in opposition to the physical. I would point out that the brain is physical, an organ of the body as much as genitalia. If DNA, genitals, breasts, length of femur, circumference of pelvis, etc. can all vary between sexes and within the same sex, why not the brain?
I was shocked to find out that the World Health Organization classified homosexuality as a mental illness up until 1990!
And the shift in the 70s was due more to activists and protests than the kind hearted nature of psychological associations, I’ve seen a more in depth article on the declassification and there was considerable pressure from outside the field.
I don’t think it means much either way what the DSM says as psychology/psychiatry is as subject to social pressure and bias as any field(I don’t believe homosexuality or transexuality are mental illnesses).
Anyone ever find it odd that at least in the USA at the same time a lot of the public freaks out at the idea of genital surgery, they also would wade through a lake of lava to make sure their male infant is circumcised?
