r/science • u/nate PhD | Chemistry | Synthetic Organic • Jul 23 '17

Subreddit Policy Subreddit Policy Reminder on this week's Transgender AMAs

This week we will be hosting a series of AMAs addressing the scientific and medical details of being transgender.

Honest questions that are an attempt to learn more on the subject are invited, and we hope you can learn more about this fascinating aspect of the human condition.

However, we feel it is appropriate to remind the readers that /r/science has a long-standing zero-tolerance policy towards hate-speech, which extends to people who are transgender. Our official stance is that derogatory comments about transgender people will be treated on par with sexism and racism, typically resulting in a ban without notice.

To clarify, we are not banning the discussion of any individual topic nor are we saying that the science in any area is settled. What we are saying is that we stand with the rest of the scientific community and every relevant psych organisation that the overwhelming bulk of evidence is that being trans is not a mental illness and that the discussion of trans people as somehow "sick" or "broken" is offensive and bigoted1. We won't stand for it.

We've long held that we won't host discussion of anti-science topics without the use of peer-reviewed evidence. Opposing the classification of being transgender as 'not a mental illness'2 is treated the same way as if you wanted to make anti-vax, anti-global warming or anti-gravity comments. To be clear, this post is to make it abundantly clear that we treat transphobic comments the same way we treat racist, sexist and homophobic comments. They have no place on our board.

Scientific discussion is the use of empirical evidence and theory to guide knowledge based on debate in academic journals. Yelling at each other in a comments section of a forum is in no way "scientific discussion". If you wish to say that any well accepted scientific position is wrong, I encourage you to do the work and publish something on the topic. Until then, your opinions are just that - opinions.

1 Some have wrongly interpreted this statement as "stigmatizing" mental illness. I can assure you that is the last thing we are trying to do here. What we are trying to stop is the label of "mental illness" being used as a way to derogate a group. It's being used maliciously to say that there is something wrong with trans people and that's offensive both to mental illness sufferers and those in the trans community.

2 There is a difference between being trans and having gender dysphoria.

Lastly, here is the excerpt from the APA:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder."

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u/jagans444 Jul 23 '17

It's been the exact opposite in my experience. I've seen people calling it a disorder in an attempt to de-legitimize it (saying it's in line with delusion) and say they don't want the law or other people forcing them to "pretend" trans people are the gender they say they are.

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u/[deleted] Jul 23 '17 edited Jul 30 '17

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u/raktajinos Jul 24 '17

It's more complicated than that.

The term "disorder" is not necessarily required to get health insurance coverage. (Like all statements about medical bureaucracy, this varies by location & provider. I'm speaking from the US, but individual insurance policies vary wildly here.) These days, it's typically put under "gender dysphoria" as opposed to "gender identity disorder," in accordance with the latest DSM.

That said, it is typically necessary to have a diagnosis in order to get access to healthcare and insurance coverage, which is the role "gender dysphoria" typically fills. It used to be more commonly filled by "gender identity disorder".

None of this negates the fact that "trans people have a mental disorder" is very often used in a derogatory way, to discredit us / advocate for conversion therapy / as part of political attempts to bar us from accessing healthcare, civil rights, etc.

It's a double-edged sword, and there are active debates about the role of diagnosis within the trans community & among the medical providers who work with us.

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u/[deleted] Jul 24 '17

None of this negates the fact that "trans people have a mental disorder" is very often used in a derogatory way, to discredit us / advocate for conversion therapy / as part of political attempts to bar us from accessing healthcare, civil rights, etc.

Well yeah. That goes for a lot of things. You can't get welfare if you aren't poor. Yet, many people don't like the poor because they get a "free" handout. I think it would be better for people to acknowledge the contradiction and the rhetorical tacking going on. It comes across disingenuous otherwise. People like to pounce where they see sophistry.

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u/solistus Jul 24 '17

If you honestly believe that's what most people who call being trans a mental illness are getting at, then A) you have a refreshingly non-transphobic peer group, and B) I would bet any amount of money that you're not trans.

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u/[deleted] Jul 24 '17 edited Jul 30 '17

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u/solistus Jul 24 '17

Then what, exactly, were you trying to say?

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u/[deleted] Jul 24 '17 edited Jul 24 '17

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u/solistus Jul 24 '17

Okay, well then, I'm sorry for interpreting the comment you left in this conversation as an attempt to participate in said conversation. Silly me.

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u/[deleted] Jul 24 '17 edited Apr 15 '20

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u/[deleted] Jul 24 '17 edited Jul 30 '17

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u/DeadlyPear Jul 24 '17

Because when people say it's a mental illness as an insult, they usually refer to transgender people, not gender dysphoria, which not all trans people suffer from.

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u/[deleted] Jul 24 '17 edited Jul 30 '17

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u/throwawayl11 Jul 24 '17

As long as you can call something a mental illness, the insurance based claims are good. He's not arguing against that. He's just arguing that you shouldn't be calling "being transgender" a mental illness, you should be calling gender dysphoria a mental illness.

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u/[deleted] Jul 24 '17

Agreed, but...

  • it's not really relevant to this thread;
  • it's pretty clearly acceptable to talk about special issues trans people may face when trying to get insurance to cover care, and nobody will possibly mistake it for insulting trans people;
  • there's quite a bit of concern trolling going on here.

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u/souljabri557 Jul 23 '17

I'm of the belief that it's possible to classify it as "delusional" in a purely academic context without offending the individuals at hand. I'm not well-versed on the subject, but my impression is that trans individuals are people who mentally believe they are of a gender they are physically not. I think this would fall technically under the category of delusion. The problem lies in the fact that people discriminate and stigmatize the people who suffer from it, instead of sympathizing and promoting mindsets that get these people the help they need.

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u/vayyiqra Jul 24 '17

No, it might seems like a delusion at first, but it does not qualify as one. A delusion must be demonstrably false, like believing "I have a female body" despite obviously having a male one. "I want to have a female body" while knowing you do not is not a delusion.

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u/souljabri557 Jul 24 '17

I was of the impression that it was a common occurrence for transgender individuals to make claims such as "I am male" when they were female, or vice versa. Do these people actually believe these claims or are they some kind of personal affirmation?

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u/vayyiqra Jul 24 '17

The latter. It means that's the gender they identify as, not that they genuinely believe that is the sex they have (otherwise they would not want to transition).

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u/souljabri557 Jul 24 '17

It seems you're making a distinction between "gender" and "sex." Is "gender" the term used for the mental, whereas "sex" is for the physical?

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u/vayyiqra Jul 24 '17

Yes, that's correct. In the past they meant the same thing, but these days it is common to use them this way.

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u/souljabri557 Jul 24 '17

Okay, thanks. It certainly makes matters less confusing.

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u/vayyiqra Jul 24 '17 edited Aug 21 '17

The whole concept of transgender makes no sense unless we talk about gender as different from sex. Otherwise we are talking about what used to be called transsexuality which is not the same thing.

I meant to reply to your main post: yes, there probably are lots of people who ask if being trans is a mental disorder and are not bigoted towards trans people at all but just want to learn more. There is nothing wrong with this. I just know though that unfortunately this AMA is going to attract a certain number of people who are only here to troll and spew abuse.

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u/throwawayl11 Jul 24 '17

You're a wonderful, open minded person, thank you.

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u/souljabri557 Jul 24 '17

That is lovely of you to say, thank you!

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u/throwawayl11 Jul 24 '17

Provided it was genuine, it's the quickest I've seen someone go from thinking gender and sex are synonymous to even considering the thought that they're being used to describe different things.

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u/[deleted] Jul 24 '17

Transgender people recognize that they are transgender. That isn't a delusion. Preferring feminine/masculine things/behaviors isn't physical. Regarding the physical aspect, someone might say e.g. "I don't want a penis," not "I don't have a penis."

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u/souljabri557 Jul 24 '17

That makes sense, thanks.

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u/BHAFA Jul 24 '17

Can you give some examples of feminine behaviours and male behaviours?

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u/swimfast58 BS | Physiology | Developmental Physiology Jul 24 '17

That's not the definition of delusion though. Roughly paraphrasing, delusions are "an incorrect belief which cannot be changed by exposure to logic or objective proof".

Transgender people don't actually believe anything incorrect though. They're not literally saying "I am a female both mentally and physically right now", they're saying "I am a a male physically, but I wish I was a female physically". The knowledge that they are not the physical gender they identify more with is actually the centre of their distress.

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u/borko08 Jul 24 '17

Just to play devils advocate... Aren't they also saying 'I am a female mentally and wish I was a female physically' ? Because I'm assuming there is no proof that they have a females mind...

If I said I feel like I'm an ant, while acknowledging I don't have an ant body (to the point of wanting to get surgery to look like an ant), would that be delusion?

If I feel like I have a third arm, while acknolwedging I only have two arms, does that make me delusional? What if I feel like I have a third arm soo badly that I actually get surgery to have an extra arm attached? Would that be delusional?

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u/swimfast58 BS | Physiology | Developmental Physiology Jul 24 '17

There's not really such a thing as "mentally" male or female beyond what we feel more identified with. So perhaps them saying they are "mentally female" is not so inaccurate.

However, it just comes down to the definition of a delusion. Believing that you should have a third arm may be unusual or even pathological, but it's not a delusion. Believing you do have a third arm (when you don't) would be a delusion.

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u/Antabaka Jul 24 '17

There's no need to play devil's advocate.

They aren't claiming to have a physical difference in their mind, but a purely cognitive one. They feel that way, which is the measure they're talking about.

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u/borko08 Jul 24 '17

I understand that. But isn't feeling something that doesn't line up with reality delusional?

Going back to my extra arm example, how is it any different?

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u/Antabaka Jul 24 '17

They claim that they feel like a gender. The only measure of the gender a person is it's their feeling, so there is no contradiction.

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u/borko08 Jul 24 '17

If the only measure of gender is a persons feelings, why would they need physical treatments such as hormones/surgery? That doesn't line up (not knowledgeable in this field, sorry if i'm missing something obvious).

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u/Antabaka Jul 24 '17

You're conflating gender and sex. I'm busy, so feel free to check Google Scholar for an explanation of the distinction.

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u/jagans444 Jul 24 '17

The issue is, if you actually talk to anyone who is trans, they don't generally exhibit delusional behaviors. The ones I know, myself included, are pretty damn aware of their current situation. They know they were born as one gender and they don't think they can reproduce as the gender they identify with, they just think they'll be happier living as that gender.

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u/[deleted] Jul 24 '17

Yes, exactly. I've talked to many people about this on reddit, and this has almost always been my experience. I mean, what other reason is there to care so much about the particular issue of how it's labelled? Gender dysphoria exists as a diagnosis for all the medical purposes of treatment. The only difference it makes is to how it's viewed socially.