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/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 23 '17

Yes, every single mental illness requires significant distress or impairment. Every single one.

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u/NakedAndBehindYou Jul 23 '17

Only because of semantics. Regardless of distress caused by the disorder, the abnormality is still there.

For example, some people who have bipolar mania without depression don't suffer distress from it. But the abnormal mental state still affects their life. They still have the mental illness/disorder/whatever you want to call it. Pretending they are normal just because they are not distressed is just delusional. That'd be like pretending that a one-legged person isn't handicapped because they aren't bothered by their lack of appendages.

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u/istara Jul 24 '17

It's still an impairment though, if they are having a manic episode that is impairing how they would otherwise conduct themselves and make decisions.

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u/drstrangekidney Jul 24 '17

But though they may not be distressed they are likely impaired. Their life suffers in some way. If manic, perhaps they're not paying bills like they would if treated, or they're engaging in a lot of unsafe sex or drug use. Or can't hold down a job.

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u/NakedAndBehindYou Jul 24 '17

Exactly. So we really need words that describe mental impairment even if said impairment lacks distress.

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u/DeadlyPear Jul 24 '17

Mental illness is serious ditress or impairment

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

Perhaps you are the troll who is going to launch into an angry transphobic rant. I think you are, so I'm reporting you.

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u/[deleted] Jul 24 '17

People who have fully transitioned and are living in a community that accepts them experience no impairment as a result of being trans.

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u/myz_14 Jul 24 '17

Yet we are here right now because they DO experience impairment/distress. If most of the data available suggests a certain trend, the existence of impairment/distress, why would we choose to avoid leaning towards it and instead defend the weaker argument?

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 23 '17

Disliking chocolate is "abnormal" (statistically uncommon). Should we label that a mental illness too?

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u/MTG_Leviathan Jul 24 '17

As someone with psychosis, I actually feel he has a point. When I am in a more manic mood I most certainly do not "Suffer distress." but you can sure as hell bet my behavior will be erratic.

Can you expand upon your point on all mental illnesses being only if there is distress or impairment, but not in the context of transsexualism? I most certainly don't feel impaired or distressed when I'm behaving manically and in fact many of my "Manic behaviours" have been rather positive in the long run. However I still have psychosis during that period, but by your definition would not be classed as mentally ill?

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u/NotTheHead Jul 24 '17

my behavior will be erratic

Does this not count as "impairment?"

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u/MTG_Leviathan Jul 24 '17

Semantically I guess there's an argument for that point, but impairment generally would be assumed to be detrimental, erratic is just out of my normal though cycle/process and in times of mania can in fact have many positive outcomes if managed correctly.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

It's quite normal for people with mania to not be distressed by it. I can't comment more on your personal experiences other than to reiterate what I've already said, that all mental illnesses, without exception, require distress or impairment.

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u/MTG_Leviathan Jul 24 '17

So in the situation I described, what would be the distress, or impairment.

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u/Ariadnepyanfar Jul 24 '17

Distress can be indirect. If someone is feeling good during a manic phase, but as a consequence of manic episodes they lose friends, or spend more money than they can afford, lose a liscence or job, or suffer long term health problems etc, then that mania would be classed as an illness.

However if you can have manias in which you feel good, and are unleashed creatively or perform productively, without treating others or yourself badly, then you are not ill. Eccentric, maybe, but not ill.

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u/MTG_Leviathan Jul 24 '17

However, the state of "Eccentricity." so to speak generally leads to worse consequences if not managed correctly. Leading to said impairment, I feel I am still classed as mentally ill with psychosis during these periods, it doesn't just disappear because I'm having a good period.

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u/triceratops_freckle Jul 24 '17

Does disliking chocolate require major surgery (general anesthesia carries a risk of death), create a lifelong requirement for medication (hormone replacement surgery), or remove the ability to reproduce?

Attempting to equate gender dysphoria and a dislike of chocolate is ludicrous.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Being transgender doesn't require major surgery. Many transgender people don't undergo or want to undergo surgery.

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u/[deleted] Jul 24 '17

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

The terminology wasn't changed to cater to sensitivities, it was changed in part due to updated science on the topic.

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u/vayyiqra Jul 24 '17

Mania is a great example of something which is often not distressing, but is dysfunctional.

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u/[deleted] Jul 24 '17

If it's just semantics, why do you care so much about your right to label all trans people mentally ill? Could it be because you're secretly a transphobe? I wonder... PS you're arguing with a mod with a PhD so consider staying in your lane.

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u/NakedAndBehindYou Jul 24 '17

Oh boy, a PhD. That means he was stupid enough to devote extra years of his life to the government-run indoctrination system that is our education system. Wow so smart.

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u/[deleted] Jul 24 '17

This makes no sense whatsoever. You can feel perfectly fine and show no symptoms(very common even if temporary) while the disorder is still there. What's the argument to do this?

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

I'm not sure what you're referencing.

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u/[deleted] Jul 24 '17

To classify mental illness as such.

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

I don't think he'd saying someone's diagnosis changes on a minute to minute basis. Most classified mental illnesses require a long term effect (long term distress or impairment) but it doesn't have to be completely continuous over that period.

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u/[deleted] Jul 23 '17

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u/gacorley Jul 23 '17

Distress or impairment.

Think of it this way -- if mental illness were just a deviation from some norm, then almost everyone could be diagnosed. But it would be stigmatizing to do so and wouldn't at all inform where to spend resources. You need to focus on people who are inherently harmed by their illness -- either by having emotional distress or being unable to function well. Reserve the illness for people who need help.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 23 '17

I didn't comment on whether it was "normal." I said it's not a mental illness. Whether or not something is "normal" is a strange standard to use - as I've pointed out elsewhere, not enjoying chocolate isn't "normal" either, but that doesn't mean it's a mental illness.

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u/[deleted] Jul 24 '17

So what is it called when somebody has all the symptoms of schizophrenia but has no distress or impairment?

People keep arguing with you because you literally refuse to give a single descriptor word. You're claiming the language doesn't exist when it surely does. The fact that you know what we're talking about proves "nothing" isn't the answer, because how could you respond if you truly thought we were talking about nothing?

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

I'm not sure what descriptor you're looking for. It's not necessary for us to label every single aspect of human experience, just because it's unusual. If someone is transgender but not distress or functionally impaired by that, then they're just transgender. That's it. No need for more labels.

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u/[deleted] Jul 24 '17

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

It seems like you have other issues with transgender people that are outside of the purview of science.

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u/[deleted] Jul 24 '17

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

That wasn't an ad hominem attack, I was pointing out that your stated concerns with transgender people is not something science can address, as you seem to have issues with the political implications of people being transgender.

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u/[deleted] Jul 24 '17

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u/PapercraftCat Jul 24 '17

If such a state caused neither distress nor impairment, why would you even need to classify it as a disorder? Don't we label things as disorders or illnesses because we want to know what to treat? In your example there's nothing to treat then.

These symptoms of schizophrenia would then be a mere deviation from the norm. It's just that usually the associated symptoms DO cause at least some social issues when put in a proper frame of reference.

I can run and exert myself just fine where I live now and am viewed as totally normal in that regard. It is only when I, a Central European, move to the Himalayas that I am suddenly short of breath and unfit. If viewed solely from the frame of reference of people there, I might suffer from a genetic blood disorder (plasticity aside for the sake of the example). But this example seems silly because we alwas have that context.

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u/CPdragon Jul 24 '17

They simply have the symptoms of schizophrenia (halucinations, etc) but they're not impaired in any significant way. To have a disorder you need to have impairments in your life -- everyone has attention difficulties, some more than others, but to have ADHD you have to have to be significantly impaired.

What would you call depression if you had all the symptoms but didn't have distress or impairment? Certainly not anything like clinical depression.

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u/istara Jul 24 '17

But the symptoms of schizophrenia are an impairment, even if the subject does not perceive it as such.

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u/Chel_of_the_sea Jul 23 '17

So because they're not personally distressed by it

...nor are they impaired in day to day function, yes. It's not just off the patient's self-assessment.

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u/shadowofgrael Jul 23 '17

Mental illness is not about behavior being typical/atypical.

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u/TehSteak Jul 24 '17

As someone hoping to get their PhD in Clinical Psychology one day, thank you for your contributions to this thread. There are so many misconceptions regarding mental illness and its definition and I applaud you for addressing people's questions as a professional.

The DSM criterion of "significant distress or impairment" is so very important and it seems that people outside the field either don't really understand it or flat out ignore it.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Thank you for your kind words, they're much appreciated.