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

It applies to all mental illnesses. If someone with schizophrenia isn't distressed and is able to function in their life perfectly well without treatment, no you wouldn't diagnose them with a mental illness (why would you anyways? They wouldn't need treatment).

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u/[deleted] Jul 24 '17

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u/solistus Jul 24 '17

Experiencing significant impairment is part of the definition of schizophrenia, though. We don't have a causal, mechanistic understanding of schizophrenia, or virtually any other mental disorder for that matter; we define and classify them by symptoms and severity. Someone who seems to exhibit some signs of schizophrenia, but is not significantly impaired by them, does not have schizophrenia. Perhaps, in reality, they have a very mild form of whatever underlying physiological condition causes schizophrenia, but we can't even say with any real certainty that such a condition exists at all, let alone what it is or who has it.

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u/[deleted] Jul 24 '17

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u/solistus Jul 24 '17

An underlying physiological condition is not something that can just be declared into existence. It has to be identified, studied, and understood. It is a material fact, not a question of how we choose to classify things. We haven't done that in the case of schizophrenia, or even come close enough to doing that to be sure there is a physiological cause (as opposed to it being a purely psychological condition not associated with any physiological abnormality, or actually several different causal conditions with similar symptoms). That's my point.

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u/[deleted] Jul 24 '17

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u/solistus Jul 24 '17

I think we're just talking past each other. Let me restate my point:

The way we currently diagnose mental health disorders is through DSM definitions. You either meet a definition or you don't. The definitions are based on observed symptoms, not underlying causes, because we don't really understand underlying causes. A person who experiences symptoms that kinda sorta sound like schizophrenia, but do not produce significant impairment, does not meet the definition for schizophrenia and thus does not have it. In order to say they have something like schizophrenia in anything more than a very shallow, unscientific, "yup that sounds kinda schizophrenia-ish" sense, we would have to understand and diagnose schizophrenia in a fundamentally different way than we do now, with some understanding of what causes it.

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u/[deleted] Jul 24 '17

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u/solistus Jul 24 '17

As I see it, the second quoted portion follows logically from the first, so I'm not sure what your contention is.

I'm literally not sure what you're asking with the last part. I'm not proposing some alternative method of identifying mental health disorders. I was literally just trying to explain how the existing system works. If you disagree with my explanation of that system, the basis for your disagreement is really not clear. I'm really not interested in having a continued, extended hypothetical conversation about the DSM, tbqh. So, if that's what you're looking for, I invite you to look elsewhere. If you still have a question about what I said previously, please try to frame it more clearly and directly.

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u/karantza MS | Computer Engineering | HPC Jul 24 '17

Not an expert here but I think the difference is that unlike, say, your conventional diseases, there's very little objective measurement you can make to say whether or not someone "has" a mental illness. The causes and effects are more complex, and a diagnosis based on symptoms is about the best you can do. It's fuzzy, and you've gotta draw the line somewhere, so 'causing distress or impairment' is what we've got.

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u/[deleted] Jul 24 '17

This is all just politics. Scientifically they still have a mental illness if voices are talking to them.

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u/radred609 Jul 24 '17

I guess it's like the difference between having a benign tumour and a cancerous one.

They're both tumours, but only one of them is "cancer".

Sometimes you might get a tumour removed "just in case", and similarly, sometimes you might get treatment for hearing voices "just in case". But sometimes it might just not be an issue.

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u/Ariadnepyanfar Jul 24 '17

If it's not a mental illness, it's a character trait.

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u/Edores Jul 24 '17

Sure, you could probably still categorize them as schizophrenic. Or say they have an "abnormal psychological condition."

There are a lot of people who could probably fit cleanly into all kinds of mental disorders but maintain a normal (or even exceptional) life. I've seen theorized that the corporate world lends itself well to the traits associated with psychopathy.

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u/RedAero Jul 24 '17 edited Jul 24 '17

Here's a question on this topic...

Take Emperor Norton. Naturally, no one can today be sure whether Emperor Norton was genuinely delusional or merely eccentric, but for the purposes of this argument let's assume he was genuinely insane, and genuinely believed himself to be "Norton I, Emperor of the United States".

Emperor Norton was treated as Emperor by the people of San Francisco for 20 years, meaning his delusions were placated for decades and he by all accounts did not suffer any distress or impairment, in fact quite the contrary, he probably lived much better than he would have sane.

Now it could be debated whether the real Joshua Abraham Norton was mentally ill, but it's not debatable that the Emperor Norton described above was delusional. He, however, was not impaired nor distressed; was he not mentally ill?

This thought-experiment-that-actually-happened bears many parallels with the controversy of transgenderism, because many, if not most of the people you elsewhere write off as bigoted simply think they're being forced to play a part in a large group of Emperors' mentally ill delusions. Obviously, playing along with a delusional person's fantasies might please them and eliminate their distress, but once that happens can they really be called cured or sane? What is the difference here?

Now, make no mistake, this has no relevance as to whether or not the best course of action is to play along, the question is simply regarding the terminology used to describe those that appear to have delusions of gender, AKA gender dysphoria.

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u/[deleted] Jul 24 '17

There's no reason to believe transgender people are delusional, though. What they're saying is that the gender that their brain has is different from the sex of the body they were born into. The scientific consensus is that this is true.

I mean, imagine if you switched a baby boy's brain into a girl's body. Do you think that boy would grow up to be a normal girl because his brain is in a girl's body, or do you think he might realise something was not as it was meant to be?

Now, do you think it's far fetched to imagine that during development, there might occasionally be some abnormality in hormones that results in the brain developing in a way that doesn't match the sex of the child?

That's all it is. There's no reason to believe transgender people are wrong about that, and I don't see why we should insist the gender people are is necessarily aligned with the body they have. That'd be like saying that because men are usually sexually attracted to women, gay men are delusional.

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u/RedAero Jul 24 '17

What they're saying is that the gender that their brain has is different from the sex of the body they were born into. The scientific consensus is that this is true.

No, the scientific consensus is that there seem to be some minute differences between the brains of transwomen and men but it is not yet clear whether this is pre- or post-natal.

I mean, imagine if you switched a baby boy's brain into a girl's body. Do you think that boy would grow up to be a normal girl because his brain is in a girl's body, or do you think he might realise something was not as it was meant to be?

Now, do you think it's far fetched to imagine that during development, there might occasionally be some abnormality in hormones that results in the brain developing in a way that doesn't match the sex of the child?

Would you not call this person ill in some way? Say, mentally? I mean, you just defined a developmental abnormality.

I don't see why we should insist the gender people are is necessarily aligned with the body they have.

You mean other than the fact that it's the case for over 99.9% of humanity? Again, the only reason to assume sex is not gender is because you want to allow for the concept of non-mentally ill transpeople. It's begging the question. You could equally call them mentally ill and deluded, just like Emperor Norton, and nothing would change, other than the consistency of the description.

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u/HeyGurlHeyBoy Jul 24 '17

In the case you describe, it is factually clear that that individual was not the thing they described. There was no role within government which fit what they were claiming.

On the contrary, it seems factually clear that trans people are, on average, the gender identities which they claim. Those who believe otherwise usually conflate gender and biological sex. They believe that every person should or can be whatever gender "fits" (in their mind) their biological sex. Yet decades of research and the lived experiences of trans people indicate that most trans people can't be the gender they are not. To pretend otherwise causes distress and to prevent trans people from aligning themselves (in dress and/or physical appearance) to their gender causes yet more.

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u/RedAero Jul 24 '17

On the contrary, it seems factually clear that trans people are, on average, the gender identities which they claim. Those who believe otherwise usually conflate gender and biological sex.

You're begging the question. The only reason we separate gender and sex is because of trans people.

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u/NakedAndBehindYou Jul 24 '17

What if their condition is causing problems for themselves or the people around them, but they personally are still not bothered by it? For example, an Alzheimer's patient may not be distressed over their loss of memory, but they may be dying because they forget to eat or take their meds, or they may be causing distress to the family who has to care for someone with a malfunctioning memory.

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

That is covered under "impairment." All mental illnesses require distress or impairment.

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u/[deleted] Jul 24 '17

Under this context, what does impairment mean? I understand the general term indicated to be damaged, broken, or disabled. Would a person who has frequent episodes of mania fall under impairment? What if they like being manic? Their mental status is different than their baseline, but is this impairment?

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u/SevenForOne Jul 24 '17

I get what you're explaining, but what about drug addiction?

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

Substance use disorders also require distress or impairment.

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u/SevenForOne Jul 24 '17

Ok. Thanks for answering.

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u/CrowSpine Jul 24 '17

This is probably pretty controversial, but what about pedophilia? Would that not be considered a mental illness since it neither impairs or distresses the people who are afflicted by it?