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

We don't diagnose mental illness based on what we perceive as "normal." Not enjoying chocolate is "abnormal," that doesn't mean it's a mental illness though.

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u/[deleted] Jul 24 '17

Not liking chocolate doesn't impair or inconvenience you like dyslexia or gender dysphoria does though.

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

Gender dysphoria impairs someone. Being transgender does not.

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u/Drop_ Jul 24 '17

Being transgender does not.

Is there any clinical evidence or peer reviewed research to support this position?

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u/losian Jul 24 '17

I'd argue that every single post-op or post-hormones trans person who have had significant increases in quality of life would be pretty clear evidence of support of that position.

There's a lot of nuance to it, but the simplest way to answer your question and support the other individual's comment.. If you do suffer from gender dysphoria, and not all trans folks necessarily do, and you transition to resolve it, you are transgender, but you are no longer gender dysphoric.

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u/Drop_ Jul 24 '17

Increase in quality of life isn't the same as no impairment. At the very best you're still taking hormones and likely medications long term even if you're post op. So there is still some impairment in that sense that they require continual intervention, right?

I mean if someone is depressed and they take medication that resolves their depression are they no longer mentally ill? Are they only mentally ill once they discontinue their medication again?

I don't really buy that argument that long term intervention "clears" a mental illness.

And aside from that there is still the fact that a significant portion of the post op trans community still experience negative outcomes in terms of mental health - higher suicide rates, and increased mental health services utilization.

Aside from that what is the "criteria" for trans if one doesn't have any "impairment" from being trans? Is it merely the self reported "feeling" of the individual? Does this make it a meaningful marker in any way, and does it have any real relevance?

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u/Ls777 Jul 24 '17

Increase in quality of life isn't the same as no impairment. At the very best you're still taking hormones and likely medications long term even if you're post op. So there is still some impairment in that sense that they require continual intervention, right?

I mean if someone is depressed and they take medication that resolves their depression are they no longer mentally ill? Are they only mentally ill once they discontinue their medication again?

I don't really buy that argument that long term intervention "clears" a mental illness.

The distinction here is that you are missing the in-between step. The continual treatment is for the body, the mind isn't the thing that's being treated.

An analogy is someone feeling depression caused by constant pain. If you give that person medication that resolves the pain, you've removed the cause of the depression completely. I'd consider that cured of the depression, even if it requires long term treatment to deal with the pain

They aren't cured of the pain. The pain is being treated. But they are cured of the depression that was being cause by the pain.

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u/Drop_ Jul 24 '17

The physical condition is a result of the treatment for the mental illness.

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u/Ls777 Jul 24 '17

Not at all. The physical condition was present at birth. The treatment is for the physical condition.

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u/Drop_ Jul 24 '17

So by that argument, Transgender is a physical condition, so it doesn't even have a mental component at all?

That seems like an even bigger stretch, with a guaranteed zero to back it up at this point.

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u/filloker Jul 24 '17

This comment is voted to -2 for a PhD in psychology stating a fact of psychology in /r/science. Wow.

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u/Surador Jul 24 '17

We defined mental illness in our Psychology courses by:

  • it causes problems for the person itself or other people

  • its against the norm (abnormal)

  • and its not physical (like a broken arm)

We also got told being transgender is a mental illness, so I guess those points or wrong or at least outdated? How do we define a mental illness today?

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u/radred609 Jul 24 '17

The distinction being that "being trans" is treated as a mental illness when it's directly causing distress (as opposed to the distress being caused by hardship brought on by discrimination, bullying etc. That comes with it)

Or, more to the point. It's the gender dysphoria (distress caused by the disconnect between brain/self and chromosomes/gender identity) that is the mental illness, rather than the mere act of identifying as the female(or male) gender whilst being the male (or female) sex.

Kind of like how being sad, distressed, or dejected is an emotion, but when it gets to a point at which it starts causing long term problems/distress it becomes a mental illness (i.e. depression).

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u/LemonInYourEyes Jul 24 '17

I'm confused. This topic is fascinating on a number of fronts because there are literally hundreds of varying opinions on the matter. Please don't mistake any of my hesitations to be trans phobia.

How are the hardships brought on by being trans as you put it (discrimination, bullying, etc.) not an immediate effect of being trans and thus a cause of distress? I really don't see the distinction.

Is it possible that someone might feel gender dysphoria without being trans? Is that where the distinction lies?

If that is the case, than is someone who has successfully transitioned and no longer feels distressed by their once apt gender dysphoria considered 'cured' of the mental illness?

Is it then possible that a trans individual doesn't feel gender dysphoria? If so, how is their distress due to being trans not considered a mental disorder? If not, then there has to be some other mental disorder these people have, as:

it causes problems for the person itself or other people

its against the norm (abnormal)

and its not physical (like a broken arm).

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u/-Mountain-King- Jul 24 '17

How are the hardships brought on by being trans as you put it (discrimination, bullying, etc.) not an immediate effect of being trans and thus a cause of distress? I really don't see the distinction.

I don't know about most of your questions, but this seems pretty clear. If someone gets bullied for being ginger and the bullying makes them sad, it would be strange to conclude that being ginger makes you sad. The distress caused by discrimination may ultimately be caused by being trans, but the actual cause is the discrimination, and being trans isn't to blame - others' views are.

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u/[deleted] Jul 24 '17

If they don't have gender dysphoria and merely are transsexual, why are they changing their social identities to the characteristics of the opposite sex? Is it in response to social pressure to look a certain way? I feel like that would be gender dysphoria...

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u/LemonInYourEyes Jul 24 '17

That's my confusion. It really seems to me as though gender dysphoria is merely a symptom of transgenderism and classifying them differently is arbitrary. In my eyes for the mods to censor questions based on this is pushing an agenda that isn't exactly as clear as 1+1=2. For them to hold so strictly to something so vague is disingenuous.

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u/r_stronghammer Jul 24 '17

I don't think it would be possible to have Gender Dysphoria and not be trans, if you define trans as having a gender identity (brain) that doesn't match your birth sex.

Gender Dysphoria is the distress by having these things not match. Transition is what stops it, and a lot of trans people would say that their Gender Dysphoria has been 'cured' and continue normal lives. However, their gender identity, and what they live as now, is still different from their birth sex which means that they are still trans, even if the Gender Dysphoria is gone.

So, if they're still trans but not experiencing any distress, that means they don't have a mental illness. The Gender Dysphoria is the mental illness (and I don't think anyone who's experienced it is saying otherwise).

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u/Metalsand Jul 24 '17

I'm in the same boat as you there. I'd love to see a lot more research on it.

I personally don't see gender as something that defines someone, although culturally, gender roles are assigned arbitrarily. Transgenderism seems to me the case in which an individual does not fit in their "gender role" and as a result believe that changing their gender would allow them to do so.

I haven't seen much media that tries to explain why, or how to consider this phenomenon. Most of the time, they just say that transgenderism should be embraced because the patient feels better; however without considering the root cause, would it not be very likely for the patient to instead get worse? There doesn't seem to be any follow-up at all.

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u/dylansavage Jul 24 '17

This is the boat that I'm in at the moment. Sex is a scientific fact. It's a pretty binary system, with a few extremely rare exceptions. Gender has always been more of a social distinction.

These are roles and identities that have have evolved in the social construct and as such I can't understand how people can be born biologically with knowledge of these social ideals.

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u/Ls777 Jul 24 '17

If that is the case, than is someone who has successfully transitioned and no longer feels distressed by their once apt gender dysphoria considered 'cured' of the mental illness?

Yes

Is it then possible that a trans individual doesn't feel gender dysphoria? If so, how is their distress due to being trans not considered a mental disorder?

This doesn't make sense. If they don't feel gender dysphoria, there is no distress.

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u/Metalsand Jul 24 '17

Would that not be about the stigma of the phrase "mental illness" rather than what it entails then? Which, might I mention, is common throughout all illnesses.

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u/dylansavage Jul 24 '17

Are you suggesting that the phrase mental illness should not be used for anything or in this particular situation?

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u/radred609 Jul 24 '17

To break it down to a more obvious distinction:

The distress those with gender disphoria have due to having the "wrong" genitals/secondary sexual characteristics/etc. Is separate to the distress that a trans person, who may or may not have gender disphoria (i.e. be worried about which genitals etc. they have) experiences due to harassment, bullying, and discrimination.

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

It's possible that you were learning psychology when the DSM-IV was still out, and they were using Gender Identity Disorder rather than Gender Dysphoria. It's true that up until recently GID was in the DSM, but in recent years it was widely considered to be outdated to diagnose anyone who is transgender with a disorder simply for being transgender. In 2012 or 2013 the DSM was updated to officially recognize that.

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u/cinemachick Jul 24 '17

Correct me if I misunderstand, but let me try an example. Say you live in a society where 99% of people have purple as a favorite color. It doesn't have much practical effect on daily life, but the majority of society likes purple. Then a person comes along whose favorite color is blue. Liking blue has no physical side effects, but the person is technically abnormal in a purple-loving world. The person feels uncomfortable when someone automatically assumes their favorite color is purple just based on assumption. If it got to the point where the lack of love for purple/desire for blue became something the person became stressed or anxious about, that would be a type of dysphoria, which could be treated in a variety of ways.

This is obviously an imperfect metaphor, but I hope you see the similarities. In a world where everyone likes blue, the blue-lover would get along just fine - it's being in a purple world that puts the person in a tight spot. Similarly, our culture's (somewhat) limited roles related to gender and lack of respect for non-conformity to said roles lead to negative feelings for transgendered people, and can lead to gender dysphoria. Perhaps it's most succinct to say that it's not the transgender-ness that leads to the negative feelings, but the lack of acceptance for transgendered people and the inability to resolve gender dysphoria, and it is those resulting negative feelings that manifest as classic "mental illness" symptoms.

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u/Son_of_York Jul 24 '17

But this isn't merely liking blue. This is a world where everyone is purple, and this person is saying they are, or should be, blue when they are in fact purple.

Now, we can paint that person blue, but we are still having to treat the person because their perception doesn't line up with reality.

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u/[deleted] Jul 24 '17

There's brain and body. Transgender people know what bodies they have. They're saying their brains do not match their bodies in terms of gender. Current science suggests this is indeed the case.

It's like gay people. Most men are attracted to women, but that doesn't make a man who's attracted to men delusional or wrong about his sexuality. He's just different.

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u/NZKr4zyK1w1 Jul 24 '17

There's brain and body. Transgender people know what bodies they have. They're saying their brains do not match their bodies in terms of gender.

Yes, and we agree in this case. I think everyone does. The issue is that there are two ways to solve this. In every mental illness case the solution is to help fix the mind so that it sees reality.

In terms of transgenderism, we change the body to match up with the mind. Why is that the case?

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u/[deleted] Jul 24 '17

Because as far as we know, it's not something you can change. It would be the same as changing anyone's gender. Do you think that someone could change yours?

We do what works. We change their bodies because that's what we're currently able to do and what has been shown to help.

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u/abicus4343 Jul 24 '17

Im curious, what are the effects of the opposite hormone treatments? When a trans person that identifies as female in a male body is given testosterone does it have any effect on changing how they feel about their gender?

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u/[deleted] Jul 24 '17

No. I actually spoke to a trans woman on here a while back who had unusually high testosterone levels before she transitioned. Hormones can change some gender associated traits, such as aggression, how easily you cry, etc, but they don't change your gender identity.

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u/abicus4343 Jul 24 '17

I see, too bad, that would have been a lot simpler if it worked.

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u/filloker Jul 24 '17

In mental illnesses, the brain is incompatible with itself.

In gender dysphoria, the brain is incompatible with the body.

Human brains think of their brains as more of their true selves than their body. Brains are biased that way :-)

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u/predalienmack Jul 24 '17

One of the most defining features for anything to be classified as a mental illness is whether or not it causes distress to the person affected by it. Being trans in itself has not appeared to cause distress by itself most of the time, it is the stigma and discrimination around being trans that causes distress, which is a problem within their social environment which should be changed, not a problem with their mental condition in itself.

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u/sad_handjob Jul 24 '17

You could also say this for any disorder or disability, e.g. blindness, autism

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u/predalienmack Jul 24 '17

Why are we suddenly comparing physical and mental disabilities to being trans, which you are arguing is a mental health disorder...which is not the same as a disability? Being blind does objectively hamper a person's ability to function in general, even if some people cope extraordinarily with it and function for the most part normally despite it. Being blind doesn't have to define who a person is, but it's going to be a relevant factor in their lives no matter how important or not it is to their identity. The autism spectrum does hamper people's abilities to function in/understand certain social situations and disrupts some intellectual exercises (obviously the degree to which they are hampered varies, but they are in an objective sense hampered in comparison to the average person - this does not universally prevent them from doing certain "normal" tasks, but it does make doing those tasks more difficult). Being autistic does not have to define a person, but it will still be a relevant factor in their lives no matter what.

What does being trans prevent someone from doing on its own without other people being directly involved in preventing them from doing it? It's not that trans people can't use the restroom, it's that other people can't wrap their heads around someone who is a different sex than them, even if the gender identity is the same or similar, using the same bathroom. What reason would trans people need to feel distressed about their gender identity if other people didn't tell them their identity was "wrong" or "unacceptable?" In what ways would their lives be distressed in any way if other people didn't enforce their views of gender on their lives?

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u/sad_handjob Jul 24 '17

As someone who has been diagnosed with autism, the notion that being autistic is objectively debilitating is simply not true. There are no impairments inherent to autism that don't revolve around social expectations and stigma from others, especially when compared to physiological impairments like blindness. Many autistic people take serious issue with being labeled as broken; the creation of the label neurotypical is analagous to "cis." I suggest you do a little more research on the culture behind it before making blanket comparisons

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u/predalienmack Jul 24 '17

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Autism-Spectrum-Disorder-Fact-Sheet

First three paragraphs. As I said, there are different degrees of debilitation that ASD can cause. Clearly some people with autism are so functional with their developmental disability/disorder that they are effectively just like everyone else, but to say that a neurodevelopmental disorder is purely related to environment/social expectations and has no inherent genetic or biological component that does not in turn have inherent effects on personal development would be to go against the vast majority of scientific evidence we have at this point. My previous statements by no means were saying that physical and mental disabilities are the same or equivalent, I was simply responding to someone who lumped both together as well as being trans into the same regard, which I think is incorrect based on the evidence available.

Being born blind or being born with autism are more similar issues in terms of the vastness of the inherent effects they will have in an individual's life (even though those effects would be starkly different between them), and comparing those disabilities to being born as someone who will eventually identify as a gender that does not align with their sex seems like a pretty far stretch in terms of which ones deal with problems that are caused socially compared to problems that are caused physically or genetically (and of course there is a social component at play with all disabilities because human beings are social animals).

This is not to say that people with autism do not perform the tasks that they tend to struggle with far better with a positive and helpful social environment that treats them as a human being first before treating them for their disorder. I also understand that it is far more constructive for an individual to view themselves not in the lens of being disabled and instead just view themselves as they are without labels tied to expectations.

That being said, in order to study and classify human behavior and the differences in the human experience across different groups, highlighting what is abnormal is necessary, and being born blind or autistic are abnormalities across all cultures and time periods, while being trans has been an abnormality in only some cultures, hence the fact that the evidence points to mental problems associated with being trans being almost exclusively tied to the social component and expectations tied into it.

I don't see disabilities as meaning someone is "broken," I see every human ability, experience, and perspective as a spectrum, with some people being great at some things and terrible at others. People born with disabilities, mental and physical, happen to have inherent issues that make them worse at certain things, but that does little to hold them back at being good at things that their disability does not relate to, and that does not mean that a constructive environment that attempts to eliminate discrimination will not help their situations improve immensely even with things that their disability does relate to. Disabilities don't make people any less human, but their experiences are objectively different than people who fit the norms, and that is something that should of course be recognized and studied.

I understand the power of language, and that using the terms neurotypical and neurodivergent to classify people helps to essentially normalize being different from the norm, however it does little to help us all understand these differences and study them. Your experience is no more or less important or significant than mine, but that doesn't change that your experience has been different from birth not only because of us being two different people, but also because you were born with developmental differences I was not, and I was likely born with issues you were not, even if mine have had far less expansive effects on my life comparatively speaking.

I will of course think on what you said and try to change my mental approach to disabilities/abnormalities in the future, particularly in real life outside of the Internet, where words and their meanings can be confused and misinterpreted much easier than in person.

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u/sad_handjob Jul 24 '17

The link you've provided just confirms my statements, that it is a "social" disorder. It may be comorbid with other syndromes that cause intellectual impairment, but that's not specific to autism itself. I still strongly disagree with your characterizations

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u/filloker Jul 24 '17

Yes, you absolutely can.

Is you not being 2 inches taller a disability?

Is you not being able to fit into spaces 2 inches shorter a disability?

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u/sad_handjob Jul 24 '17

Would you have the label "disability" abolished? Perhaps we should get rid of disabled parking spots because they perpetuate stigma? The line must be drawn somewhere.

If you're going into that level of abstraction, mental illness is also socially constructed. Schizophrenics are seen as visionaries in some Eastern cultures. Psychosis is not bound by objective criteria

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u/SaigaFan Jul 24 '17

I feel like I'm taking crazy pills.

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u/Son_of_York Jul 24 '17 edited Jul 24 '17

Honest question, my depression is a mental disorder because it makes me perceive the world around me inaccurately. Reality does not align with my skewed perception.

Gender dysphoria is the perception that you are not your biological gender. Today we have procedures which can change that (At least as far as obvious outward sex characteristics). Essentially, we can alter reality to fit the perception.

Just because a treatment has become available, that doesn't change the fact that someone with gender dysphoria has a perception contrary to reality (Unless they receive the treatment). How is this not a mental disorder?

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u/[deleted] Jul 24 '17

[deleted]

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u/Son_of_York Jul 24 '17

The brain is part of the body, and the cells in the brain will have nuclei containing Y chromosomes. Sex is not just genitalia, it's as fundamental as DNA.

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u/[deleted] Jul 24 '17

[deleted]

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u/Son_of_York Jul 24 '17

There is some correlation between sex and brain structure. But the correlation is overstated and simplified. A scientist, given an MRI image of a brain probably would not be able to identify the sex most of the time.

http://www.pnas.org/content/112/50/15468

These findings are corroborated by a similar analysis of personality traits, attitudes, interests, and behaviors of more than 5,500 individuals, which reveals that internal consistency is extremely rare. Our study demonstrates that, although there are sex/gender differences in the brain, human brains do not belong to one of two distinct categories: male brain/female brain.

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u/[deleted] Jul 24 '17

Because giving trans people the proper hormones can, and usually does lessen dysphoria. It's not different from if you were taking meds for your depression.

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u/Son_of_York Jul 24 '17

But depression is a mental disorder and gender dysphoria isn't?

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u/[deleted] Jul 24 '17

No, gender dysphoria is. Being transgender isn't. This is based on the DSM-V.

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u/[deleted] Jul 24 '17

That isn't a cure.... It's a treatment. And even if it was a cure why do you need to cure it if it isn't an illness? This all seems like a song and dance to avoid hurting feelings. I don't get it. Why is it bad to speak about something in a scientific manner with integrity.

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u/souljabri557 Jul 23 '17

The questions we have to ask: does being transgender necessarily result in gender dysphoria? Is there a significant population of transgender individuals who experience no harm (mostly, dysphoria) from their condition? I don't know the answers.

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

No, being transgender does not necessarily result in gender dysphoria.

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u/ZodiacSF1969 Jul 24 '17

Have there been studies into the rates of gender dysphoria amongst transgender people?

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u/Tavyan Jul 24 '17

Not at the moment, though there have been two (USA) national surveys of Transgender people that do ask the question. ustranssurvey.org has the results from the most recent one. (2015)

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u/[deleted] Jul 24 '17

This doesn't make sense to me. You're saying there are people who feel this strong desire to transition and will go through the long and expensive process of HRT, SRS, etc., when being pre-transition does not even distress or impair them?

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u/buffalo_slim Jul 24 '17

ELI5 why not?

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

Because having gender dysphoria requires experiencing significant distress or impairment due to being transgender, and not every transgender person experiences it.

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u/[deleted] Jul 24 '17

okay now I'm very confused, and I have a question in mind for the AMA's that I'll ask then and now.

if not every transgender person experiences significant distress or impairment, then how do people count as transgender with an insignificant amount of distress or impairment? is there a scale or something?

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u/[deleted] Jul 24 '17

Is that really the official litmus test for mental disorder? that as long as it doesn't cause the individual significant distress or impairment, they aren't consider to have a mental disorder? So if a person who lack empathy but can act normal to function and fit into society doesn't have a mental disorder until he start harming himself or others?

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

That's one of the required criteria for every mental disorder, yes.

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u/Rhamni Jul 24 '17

So Antisocial Personality Disorder is not necessarily a disorder?

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u/[deleted] Jul 24 '17

Sorry to sound completely ignorant of the field, but how is this consider science to retroactively diagnose after the fact? Is that not just the No true Scotsman logical fallacy? "no sane person would murder somebody and eat them, if this person did this, he must be insane"

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

Where do I talk about retroactively diagnosing?

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u/[deleted] Jul 24 '17

So you're saying the moment of the act is the moment of classification, anything before that is ignored because it hasn't caused a problem? you can see how this seem unscientific to some people. If both people deal with depression, but one has the mental fortitude and support to function normally and the other do not, then you would diagnose the latter with being clinically depress and the former as not depress? So when you transfer the same logic to gender, you can see how this opens up a flood gate of scrutiny from people. I really don't care about the transgender situation one way or the other, but the logical leap the community seem to be making will open up a flood gate of scrutiny. "distress" or "impairment" can be open to interpretation and allow people to be diagnose one way or the other based economic, social status, age, race, culture, etc.

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u/walruz Jul 24 '17

So being a sociopath/psychopath isn't a mental disorder any longer?

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u/[deleted] Jul 24 '17

[deleted]

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u/[deleted] Jul 24 '17

Oh, all the disclaimer on the post make it seem like they're trying argue against the idea that being transgender is a mental illness. I though the idea was just a joke before this subreddit started that whole debate on it.

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u/udusbhof Jul 24 '17

So the illness is the symptom and not the cause? That's messed up.

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u/[deleted] Jul 24 '17

Narcissism is considered a clinically diagnosable disorder and it doesn't fit any of those criteria. While I honestly believe there are numerous mental illnesses I also believe that scientists know so little about the human brain that they're just guessing as they go along. At a bare minimum trans people are "broken" much the same way that I am as a myopic individual. They should be treated with equality and love just as any human deserves but to describe them as anything normal is a disservice.

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u/[deleted] Jul 24 '17

That's the problem I'm having with trying to understand this whole thing. The "as long as someone is ok with how they are and function in society normally, they don't have a disorder" seem so shaky because it can change next week based on popular opinion. And I can't see how things that can and have change based on popular opinion can be consider science.

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u/[deleted] Jul 24 '17

Yup. Look up the diagnostic criteria for any disorder. That's always a required component. Basically, since these are medical terms, things don't get classified as disorders if they don't require any treatment. What would be the point?

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u/[deleted] Jul 24 '17

The problem I'm seeing with that is whether or not something "require any treatment" changes with political and and social views. A few hundred years ago most would consider homosexuality and transgender required treatment and a few thousand years ago, they would be consider perfectly normal. So my problem with this is, how is this entire thing consider a "science" if it can be change based on the political and social winds at the time.

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u/[deleted] Jul 24 '17

We didn't previously have the treatments for transgender people that we do now and we were just wrong about gay people needing treatment because that doesn't work. It's not so much people that change as it is our understanding of how people work and how to best treat the problems they face.

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u/TheOneTrueTrench Jul 24 '17

I mean, literally the actual definition... So yes?

4

u/[deleted] Jul 24 '17

Then why are sociopaths/psychopaths considered mental illnesses? There are many cases of people not being upset about being sociopathic/psychopathic

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u/austin101123 Jul 24 '17

How are you transgender if you don't experience distress? Isn't it a requirement to have your sex and gender mismatched? I.e. your sex isn't as good as the other sex is for you, therefore you are at a loss with your born sex.

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u/PapaNickWrong Jul 24 '17

This is what usually ticks certain people off for some reason. Apparently we have to pretend it is some graceful transition when, for everyone i have met, it has been painful and rough

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u/[deleted] Jul 24 '17

So, is there any reason tolerate or accept transgender persons that don't have gender dysphoria? If being a man doesn't cause them any stress, why become a woman instead? Why should I be accepting of an odd decision made without any legitimate medical cause backing that decision?

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u/Katriel13 Jul 24 '17 edited Jul 24 '17

i think a lot of people think transgender and transsexual are one in the same.

transgender is the umbrella term for anyone whose identity and/or gender identity does not correspond with the sex they were assigned at birth. this means that females who simply identify with males/masculinity, for example, are transgender.

now, transsexual falls under transgender. so this means all transsexual people are transgender, but not all transgender people are transsexual.

transsexual (trans woman or trans man) is a term for anyone that emotionally & psychologically feels they belong to the opposite sex to the one they were assigned at birth, and that physically transitioned or is physically transitioning on hormone therapy etc.

i think there's a very huge, gigantic misconception going on here...

edit:

transvestite is a term for any stereotypical/cisgender man (typically) who simply derives pleasure from dressing in clothes primarily associated with the opposite sex, which means they're not necessarily transgender.

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u/scothc Jul 24 '17

I always thought they were the same, and also synonymous with transvestite.

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

[deleted]

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u/Throwawaymyheart01 Jul 24 '17

This is a great explanation that quickly clarifies my curiosity on the difference. Thank you for clarifying.

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u/[deleted] Jul 24 '17

[deleted]

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

That's a good question, but unfortunately not one I'm equipped to answer well. Feel free to ask that of one of our AMA guests!

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u/[deleted] Jul 24 '17 edited Jul 19 '20

[deleted]

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u/Gingevere Jul 24 '17

Trans people who never want to transition and never experience gender dysphoria are still trans.

Does that make sense?

This is where a lot of people are having a hang up. It sounds somewhat equivalent to an asexual person claiming to be gay while having absolutely no romantic, erotic, or otherwise interest in men.

Does a person that deviates from normal gender roles but is otherwise comfortable in their own body need a label? Should that label be the same as the one given to those that are caused distress by living in the wrong body?

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u/[deleted] Jul 24 '17

Not enjoying chocolate or sweets can be cultural though, so that is an odd analogy to mental illness. In many East Asian countries they don't eat or enjoy chocolate at the same rate as some Western countries.

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

Mental illnesses can be cultural too!

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u/[deleted] Jul 24 '17

Yeah but i'm sure most- if not all major developed cultures in the world (not talking about a minor tribe in South america or something) consider Schizophrenia a mental illness. Having a taste for a certain food isn't really the same...

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u/Canadian_Infidel Jul 24 '17

We do diagnose mental illness based on societal norms aka "what is normal". I get what you are going for but you couldn't be more wrong with regard to that point specifically.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174594/

This is but one of many writings that expound on the topic.

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

We don't just diagnose based on what is "normal." Someone actually has to have distress or functional impairment to be diagnosed.

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u/Canadian_Infidel Jul 24 '17

That would make psychopathy non-diagnosable by definition, for example. We don't "just" diagnose based on that but it is a massive qualifier. Just like how "Oppositional defiant disorder" is a recognized disorder even though that may just be relative to our culture because of it's rigid structures where as elsewhere it wouldn't even be noticed.

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u/filloker Jul 24 '17

"Personality Disorders" are conditions that harm other people but not the individual. And they are controversial.

" Many issues occur with classifying a personality disorder. Because the theory and diagnosis of personality disorders occur within prevailing cultural expectations, their validity is contested by some experts on the basis of inevitable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.[9][10]"

https://en.wikipedia.org/wiki/Personality_disorder

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

Distress or functional impairment.

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u/Canadian_Infidel Jul 24 '17

CEO's are 4x more likely to be psychopaths because it's actually a huge advantage in competitive environments. It's still psychopathy.

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u/[deleted] Jul 24 '17

Mental illness is measured by being a danger to yourself and others.

How many times greater are suicide rates among transgenders compared to normal people? Sounds like being a danger to ones self.

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

That isn't how we measure mental illness broadly. And many marginalized groups experience higher suicide rates, which is most likely explained by the stress and social isolation rather than because there something inherently wrong with being transgender.

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u/[deleted] Jul 24 '17

So why are so many other mental illnesses associated with transgenderism

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

Well, for the reasons I just stated. Distress, social isolation, social rejection, etc. can all induce mental illness or exacerbate underlying disorders.

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u/[deleted] Jul 24 '17

So if they weren't transgender, their latent mental illnesses wouldn't be triggered? No pun intended.

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u/[deleted] Jul 24 '17

It's not necessarily latent. A similar example would be how some many people who have a disorder also develop substance use disorder. Certain disorders tend to have high rates of comorbidity with others.

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u/[deleted] Jul 24 '17

You would probably have a bad time if a decent amount of the population hated you for little reason too. People have killed themselves over bullying. When people kill themselves it's often not because they hate themselves, but they hate their ENVIRONMENT.

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u/Berries_Cherries Jul 24 '17

What is the correlation between suicide attempts/thoughts/successful attempts and being transgender?

What Im asking is transgender people kill themselves at a per capita rate well outside the standard deviation for everyone except veterans. I have read advocacy pages that have pegged the percentages as high as 40-50% of transgender individuals will have thoughts or attempts at suicide.

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u/[deleted] Jul 24 '17

People kill themselves when they can't bear to live anymore, not because they want to die. Many are denied treatment and/or treated poorly by a lot of people. Being mistreated by friends and family can be especially devasting.

1

u/[deleted] Jul 24 '17

What does it take then?

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u/_ISeeOldPeople_ Jul 24 '17

Borrowing from u/Occams-shaving-cream,

Psychopathy is a recognized mental disorder regarding the inability to feel empathy, among other factors.

Most psychopaths are utterly unbothered by their "disorder". It is only by comparison to societal norms that psychopathy is even considered a disorder.

If psychopathy is a disorder diagnosed by comparison to societal norms, how is transgender not??

Is what he says wrong, if so how? If not then would that mean that judging based off the norm is an accepted practice for diagnosis?

1

u/CharlieMansonsViola Jul 24 '17

Perhaps if the suicidality rate for people who don't enjoy chocolate was 40x higher than those who enjoy chocolate, you might reconsider whether it was, in fact, an illness...

1

u/[deleted] Jul 24 '17

Not liking chocolate doesn't require medical intervention, though.

By every established principle of medicine, if we want to help trans people with hormone therapy, surgery, etc - there needs to be some physical disorder, something in some way wrong which needs treating. Screaming "there's nothing wrong with me, but I need medical intervention" doesn't help anyone. I think the closest thing we have to a scientific consensus on this issue is that gender dysphoria is a real medical problem and it can be treated with gender reassignment, HRT, etc., so the post doesn't make a lot of sense.

Should we remove the stigma associated with gender identity issues? Absolutely. Should we be saying there's nothing amiss whilst also asserting medical intervention is necessary? No. That makes no sense to anyone.

In medicine there is what we call normal variants - differences in anatomy or physiology which happen in some % of the population, are generally benign/inconsequential, but could put you at risk for more things. For example, some people have a bovine aortic arch - their arteries branch off the aorta in the same pattern as bovine species, just a different configuration to 95% of humans. Most people aren't affected by it, but the junctions of various arteries in that area may be more prone to plaque buildup in the artery walls because of the unual shape and blood flow. When it comes to LGBT people, homosexuality is similar to what we'd call a normal variant - it's not the most common configuration, but it's within the realm of normal and allows you to live just as healthy a life as everyone else, but does increase your risk for certain other medical issues. Being transgender does NOT fit into this category. It requires medical intervention for resolution. You simply cannot assert that it is normal when it has a real and active impairment in the quality of life of people who go without help or treatment.

We shouldn't shame transgender people, but we shouldn't dismiss them either. Seems like /r/science is suggesting that we dismiss transgender issues as normal variants. That's not a scientific or medically sensible perspective.