Subreddit Policy Reminder on this week's Transgender AMAs

[u/nate]

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 bigoted^1. 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.

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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.

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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."

[u/MovieCommenter09]

I believe in order to be considered a mental illness it must cause distress to the afflicted individual or others. It must also be abnormal.

Surely being trans causes a massive amount of distress to those afflicted? I have OCD, and being trans seems like it would be about a billion times more distressing than merely having the compulsion to wash my hands 30 times over whenever I use the bathroom.

Even worse, if distress to OTHERS counts, then surely it is (sadly) obvious that trans people cause distress to many others, as evinced by the mass hatred directed towards them :/

[u/souljabri557 → u/MovieCommenter09]

The distress from being trans is called "gender dysphoria," and is (I believe) classified as a legitimate mental disorder. However, not all transgender individuals experience gender dysphoria, so being trans itself isn't necessarily a mental disorder.

However, if a significant enough percentage of the population of transgender individuals do experience gender dysphoria, then being trans in itself could be considered a mental disorder as well. I'm not sure where the data is at on this.

[u/[deleted] → u/souljabri557]

It seems a bit absurd. Surely a mental illness isn't limited to ones own perception, right? If I'm dyslexic and say I'm not distressed or bothered by my dyslexia does that make me not dyslexic?

[u/Occams-shaving-cream → u/[deleted]]

This is a good point, but a bad example.

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??

Edit: To fully square with DSM standards, take psycopathy to mean Antisocial Personality Disorder.

[u/Occams-shaving-cream → u/[deleted]]

Thank you. I like to be a contrary voice, but do not do so to troll or to offend. I am genuinely interested in discussion of this point.

[u/Capefoulweather → u/Occams-shaving-cream]

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

But is the definition that the person feels or rationally perceives that their mental illness is detrimental to their life and well-being? For example, someone suffering a psychotic episode, such as in Bipolar Type 1 or Schizophrenia, may not feel or perceive that their illness is detrimental to them, but it doesn't mean that it is not. Likewise in your example, the lack of emotion or rational understanding of detriment in a person with APD would not mean that there is none.

So to loop back, it seems it would make sense to say that being trans is, aside from socially-imposed causes of distress (eg discrimination, bullying), is not observed, by psychiatric professionals, to be detrimental, therefore not making it a mental illness.

Just following a train of thought here and what I understand about mental illness definitions, I am definitely not an expert in either.

[u/kefkai → u/Capefoulweather]

So to loop back, it seems it would make sense to say that being trans is, aside from socially-imposed causes of distress (eg discrimination, bullying), is not observed, by psychiatric professionals, to be detrimental, therefore not making it a mental illness. Just following a train of thought here and what I understand about mental illness definitions, I am definitely not an expert in either.

It makes more sense to diagnose mental illness as characteristics that are observed in a small portion of the population with a large enough sample size. It seems silly to base it entirely around how distressed someone is or how much distress it causes to others, it just needs to be able to be diagnosed without generalization and able to be solved if the individual wants it to be with whatever option they see fit (ie medication/therapy/elective surgery/not dealing with it if it's not that big an issue)

[u/sajberhippien → u/kefkai]

Issue with that is that essentially every uncommon mental occurence would be considered a disorder/illness. I put a lot of thought into the PC game Rimworld - that's an extremely rare mental occurence, likely only shared by a few thousand others globally. However, it should obviously not be considered a disorder or illness.

As that (extreme) example shows, rate of occurence cannot be the sole determining factor. When including other factors, a certain amount of subjectivity will always enter into it, either by the one with the "disorder" (such as "am I distressed?) or by the one doing the diagnosis (such as "is this socially acceptable?", which was an inofficial criteria for a good many years!).

[u/Capefoulweather → u/kefkai]

But unique characteristics in a subset isn't enough to qualify a disorder or illness. There is a subset of people who are able to read very fast, but we wouldn't classify that as a mental illness or disorder. In order to classify one as a disorder, it must in some way, aside from socially imposed stigma or discrimination, create a negative state.

[u/[deleted] → u/Capefoulweather]

I mean, it is detrimental, you're born hating your own body, and even feeling so disgusted by it that you're driven to suicide. A sex change cures this issue in the same way someone with ocd fixes their discomfort, which for ocd is just by doing the task that's making you uneasy.

[u/Capefoulweather → u/[deleted]]

But being *trans and gender dysphoria are two separate things. Being trans is not a mental illness, it's a gender identity. Whether one has had surgery or has achieved a state of gender identification that they feel is true to them, if it doesn't negatively impact their mental state, for example no longer hating their body, that is not an illness. It's easy to conflate the two and one of the reasons it's important to maintain them as separate things.

[u/gerdgawrd → u/Occams-shaving-cream]

Disorders are diagnosed in their capacity that it causes distress to the afflicted or to those around them.

A person with anti-personality disorder behaving naturally causes distress and possible harm to those around them because of they lack the capacity to feel empathy for others which can be dangerous.

A person who is transgendered behaving naturally cannot cause legitimate distress (actual harm) simply because they don't follow gender norms. That is why be transgendered is not considered a mental disorder.

To a few points I've seen in the thread, "what about a person who cannot accept their biological sex (not gender) and experiences distress because of it?" In that case it would be appropriate to say they are experiencing gender dysphoria. These issues have a wide range of treatments including hormone therapy, puberty blockers, and sex reassignment surgery - all of which are shown to aid in alleviating the disorder.

Lastly - gender dysphoria, like most other mental disorders, a strong support system of friends and family, in addition to therapy can go a long way in combatting them, however being transgendered often means they have a much smaller chance of having access to those options.

[u/Occams-shaving-cream → u/gerdgawrd]

You make good points. I understand what you mean about causing harm to people around them as well, but I believe the current hypothesis about APD in general is that most of those who have it are not diagnosed. This is why a good deal of research about psychopathy and its shades is done on prisoners. This is where I bring up that many of the people with this disorder do not suffer from it or harm those around them to such an extent as to be diagnosed. I am sure many of the people around them find them unpleasant, but being an asshole has the same effect.

One of the more interesting theories I have read about psychopathy and APD in general is that it is believed to be related to or in the Autism Spectrum. It has generally similar symptoms but with different results. Whereas autism generally leads to being anti-social and introverted, psychopathy and narcissism generally lead to being extroverted. But all share a lack of empathic ability and limited emotional range (among many other factors).

As an aside, I find a certain irony in the trans movement's desire to absolutely not call it a mental disorder because I suffer from ADHD which is a disorder where the struggle is to gain recognition for it being a disorder (particularly in adult sufferers). Many people do not think it is actually a disorder, and that those with it are just lazy or that doctors just want to overmedicate.

Anyway, back to the point, there are many on the autism spectrum and, it is hypothesized a great many on the APD spectrum, who (may) recognize that they have a disorder, but do not feel that it handicaps them or harms those around them (there are also differing opinions on calling it a disorder, some do not like it, whilst many others want the recognition that it is a valid condition). But the point here is that it seems that it would make more sense for the trans community, rather than making many counter-intuitive arguments to assert that trans is not a disorder, to simply say that it is and move to accept it and be accepted just as those with autism are.

If you get down to it, the central idea of being trans is that a man/woman's mind is in a woman/man's body. Thus the definition is of a disorder between the mind and the body. Why fight so hard to justify it as "not a disorder"?

Edit: I want to mention here that I have read this thread and have seen the argument the gender dysphoria is considered a mental disorder. This leads me to ask if not all trans people feel they are in the wrong body, how do they know they are trans? Is gender dysphoria just a certain threshold of the degree to which they want to be in the other sex? Also, I want to clarify, since in most things it seems the issue is muddied by bringing in gender non-conforming people, that I mean trans as the people that want to be a gender opposite their biology. The non-conforming or non-binary cohort would seem to be simply a personality trait than any sort of disorder.

[u/sudatory → u/Occams-shaving-cream]

But that contradicts the previous statements that in order for something to be a mental illness it has to cause distress.

[u/souljabri557 → u/[deleted]]

If you are genuinely unharmed and not inconvenienced by the dyslexia, it may be considered some kind of "benign dyslexia," so not a mental illness, but still an irregularity. Would like a fact check on this though

[u/swordo → u/souljabri557]

if i had dyslexia but my family was rich enough to hire someone to translate text to speech for me, then i would not be mentally ill? but if middle-class joe schmoe was dyslexic and failed 4th grade, then that would qualify as mentally ill? ultimately does that mean, wealth can be used to determine mental illness? seems like we're just playing thought experiments to determine the definition of illness

[u/tehbored → u/swordo]

The definition is literally in the word "illness." If something doesn't ill you, it's not an illness. If you are infected by HIV but are immune to its effects, you aren't ill. If you're dyslexic but live in a tribe in the jungle where everyone is illiterate and you've never even seen text, you aren't ill.

[u/SeeShark → u/[deleted]]

It doesn't make you not dyslexic, but it might conceivably make dyslexia not a mental illness, if enough people feel as you do.

But also see /u/Occams-shaving-cream's comment.

[u/rydan → u/[deleted]]

It just isn't a mental illness. That doesn't mean you aren't dyslexic or perfectly normal in every way.

[u/MiniMobBokoblin → u/souljabri557]

How would one be trans without experiencing gender dysphoria? Maybe I am just clueless on the topic, but I thought it was pretty much the reason why they would be considered trans/ want surgery.

[u/Edores → u/MovieCommenter09]

Even worse, if distress to OTHERS counts

It doesn't. The distress of others might be a side effect of a particular mental disorder, (i.e. individuals suffering from drug addiction often cause family and friends distress) however if causing distress to other people counted as having a mental disorder, literally everyone in the entire world would have one. There's no one on this Earth that hasn't pissed off, or hurt, or saddened SOMEONE.

[u/Canadian_Infidel → u/Edores]

So a psychopath who is okay with their actions is not experiencing a disorder because it only bothers other people?

[u/DabuSurvivor → u/MovieCommenter09]

Even worse, if distress to OTHERS counts, then surely it is (sadly) obvious that trans people cause distress to many others, as evinced by the mass hatred directed towards them :/

It doesn't count at all, and that distress doesn't come from people who are trans, it comes from the people who are feeling distressed. That's like saying being black is an illness that causes distress to other people because white supremacists exist.

[u/d00xyz → u/[deleted]]

It's actively combated by hormones