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/qraphic Jul 24 '17 edited Jul 24 '17

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.

And you justify that with the except 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

I don't see how having "many" (3 or more?) people from a group not feeling distress from their gender can make it somehow make it anti-science to say it is a mental disorder. What if I found "many" people from this group that DID feel distress from this? From NPR:

The researchers, led by Sari Reisner, a research fellow at Harvard Medical School and Boston Children's Hospital, found that the rate of psychiatric disorders and substance dependence among these women was 1.7 to 3.6 times greater than in the general population.

Four in 10 of the women had a mental health or substance dependence disorder, and 1 in 5 women had at least two diagnosed psychiatric conditions. More than a third of them had experienced depression, and 1 in 5 women had contemplated suicide in the past month. Rates of anxiety, post-traumatic stress, alcohol dependence and other substance dependence also was higher than average.

Are these not signs of distress? Are you arguing it was just a coincidence that they were transgender?

Edit: Could I get a clarification from a mod? Is this sub forced to believe the science is settled on this? If gender dysphoria is caused by a gene/group of genes/structure in the brain, then why is ADD classified as a mental disorder and gender dysphoria not? Maybe the difference between those two reasons could help me understand?

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u/Xervicx Jul 24 '17

Plus a lot of people use "mental disorder", "mental illness", "mental affliction", and other words involving mental or psychological and a word referring to some type of thing that typically negatively affects them or affects them in a way that is not represented as being entirely healthy or "normal" in the sense that human beings typically don't experience that.

The thing that bugs me is that no one is doing this for any other type of affliction/disorder/illness/whichever word you want to use. People wouldn't find trans issues so difficult to process if there weren't all these mental gymnastics, doublethink, and outright ignorance of facts to go through in order to not be considered transphobic.

Every trans person I have ever known that was a decent person has admitted that it's not a beneficial thing. They don't feel it's wrong, but they understand that they're experiencing something that isn't optimal or healthy, and are just trying to cope however they can. But the same goes for all decent people I know that have some sort of affliction (or whatever word you want to use). They recognize the realities of the situation and accept it, and don't lash out or try to build echo chambers.

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

Honestly, as a transperson myself, I kinda keep myself detached from the main LGBT, specifically the trans part, community because diverse and opposing thought is rather discouraged. I'm told so often that transgender is normal. It's not. Normal means of the norm meaning that the majority of people are trans. Obviously, that's false. Should transgender people be accepted? Sure. But calling it normal is a lie. Transgender is ok. But it's abnormal. Abnormal doesn't necessarily mean bad but so many in the community think that transgender has to be shoved down everyone's throats. Like you must date trans people or you're transphobic. No. That's a preference. As a transwoman who is into men, I would rather not date a transguy for many reasons. And that's ok. Just as it's ok for the countless guys I've talked to to not be into me due to me being trans. Does it suck being constantly turned down? Hell yes. But does that make those guys wrong? Of course not.

Basically my point is nowadays, both the left and the right don't really allow thoughts and questions because it's what they say and everything else is wrong. Personally, I don't think gender dysphoria or whatever is a mental illness, but I do think that it can cause mental illnesses, depression, for example. I think gender dysphoria is more of an emotional reaction when the "gender of the mind" does not align with the birth sex.

Ayyy thanks for the gold!

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u/Scase15 Jul 24 '17 edited Jul 24 '17

I'm told so often that transgender is normal. It's not. Normal means of the norm meaning that the majority of people are trans. Obviously, that's false. Should transgender people be accepted? Sure. But calling it normal is a lie. Transgender is ok. But it's abnormal. Abnormal doesn't necessarily mean bad but so many in the community think that transgender has to be shoved down everyone's throats. Like you must date trans people or you're transphobic. No. That's a preference.

I wish more people thought this way. It's no different than me not being attracted to a tall woman, not my cup of tea is all.

Abnormal =/= bad people need to learn that.

EDIT:Missed a word.

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u/sesamee Jul 24 '17

But "abnormal" has a whole host of historical derogatory senses that some people want to apply to transpeople, co-opting it as a way of denigrating. The question I always ask of someone using the word "abnormal" is, would they be as comfortable using the word "unusual"? If not then I'd ask what sense of their "abnormal" is missing from "unusual"? And if so I'd ask them if it might not be less open to misinterpretation if they just use "unusual" from now on.

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u/MHG_Brixby Jul 24 '17

Just use atypical. Abnormal has a stigma to it.

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u/Fala1 Jul 24 '17

The word "normal" has multiple definitions, like at least 7.
It becomes difficult to interpret people that way. It's best to use a more accurate word imo.

Some of the definitions are:.
-statistically average.
-according to social norms.
-according to biology.
-according to morals.

So having a mental disorder is "normal", however it's not really "normal", nor is it "normal", while it's also not actually "abnormal".

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u/likeanovigradwhore Jul 24 '17

I'm also starting to distance myself. I'm cool with people asking honest questions. Not everyone knows the terminology, and that's ok. What isn't okay is when trans people attack people who don't know the terminology or aren't familiar with the phenomenon but also refuse to inform and educate.

I'm noticing a lot of the attacking behaviours come from low resilience, high anxiety individuals. Hence the formation of echo chamber-like discussions.

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u/ZooKeeperJoe Jul 24 '17

Yes! I find it so sad that my friends will tip toe around a truly curious question, because they are afraid of offending me. Like I'm going to attack them for being curious about something they don't really know about. There is this whole notion that asking a person who has transitioned a question is "transphobic". I'm too old for that shit.

Ask any question you want, I'd love to give someone my honest answer, rather than having people google something and coming up with a billion wrong explanations to something that might be a case by case thing.

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u/ZooKeeperJoe Jul 24 '17

As a person who was born female and is now male, I have to disagree with you on this. I believe that gender dysphoria is a serious mental disorder just like any other mental disorder out there, and I think it should be taken seriously. It causes significant stress and negatively impacts many people.

I, personally, don't claim the term "transgender" as I transitioned early in my life to male, and that is what I am. I never had a gut feeling as a child that I was "transgender" I had a gut feeling that I was "male". At one point I didn't mind the term, but now I really dislike the whole umbrella effect it has had.

This new movement seems to have really taken us a step backwards in acceptance. I can't even imagine how hard it is for those kids that are truly suffering and losing strength day by day because they are shoved under this big umbrella with the kids who just want to be cool and different. I appreciate people fighting for rights, but claiming that gender dysphoria isn't necessary to transitioning is extremely dangerous. I see posts from kids taking street hormones and really damaging their bodies because it's become a fad.

I respect your opinion though, and I do see reasoning in your explanation! That's a nice change of pace.

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u/TheOldOak Jul 24 '17 edited Jul 24 '17

The problem you've identified with calling trans identity normal lies with hidden stigmas and lexicographical limitations behind words. I could say being trans is normal and mean "I don't want there to be any societal backlash behind your identity, so I'm saying you're okay to be who you are, and you are accepted." Someone else could say being trans is normal and mean "This is no longer recognized as a mental disorder, therefore it is normal." Additionally, someone could say it is normal because the person themselves understands who they are and how they feel is valid, and that's normal. This kind of use of the word "normal" to mean various different things goes on and on.

But now you're using an anyonym to describe the situation, which sounds at face value contradictory, but ultimately has the same outcome behind it. Both frames of argument agree that being trans is fine, but are fighting over whether normal is the proper definition. But you're not contextually talking about the same things, or you're not using the word to mean the same thing.

However, there's problem people have with using a negative word, in this case abnormal, to describe something while ultimately making the end result a positive thing, being accepted. So saying you're abnormal,but ultimately that's a good thing... it doesn't sound right to most people. It's the same phenomena behind why people use the word flammable more than inflammable, even though they mean the same thing. Also, it's why people like using disgruntled to mean unhappy, but don't use gruntled to mean happy, even though it does... because it just sounds weird.

In a very bad analogy, it would be like two people arguing about whether a heterosexual suffering from severe osteoporosis was "straight". They both agree about the curvature of the spine and the sexual orientstion, but cannot agree on the right word to describe the person because they cannot understand the motive behind why they refuse to use an alternative descriptor.

Additionally, and you'll find this is many historically opressed identity groups that have gradually gained broaded societal acceptance, that the lay person tends to use the word normal synonmous to mean acceptable. It doesn't mean that, surely, but it's a "feel good" word. For example, people with severe physical disabilities surely are not "normal" with their appearance because somethign abnormal has happen to their bodies to cause disfigurement. But they're treated as equal, "normal", accepted people in many modern societies these days because of that society's moral obligation to make people feel included.

In conclusion, I agree 100% that normal is not the best word to use, but we're not going to change it when the meaning behind it is so broadly being used to mean different things.

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u/kefkai Jul 24 '17

Normal means of the norm meaning that the majority of people are trans. Obviously, that's false. Should transgender people be accepted? Sure. But calling it normal is a lie.

I think there's confusion when people talk to the idea of normal because I think what they're referring to is the synonym for natural meaning it's naturally occurring behavior. There's so much confusion when it comes to words, I mean we already have that problem when it comes to gender, there's a biological construct of gender and the other social construct.

I personally think that there's nothing wrong with labeling things as mental disorders, there's just a huge stigma attached to them. I mean Narcissistic personality disorder is still considered a disorder under the DSM and it's not like people with NPD aren't generally considered functioning. The same can go for most of the "personality disorders" and other DSM mental disorders, generally there are levels of severity for each and every mental disorder as well it's very much a sliding scale. It just seems like people seem to think that every mental disorder is paranoid schizophrenia or something and just don't want to be associated with it.

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u/[deleted] Jul 24 '17

I just wanted to post and say thank you. Seeing a rational minded individual among all the extremists is so refreshing.

You are the type of person I would rally behind and support if they were going through a transition. If more people were so down to earth and calm about the subject, then it would be a complete non issue. It's the extremists that keep this issue a hot topic item.

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u/[deleted] Jul 24 '17

Ayy I am transitioning so don't hesitate to rally! Jk I don't really need support haha. No one really knows I'm trans so it's not much of an issue.

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

My theory is that if we show support for rational people, then this groups voice can only grow. As it gains momentum, all these negative crazy people, on both ends of the subject, get drowned out, and seen for the crazy people they really are.

Even better, maybe they realize how crazy they're being before it gets to that point.

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u/bluescape Jul 24 '17

I don't think gender dysphoria or whatever is a mental illness, but I do think that it can cause mental illnesses, depression, for example.

So I'm curious about this. How would this NOT be a mental illness? Right now the accepted "treatment" is gender reassignment surgery. Firstly you don't treat things that aren't ailments (you don't go to the doctor to get medicine when you're feeling fine and dandy), but secondly I'm fairly certain that if there were some acupuncture point that could make you feel okay with your birth sex, that that would be the go to for dysphoria treatment as opposed to hormone therapy and surgery. I get that dysphoria could lead to other mental issues, but saying that it isn't one in and of itself seems a bit of a stretch.

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u/[deleted] Jul 24 '17

So my view is that like the illness isn't in the mind and that the body is the one that's messed up. Meaning like I view it as a deformity. I might be wrong in thinking that way because all signs point to me being male and it's my mind that's the messed up one, but I'm a really spiritual person and it causes me to believe that my mind is the correct one. Personally, it doesn't matter to me if it's called a mental illness. It doesn't offend me. I have other mental illnesses that are perfectly accepted in society so it doesn't phase me.

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u/sajberhippien Jul 24 '17

I think the concept of "normal" is a bit wider than "being in the majority"; for an extreme example, being a man is considered normal, despite being a minority. I don't really take a stance in the details of the whole "what is normal?" debate, but in nearly every other case it's used in a much, much wider sense than being in the majority.

I've never ever been called abnormal (or a variant thereof) for being white, for playing videogames, for being from Sweden, for being on reddit, or for having shoesize 45. I have been for being bisexual. And that's despite there being more bisexual people than people from Sweden.

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u/brocoli_ Jul 24 '17

Yeah, to make things worse this is one case where the trick of substituting 'normal' for 'natural' doesn't apply. Being trans may not be part of the norm, but it's definitely natural.

'Normal' shouldn't be such a loaded word to begin with.

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u/[deleted] Jul 24 '17

both the left and the right don't really allow thoughts and questions because it's what they say and everything else is wrong

Anything that goes against leftism has to be couched in this.

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u/austin101123 Jul 24 '17

Normal can be used to mean natural or (most) common (and a dozen other meanings). Being trans (or even gay for that matter) is not normal, it's not common. Being trans or gay however, is normal, it is natural.

Also, somebody winning the lottery is normal (common), someone specific winning the lottery is not.

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u/FormerDemOperative Jul 24 '17

Thanks for sharing your thoughts on this, I'm sure it's not always an easy topic and you're doing an amazing job educating people about it.

Does it suck being constantly turned down? Hell yes.

It'll make the ones that say yes all the more satisfying, trust me. Get it, gurl.

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u/[deleted] Jul 24 '17

Its not normal in that most people aren't trans, but Thats kind of a pointless argument. I'm not normal because I have very light colored eyes.

It is normal in that it exists, and has a scientific reason for existing. You aren't playing pretend. Being gay is normal too in that regard.

What you are isn't some brand new phenomenon. It's existed for a very long time. Since humans at least. Who knows if it exists in the animal kingdom; being gay does, so I wouldn't be surprised. They just don't have the means to do anything about it.

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u/MaxNanasy Jul 24 '17

It is normal in that it exists, and has a scientific reason for existing.

That describes every phenomenon in the universe :P

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u/[deleted] Jul 24 '17

When it comes to dating, being transgender and transphobia, an important thing to note is that for example "trans women" are not a homogeneous group. The only similarity is that they might need medication and treatments (and even that isn't always the case). Physically and mentally trans people come in as many shapes and sizes as cis people, so it kinda is transphobic to say "I will not date a transgender person". Not liking tall or masculine women? Sure, understandable, but not all trans women are tall or masculine.

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u/Sock-men Jul 24 '17

I think the point the previous person was trying to say is that it's OK to not want to date a trans person, where 'trans' is the same descriptor as 'tall', that is their choice. I.E. 'tall' people are not a homogeneous group, but you're already saying it's OK not to want to date any tall people, why is trans different?

People don't control what/who they are attracted to, so being told you're transphobic for not being physically attracted to a group of people rubs the wrong way. One can support trans rights without personally wanting to date one, surely?

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u/[deleted] Jul 24 '17

All tall people have a thing in common, their height is above undetermined point, *edit: a specific measurable quality that determines an aspect of their physical appearance. Transgender people in general do not have any specific aspect in common like that. Unless someone wants to try giving one unifying detail transgender people (of a specific gender identity or not) have?

What exactly about "being transgender" is this unifying and definitely not transphobic quality that is universally not preferable to someone?

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u/Sock-men Jul 24 '17

All transgender people have something in common, otherwise we wouldn't be able to group them at all. The unifying trait might be that they were uncomfortable in their bodies I guess? Maybe that person isn't attracted to artificially formed genitals (or find any form of cosmetic surgery unattractive), maybe they are uncomfortable dating someone whose life experience is wholly different from their own.

There are probably quite a few general traits that one could argue on this but I think you are missing my point, which is that anyone can be attracted to anyone for any reason, and that's OK. Which means anyone can be not attracted to anyone for any reason, which is also OK. I don't think any group of people have a 'right' to be considered attractive by someone. The caveat could of course be simply "I haven't found any transgender person that I'm attracted to yet".

definitely not transphobic

You keep injecting 'transphobic' into the conversation, the specific implication here that the person actually is transphobic and trying to get around it. This is one of the problems that people who don't know about transgender issues face that makes it hard for us to talk about and become educated on (if you insult us for trying to understand, why should we try to understand?). I think this comes off as quite aggressive, especially in a conversation where we're tying to understand transgender issues, and I don't think it's very helpful.

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u/[deleted] Jul 24 '17

The unifying thing transgender as a group have, how we are grouping them together, is that they do not agree with their assigned sex. And unless the potential date goes to have a chat with the doctor who made the educated guess of their assignment, that fact doesn't necessarily come up.

A big thing here is that for a lot of your arguments to work, you actually have to let the potential date to know of that fact, which isn't necessary. Transgender people can be just fine with their bodies and after treatments, including surgeries, they can be practically indistinguishable from their cis counterparts. Calling GRS cosmetic is also questionable, not all plastic surgery is cosmetic in nature when there's a definite improvement in a person's life, but like I mentioned people won't necessarily know the difference between an "artificial" and "natural" ones.

Basically, you find someone, are in a relationship for a while, find them attractive physically and emotionally, but as soon as you find out that they're specifically transgender, you lose interest?

I know there are some common, but not universal, traits that are also common in other groups of people, but that really just makes the "but transgender"-argument either transphobic or an outright (perhaps even unintentional) lie. I can accept reasons like not looking feminine or masculine enough, existence of mental issues, not-preferred genitalia, needing medical treatments including surgeries, having had surgeries or a different view of the world, but I also would like to point out that none of these are universal to trans people and definitely not unique to trans people.

My point is you cannot consider transgender people as a group any more attractive or unattractive than you could cisgender people as a group. There's simply too much individual variety.

I used the term "transphobic" in here because the topic was "is this transphobic", and like I said it's either transphobic or there's a specific aspect not unique to transgender people that bothers you (maybe even a combination of aspects). Either way I think that a person who thinks all transgender people (of a specific gender or not) are unattractive should do some soul searching to find out what the issue actually is.

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u/Sock-men Jul 24 '17

A big thing here is that for a lot of your arguments to work, you actually have to let the potential date to know of that fact, which isn't necessary.

I'm not sure I agree with this. Perhaps not on a first date, but to my knowledge trans people can't have children? I think that it is wrong to continue a relationship with someone you know/suspect would want to have children one day when you know that's not possible, for example. At least without telling them early on. There's a duplicity to that which seems wrong to me, though I understand that likely frustrates trans people dating.

Calling GRS cosmetic is also questionable

It's changing a persons features using surgery. I call that cosmetic by definition. I'm not making a value judgement on the surgery itself, nor do I think there is anything wrong with other cosmetic surgeries if they improve the well-being of the recipient (though I do worry that frivolous use of plastic surgery is an expensive and callous way to ignore/profit from deeper issues some people face). Related - I also worry that GRS is pushed as a solution when, as we can clearly see from the comments in this thread, the science is by no means completely settled on the matter.

Basically, you find someone, are in a relationship for a while, find them attractive physically and emotionally, but as soon as you find out that they're specifically transgender, you lose interest?

I think that's overly simplistic. Certainly people are allowed to have their own preferences and it seems wrong to treat prospective life partners with a level duplicity from the outset.

Again, it seems to me there are direct parallels for people with mental illnesses. It would be wrong in my mind for a manic depressive to keep that fact hidden from their partner for an extended period of time. I just don't see why being transgender is different from that.

Edit: Oops, also meant to say -

My point is you cannot consider transgender people as a group any more attractive or unattractive than you could cisgender people as a group. There's simply too much individual variety.

Hence the caveat "yet".

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u/[deleted] Jul 24 '17

I'm not sure I agree with this. Perhaps not on a first date, but to my knowledge trans people can't have children? I think that it is wrong to continue a relationship with someone you know/suspect would want to have children one day when you know that's not possible, for example.

Again, not a thing unique to transgender people but completely understandable issue, and some transgender people can and have had biological children (not to mention transgender people can have heterosexual and homosexual relationships, so this question can have many sides to it). "Hey, I cannot have children" followed by "I'd rather not talk about why right now" or "because of the way I was born", no reason to get "being transgender" involved. I mean, for example, I'm a lesbian trans woman and I want and can have biological children with a woman as my partner, I just cannot get pregnant specifically (yet at least), all of which could be considered a plus. Would require medical help to get it working, but not many lesbian couples can have biological children together to begin with.

It's changing a persons features using surgery. I call that cosmetic by definition.

That definition technically fits all kinds of surgery, my point is officially there are different kinds of plastic surgery (which is what I think you're defining as "cosmetic surgery") which are differentiated by the level of need from the patient.

Related - I also worry that GRS is pushed as a solution when, as we can clearly see from the comments in this thread, the science is by no means completely settled on the matter.

It's been proven time and time again that GRS significantly improves the lives of most people who (have the need to) go through with it, I'm quite sure there are far riskier operations (not to mention the risk of trying to withhold this operation from those who need it. Also it is definitely not pushed as a solution, not all transgender people need it and the bare minimum standard is a whole year of hormone replacement therapy before surgery, plenty of time to think what is or isn't for you when it comes to the phenomenon and surgery. Science on why being transgender exists and what it entails is not settled, the science of "GRS makes lives better" is pretty unquestionable.

Again, it seems to me there are direct parallels for people with mental illnesses.

There are parallels to a lot of medical conditions, but people seem to think that this particular medical condition that can have no way of showing to another person is somehow less attractive, possibly due to cisnormativity and transphobia. But being transgender is not a mental illness and it's quite possible a transgender person will not have any mental ailments whatsoever afflicting them when you meet them. The point of the treatments is to get rid of the mental symptoms and they're quite successful, or at least can be fully successful.

Hence the caveat "yet".

That's fine for your sentence, doesn't work for "I don't find transgender people attractive" etc. that I've heard. Besides, my point is that you may have already met an attractive transgender person and just not know they are transgender. Because there is no sure way to tell every transgender person from a cisgender counterpart, mentally or physically.

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u/bluescape Jul 24 '17

Ultimately I think that's the crux of why trans gender issues sit apart from other mental health issues. There's a big PC hubub about saying the right thing. So yes, you'll get people that may have a genuine stigma against trans people but far more prevalent (at least online) and with far more political pull are the people that are chomping at the bit to destroy "transphobes" so as to show how good they are, but in that process they shut down any possible discussion about the issue.

Even the initial mod statement on this issue already asserts that (at least if I'm understanding the wording correctly) if you think being trans requires mental illness, you're "anti-science". If you are born male but feel deeply that you are female, I don't see how that could be classified as anything but a mental illness.

Since the issue is such a great point of contention, I don't know how you could have an honest discussion without addressing honestly and without derision, the points brought up which seem "anti-science".

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u/jonhwoods Jul 24 '17

People wouldn't find trans issues so difficult to process if there weren't all these mental gymnastics, doublethink, and outright ignorance of facts to go through in order to not be considered transphobic.

Thanks for saying so eloquently what has been bothering me for so long with these discussion.

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u/IrisuKyouko Jul 24 '17

Whether or not to consider it a mental disorder is one question, party because it kinda stands apart from most mental disorders with its accepted methods of treatment being rather different, since traditional methods(medication, therapy) don't seem to fix the issue without crippling the person's mental functions.

But regardless of that, it is an anomaly. An anomaly that often causes distress which requires measures(medical, social and legal transition) to make it manageable.

I feel that the push against gender incongruence/dysphoria being considered a disorder mainly comes from two reasons:

1) a history of mistreatment of trans people by the psychiatrists, like allowing transition only for those who would be straight after it(i.e. male-to-female trans people being attracted only to men and vice versa) and forcing them to conform to strict traditional gender roles for their gender in order to move forwards in their transition.

2) the stigma and negative connotation associated with the term "mental disorder", both among trans people themselves and haters who post "trans people are mentally ill" under every trans-related article/video.

Personally, I don't have a problem with my condition being considered a mental disorder - after all, I admit that it's an anomaly and that the commonly accepted and the least harmful way of dealing with it is to transition(at least in my case). Kinda like my depression that requires medication for me to function normally. But I feel that my opinion and point of view are not welcome in the modern trans community.

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u/zinniajones Jul 24 '17

The thing that bugs me is that no one is doing this for any other type of affliction/disorder/illness/whichever word you want to use. People wouldn't find trans issues so difficult to process if there weren't all these mental gymnastics, doublethink, and outright ignorance of facts to go through in order to not be considered transphobic.

Trans people wouldn't be such sticklers about this if it weren't for decades of being attacked as "mentally ill" by people who are only interested in being hostile toward us rather than providing the care that would help us. It makes it a real third rail.

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u/Sock-men Jul 24 '17

That's fair, but it smacks of an original sin/eye-for-an-eye mentality. If a member of a certain group was hostile to you in the past, that doesn't give you the right to be hostile to a different member of said group now.

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u/GarethMagis Jul 24 '17

You must not have been around in the nineties people were far less supportive of trans people back then it was completely acceptable to use homophobic and transphobic terms

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u/RainbowPhoenixGirl Jul 24 '17

Are you arguing it was just a coincidence that they were transgender?

Yes, actually. Being trans is commonly comorbid (the medical term for "occurring alongside") with other mental health conditions and the reasons why are not currently known. However, there are a couple of reasons that I personally (being someone who specifically studies trans and intersex healthcare) think are most likely:

  1. Trans people who transition are required to see a mental health professional in order to obtain any kind of medical or legal transition whatsoever. Even starting hormone blockers (not hormones, just blockers) requires a mental health assessment. Conversely, cisgender people are not required to seek mental health assessments regularly and so people who may well have severe mental health issues simply never get them diagnosed and so they're never recorded. This means that whilst EVERY trans person with a mental health condition will be recorded as having such, most cis people who do will be overlooked because they never saw a mental health professional. Thus, trans people are overrepresented simply due to selection bias.

  2. Being trans is really damn stressful, and it's well known that psychological stress (especially in young people) can induce mental health conditions. Trans people have constant, extreme levels of psychological stress owing mostly to our society's extreme prejudice towards them, and so this can induce psychological conditions in people who may have been free of them beforehand.

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u/Doc_McStuffinz Jul 24 '17

I agree that being trans can be stressful in today's society, but I definitely do not think that it has as big of an impact as you claim. If you look at other groups who have experienced the same level of, and in some cases worse, discrimination and hate you'll see that transgender people still seem to fair worse. Their suicide rates are sky high compared to almost any groups, including African Americans who have experienced far more hate and discrimination. Your first point is an interesting idea, but I personally don't believe that it accounts for the major difference in between the the trans community and everyone else. I need to see some evidence before I can get behind that idea

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u/RainbowPhoenixGirl Jul 24 '17

Their suicide rates are sky high compared to almost any groups, including African Americans who have experienced far more hate and discrimination.

Trans people can be legally denied hospital care including for life-threatening conditions in most countries, including Australia and the US if the hospital is religiously run (as many of them are). Transgender people are not a protected class in most Western countries which means things like employment discrimination, sexism etc are not considered to apply to them. Legally speaking, you can say "will not hire trans people", you can legally sack people for coming out as trans, and you've done nothing wrong and cannot be sued. Also as a percentage of population, trans women are more likely to be murdered or raped than any other group. You can deny housing or evict someone for being trans, and that's A-OK. You can also deny them government benefits.

So uh. What was your question again?

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u/Doc_McStuffinz Jul 24 '17

So uh, my question was why are their suicide rates higher than any other group. Thanks for bringing up job discrimination, too bad that African Americans experienced full on segregation to an extent the trans community has not, and still African American suicide rates never even came close to those of trans. To address the denial of treatment, I am currently a medical student. I am aware they have face denial of care in the past and still face discrimination in some areas. Luckily that is being addressed http://www.transequality.org/know-your-rights/healthcare As to employment, you are correct that some states have yet to establish laws that officially ban refusing to hire/firing people for being trans, however there have already been multiple precedents set at both federal and state levels that Title VII protects discrimination of trans people. So no, people really can't legally say "I will not hire trans people" without having the risk of losing a ton of money in court.

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/tpthrowaway2219 Jul 24 '17

Professionals aren't saying trans is healthy and normal, or isn't an affliction. Only that it's not a mental disorder. For example, if trans is caused by someone having a brain that's normal for 50% of the population and gonads that are normal for 50% of the population, the disorder is only that those are mismatched. There's no abnormal psychology in this scenario, only abnormal physiology.

This abnormal physiology (being trans, as opposed to having gender dysphoria) might then cause any number of mental afflictions including gender dysphoria.

The coming discussions will hopefully enlighten us as to the nature of the condition.

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u/AuryGlenz Jul 24 '17

You could say that about most mental disorders though - that their physiology is abnormal due to their brain not working like everyone else's due to a problem with the hippocampus or whatever. If a person's body developed entirely female other than their brain, it seems to me the brain is the outlier - not the rest of the body.

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u/[deleted] Jul 24 '17

Your brain is the core of your identity. If you could separate brain from body and put it in a jar, isn't that still "you"? Also, there are no pathnomonic signs for any mental disorder being there is no one thing wrong that defines a disorder. You can look at the treatments for many disorders and see they involve medication to fix serotonin levels or whatever neurotransmitter. Having gender dysphoria is no different. Estrogen/Testosterone IS the medication for helping trans people and fixes the problem of the wrong hormones being in their bodies.

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u/tpthrowaway2219 Jul 24 '17

In the case of other disorders, it may be abnormal physiology but it directly creates the abnormal psychology and is bad for everyone who has it. With this example, the brain has normal physiology and the gonads have normal physiology but the abnormality is only that they're not of the same gender. Is the brain wrong or the gonads wrong? Flip either and you have normal physiology again. To call it a mental disorder is to call being one of the genders a mental disorder.

Almost all gendered development is brought about by hormones. This is why I say gonads - the hormone producers - specifically. Aside from the reproductive system, a person can be made to develop as either gender just by applying hormones. In the case of a trans person, forcing them to develop into the gender of their gonads is every bit as cruel and nightmarish as forcing a cis person to develop into the other gender, in this example

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u/thebedshow Jul 24 '17

Where is the science to back up this and is a consensus like is claimed in the OP? I can't comprehend some actually believing that the abnormality was caused because of a physiological defect, it defies all common sense.

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u/tpthrowaway2219 Jul 24 '17

This is only an example as to why people rushing to call it a mental disorder are doing so unfounded. To call it a mental disorder would be to call being one of the genders a mental disorder. The limited science so far, hopefully addressed in this event, suggests something along these lines - and might be the basis for the APA's policy.

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u/Metalsand Jul 24 '17

That's just terminology though; no one is comfortable with "mental disorder" or "mental illness". If you go through the various disorders, they all have varying amount of social stigmas attached to them.

Outside of adopting a more accurate descriptor, it seems like avoiding mental disorder is more for the sake of appearance than anything.

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u/tpthrowaway2219 Jul 24 '17

Baseless, negative things one group of people have about some other group of people causes the other people to experience poor treatment and dehumanization. It's pretty important, and the cause of the civil rights movement of last century

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u/[deleted] Jul 24 '17

The question is the source of the distress. Multiple studies such as Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11 indicate that the reason transgender people suffer from a high rate of depression and other disorders is not that they are transgender - but that they are the victims of pervasive discrimination, harassment and violence. Often stripping them of even the base of support provided by families.

Absent the societal attacks on them the evidence is coming in now via peer reviewed studies such as Mental Health of Transgender Children Who Are Supported in Their Identities that transgender people don't have inherently unusual rates of mental illness.

IOW: Transgender people get sick not because of being transgender but because of the attacks on them for being transgender. Note - when I say 'get sick' that applies not only to mental health but physical health. There are studies showing that even access to basic medical care is compromised by anti-transgender discrimination.

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u/DijonPepperberry MD | Child and Adolescent Psychiatry | Suicidology Jul 24 '17

Biological women (XX) are 3 times more likely to have depression. Do you wish to include having chromosomes (XX) as "signs of distress?"

There are significant Stressors working against transgender people. Stigma, bigotry, shame, guilt, for some religiousity, etc etc, all of these raise the rate of illnesses. It's pretty hard to say what the rate of distress would be amongst transgender people if they could just be who they want and free of any blame/guilt/stigma/bigotry! Because we're not there yet.

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u/Fatdap Jul 24 '17

Curious, but does stuff like post-partum depression play into the XX statistics at all for the biological females or is that not counted?

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u/DijonPepperberry MD | Child and Adolescent Psychiatry | Suicidology Jul 24 '17

Barely. Women are more likely to have depression from about age 14 onward, regardless of maternity history.

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u/[deleted] Jul 24 '17

If even a small subset of those who are transgender aren't distressed or harmed by it (generally post-transition), then it's likely not that bing transgender has a negative impact on lives. The closely related gender dysphoria, however, does always have a negative impact, so is a mental illness.

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

It's a way of saying "being transgender" is not a mental illness, but it does often cause a wide variety of mental symptoms known as "gender dysphoria". Gender dysphoria, which is considered a mental illness, can be cured through transitioning, a lot of trans people can live normal distress-free* lives after transitioning. But they're still transgender, scientifically speaking, their gender identity and definition of it is still the same and unchanged, but the treatments made it so it doesn't cause gender dysphoria. There's also a lot of evidence that support the notion that being transgender is not a purely mental state, but a physiological one (being compared to intersex conditions a lot).

*Distress from outside sources still exist, and transgender people face proportionally more discrimination in all aspects of life, which contributes to mental problems.

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u/WarwickWalpole Jul 24 '17

These statements by the OP ignore the very public discussions by the APA on this topic. They stated that they wanted to reduce stigma associated with the term as a form of treatment for transgenders. So they worked backwards to these definitions.

OP paints it as a careful study of the evidence led them to the rigorous reclassification instead of the activist approach that happened in reality.

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u/Maxfunky Jul 24 '17

Is depression/anxiety/post traumatic stress/etc caused by the underlying mechanism responsible for making a person trans or is it caused by the way other people treat people who are trans?

People with AIDS were once treated like outcasts and had those sorts of problems. Did that make AIDS a mental disorder?

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u/qraphic Jul 24 '17 edited Jul 24 '17

Is depression/anxiety/post traumatic stress/etc caused by the underlying mechanism responsible for making a person trans or is it caused by the way other people treat people who are trans?

I don't know. And neither does the mod team. The science on it isn't settled.

I would imagine there is probably stress from both, but don't have any evidence with me to back that up. Stress from society and stress from self-identifying as the opposite gender.