Which Is Disordered: Transgender Persons or Society’s View of Transgender?

One problem with conceptualizing mental disorders is that the disorder is thought to reside within the individual, but we all exist within the context of our culture. A dysfunctional culture, however, will try to marginalize those who are mentally healthy enough to go against the flow regardless of the social penalties.

For example, in 1851 Dr. Samual Cartwright claimed that runaway slaves suffered from drapetomania, a mental disorder characterized by a desire for freedom. Yet, autonomy is a basic desire of all people – it’s hardwired into our brains.

In 1973 the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) because there’s no scientific evidence that being lesbian or gay is pathological. Rather, it’s society’s prejudice that creates emotional conflicts for those who are not heterosexual.

I took psychopathology as a college student in the mid-1990s and was assigned a fifteen page term paper. Everyone else in the class chose well known mental disorders such as schizophrenia, bipolar, depression, and anxiety. I wanted to write about something no one else did, so I combed through DSM-IV (the fourth revision of the manual, published in 1994) and found gender identity disorder.

It had never occurred to me that a person could feel trapped in a body of the wrong sex.

I was also surprised by the lack of research. Most of what I found were outdated Freudian theories about unresolved Oedipal and Electra Complexes. Basically, it’s all your mother’s fault. Except that stories of transgender individuals often contained a common element: around age three or four, when children learn the concept of gender, a biological female knew he was male in a rather matter-of-fact way and couldn’t understand why no one else could see that. But this is not what you’d expect if the child’s demented mother unconsciously were trying to re-socialize the toddler as male.

There were some scientists who speculated that self-perception of sex is hardwired in the brain, and this hardwiring occurs during pregnancy when various features each have their critical period of development. They wondered if non-average levels of sex hormones during a certain phase of gestation could result in a female fetus developing a male brain, or vice-versa. Even today the question has yet to be definitively answered.

I should point out that genetically, XX and XY are not the only possibilities – there’s XXYY, XXXX, XXXY, and so on. This doesn’t necessarily relate to transgender, though sometimes it pertains to intersex individuals.  And it’s important to realize that intersex and transgender are distinct.

In my paper, I concluded that more neuro-biological research needs to be done, and if evidence for a biological basis mounts then gender identity disorder should be removed from the DSM.

This was a cautious conclusion. Homosexuality was removed from the DSM even without definitive evidence of a biological basis. It was enough to show that gays and lesbians do not suffer from mental illness at a rate greater than heterosexuals (after controlling for distress related to living in a homophobic culture).

After college I found a job and ended up working with a transgender individual. This person made the theoretical real. Having tried everything to become the gender that would match the genitalia, having succeeded only in causing more distress, then turning to hard drugs for self-medication with resulting medical and legal problems, and suicide attempts, this person finally decided to accept it and found peace.

At that same time I had a friend who had been out as a gay man since his freshman year of college. One day we were discussing scientific attempts to prove a biological basis for homosexuality. He said the question was a distraction in many ways. Even if it’s nurture rather than nature, it becomes indelible early on. The notion that being gay is only legitimate if it’s biologically based struck him as homophobic.

That’s when I decided the same is true for being transgender (which is distinct from sexual orientation). Why is an interesting question, but it’s not central. DSM-V was published in 2013, and gender identity disorder has been replaced with gender dysphoria. The American Psychiatric Association states, “gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition”.

This is a move in the right direction. And greater societal acceptance is key to reducing “clinically significant distress”.

Society didn’t used to question what it means to be a man, but with shifting gender roles this has become a big question. However, society has always demanded that you prove you’re a man. And this can lead to some clinically significant stress and problematic behaviour.

How does a transgender man prove he’s a man? He shouldn’t have to. No one should have to. You’re a man because you say you’re a man. And there are myriad ways of being a man.

Gay men and trans men are outside the man box. But so are a lot of cis-gender heterosexual men. The latter, however, lack societal permission to be outside the box. We can change that.

A final thought. There are some awesome parents out there who listen to their transgender children and support them. The Whittington family posted a Youtube video showing how they support their son. An obvious question is: What happens when the child hits puberty? Hormone therapy can be tailored specifically for children, as Norman Spack explains in a TED Talk.


3 thoughts on “Which Is Disordered: Transgender Persons or Society’s View of Transgender?

  1. You’re a man because you say you’re a man. And there are myriad ways of being a man.

    This is merely post-modern X is true because I define it into existence thinking. Words have definitive meanings, even if they have more than one sense. A word that means anything is literally without meaning in that it loses all value as a signifyer. The term “Man” signifies homo-sapiens, and “man” refers to a mature XY chromosome bodied homo-sapiens.

    Your article errs in that it mistakes sex for gender. One is a set of biological traits, the other is nothing more than a sense of identity based on the perception of physical variables.

    I hereby claim that I am a woman.

    Of course I have a prominent beard, moustache, a penis and testicles, no hair on my head and hair in places other than my head and am taller, stronger and more muscular than that average woman my voice is rather deep and most people would mistake me for a prototypical man 99.999999% of the time. I share none of the traits that women have, I do not live like one, look like one, and can in no way be recognized by anyone as a woman. But, because I claim that I am, you are forced to agree with me, or appear to be an insensitive, uncultured, self-serving oaf deserving of scorn and mockery and you must accept a sense of lowered social status.

    I am perfectly sincere, and will be deeply offended should you disagree with me.

    Either way you play the game, you’re fucked and I own you for a simple reason: I’ve gotten you to abandon good sense under the pretext of good will. You have been trapped with the fallacy of reification. I’ve gotten you to believe that a concept is somehow a concrete reality, then, further, I’ve encouraged you to muddle the lines though sloppy use of terminology.

    Let us see if your statement can be falsified. If there are myriads of ways of being a man, is there a way that one cannot be a man?

    Your post is well meaning, but is an ass kiss to those that would have you that accept absurd claims. It is possible to respect people for who they are while dismissing non-sense claims.

    You ask “Which Is Disordered: Transgender Persons or Society’s View of Transgender?”

    The correct answer is: neither.

    People who are physically intersexed fall outside of the average categories as those that are above or below the average thresholds of height, weight, proportion or other factors. They have their own journey to take, and get to make up their own rules. Those that fall into the typical XY or XX are either male, or female, regardless of how they feel about themselves. Their sense of identity, however, is entirely up to them. While it might be kind and even courteous to accept them as though they were of any given group, it is not a requirement.

    1. You’re right that sex and gender and not identical, and the term transgender implies as much. From what I understand, though, a transgender male identifies not merely as masculine but as a man and in some places can legally have their sex (for example on their driver’s license) changed. So, I wonder how folks in the transgender community would respond to your critique (I really don’t know how they would).

      1. I’ve typically had two different responses. Basic acceptance on one hand, or outrage on the other. The former typically comes from real life, the latter from on-line communications 🙂

        If one comes from the position of general acceptance of people’s dignity, there’s rarely an issue. I recommend that if interested, print the comment out and go find yourself a real-world area with a bunch of trans-gendered folk and ask.

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