Dear GOP, Trans People Aren’t Sick. You Are.
Transgender people are not mentally ill. Being transgender is not a mental disorder. And anyone who argues otherwise is directly contradicting current medical consensus.
These lines of anti-transgender argumentation were already common before the March passage of North Carolina’s HB 2, which requires transgender people to use public bathrooms matching their birth certificates.
For instance, when Caitlyn Jenner came out last year, conservative blogger Matt Walsh called her a “mentally ill cross-dresser” on Glenn Beck’s The Blaze. A long list of right-wing media outlets and pundits have echoed the “mental illness” language: The Federalist, Breitbart, TownHall, Rush Limbaugh, the list goes on. Check out the comments on any story about transgender issues and you’ll find it there, too.
But now that public attention is squarely trained on the bathroom debate, the “mental illness” credo is gaining traction once again, even among some state lawmakers. And with the Obama administration responding to HB 2 in full force, the psychological pathologization of transgender people is threatening to reach fever pitch.
This February, South Dakota state senator David Omdahl claimed transgender people were “twisted” in order to argue for bathroom restrictions. And in mid-May, Tennessee Representative Susan Lynn opined on Facebook: “Transgenderism is a mental disorder called gender identity disorder—no one should be forced to entertain another’s mental disorder and it is not healthy for the individual with the disorder.”
Just last week, former U.S. congressman John Linder argued on The Daily Caller that the Obama administration is “normalizing a mental disorder as a matter of public policy.”
Wherever Lynn and Linder got their information, it’s embarrassingly out of date. In fact, most opponents of transgender rights could stand to review some recent psychiatric history.
Gender identity disorder (GID) was indeed a diagnosis in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). But the APA replaced GID with gender dysphoria (GD) in the DSM-V, which was officially approved in 2013—years before the current bathroom fracas.
The APA made this change with the stated intention of de-stigmatizing transgender people. As they explained in a GD fact sheet, the new language “removes the connotation that the patient is ‘disordered” [PDF].
One of the main reasons GD is still included in the DSM-V is because the APA wanted to ensure continuing access to transition-related health care. The fear was that, without some sort of diagnostic category, insurers could justify cutting off treatments that they previously offered to transgender patients.
As noted on the GD fact sheet: “Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and won’t be used against them in social, occupational, or legal areas.”
It couldn’t be clearer: Anyone who tries to leverage clinical language against transgender people is directly contradicting the largest psychiatric organization on the planet. And to say that transgender people are inherently mentally disordered is to intentionally wield as fact an implication that the APA went out of its way to combat.
That disjuncture wasn’t always so stark. In the DSM-IV, GID was grouped in with diagnoses like pedophilia and exhibitionism in the chapter “Sexual and Gender Identity Disorders.” Under that rubric, it was easier—but still disingenuous—to argue that transgender people should not be legally protected because they have a “mental disorder.”
In the DSM-V, however, GD is described not as a disorder but as a potentially distressing “condition” that may result from an “incongruence between one’s experienced or expressed gender and one’s assigned gender.” Instead of being grouped with an unsavory category like pedophilia, GD has its own individual chapter [PDF].
And while it is true that transgender people often seek out clinical treatment, the problem is not their identity but rather the distress of dysphoria. As the DSM-V notes, the new guidance “focuses on dysphoria as the clinical problem, not identity per se.”
According to the APA, this “clinical problem” is commonly addressed through “counseling, cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender” [PDF]. Almost every leading professional organization supports these same treatments.
Given the ready availability of this information, it’s likely that many conservative bloggers and anti-LGBT lawmakers are aware of this medical consensus.
A web search for “Is being transgender a mental disorder?” will turn up this answer from the American Psychological Association: “Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder.”
This may be why the anti-LGBT crowd so quickly latches onto a small handful of superficially reputable medical experts who buck against transgender rights.
When the American College of Pediatricians (ACPeds) called health care for transgender youth a form of “child abuse,” Breitbart, The Daily Caller, The Blaze, and other right-wing outlets ate it up. In reality, ACPeds is an anti-LGBT group with an estimated membership of just 200 people. The leading organization for U.S. pediatricians is the 64,000-member American Academy of Pediatrics (AAP), which supports transgender youth.
And when former John Hopkins psychiatry chair Dr. Paul McHugh called transgender identity a “mental disorder” in a Wall Street Journal op-ed, he, too, found a captive audience among the far right.
Ignoring the fact that McHugh is wildly out of step with the APA, he has a history of opposing LGBT equality. In 2010, for example, he filed an amicus brief in favor of California’s same-sex marriage ban [PDF].
The many outlets that uncritically repeated the claims in McHugh’s WSJ op-ed failed to do basic fact checking. McHugh cited a 2011 Swedish study to argue that sex reassignment surgery increases the risk of suicide. In fact, the study explicitly stated that “the results should not be interpreted such as sex reassignment per se increases morbidity and mortality.” The lead author, Dr. Cecilia Dhejne, later confirmed to TransAdvocate that her work was misrepresented.
In a response letter to McHugh, psychiatrist and World Professional Association of Transgender Health (WPATH) board member Dr. Dan Karasic explained: “A closer reading of [Dr. Dhejne’s] paper shows that the increased mortality is in those who had surgery before 1989, and that mortality in trans people after 1989 is not statistically different from the general population.”
This is the sort of cherry picking that opponents of LGBT rights must use to try to convince themselves—and others—that transgender people are deviant or disordered. Labeling transgender people as such might sway the uninformed but it won’t reverse history and it can’t stop medical science from advancing.
In 2016, this argument is over for anyone who cares about the facts.