Are you mental?

Note: this post deals with mental disorder as it relates to gender dysphoria.  I’m not an expert, so I’m examining the words of experts and relating them to my own experiences.  I know that some people have fundamental disagreements with aspects of what I say below, and I welcome conversation and respectful debate.  Also, if I say something that feels wrong or disrespectful towards your own experience, please let me know – I’m a work in progress, and so is my blog.

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Hello Reader,

Ok, so I’m not British, but this idiom just seemed to fit.  Google.com gives two definitions for the word mental: 1. of or relating to the mind, 2. of or relating to disorders of the mind. If you haven’t picked up on it yet, I tend to be methodical and analytical.  I’ve had people describe me as “cerebral”.  Add to this that I’m very much an introvert, and I spend a lot of time in my own thoughts – in my own mind.  So the first definition for mental definitely applies to me.  But what about that second definition: of or relating to disorders of the mind?

Let’s start by looking at the DSM-5 (the American Psychatric Association’s Diagnostic and Statistical Manual of Mental Disorders, version 5), which defines Gender Dysphoria as:

In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics
3. A strong desire for the primary and/or secondary sex characteristics of the other gender
4. A strong desire to be of the other gender
5. A strong desire to be treated as the other gender
6. A strong conviction that one has the typical feelings and reactions of the other gender

Let’s parse this a little bit:”gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender”.  So basically, if one feels that there is a difference between the gender they were assigned (at birth) and what they experience and/or express, they meet this first criteria.  Next, “and significant distress or problems functioning”.  This is important.  If one feels the difference between their assigned and experienced gender, but does not have “significant distress or problems functioning”, they fall outside of the definition of this mental disorder.  So, if you feel the mismatch, but it doesn’t cause you any discomfort or problems, you don’t have a mental disorder.  The next part sets some further qualifications and markers which can be used to distinguish this from other disorders: it lasts at least 6 months, and has a few qualities which are common to those with this condition.

Digging deeper, let’s make sure we understand this word “disorder”.

disorder noun
1: lack of order
2: breach of the peace or public order
3: an abnormal physical or mental condition

To me, the definition of the word “disorder” evokes a few thoughts: it’s messy, it’s not peaceful, it’s not desirable, and it’s a condition (that is, it’s not permanent).  While the first thoughts are unpleasant, it’s the last which gives me hope – that if enough of the qualities which define the disorder can be eliminated, then the disorder is also eliminated.

So, let’s look at the description of Gender Dysphoria again, and boil it down to simpler terms:

1. The gender one has been assigned does not match the one that they feel
2. This mismatch causes the person distress and/or problems functioning
3. This persists for more than 6 months, and,
4. It’s marked by some of the following:
   • a mismatch between a person’s body’s sex characteristics and how they experience and/or express their gender
   • wanting to be rid of those characteristics which do not match the person’s experience/expression
   • wanting those characteristics which are typical of someone with the gender this person feels themself to be
   • wanting to simply “be” that gender
   • wanting to be treated by others the way that people of that gender are typically treated
   • feeling that one’s feelings and reactions are typical of someone of the experienced/expressed gender.

Which of these can be changed?

#1: there are only two qualities which can be addressed: the gender one is assigned, and, the gender one feels.  My  experience is that I’ve spent most of my life trying to deny the gender I feel.  While I became quite good at acting the part of my assigned gender, I could never get rid of the feelings which told me that “something isn’t right” about my gender.  Flipping it around, can I change the gender that I’m assigned?  Well, first, who assigns gender in the first place?  The short answer is that for most of us, our gender was assigned when we were born, based upon the appearance of our external genitalia (are you an “innie” or and “outie”?), then our families and society makes the assumption that this assignment is correct and sets out reinforcing this assignment for the rest of our lives.  Can it be changed? Well, yeah, kinda.  This gets into a concept called “passing”, which I’ll get into in another post.  But the crux of it is, if a person can convincingly enough resemble the typical characteristics of their experienced/expressed gender, other people will accept and validate the person as having the expressed gender.

#2: the variables here are “mismatch (of gender)” and “causes distress or problems functioning”.  As I mentioned in the last paragraph, I’ve tried fixing the mismatch by denying it’s very existence, and that didn’t work.  For this one, I’m working to eliminate the “distress and problems functioning”.  To this end, I’m doing a variety of things: writing this blog, keeping a journal, discussing my feelings with my family, working with a counselor.  I’ve come to realize that, while I cannot eradicate the feeling of gender mismatch, I can work to reduce (and hopefully someday eliminate) the effects they have on me.

#3: I’m sorry, I misplaced my TARDIS. Can I borrow yours?

#4: This is the list of characteristics which mark gender dysphoria.  I have some, but not all of them. Again, my experience is that I’ve tried to deny them, but they simply “are”.  I can no more change them than change the color of my eyes.

All this is to say that I’ve realized that while I may never get rid of the feeling of mismatch between my assigned and experienced gender, I can and am working to accept these feelings and integrate them into my life in ways which get rid of the negative effects.

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Gender dysphoria may be unique in the spectrum of mental disorders in how it is treated.  With most mental disorders, the treatment centers around correcting the root cause of the disorder and “fixing” the mind.  Gender dysphoria is treated by helping the person adjust to the feelings – there is no known “cure” for gender dysphoria, at least no cure in the traditional sense. From the DSM-5:

Treatment options for gender dysphoria include counseling, cross-sex hormones, puberty suppression and gender reassignment surgery. Some adults may have a strong desire to be of a different gender and to be treated as a different gender without seeking medical treatment or altering their body. They may only want support to feel comfortable in their gender identity. Others may want more extensive treatment including hormone treatment and gender reassignment surgery leading to a transition to the opposite sex. Some may choose hormone treatment or surgery alone.

Individual therapy can help a person understand and explore his/her/their feelings and cope with the distress and conflict. Couples therapy or family therapy may be helpful to improve understanding and to create a supportive environment. Parents of children with gender dysphoria may also benefit from counseling. Peer support groups for adolescents and adults and parent/family support groups can also be helpful.

[…]

A person may also address social and legal transition to the desired gender.

In a nutshell, the treatment for someone with gender dysphoria is working towards self-acceptance and building a supportive environment around them, and possibly by also pursuing physical/medical changes which help to affirm the person’s gender.

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Am I mental? At the moment, yes, in both senses of the word.  But I am thankful that this is a disorder which does not affect my ability to think, reason, and be logical and rational, and that there’s hope that I will be able to make adjustments to my life which will enable me to leave behind the disorder.

So, back to your homework: what was your answer before you read this post?  Did you think gender dysphoria is a mental disorder?  Has your opinion changed?  Do you think your approach to a person with gender dysphoria may be different now?  And for next time: How do you react to a person for whom it is difficult for you to determine their gender?  How do you react to a person for whom you believe that the gender they are expressing does not match the gender they were assigned at birth?

Cerebrally yours,

Me