For the 40 something years before I went into treatment for transsexuality nobody had ever questioned my mental faculties and nobody (including myself) had ever thought that I should get any kind of psychological support or mental treatment for anything. Nevertheless, I found myself convicted of having a mental illness, never mind one for which there is no diagnosis except for who I am! But is transsexuality really a mental illness or is it a physical problem?
My own self-experience pre-treatment was certainly that of a female with a physical disability, however I full well know that medicine portrays transsexuals (no matter if pre- or post op, non-surgical or without any treatment at all) as a mental illness, according to them we suffer from something they currently call "gender dysphoria". Like so many transsexuals I don't agree with this - here is why:

 

To start with it is important to understand why transsexuality ends-up in the psychiatrist's office in the first place - which is in itself simple enough: The treatment of transsexuality requires the authority to write prescriptions (for hormonal treatment) and medical referrals (for surgery). Hence, unlike every other personal identification, transsexuals are forced to seek the assistance of a person who is licensed to practice medicine to obtain what they need to live their identity! These prescriptions and referrals are usually given to us by medical doctors (in some cases other licensed practitioners help us, but they often end-up in the medical crossfire between non-acceptance and professional restrictions).
Because transsexual individuals usually present physically completely normal in every respect in a medical sense the medical community interprets our request for treatment as an expression of an emotional condition and consequentially refer transsexuals to psychiatrists. There the inconsistency between the body and the mind is interpreted as a mental illness solely for the fact that no physical ailment can be found, EVEN IF THE INDIVIDUAL PRESENTS NO CURRENT AND/OR PAST EMOTIONAL, SOCIAL OR BEHAVIOURAL PROBLEMS WHATSOEVER!

 

The logic that something must be "of a mental origin" whenever no physical cause can be identified may be sound for many other ailments (or it may not), however for transsexuality this argument fails completely. Because, unlike every other medical condition in existence, there are two sets of biological parameters that could reasonably be applied to a transsexual individual, these are both considered "medically normal" as well as "mentally normal", one being "the male normal", the other "the female normal".
Now if I am - pre-treatment - deemed "medically male" then I score "physically normal" in every respect. In this scenario it becomes understandable why my self-experience of being a woman would be interpreted as a mental condition. If however my medical parameters would be compared against "the female normal" then it would instantly be obvious that physical treatment is indicated (incidentally this would be the very same treatment I myself want). In this scenario MY MENTAL SELF-EXPERIENCE AS A WOMAN WOULD BE DEEMED ENTIRELY NORMAL whereas my obvious physical inconsistency to expectations would be interpreted as a physical disability - I would be seen as a woman who has had the misfortune of being born with the wrong reproductive system! Obviously the important question here is which one of the two interpretations is correct (or better)?

 

At this time a great majority of medical practitioners, in particular psychiatrists, insists that gender is a biological/physical capacity (and any aberration of my self-identification to this is therefore deemed a mental condition and warrants mental treatment) whereas I insist that gender is a mental/emotional capacity (and any divergence of my biological self is a physical condition and warrants physical treatment). The problem is that the decision which view is the correct one is entirely subjective as there is no way to find out. After all, this is the very reason why transsexuality needs to be self-identified and cannot be tested for!
So apparently this is ultimately not at all a question whether I am mentally ill or not! Ultimately this is a question of WHOSE INTERPRETATION OF MY LIFE TAKES PRECEDENT when there are no facts whatsoever to base a conclusion on: My own or the one of somebody else?

Of course given the fact that it is the doctor who is to make this determination (for the simple fact that he has the power to write these prescriptions and referrals), it comes as no surprise that IT IS HIS PREFERENCE THAT TAKES PRECEDENT, NOT MINE! Given the fact that a transsexual's life depends on the well-meaning of his/her doctor (it is difficult enough to find a well-meaning one) few individuals will contradict or challenge this, except maybe outside of the medical office...

 

Apart from these (theoretical) insights there is also the fact that the currently available physical treatment (hormonal and surgical gender alignment) seems to work just fine for most people. On the other hand the mental-health community has yet to demonstrate a way how to change a person's self-identification so he/she would accept to be the other gender than the one he/she currently feels (at least without in the process severely damaging or killing this person). Very fundamentally it is difficult to imagine that such a treatment could actually exist because if it would be applied to a person then it would have to be expected that this person would no longer be him/herself afterwards. After all a treatment that changes a person's identification from female to male (or vv.) would seem to require a rather dramatic change of this individuals personality. In my opinion it is very questionable if to provide such a treatment (never mind enforce it) would be [a] ethical [b] leave the individual in any way emotionally intact and [c] allow the person to experience him/herself as "the same individual" afterwards as he or she was before.
So if physical treatment is available and works just fine while mental treatment is neither available nor is it likely to ever become possible, just why do the medical and in particular the mental-health people insist that this is a mental problem, not a physical one? Well, at this point I would like to allow the reader to indulge him/herself in some speculation...



For more see the human rights page and the ethics page!