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?
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
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".
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!
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.
For more see the human rights page and the ethics page!