Is Gender Dysphoria A Mental Illness?

Is Gender Dysphoria A Mental Illness? 

In 2006, a North Carolina woman, Jewel Shuping, deliberately poured drain cleaner into her eyes, rendering herself blind. Why? Because she believed she was a blind person trapped inside a sighted person’s body. In Otawa, Canada, a man who prefers the pseudonym “One Hand Jason”, deliberately severed his arm with a power saw because he believed he was a disabled man trapped inside an able body. These are not isolated cases. There are literally hundreds of other cases world-wide, where people have mutilated themselves to achieve a physical state that accords with their mental self-perception. Colloquially, people suffering from this condition refer to themselves as “transabled”. ( There is even a case where a person believes he is a dog trapped inside a man’s body, and spends large amounts of time living in a dog kennel in his back yard.  In fact, so many people suffer from this psychiatric illness that it has been given its own classification in clinical diagnostic manuals, “Body Integrity Identity Disorder” (BIID).

We rightly identify these people as having a mental illness. Yet in the case of someone who believes he/she is a woman trapped inside a man’s body, anyone who dares to call it a mental illness invites scorn and vilification upon themselves, involving disparaging terms such as “bigot” and “genderist”. Is transgenderism a mental illness? Are there any academically and professionally respected sources towards which we can turn, to help us reach an informed opinion?

Yes. The Diagnostic and Statistical Manual of Mental Disorders (DSMMD) is the internationally recognised gold standard diagnostic tool for the identification and treatment of mental illness, published in conjunction with the American Psychiatric Society. It categorises both Gender Dysphoria and Body Dysmorphic Disorder as treatable mental disorders. Gender Dysphoria refers to a state of distress resulting from dissonance between one’s perceived gender identity and one’s physiological gender. Body Dysmorphic Disorder is the obsessive idea that some aspect of one’s own appearance is severely flawed and warrants exceptional measures to hide or fix it. When applied to the transgender issue it refers to a deep disgust and revulsion towards one’s own genitalia and a desire to have the genitals and body shape of the opposite sex.

In other words, the current official view of world-wide psychiatric professionals, expressed in the DSMMD, is that people who identify as transgender, believing that they are one gender trapped inside the opposite gender’s body, are sufferers of a mental illness.

Furthermore, there is significant research identifying an extremely high prevalence of other mental illnesses among transgender people. A 2013 study published by the U.S. National Institute of Health found that 65% of transgender people in the study had lifetime ideation of suicide and 41% had attempted suicide. A 2017 Australian study of 595 transgender people between the ages of 14 and 25, conducted jointly by the University of Western Australia and Curtin University, found that 50% had attempted suicide and a staggering 70% were being treated for other mental illnesses such as bipolar disease, schizophrenia, psychosis, anxiety and depression. These and many other studies reveal the profound and pervasive mental unwellness of transgender individuals.

The LGBTQI community have strongly objected to the classification of gender dysphoria as a mental illness, and are currently mounting a campaign in the United States to pressure the American Psychiatric Association (APA) to remove the classification. The APA has, to date, resisted this pressure, arguing that declassifying it as a mental illness would extinguish the federal funding that currently subsidises the treatment of this condition. What treatment does the APA and the gold-standard diagnostic tool, the DSMMD, recommend? Cognitive Behavioural Therapy (CBT). CBT is an evidence-based psychosocial intervention that involves intense counselling to challenge and correct unhealthy thought patterns.

In other words, the current official stance of psychiatric professionals is that those who present as transgender are suffering from a mental illness that is treatable with appropriate counselling. I use the term “current official stance” deliberately. There is a growing number of psychiatrists who are now questioning this categorisation of transgender as a mental illness. The ubiquitous societal push towards political correctness, resulting in a growing number of LGBTQI sympathisers within various psychiatric associations, has led to a call to review diagnostic manuals such as the DSMMD.

How are we to respond to all this? My view is that transgenderism is a mental illness. People who believe they are one gender trapped inside the body of the opposite gender are profoundly unwell. They are as disturbed as the sighted woman who believes she is really blind, or the able-bodied man who believes he is really disabled. In saying this, there is no judgmentalism, no condemnation. Transgenderism is a sickness, not a sin. On the whole, these people have not deliberately chosen to spurn their physiological gender, in some kind of recalcitrant rebellion against God or society – a kind of “stick it to the man” act of defiance. No. They are profoundly disturbed individuals whose “unwellness” creates significant internal turmoil and distress. As a Christian, my response towards transgender people ought to be one of compassion, not judgment. To condemn someone because they suffer from Gender Dysphoria makes as little sense as condemning someone because they suffer from depression or schizophrenia. They are sick, not naughty.

At a deeper theological level, we need to view Transgenderism through the lens of the opening chapters of Genesis.  Gender Dysphoria and Transgenderism are another reminder to us of the ubiquitous and profound consequences of The Fall.  The world in general, and people in particular, no longer function perfectly as we once might have. Each one of us is inherently flawed. We have inherited an intrinsic unwellness that manifests itself in all sorts of ways; insecurity, paranoia, various anxieties, depression, narcissism, dishonesty, arrogance, pride, selfishness, … etc. Some of us are fortunate, because our flaws are less obvious and more socially acceptable than others.  It is this paradigm of The Fall and its consequences that lead me towards compassion rather than judgmentalism. For I am a fallen creature too, who will struggle with elements of my own unwellness all the days off my life.

On the other hand, my compassion arising from this Biblical paradigm does not mean that I condone the current societal push to accept transgenderism as a normal and healthy expression of the diversity of human sexuality. The early chapters of Genesis describe the creation of two clear genders. In the beginning God created us male and female. He did not create a mixed category of half and half. The Bible gives no indication that God might, on occasion, intentionally create a person of contradictory or confused gender, or that one of the angels working on the baby production line might periodically lose focus and put the wrong spirit in the wrong body. Gender fluidity or gender confusion cannot be substantiated from the Bible as part of God’s perfectly created world. To promote transgenderism as a normative variation of healthy sexuality would be to deny its inherent sickness – a sickness that is both mental and spiritual.

Sadly, the current push to portray transgenderism as normative, healthy and even desirable, is gaining almost exponential momentum:

  • There are growing calls for transgender or gender-neutral toilets in schools, universities and public places
  • Some people are advocating that people should be able to enter whatever gender-specific toilet they identify with, irrespective of their physiological gender
  • A recent trial of the Safe Schools program in South Australia included books presented to Year 1 students showing mothers transitioning to fathers, as well as young children who were gay or transgender.
  • Subsequent to the trial of the Safe Schools program, academics from Flinders University, Clare Bartholomaeus, Damien Riggs and Yarrow ­Andrew have called for a nation-wide roll out of ­resources about gender diversity, such as picture books, to be made available to preschool, primary and secondary students, to help schools “create inclusive whole school ­cultures”.
  • On August 17, 2016, South Australian Premier Jay Weatherill voiced support for a primary school expansion of the Safe Schools program, while deflecting questions on whether five was too young for children to understand gender transitioning.
  • The LGBTQI community, and many health professionals, now openly promote gender re-assignment surgery as a legitimate and healthy course of action for those who experience Gender Dysphoria.
  • There is a growing trend for new parents to not identify the gender of their babies on birth certificates, as well as giving them gender neutral names, in order to allow them to one day choose their own gender.
  • In some cases, children as young as 5 are being allowed to transition towards eventual gender reassignment, based upon their immature, often whimsical, preferences.

All these politically correct trends deny the inherent unwellness of transgenderism, and seek to normalise it within schools and the wider society. Condoning gender reassignment (either behavioural or surgical) fails to recognise Gender Dysphoria as the mental illness that it is. Gender reassignment makes as little sense as setting up voluntary amputation clinics for people who would like to transition from able-bodied to disabled. Constructing gender-neutral toilets, or allowing transgender people to use whatever toilet they like, only reinforces their illness. It is like constructing “pee poles” in public places for people who think they are really dogs and want to urinate doggy-style.

Mental illness needs to be treated, not made normative.

Of course, treating any kind of mental illness requires, firstly, the recognition that the illness exists. People who deny that they are sick, cannot be treated. In that case, all we can do as Christians is love them and ask God to draw them to the Saviour. Because, ultimately, that is what is needed. Jesus came to seek and save those who are lost. And He is still seeking them today. All of us are equally in need of His mercy. In the end, it is not a person’s gender or sexuality that will determine their salvation, it is whether they have come to know their Creator God, through the grace and mercy of Jesus Christ His Son. Let’s not lose sight of this as we seek to engage in informed dialogue on this complex ethical issue.

(In my next post, I will evaluate the genetic and hormonal arguments often used to justify the normalisation of transgenderism).