Why does gender identity have to be associated with mental illness?

One of the issues that I have with the field of psychology is the social stigma that builds up around people who have “mental disorders” as a result of studies that psychologists have conducted. An Introduction to Transgender History by Susan Stryker caused me to think more about one of the stereotypes that all transgender people are suffering some time of mental illness. I have heard people generally say that they  think that it is this sort of “chemical imbalance” within someone’s brain that is the reason behind them wanted to act outside of conventional gender roles. Gender roles are defined by Stryker as an unwritten rule that “tells us that if we don’t perform the prescribed expectations, we are failing to be proper men and women” (12). In my opinion, categorizing transgender as a mental disorder has repercussions in our culture which negatively police transgendered bodies and stigmatize them into bodies born with brain defects.

Stryker includes a passage in her novel about transgender history on Gender Identity Disorder. She begins with explaining the meaning attached to the label which include, “feelings of unhappiness or distress about the incongruence between the gender-signifying parts of one’s body, one’s gender identity and one’s social gender (a condition sometimes called “gender dysphoria”) are officially classified by medical and psychological professionals in the United States” (13). This is the definition provided by the Diagnostics and Statistics Manual of Mental Disorders from its 4^th edition, published in 2000 which Stryker talks about on page 14 into further detail. Before I go on to discuss the implications of these ideas, I want to dissect exactly what this definition entails. I think that people looking at the DSM definition would probably assume that this has to be a real mental disorder, considering the fact that it says that feelings of unhappiness occur as well as becoming distressed because your biological parts identify with the social norms of what gender is and is not. When you say that someone suffers from “dysphoria,” you claim that the person is not doing well. Why does the DSM have to say that people are suffering from “gender dysphoria” if they want to identify with whatever gender makes them feel the most comfortable?

I found an argument from two doctors of psychiatry who argued the pros and cons of classifying gender identity disorder as a mental illness. Dr. Robert L. Spitzer argued that, “surely something remains profoundly wrong psychologically with individuals who are uncomfortable with their biological sex and insist that their biological sex is of the opposite sex. The only diagnosis that is appropriate for such cases is GID.” Dr. Spitzer makes assumptions that there has to be something wrong with someone if they think they are transgendered. Dr. Dan Karasic discusses cons of the GID label. He believes that, “gender behavior outside of traditional role is not mental illness”.  He then says “patients would be better served by a narrower diagnosis that describes psychological distress about one's gender but does not pathologize transgendered people who have adjusted well by modifying their bodies and/or presentation of gender”.

From reading Stryker’s passage on GID, I believe that she would most likely agree with Dr. Karasic’s side of the argument. He believes that the detailed diagnosis of gender identity disorders are not suitable for transgender people that might actually go through distress because of the gender roles that have become traditionally followed. The labeling of these “disorders” dictates that transgendered identifying people are abnormal. According to Stryker, “some people resent having their sense of gender labeled as a sickness, while others take great comfort from believing that they have a condition which can be cured with proper treatment” (13). Stryker continues to talk about how even though GID is listed officially as a real “ mental illness”, transgender people are discriminated against because it can be hard to get access to the surgeries they want to receive because they are seen as for “cosmetic” purposes. She says that if GID “is to be considered psychopathological, its treatment should be covered as legitimate” (15). Perhaps this narrower focus in the DSM that Dr. Karasic is talking about would allow for those who are transgender to have better access to health care because they wouldn’t be pathologized.

As of May, there is a now a new definition for those with “Gender Identity Disorders” in the DSM 5, which is now the most recent edition. Huffington Post recently wrote an article about it titled Gender Dysphoria: DSM-5 Reflects Shift in Perspective on Gender Identity. This article quoted Robin Rosenberg, who is a clinical psychologist who described that the “shift reflects recognition that the disagreement between birth and identity may not necessarily be pathological if it does not cause the individual distress.”  The new definition of GID rather than claiming that it is an “abnormal mental illness” as it does in the DSM-4, now is aware that someone doesn't have to be labeled as abnormal cross the gender boundaries in which they were born into. Rosenberg also explains how the distress that was originally thought to have caused by being transgender is actually because of how culture places a stigma on people that are.

This new definition to me sounds a lot better than the old. However, why should gender identity be categorized as a “disorder?” Even though this definition also explains that distress is not inherent to being transgender, doesn't it further label those who are as a sort of cultural enigma that needs to be figured out?  Maybe transgender people would be better able to access the surgeries they desire if we stopped trying to say they are abnormal. Why can’t the procedures they want become a new norm, especially if people in our society do have cosmetic surgeries like nose jobs? Stryker ends her piece on Transgender History saying that “struggles revolving around GID form an important part of transgender political history and contemporary activism” (16). GID keeps being redefined through contemporary activism, but having it labeled as such keeps the stigma of abnormality in place.

Power to the people! If you're interested in learning about GID reform, this link provides some awesome information on attempts taken to try to remove the stigma of mental illness associated with gender identity and remove the pathologization of transgendered people.