January 1st, 2017 will see 'being transgender' declassified as a mental illness in Denmark, a momentous and long-awaited move which will surely put increased pressure on the World Health Organisation (WHO), to remove the diagnosis from its list of mental disorders.
This pressure is set to further increase with the release of evidence, published in The Lancet Psychiatry journal this week, which has found that the distress and dysfunction felt by transgender patients is caused by experiences of social rejection and violence, rather than by gender incongruence itself.
These findings corroborate what those of us specialising in this field have always known: being transgender is no more a mental illness than homosexuality.
So what exactly is 'gender variance', how does it differ from 'gender dysphoria', and why does it matter?
In short, 'gender variance' describes a situation where the patient's known gender varies from the gender assigned to them at birth, in line with their physical anatomy. This in turn can give rise to 'gender dysphoria': the deep sense of discomfort which comes with being gender variant.
But the argument posed by the study, which is the first of several being carried out worldwide, is whether the gender dysphoria and the high incidence of depression, anxiety, self-harm and suicide, common among those presenting with gender variance, is a direct result of the gender variance itself or whether the presenting mental vulnerability is born out of the lack of social acceptance that greets those who are gender variant.
Whilst conducted among a relatively small sample of 250 transgender people, the study showed that more than three-quarters of participants (76%) reported experiencing social rejection related to gender incongruence, most commonly by family members, followed by schoolmates, co-workers and friends. The majority of participants (63%) had been victims of violence related to their gender identity and in nearly half of these cases, the violence was perpetrated by a family member. Psychological and physical violence were the most commonly reported, and some experienced sexual violence.
These findings echo my own experience of treating patients with gender variance. More often than not their story is a tragic one. But what is clear to me is that it is not the fact that these patients are transgender that causes their mental struggle, it is society's response to their variance, and I am sorry to say, in too many cases, it is the response of the medical profession.
Research such as this gives hope to all those people with gender variance, it legitimises their condition, helps both the patient and those around them to realise and accept that they are not mentally ill. Declassification by the WHO would represent a huge victory for the transgender community.
It is worth remembering that, until 1990, homosexuality was classified as a mental illness in the same way as gender variance is currently. It was medically treated with aversion techniques that, not surprisingly, did not work. What did work was a change of approach. The realisation was that to live as a well-adjusted, happy homosexual you did not need compulsory psychiatric intervention, you needed acceptance, the same holds true for the transgender community.
Denmark is paving the way for the rest of the world by declassifying gender variance. It's time for the UK and the rest of the world to do the same.
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