I have thought about writing a post of this nature for awhile, but recently I had an added incentive for wanting to write it. I had a telephone intake on 9/1/20 for bottom surgery. Initially the person conducting the intake, who is a transwoman herself, said having the surgery is not about if your trans enough. I was put a bit at ease, since, while things have moved on since earlier surgery approval processes, I was worried about having to present the standard story of I knew like for ever. However, her statement had nothing to do with meeting the criteria because insurances pay out based on certain criteria that needs to be provided in a letters from two mental health providers. One of those criteria is documented gender dysphoria. I had the impression that I could speak of it as body dysphoria, but was told that it wasn’t the same. I will argue, while they are technically different, they are substantively the same. And, that body dysphoria is the better of the two for several reasons.
My basic disagreement between these terms is philosophical. Gender dysphoria is the medical term for when a transgender person is feeling “uneasy, unhappy, or unwell” because of their gender (via Google search of dysphoria meaning). It is listed in the DSM-5 as a mental illness. The following is the diagnostic criteria:
“In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
- A strong desire to be rid of one’s primary and/or secondary sex characteristics
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of the other gender”¹
These criteria all speak about gender, and only the first 3 speak about the body. But, should desire or conviction be treated as a sickness. Should any of these criteria be treated as an illness? Only working with the medical community will solve those first 3, and therapy could assist someone who has issues with the last 3, but you don’t need to have a mental illness to see a therapist to help you work through issues or distress.
In my case, I don’t have a strong desire to be the other gender. I already know I am a woman, which is different from the sex I was assigned at birth (“the other gender”). But, at birth they can not determine your gender, it is not written on your genitals. I do desire to be treated as a woman, but as an uppity woman, I demand it, granted there maybe some situations where it would be prudent to remain quiet. But, for the most part I am treated as one. And what’s wrong with having number 6. That would be more of an indication that one is of the other gender. I mean I don’t have a problem with this conviction. And, I don’t see having a conviction about something in most cases as an mental illness.
Now I will fully admit that I am affected by the first three. And, yes I need medical treatment, but only because medical providers are the only ones who can safely provide it. But, cisgender persons have similar body image problems; it is just that they are not having an issue with it because of the mix up “we”† as trans persons have over our gender situation and assigned sex at birth. They seek some of the same type of surgeries as we do. Even ciswoman seek out vaginoplasty to make their vaginas more acceptable to themselves. Yes, granted, they are not getting a neo-vagina like a transwoman would. And, a good many ciswoman seek breast augmentation. Even facial surgeries are sought by them. But, they aren’t label as being mentally ill because of these desires.
So while, gender is at the root of my dysphoria, it is all about my body or in the one case other people are the root, and other people have bodies. But, there is another reason that body dysphoria is a better term. This is that our brains, whose function creates gender thoughts and feelings, cis or trans, is a physical component of our bodies. You cannot separate our minds from our brains—no brain, no mind. We are physical through and through, and that means are whole functioning as a thinking and feeling being is part of our bodies.
Some claim that the mind is indeed somehow separate from the brain, or is not totally dependent on it. These are people that have a duelist philosophical view point of the mind and brain. But, no one that I am aware of has shown us what this mind stuff, independent of the brain, is or where it resides. Science has not found it. Neuroscience does not even study the mind, but studies the brain. Yes, psychology speaks about the mind, but it is, I believe, just a convenient place marker for our thoughts and feelings.
So, maybe I should look at the benefits and deficits, or pros and cons of using gender dysphoria vs. body dysphoria. First, it should be a toss up because dysphoria if you are dealing with the same feeling(s) as stated above. and so the root cause does not matter if you are looking at the feeling state(s) involved. Even the treatments can be the same—surgery or therapy. With dysphoria we feel wrong enough that we seek changes to ourselves because of it. Unfortunately, some just suffer with it without getting any help because of the generalized transphobia lens we are often seen through. Seen like this it is society’s views that causes the dysphoria. I won’t say the fault is solely or even mostly societies fault, after all as one who has it, it is as real as real as it can get without societal considerations. Sure these considerations affect me, but for me it is more of an internal struggle.
But, I don’t get upset or distress because of my gender or because I am a transwoman. I am happy as a woman, I can know longer imagine myself as a male. Sure, there is lot to deal with and navigate through. But, it is not that I have a strong, or any really, desire to be the other gender, which now for would be male. And, I definitely do not want to be male. While it is true that I have a strong desire to be treat as a woman, I find that socially and in public this is pretty much a full time occurrence, and on the occasional misgendering, a simple correction changes the persons view at least outwardly. The strong conviction of having typical feelings and reactions of the other gender, I do have, but it is not a distresser to me. It is actually very affirming of being a woman. So, I have no issues with it.
My view is that I fit the criteria for gender dysphoria, so will certainly receive that diagnosis, but only for the sake of getting bottom surgery. Both of my mental health providers are willing to do this, but agree that body dysphoria better captures what my position is. I will grant that for those who do have any of the last 3 gender dysphoric symptoms it is fitting to be diagnosed as suffering from gender dysphoria. Since I don’t, my body dysphoria should definitely meet the requirements for vaginoplasty.
But, still since the brain is part of the body, body dysphoria is a philosophically better term to use then gender dysphoria. It would also lessen the stigmatizing of those that are diagnosed as having gender dysphoria. Having body dysphoria normalizes it by not pointing a finger at you for being a different gender than that which you were assigned at birth, which is no fault of your own. And, body dysphoria captures what is occurring, and it, while still indicating a mental health problem, can be seen as no different than those that want to change their bodies to better fit their own view of their body.
I do think I have present a reasonable argument for my view that body dysphoria is a better way to view our gender situation than gender dysphoria because you can have the first 3 without the last 3, and even if you have the last 3 the ultimate causal reason is the brain, which is part of the body. Plus, it involves far less stigma to have a body dysphoria than to have a gender dysphoria.
† “We” is in scare quotes because not all transgender individuals are affected by these body issues, but enough are that I feel I belong to a significant group of people that do, hence my use of the word.
[After writing this and also in discussion with a friend, it is becoming apparent to me that I am being gate kept. This feeling increased after a second phone call from John Hopkins over who can write a second referral letter.]