Classifying Transgenderism: Meeting the Medical Threshold

Denmark became the first country in Europe to allow transgender people to legally change their gender without medical records in 2014.^[1] Two years later, Denmark became the first country in the world to announce that it will remove transgenderism from its list of mental diseases, effective January 1, 2017.^[2] This, despite the fact that the World Health Organization lists gender identity disorder—the term medically used to refer to transgender people—as a mental disorder in the World Health Organization’s International Classification of Diseases.^[3][4]

Given that transgender people perceive themselves differently than the testimony of objective reality, transgenderism meets the definition of a mental disorder according to the Diagnostic and Statistical Manual of Mental Disorders. The American College of Pediatricians explains:

A person’s belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. These children suffer from gender dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder (GID), is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V). The psychodynamic and social learning theories of GD/GID have never been disproved (emphasis removed).^[5]

The classification of transgenderism as a mental disorder may not be politically correct, but with the absence of objective evidence disproving such a classification, the medical community is compelled to treat it as such. Failure to do so would be inconsistent with how psychiatry defines other recognized disorders of assumption. Former psychiatrist-in-chief at Johns Hopkins Hospital and University distinguished professor of psychiatry at Johns Hopkins School of Medicine Dr. Paul McHugh explains:

The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one’s maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.

With body dysmorphic disorder, an often socially crippling condition, the individual is consumed by the assumption “I’m ugly.” These disorders occur in subjects who have come to believe that some of their psycho-social conflicts or problems will be resolved if they can change the way that they appear to others. Such ideas work like ruling passions in their subjects’ minds and tend to be accompanied by a solipsistic argument. [This is the theory that only the self exists, or can be proved to exist, or an extreme pre-occupation with one’s feelings and desires.]^[[6]]

For the transgendered, this argument holds that one’s feeling of “gender” is a conscious, subjective sense that, being in one’s mind, cannot be questioned by others. The individual often seeks not just society’s tolerance of this “personal truth” but affirmation of it.^[7]

The medical threshold has been met. Consistency demands that we classify gender identity disorder as a mental disorder. Nonetheless, the classification of transgenderism remains highly controversial. Despite transgenderism’s similarities with other disorders of assumption, the mental health community has come under severe political pressure to declassify transgenderism as a mental disorder.