What transsexuality has to do with mental health

Until transsexuals arrive in their own sex, they have to overcome many hurdles – social and medical “One day, when I grow up, I will be a beautiful woman. But today I am still a child, today I am still a boy.” This is what the New York artist Anohni sang back then under the name Antony on her album “I Am a Bird Now” in 2005, and she once said in an interview that she had never made a secret of the fact that she was more transgender. And: She always saw herself as a woman, but did not have the courage to ask others to address her as a woman. It lasted until 2015, when she officially changed her name at the age of 45.

Everyday hurdles

If the gender identity and the physical gender do not match, we speak of transidentity or transsexuality. For transsexuals, arriving in their own sex is a long process. Until then, they will have to overcome many hurdles – social as well as medical. The path runs from psychotherapy to diagnosis, through hormone treatment to sex-adaptive surgery, but not everyone decides on this final step. Social incomprehension and a widespread transphobe attitude cause enormous suffering among those affected. This manifests itself, among other things, in countless everyday obstacles: For example, if you have to show your ID card, which is in a man’s name but you look female. Sitting in the waiting room can also be an obstacle if one is called with a woman’s name but is outwardly male. Or such everyday things as going to public toilets and filling out a form, if only the two options “male” and “female” are available.

Pathologizing and incapacitating

And then there is the legal basis of gender change: people who are not self-determined experience the psychological and psychiatric diagnoses that are required in Austria, for example, in order to change their first name and gender entry. In a position paper written in 2016, transgender groups describe the handling as “pathologizing and incapacitating harassment”. This view is shared by the Viennese association Trans X, which was founded in 1995. Eva Fels also believes that transgender persons are often regarded as pathological and not taken seriously. She is a transgender activist and has been chairwoman of the Austrian association Trans X since 2000. “When the topic of transidentity arises, therapists often cannot react adequately. Depression, anxiety disorders or autistic traits are then diagnosed on the basis of one’s own ignorance, which usually dissolve as soon as one has found the right therapeutic support,” says Fels.

Transsexuality is considered a mental illness

The classification of transsexuality as a mental illness is considered particularly degrading. A diagnostic handbook of mental disorders, currently ICD-10, which still lists transsexualism as a mental disorder. Although a new version of the ICD-11 is currently being worked on and is expected to appear in 2018, it remains to be seen whether the revised version will delete the classification of transsexuality as a mental illness. Back in 1974, when homosexuality was removed from the international catalogue of mental disorders, millions of homosexuals were healed in one fell swoop. Parallel to the ICD-10 there is the DSM-5, the psychiatric classification system of the USA. Here at least the medical diagnosis “gender identity disorder” in 2013 was replaced by the diagnosis “gender dysphoria”, which means as much as a rejection of one’s own gender. “Transsexualitàˆt is not a mental disorder or disease. Transsexual people are healthy people who suffer from a constitutional gender mismatch,” says Cornelia Kunert. She is a psychotherapist, supervisor and member of the expert team for transsexuality/trans identities of the Austrian Federal Association for Psychotherapy. The association Trans X also points out that the only cause of illness is the compulsion to have to live in a gender that is perceived as wrong.

When depression disappears

“Transsexuals do not experience themselves as mentally ill and feel sustainably better and become more functional when they go through a gender-adapting process,” says therapist Kunert. She argues in favour of removing hurdles and guaranteeing free access to medically assisted hormone therapy. The positive psychological effect of hormones is considerable. Kunert: “Depression and anxiety disorders, which otherwise occur frequently in transsexual persons, melt away.” This “congruence dynamic” is a sign of the increasing convergence of self-awareness and physical constitution. A recent study in Vienna confirmed that gender identity is not a psychological phenomenon, but rather biologically demonstrable.

Influence of gender-adapted treatment

A recent study from the Netherlands also assumes this – however, it goes one step further and examines rare cases in which transsexuality and psychoses are present simultaneously. The study suggests that not only anxiety disorders and depression can be cured by gender-alignment measures, but psychotic disorders are also declining. The results were published in April 2017 in the journal “LGBT Health”. In their report “Gender Dysphoria and Co-Existing Psychosis: Review and Four Case Examples of Successful Gender Affirmative Treatment”, the Dutch research team led by Julia Meijer from the University of Amsterdam describes four case studies. The subjects were two transmen and two women aged 29 to 57 years. The result: transgender persons who were diagnosed with a psychotic disorder could be successfully treated with gender-adaptive measures, i.e. with psychological, endocrine and surgical treatment. Meijer and her team admit, however, that psychotic developments with simultaneous transsexuality affect a negligible number of cases.

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