December 25, 2014

How psychiatry and psychology have been used to suppress gender variance

We have to stop using psychiatric models and terminology that are clearly bigoted and aimed at upholding outdated views of sex and gender.

Modern psychiatry is moving from bigoted sexism to
more respect for sex and gender diversity
Illustration: Cienpies Design

There is a tendency in the crossdreamer and transgender debates to pretend that we are somehow having a kind of disinterested discussion, where scientific "facts" can be trusted to tell us what is the "objective truth" about sex and gender.

Since psychiatry has claimed the scientific authority over sexuality, sex identity and -- to a certain extent -- cultural gender, this means that we often go to psychiatrists and sexologist to find theories, models and narratives that can explain sex and gender variation.

Psychiatry and psychology are not exact sciences

There is nothing wrong in doing so, per se, as long as we keep in mind that psychiatrists (and psychologists) are like all other human beings: fallible and caught up in the prejudices of their time.

This only becomes a problem when we forget that the presence of a scientific-sounding terminology and a Ph.D. does not stop bigoted crap from being bigoted crap.

Psychiatry and psychology have been used to uphold political and social power-structures for more than a century.

From hysteria to autogynephilia

It wasn't that long ago psychiatrists fully believed that the diagnosis of "hysteria" (being over-emotional, seductive and displaying a lack of self control) could be used to describe the nature of the female sex in general.

It wasn't until 1980 the American Psychiatric Association acknowledged that the "histrionic personality disorder" (a less toxic name for hysteria) was "a caricature of femininity" (Tosh).

In the same way the medical term "nymphomania" was routinely used to invalidate women with a healthy appetite for sex. Since women were not supposed to be sexually aggressive, and many of the male doctors felt threatened by independent women, they used the term "nymphomania" as a scientific sounding way of branding these women "slut". In a similar way the "hysteria" diagnosis had been used to hospitalize and castrate feminists in the late 19th century.

My point is that we have to scrutinize all psychiatric theories about sex and gender to see if they are the product of cultural bigotry as well.

Psychiatry has been used to reinforce traditional gender roles

Having gone through many studies of the history of psychiatry, I am  convinced that diagnoses like "gender identity disorder", "transvestic fetishism", "transvestic disorder" and "autogynephilia" have much in common with "hysteria" and "nymphomania".

The  main difference is that while nymphomania and hysteria were used to control women, these terms are normally used to control men who are violating the main gender codex: A man who dreams about being a woman must be mentally ill, as being a man is so much better than being a woman.

In other words: A man who imagines himself as a woman, or -- even worse -- a trans woman who thinks of herself as a woman, has threatened the psychiatrists' belief in male supremacy. Because of this they have actively tried to "cure" trans women by torturing them in hospitals, or by forcing them into obedience and/or hiding by labelling them as perverts.


Psychotherapist Stanley Siegel has a very interesting take on the traditional ideologies underpinning much of psychology and psychiatry. In a recent article in Psychology Tomorrow he argues that too many psychotherapists see their patients' problems as rooted in pathologies, instead of looking at them as the psyche's way of trying to become whole.

He writes:
"Efforts to standardize “normality’ have lead to the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association’s (APA) imperial attempt to label and codify much of so-called dysfunctional behavior, clustering it into diagnostic categories in relation to agreed-upon definitions of 'normal.' 
The newly published–and deeply conceptually flawed–DSM-V medicalizes problems or symptoms caught in its net, forcing clinicians to make distinctions that trivialize individuality and creativity and lead to unneeded treatments and drug prescriptions –a goldmine for pharmaceutical companies.  
[...] the DSM-V serves more like a guide for therapeutic witch-hunts generated by an elite, powerful few seeking to shoehorn patients into cost-effective, 'evidence-based' treatments. Diagnoses become life sentences, branded into the consciousness of patients and their families as well as medical and insurer data banks that follow them throughout their lives."
It is not that some of the people working on these manuals do not understand the problem. For instance: the latest edition of the DSM-5 no longer describes "gender dysphoria" as a mental illness, which is good, but the "transvestic disorder" (crossdressing and crossdreaming) remains a "paraphilia" (perversion).

Gender madness

In her book Gender Madness in American Psychiatry Kelley Winters points out that:
"The diagnostic category of Transvestic Fetishism (TF) labels cross-dressing by heterosexual males as a paraphilia or sexual deviance, devaluing expressions of femininity. These labels reinforce social stigma of madness and perversion for all gender-variant people with consequences very similar to those described by Dr. Kameny and Barbara Gittings for lesbian and gay people in the 1970s."
Kameny and Gittings argued that by labelling homosexuality as a mental illness the medical establishment had  buttressed the prejudices of society and assisted bigots in the perpetuation of their bigotry. The psychiatrists had destroyed the self-confidence and self-esteem of homosexuals, impaired their self-image, and degraded their basic human dignity.

Now that both psychiatry and psychology are increasingly recruiting women to leading positions, this tendency of invalidating femininity is becoming less prevalent. I guess that the fact that the DSM-5 replaced the term "gender identity disorder" with "gender dysphoria" and no longer considers transsexuality a mental disorder, is partly caused by this shift.

Furthermore, the fact that female to male transgender people have become more visible has also made it much harder to reduce gender variance to a male sexual perversion. Ray Blanchard's desperate attempts at denying that female to male crossdreamers and crossdressers exist, only serves to undermine his autogynephilia theory.

The ICD abandons traditional sexism

We see the same trend towards a more openminded psychiatry in the current proposal for the next edition of the medical manual of the World's Health Organization: The ICD-11.

The ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health, states that it
"...believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more reflective of current scientific evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services."
They have suggested to remove "fetishistic transvestism" from the manual. "Gender incongruence" is no longer to be considered a mental illness.

Sexual fantasies are natural

All of this also changes the way psychiatry looks at sexual fantasies. We are moving back to ideas similar to the ones expressed by Magnus Hirschfeld, who believed that sexual fantasies -- the unorthodox ones included -- were  expressions of normal psychological growth.

Siegel is clearly anchored in this other strand of psychology and psychiatry, the one of Hirschfeld, Kinsey and others who respect the diversity of mankind.

Siegel puts it this way:
"Every sexual experience is inherently different because it draws upon the individual and cultural history of the participants as well as how they come together at a particular moment in time. Yet, diagnostic categories for so-called 'unhealthy', 'deviant' or 'perverse' sexual behavior have been standardized in the DSM from its earliest publication. 
These diagnosis have too often served as the justification for dangerous treatments such as Conversion Therapy in which homosexual patients are taught heterosexual behavior.
Yet, what had been vigorously defended for decades as psychological 'truth,' was later cast aside. In 1973 homosexuality was eliminated from the DSM; other categories of sexual behavior once considered deviant have undergone a similar fate as values and attitudes toward sex have changed. "
Siegel, like me and people like Hirschfeld, think of sexual fantasies as something natural:
"Far from pathological, our deepest sexual desires reflect our unique histories and are as original and varied as we are as people. They represent subconscious attempts to resolve childhood conflicts or to satisfy unmet needs by turning painful feelings into pleasurable ones through eroticizing them. Our fantasies, whatever they may be, are windows into our deepest psyche. They have value and purpose that can safely and intelligently be used to create a gratifying and meaningful sexual life."
Do not use the language of your oppressors

Siegel compares the field of psychology (and I guess, implicitly also psychiatry) with religious fundamentalists who preach that sexual fantasies are sinful and strictly prohibited by the Bible.

By labelling people as perverts these so-called experts often cause the very symptoms they use to prove that their "patients" are mentally ill.

Blanchard and his allies interpret, for instance, the emotional isolation of some crossdressers and crossdreamers as "narcissism", which they consider a symptom of "autogynephilia". They do not grasp that this isolation is caused by the stigma that follows diagnoses like "autogynephilia" and "transvestic fetishism". How are you going to establish a healthy love life with a partner, if you fear that anyone who knows your real nature will abandon you?

This is why I believe open-minded and compassionate LGBTQA people, including transgender and genderqueer ones, should stop using the stigmatizing terminologies used by the bigoted side of the medical establishment. By using their terms we strengthen the narratives that make being gender variant so hard in the first place.

Read Siegel's article here!

Kelley Winters: Gender Madness in American Psychiatry
Jemma Tosh: Perverse Psychology: The pathologization of sexual violence and transgenderism
See also:
What the DSM-5 says about terms like transgender, transsexual and gender dysphoria
The original DSM-5 text on gender dysphoria
What happens to crossdressing and crossdreaming in the International WHO ICD-11 manual?


  1. It seems to me that these changes impose a new double standard to getting the medical community to treat gender dysphoria. Right now medical insurance is opening up to paying for hormone and basic surgical treatments. Once the medical diagnosis are removed, then there's mo longer a need for insurance to pay for treatments. We may feel like a female, and females get to have hormone treatments, but because we no longer have a condition to be diagnosed, we don't get the hormone/surgical treatments.

  2. Jack I am no longer stigmatized by what is taken for objective truth by the psychiatric community and trust my heart and mind to guide me instead. In fact my study of the literature has only confirmed what you and I already know in that the science is far more inexact than people might think. The subjective nature of this field is astounding. The new generations go far more by feel and have a healthy mistrust ot the complicated structures that were put before them to accept. They will not be fooled as easily which isva very good thing.

    The true model of human diversity will triumph in the end.


  3. Jack,

    Isnt this perhaps at risk of going too far in the other direction? I think it is a little strange that dysphoria is not considered a mental health problrem since it is, by definition, a state of mental distress/pain. Physchiatry needs to focus on human well being, and while I think even many of the villians here thought they where doing so, that should not taint that fact that many of these former 'disorders' listed can be experienced in extremes that do affect mental health and that distress, at least in a large part, can be seperated from societies stigma of these things. I guess I am assuming that dysphoria still be painfull even if there was no associated stigma. Just a thought. I thiink I would agree that any 'fetish' should not be thought of as a disorder so long as it does not do harm to anyone.

  4. "Applause".

    Awesome post, Jack! My feelings exactly.

  5. @Koala

    "I think it is a little strange that dysphoria is not considered a mental health problem since it is, by definition, a state of mental distress/pain."

    I believe you are right about this, in the same way the severe depression a gay man or lesbian women may feel when being thrown out of their families, represents real psychological suffering.

    My point is that being transgender or homosexual is not in itself a mental disease. Much of the suffering is caused by the way society treat people like us.

    As regards gender dysphoria, there may be an additional dimension. The incongruence between body and the gender identity may in itself cause much suffering, and I am not convinced this suffering is caused only by the reactions of society.

    Still, I do not think it is right to put this suffering in the same box as insanity and "perversions". There must be a way of classifying mental distress that does not end up labelling you as mentally ill. It seems the leading psychiatrists finally agree with this.

    However, I recognise the problem presented by @J. AlanaS, i.e. that insurance companies or public health institutions need some kind of diagnosis in order to cover relevant treatments.


    "The true model of human diversity will triumph in the end."

    Amen to that, sister!

    and thanks @Elsa!

  6. Maybe a big part of the problem is that all forms of physciatric problems seem to carry a stigma. There is sort of a unspoken culteral assumption that physchiatic problems are in some way optional or relfect on the character of the person suffering from them.

  7. @Koloa

    "...reflect on the character of the person suffering from them."

    It is fascinating to see how Blanchard's latest incarnation of the autogynephilia theory turns crossdreaming into a separate sexuality or sexual orientation. Since he believes crossdreaming is inborn this effectively turn crossdreamers into eternal outcasts carrying the label of "paraphilia". They are neither gay nor straight and have therefore little hope of finding true love.

    The truth, of course, that crossdreamers may be gay, straight, bisexual, pansexual and so on and so forth, like everyone else.

  8. Another excellent post. I believe a change in paradigm is needed and I think you are aiming right for the heart of the issue with this post.

    I might add, since I work with the hospitalized mentally ill, that many of them feel no dysphoria or mental distress and pain. They often have no bearing for that. It is simply a label we apply by putting ourselves as a comparison to their plight. It is us "normal" people who are the ones who are uncomfortable with them and then attach a label to them so we can put them away and we do not have to deal with them.

    Equally, most of the distress that the people I come into contact with is still related to how we are treating them or boxing them in, in response to their displayed behaviors. Very rarely do I hear from them that they wish to be "normal" or did not have their problems, in fact most of the time they express dismay at our backwardness, our inability to see the world through their eyes, etc. Now this is just a segment of the mentally ill, and should in no way be construed to be representative of everyone. Just an observation.

  9. Anonymous you are so correct. Much of the distress many of us have gone through stems from the comparison between ourselves and others. You just need to concern yourself with what is normal for you and not worry about what others think. It is the only way to live life under any circumstance.

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