In 2016, I wrote a blog for the Huffington Post (https://www.huffingtonpost.co.uk/dr-helen-webberley/the-transgender-umbrella-_b_11222336.html) about why being transgender should be declassified as a mental illness.
On January 1st, 2017 Denmark led the charge and this week the World Health Organisation (WHO), announced on its twitter feed that it is to remove the diagnosis from its list of mental disorders.
This will be a welcome clarification for so many trans and non-binary people who have for years been subject to lengthy and invasive assessment procedures in order for them to ‘prove’ to healthcare professionals that their mental wellbeing and their gender identity are two very separate matters.
In my work with these patients, I have been warned extensively not to underestimate their ‘vulnerability’, that their condition ‘does not stand alone from mental health issues and psychosis.’ I could not disagree more with this position.
As research has shown, and I agree, there is often an increased incidence of stress, anxiety and depression among members of society who are gender incongruent. However, rather than being caused by the gender incongruence itself, the distress and dysfunction felt by these patients is so often caused by the following key factors:
– experiences of social rejection
– barriers to accessing medication
– violence endured as a result of gender non conformity
But, while gender incongruence is not a mental illness, these people still need the intervention, support and understanding of the medical profession to get them the help they need to manage the medical aspects of their transition.
There will be many trans and non-binary people who may not feel that this goes far enough. Who may still feel that it is wrong to medicalise their gender incongruence at all, but in doing so we allow the pathways for the medical and surgical intervention that so many are looking for.
Consider if you will a patient coming to their GP for the contraceptive pill, or management of the menopause. These people are not ill, but they do need medical intervention.
Gender non conforming patients may come forward for emotional support, hormonal manipulation and in some cases, surgical intervention. The onus is on the medical profession to help, rather than putting up barriers.
My experience of working in the sexual health environment has been positive, encouraging, unprejudiced and inclusive. Exactly the sort of welcome we should be affording transgender and non-binary members of society.
Reclassification by the WHO represents a huge victory for the transgender community. It gives hope to all those people with gender variance, it legitimises their condition in the eyes of the beholder – something that is so essential for this group of people who have spent so long justifying their existence.
Quite how the reclassification by the WHO will impact the perceived need in some circles for psychiatrists and psychologists to be the gatekeepers to medical intervention is quite another matter. It will be interesting to see how this pans out.