عربي

Words by: J. RN.
Artwork by Mary’s Art
This article is an outcome of a writing workshop conducted by My Kali magazine

⚠️ Artworks include nudity

Gender dysphoria is experienced by 1M+ biological males and 200K+ biological females around the world (according to the DSM-5), and yields higher suicide rates compared to the general population (50% of gender dysphoric individuals have experienced suicidal tendencies or have attempted suicide at one point in their life).1 This article aims to provide an introduction to gender dysphoria, drawing on current research and debates. Additionally, it explores the predominant history of weaponizing medical knowledge, specifically the use of the DSM, to oust and control non-hetero sexualities and non-cis identities. Last, this article sheds light on Gender Dysphoria in Jordan, specifically, where medical education is based on American and European curricula.2

A Brief History

Gender Dysphoria is defined by the DSM-5 as an incongruence between an individual’s biological sex (or gender assigned at birth) and their current gender (the way they percieve themselves in regards to gender expression/identity).3 The origins of the term are ambiguous and contested: many attribute it to Norman Fisk’s4 1974 article on “Gender Dysphoria Syndrome,”5 while others attribute it to Alfred Kinsey6, who used the term to describe a patient who wished to undergo gender confirming surgery to relieve dysphoric ‘symptoms’ they were experiencing.7 

Nonetheless, the history of the term remains strongly associated with the trans movement and trans healthcare, following Magnus Hirschfeld’s8 terming of “transsexualism” in 19239 and the popularization of the term “transsexual”  by Harry Benjamin10 in 1966.11 

Yet, identifying gender diversity as a mental disorder wasn’t solidified until the 1980s’ release of the DSM-3.12 This marked a pivotal change in the importance of the DSM in upholding the pathologization of gender whilst also controlling access to trans healthcare, as the DSM-3 encompassed the first psychiatric diagnosis of “gender dysphoria”, which, then was labeled “transsexualism.”13 However, this terminology was scrutinized by LGBT+ activists and progressive medical researchers leading to its removal in favor of “Gender Identity Disorder” in the 1994 DSM-414 and then “Gender Dysphoria” in the most recent DSM (2013).3

Artwork by Mary’s Art

Debates and Research – Regional Overview

“Gender Dysphoria” as an illness has been sustained over the years under the pretense of ensuring access to gender confirming healthcare. Yet, debates within the global trans community continue to question the need to pathologize gender, and the dependency of healthcare accessibility on proving the “sickness” of individuals who exist beyond the heternormative cisgender binary15. 

Jordan’s medical scene doesn’t stray too far from this narrative, following in the footsteps of the West’s historical and on-going pathologization of diverse genders, it perceives Gender Dysphoria as a mental disorder, with some psychiatric centers and medical professionals even highlighting their “LGBT+ Counseling and Gender Dysphoria” services. Moreover, a law was passed in 2018 to indict physicians who perform gender confirming surgery, unless surgery is to be performed on a “suitable candidate” elected by a governmental medical committee and with the approval of the Ministry of Health.16 Further, Jordan’s efforts to distance itself from such `taboo subject matters’ not only stifles public conversation around gender identity and sexuality, and jeopardizes gender dysphoric individuals who seek professional medical help through false diagnoses, discrediting or brushing off traumatic personal experiences, and nearly impossible access to trans healthcare (especially transition-related therapies).  

The DSM-5, Depathologization, and the Gender Binary

The DSM-5 classification of Gender Dysphoria reinforces the gender binary through upholding cisgenders as “normal” and assuming gender identity to be static. The “diagnosis” not only requires that a person feel dysphoric for at least 6 months, but also, mandates that they tick off ‘symptoms’ from a checklist which embodies the narrative of “wanting to be/identify with the opposite/another gender.” This dichotomous persistence excludes all gender non-conforming individuals, whom sometimes also fall under the “trans” umbrella.17 In addition, the suggested importance of having a medical professional dictate if an individual is dysphoric only strengthens the power imbalance between oppressed and oppressor by granting one party the permission to validate/invalidate distinctive experiences through weighing them against and fitting them into the hegemonic gender binary.18 

Furthermore, research focusing on gender dysphoria has begun to question the scales utilized by medical professionals, as well as strive for gaining an understanding of gender-nonconforming persons’ varied experiences with gender dysphoria. One study published in the Transgender Health Journal in 2020 sought specifically to explore non-binary gender dysphoric experiences. The study reflected on the historical context in which gender dysphoria was initially addressed, drawing ties between the roles of the medicalization of gender dysphoria and the popularized “woman trapped in a male body” message in reaffirming the gender binary, and supporting the continued pathologization of trans experiences. The results of the research corroborated the findings of similar studies for the need to develop customized healthcare and support services tailored to the unique individual’s lived experiences, rather than relay on futile, cis-gendered diagnostic tools.19

Another study published in Perspectives on Psychological Science in 2019 wished to tackle the issue of Gender Dysphoria as an autonomous condition occurring only in an individual’s mind (in accordance with the DSM-5). The scholars questioned this discourse by channeling a depathologizing perspective and drawing on the theory that gender identity develops naturally. The researchers argued that if the pathologizing perspective continues to be applied, then gender dysphoria should be understood as a “problem located in the body rather than the mind,” backing their proposition through highlighting that treatment protocols are focused on “healing” the body.20 

On one hand, this approach, which tries to break free from medicalizing non-cis gendered bodies, falls within the same trap of upholding a gender binary and builds on outdated medical convictions that seperate physiological wellbeing from mental.21 On the other hand, the researchers contradict their definition of gender identity as naturally occurring by overlooking the role of social contexts and socialization in reproducing gendered bodies.22 Although the study advocates for every person’s right to customized transition-related care without the precondition of a (mental) diagnosis, it fails to conceptualize a healthy existence beyond the gender binary. This is apparent in the language used throughout the study, which limits gender dysphoric experiences23 to binary-gendered bodies pursuing transition. 

Artwork by Mary’s Art

Gender dysphoria can’t continue to be discussed without also discussing social factors, since gender identity is socially constructed. A recent study, published in November 2021 explored the direct impact of social factors, like family support and acceptance of gender diverse identities in the community, on the likelihood of developing gender dysphoria. The research revealed that the sociocultural context plays a significant role in determining the prevalence and severity of gender dysphoric experiences. However, the insurmountable volume of research being produced has yet to implicity discuss the positionality of the cis-gendered norms in the pervasively binary gendered world we navigate. 

Going forth, it’s imperative that we acknowledge that gender is the product of a patriarchal system, and hence, the pathologization of bodies based on gender becomes nothing less than a state approved tool of destruction. Nevertheless, depathologizing gender dysphoria without having an alternative mechanism to ensure accessibility to trans and gender diverse healthcare and relevant amenities will rob many individuals of a better quality of life.

In this context, I would like to invite you to contemplate how the discourse might shift if we were to exist in a non-gendered world. Could gender survive beyond the confines of “masculinity” and “femininity”? Beyond the socially constructed and widely proliferated “right way” of being? And what would be of Gender Dysphoria then?

References and resources

  1.  García-Vega, Elena, Aida Camero, María Fernández, and Ana Villaverde. 2018. “Suicidal Ideation and Suicide Attempts in Persons with Gender Dysphoria.” Psicothema 30 (3): 283–88. https://doi.org/10.7334/psicothema2017.438.
  2.  Tamimi, Ahmad Faleh, and Faleh Tamimi. 2010. “Medical Education in Jordan.” Medical Teacher 32 (1): 36–40. https://doi.org/10.3109/01421590903196953.
  3.  American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association.
  4.  *Norman Fisk was a psychiatrist interested in better understanding sexuality and gender. He is most known for coining the term “Gender Dysphoria Syndrome” and putting forth the idea that gender dysphoria might be a product of cis-heternormative socialization (gender roles and norms). (Jessen and University of Oslo – Centre for Gender Research 2020)
  5.  Fisk, N M. 1974. “Editorial: Gender Dysphoria Syndrome–the Conceptualization That Liberalizes Indications for Total Gender Reorientation and Implies a Broadly Based Multi-Dimensional Rehabilitative Regimen.” Western Journal of Medicine 120 (5): 386–91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130142/?page=1.
  6.  *Alfred Charles Kinsey was a biologist and sexologistr in the early 20th century. He is most known for establishing the institute for sex research in the Indiana University and for his books on human sexualities which utilized a scientific research approach to understanding sexuality and gender. (Kinsey Institute Indiana University 2019)
  7.  Ettner, Randi. 2020. “Etiology of Gender Dysphoria.” In Gender Confirmation Surgery, 21–28. Cham: Springer. https://doi.org/10.1007/978-3-030-29093-1_2.
  8.  *Magnus Hirshfeld was a prominent sexologist between the late 1800s and early 1900s. He represents a pivotal moment in the trans movement, as he was the first person to perform sex reassignment surgeries throughout the 1920s. (Rodrigues, Carneiro, and Nogueira 2021)
  9.  Schechter, Loren S. 2018. “Surgery for Gender Dysphoria.” In Plastic Surgery: Volume 4: Lower Extremity, Trunk, and Burns, 333–49. Elsevier.
  10.  Harry Benjamin was an endocrinologist and sexologist best known for forming the Harry Benajmin International Gender Dysphoria Association (1979), now the World Professional Association for Transgender Health (WPATH). (Schilt 2022).
  11.  Capetillo-Ventura, N.C., S.I. Jalil-Pérez, and K. Motilla-Negrete. 2015. “Gender Dysphoria: An Overview.” Medicina Universitaria 17 (66): 53–58. https://doi.org/10.1016/j.rmu.2014.06.001.
  12.  Davy, Zowie, and Michael Toze. 2018. “What Is Gender Dysphoria? A Critical Systematic Narrative Review.” Transgender Health 3 (1): 159–69. https://doi.org/10.1089/trgh.2018.0014.
  13.  Drescher, Jack. 2010. “Transsexualism, Gender Identity Disorder and the DSM.” Journal of Gay & Lesbian Mental Health 14 (2): 109–22. https://doi.org/10.1080/19359701003589637.
  14.  American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders : DMS-IV. Washington, D.C.: American Psychiatric Association.
  15.  Stryker, Susan. 2008. Transgender History. Berkeley, Ca: Seal Press.
  16.  Anwar, Maya. 2018. “Jordan’s Parliament Passes a New Law Related to Transgender People.” Https://Planettransgender.com/Jordans-Parliament-Passes-a-New-Law-Related-To-Transgender-People/. December 27, 2018. https://archive.fo/fjWhF.
  17.  Jones, Bethany A., Walter Pierre Bouman, Emma Haycraft, and Jon Arcelus. 2018. “The Gender Congruence and Life Satisfaction Scale (GCLS): Development and Validation of a Scale to Measure Outcomes from Transgender Health Services.” International Journal of Transgenderism 20 (1): 63–80. https://doi.org/10.1080/15532739.2018.1453425.
  18.  Johnson, Austin H. 2018. “Rejecting, Reframing, and Reintroducing: Trans People’s Strategic Engagement with the Medicalisation of Gender Dysphoria.” Sociology of Health & Illness 41 (3): 517–32. https://doi.org/10.1111/1467-9566.12829.
  19.  Galupo, M. Paz, Lex Pulice-Farrow, and Emerson Pehl. 2020. “‘There Is Nothing to Do about It’: Nonbinary Individuals’ Experience of Gender Dysphoria.” Transgender Health 6 (2). https://doi.org/10.1089/trgh.2020.0041.
  20.  Ashley, Florence. 2019. “The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health.” Perspectives on Psychological Science 16 (6): 1159–64. https://doi.org/10.1177/1745691619872987.
  21.  Gabor Maté. 2019. When the Body Says No : The Cost of Hidden Stress. London: Vermilion.
  22.  Cooper, Kate, Ailsa Russell, William Mandy, and Catherine Butler. 2020. “The Phenomenology of Gender Dysphoria in Adults: A Systematic Review and Meta-Synthesis.” Clinical Psychology Review 80 (August): 101875. https://doi.org/10.1016/j.cpr.2020.101875.
  23.  Goldbach, Chloe, and Douglas Knutson. 2021. “Gender-Related Minority Stress and Gender Dysphoria: Development and Initial Validation of the Gender Dysphoria Triggers Scale (GDTS).” Psychology of Sexual Orientation and Gender Diversity, November. https://doi.org/10.1037/sgd0000548.