Identity: The Gateway Drug

Where pride dies from medical overdose

As a licensed mental health professional, I spend admittedly far more time than the average person does trying to understand what is happening in my profession. The idea that gender dysphoria should universally be treated with gender affirmation is such a foreign concept when you know how dysphoria of any kind has been treated for decades. 

Diagnosis of body dysmorphic disorder, for example, is treated with psychoanalysis to determine what caused the patient to have thoughts incongruent with their body. CBT may be used to confront cognitive distortions and choose new core beliefs with intention. Behavioral therapy may be done to address behaviors that are perpetuating the dysphoria and increase behaviors that give the patient a sense of control to make healthy choices for their biology. Trauma work would consist of psychoanalysis, EMDR, or prolonged exposure therapy to cut ties with bitterness, increase forgiveness, and build resiliency. Rogerian therapy would be used to increase a patient’s feelings of being understood, seen, and heard as well as their inherent humanity valued. At no point would a therapist recommend surgery in an attempt to force the patient’s body to match their incongruent thoughts. The problem is not in the patient's body. It is in their mind.

Diagnosis of eating disorders, such as anorexia or bulimia, would be treated similarly to the ways described for body dysmorphic disorder with added layers of additional providers to ensure the patients physical health. A multidisciplinary approach using dieticians, nutritionists, doctors, home healthcare, nurses, family members, and mental health providers would be used to help the patient confront their own incongruent thoughts about their body and rebuild fact based, healthy thoughts regarding both body and food. I am not a specialist in this area. There may well be additional resources used to treat anorexia. You can rest assured no medical or mental health professional is affirming the patient's incongruent beliefs. 

OCD, something I wrestle with, can present with intrusive thoughts and compulsive behaviors related to dysphoria; also something I wrestled with related to body dysphoria and eating disorders. A case could be made that all of these diagnoses are a type of OCD in that they present with obsessive thoughts followed by compulsive behaviors. Treatment for OCD often includes psychoanalysis, CBT, Rogerian, and Adlerian therapies. Intrusive and obsessive thoughts are identified and labeled as such. They are not affirmed. Triggers for intrusive and obsessive thoughts are identified. Thoughts regarding those triggers are not affirmed. Coping strategies for combating intrusive and obsessive thoughts are taught and practiced. Thought stopping, thought tracking, and thought confronting skills are utilized. Exposure therapy may be used to reduce irrational thoughts. Irrational thoughts are not affirmed. Checking behaviors are identified and either classified as helpful or harmful. Helpful behaviors may include things that the average person does to manage time, events, relationships, and responsibilities. Unhelpful behaviors may include things like superstitious thoughts (counting, repetitive words/phrases) or actions (locking the doors several times or repeated washing of hands). Unhelpful behaviors are not affirmed. 

Given the way other disorders revolving around incongruent thinking are treated, why is gender dysphoria the only one treated with affirmation and hormone/surgical intervention? Identity. No other disorder has been linked to the LGB community as an expression of someone’s identity. Putting my concerns aside regarding anyone placing their identity in their identity markers, I think it is especially damaging to put one's identity in fluid feeling or obsessive thought. This was a very intentional move to reduce pushback from those who may have concerns and increase support from those who are all in without question for LGB causes.

To be abundantly clear, I am not questioning LGB causes at all. On the contrary, I am pointing out how the LGB community has been hijacked and used as shields for organizations and individuals who profit from the medicalization of obsessive and compulsive dysphoria. 

Unfortunately, those with gender dysphoria are the most hurt by this grift. Rather than receive care that may resolve their dysphoria, they are offered irrevocable changes to their endocrine and reproductive systems, which impact their entire body.

There is absolutely no guarantee obsessive thoughts and compulsive behaviors will stop once transition has occurred. We are actually seeing the opposite situation in which those who have transitioned continue to wrestle with obsessive thoughts and compulsive behaviors. The thoughts and behaviors may shift some. Transitioners may obsess about “passing” as the opposite sex. They may obsess about finding a partner that will accept them for who they claim to be as well as their ongoing medical complications. Transitioners may obsess about managing the ongoing medical interventions that are necessary to prevent the body from healing itself, which could actually be extremely dangerous for the patient. They may begin to obsess about health, safety, dying, or any number of things they cannot completely control. 

Euphoria is not a sustainable emotion. It is by its very nature fleeting. The search for trans euphoria becomes more like an addiction than OCD. It will take ever more medications and surgeries in search of that same high they felt after their initial step to satiate their thoughts and compulsions. Addiction, something I know well personally, is an unquenchable beast that demands the worst in human behaviors.

Individuals may begin to exhibit borderline or narcissistic traits as they demand absolute conformity to their self-identifying language. Individuals may cut out anyone who loves them but cannot agree they have changed biological sex. They may threaten to harm themselves or someone else if they are denied affirmation or another medical intervention. They may have been threatening self-harm for a long time at this point. Verbal abuse, social abuse, environmental abuse, and financial abuse may all follow from the individual’s every growing need to feel some sense of control alongside a need to release the pressure from not feeling content or euphoric. Lies, threats, projections, slander, coercion, manipulation, and insults may all be used to pressure others into compliance. 

There are, of course, some transsexuals who never resort to chasing euphoria, addictive behaviors, or abusive behaviors. Some transition to various degrees and others don’t. Those whom I have personally spoken with tell me they still experience intrusive thoughts and compulsions. Whatever the underlying cause of their dysphoria was/is, they are still wrestling with it. They do not seek conformity in thought or affirmation from others. They simply want to be left alone to live a life as best they can. Unfortunately, they are called traitors, internalized transphobes, and bigots for their refusal to force others to affirm them.

Those most likely to call them those things tend to be the same individuals, or their social warrior allies, who claim transitioning was the most healing and wonderful experience of their lives, and maybe it was felt that way. However, healthy individuals don’t call others names because they have a difference of opinion on a course of treatment. 

That level of spite comes from an affront to perceived identity. It has nothing to do with the treatment at all. The refusal to affirm is felt as a personal attack on identity with a healthy dose of victimhood mentality. There is nothing rational or health focused in those conversations. The goal is destruction of the individual who wants a conversation based on facts, research, grammar, and common sense. I find it strange we would even violate the “do no harm” clause in an attempt to research whether or not creating lifelong harm to healthy bodies is a viable answer to a mental health condition. Why are we even accepting that as the starting line? I’m sorry, not really, but no. You are going to have to justify to me why anyone should engage in the destruction of bodily integrity in the first place when all other dysphoria is treated with mental health treatments.

It matters not if you are asking for a review of the available treatments and why one person may benefit from one and another from another. No amount of reason or nuance will pacify the individual enraged because their self-claimed identity is not assumed to be the only evidence needed to support their preferred method of treatment. It is a debate between “who I say I am” and “others”. You cannot win that debate. They will not hear all your knowledge, expertise, research, etc. It is their chosen identity at stake. You are talking mental health, and they are talking about threats to their very existence, as if their life immediately ends should gender affirmation end. 

In my opinion, the best thing to do is just move on from those encounters. Take all of your awareness, information, and well thought out perspectives to those who are willing to listen without accusing your of literally trying to kill them with a civil discussion. Those secure in their identity don’t need you to agree with them. Your opinion doesn’t change who they are in the slightest.