A Diagnosis of Dysphoria

When I was 38, my girlfriend broke up with me. She indicated that her life had become too complicated to maintain a relationship – too many other demands on her time and energy. And Iw as obviously just casually involved, enjoying the connection for the sex and fun. She knew it wasn’t serious for me because I hadn’t tried to restrict her from dating other guys and, besides, I was a guy. Things are different for guys, she said. It might hurt now but within a month or so I’d be dating someone else.

The combination of this characterization and the horrifying prospect of trying to flirt and date again kept me sidelined for over a year in hurt and anger, and then drove me into a more specific despair. I felt alien, unknowable.

I had come to New York City 12 years earlier, to find support and understanding and community as a male who felt and thought differently than other males; I’d come to New York as a would-be activist heterosexual sissy. But I hadn’t found others like me or an identity-community to be an activist within.

Since I had counseling services covered by my employer-issued health plan, I made some calls, wanting someone to talk to.

“Oh, yes, there’s term for that now, and a lot of literature about it, it’s called gender identity dysphoria. Can I schedule you for next Tuesday?”

That snapped-in, over-the-phone diagnosis was partially correct. I was in serious distress, I was feeling very poorly understood in all my available social environments; I felt trapped and imprisoned within the set of beliefs and assumptions that I was a Man. But the diagnosis was partially incorrect as well: I did not have any issue with my body or with how my body per se was categorized by the people around me.

My real complaint lies not with the specific inaccuracy of the diagnosis, but with the mindset behind it, the tendency to medicalize differences, to define them as pathological. I was, as I said, in distress, but my difference was not and is not an ailment. Even if the distress would not have been occurring if it weren’t for my difference, the difference wasn’t and isn’t the location of the malady.

This was not the worst offense of this nature that I’ve experienced. In 1979, I had gone to the university medical clinic’s walk-in therapy facility to talk about feeling like I was more of a girl than I was kin to the other boys, only to be told “We know what causes that now” and prescribed Stelazine, an antipsychotic neuroleptic drug.

Medicalizing, or “psychiatrizing”, people’s differences – such as being gender-atypical – defines the problem as residing in the suffering person’s own self, when in cases like these the problem actually resides in society and its shared systems of beliefs and understandings. Or lack of understandings, if you prefer.

This mindset, this clinical behavior on the part of therapists and therapeutic practices, is an outgrowth of our western medical tradition, where patients are subdivided up into systems and organs and thought of as ailments to which the correct medical intervention merely needs to be applied. The right pill, the appropriate intervention. The tendency is exacerbated by the insurance companies, which pay for the treatment of ailments (“please provide the diagnostic code on line 7”), and medical malpractice law, which sees culpability for anything going wrong when a specific medical malady is not addressed with the established protocol.

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