Are We Maladaptive?

Okay, so I got myself into a bit of a tiff with Abby down below. Here’s the link.

In general, the conversation is about how GID should be classified in the DSM. The tendency, obviously, is for us to want a kinder, gentler revision…one sensitive to our feelings, and easier to schlep to the public than something like “autogynephilia”. Ideally, we’d get it removed entirely.

That doesn’t seem likely to me, of course. Unlike homosexuality, transsexuality requires treatment (currently that treatment involves hormones and surgeries…hopefully that will always be the case). And as long as treatment is necessary, the doctors will need a set of diagnostic criteria…hence the DSM.

But maybe I’m wrong.

Maybe gender dysphoria is a physical ailment, as I’ve so often heard said, rather than a mental one. Maybe it’s like having kidney stones. Kidney stones often require surgery, but I’m pretty sure they’re not listed in the DSM.

Maybe we can prove that gender dysphoria is like kidney stones.

Harkening back to my undergrad days and my Abnormal Psychology class (thank you Ms. H.!), along with the help of Google, I was able to dredge up the criteria for mental disorders.

For a given behavior to qualify as a mental disorder, it must meet these four points:

  • Statistical Infrequency
  • Deviation from Social Norms
  • Personal Distress
  • Maladaptiveness

The first two are obvious…we meet those. No argument here.

Personal Distress seems obvious. Yes, the dysphoria we suffer causes us distress. The same was (and still is, occasionally) said of homosexuality. Is it the dysphoria itself that causes the distress, or the way the rest of the world treats us? I suppose that question can only be answered by the individual.

The one that really gets my goat, though, is the maladaptive piece. According to one website I looked at:

A behavior pattern or characteristic is “adaptive” when it is constructive, helpful, healthy and contributes to the person moving in a valued direction.

A maladaptive behavior is the opposite then…a behavior that is destructive, unhelpful, unhealthy, and contributes to a person moving in a non-valued direction. The site gives the example of heroin use as being maladaptive (duh).

So what behavior are we talking about here? If we’re talking about having gender dysphoric feelings and not acting upon them, then yes, I’d say that’s a maladaptive behavior. But shouldn’t we be looking at it the other way? Shouldn’t we wait until a person does act upon a feeling, then judge whether it’s adaptive or maladaptive? To use the example above, the urge to use heroin is only maladaptive when acted upon; to not act upon it is responsible, and therefore adaptive. I’m going to go out on a limb here and say that the same standard should be applied to all such observable behaviors. And most times that I’m aware of, acting upon gender dysphoric feelings results in a person “moving in a valued direction” (except, of course, where Personal Distress rears its head).

Is this going to be the case for everyone? Probably not. There may be people out there who meet all four of these criteria. And there’s no reason the DSM can’t include an article that addresses the needs of these individuals…they did it for homosexuality. But for the rest of us – and every successful transition is another case study the DSM crew should look at – is there a way we can be excluded from the onus of GID and still receive the treatment we need?

To be perfectly honest, even I’m not convinced by my argument. Obviously, being transsexual is not like having kidney stones. And while I think the whole adaptive/maladaptive thing is interesting, I’m sure I’m not the first person to think of it. Sadly, it’ll take more than an hour’s worth of Google research before I’ll be able to completely repudiate decades worth of mental health research, but in the meantime, there are a few people out there who can make those kind of claims.

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7 Responses

  1. OK, here’s some gasoline for the fire. I’ll probably get burned by the blast wave when I throw it in but that happens. 🙂
    I think we show a lot of maladaptive behaviors in the process of dealing with this ugly thing called Gender Identity Disorder.
    When you consider that “maladaptive behavior” is basicly a description that is a reflection of what’s socially acceptable, then some of the things that we do to deal with GID are as maladaptive as the way we deal with the rest of life when we’re not doing something constructive about our GID. In the case of heroin use, that’s also a medical issue, but then, so is HRT. It would seem that, in the current society, we don’t fit in anywhere, we’re damned if we do and we’re damned if we don’t. We’re antisocial and maladaptive if we don’t deal with our GID, and we’re socially unacceptable if we do deal with it, although there are indications that society is starting to change it’s attitude toward us, very slowly.

  2. A tiff? I’m not sure that’s how I would describe it, more like a difference in approach in my mind.

    In any case, I find the focus on adaptive/maladaptive behaviors interesting and useful. And I agree that the focus, at least in our case, has to be on the behaviors and not on the thoughts or feelings we have about who we are. Frankly, denying the truth of who I am for 50+ years was extremely *maladaptive*, while transitioning to living as Abby full time (1 year ago yesterday!) was the most *adaptive* thing I’ve ever done, in that it has led to more peace, joy and happiness in my life on a consistent basis than I have ever experienced before.

    As to whether GID is similar to having kidney stones, as I just commented on the last thread ( https://transcendgender.com/2008/05/09/some-thoughts-on-controversial-transgender-theories/#comment-145 ), I don’t really care why I am the way I am. I just want to be treated with respect and fairness and have adequate access to appropriate medical care. I would prefer that that happen without including transsexuality in the DSM, but, if that’s what it takes, that’s OK, as long as it is revised to remove the implication that the “disorder” comes from knowing that our gender differs from our sex, and instead shifting it to the denial and other maladaptive behaviors we adopt to avoid acceptance of that reality and to cope with the harassment and disapproval of others that many of us experience.

  3. Damn, the link I tried to insert in my last comment doesn’t work and got cut off, so it doesn’t even work to copy and past it into your browser. There’s got to be a way to do that. Can anybody give me a quick lesson in HTML or whatever else I need to know?

    In the meantime, this link will work if you copy and paste it into your browser: http://tinyurl.com/5r255s.

  4. I’m not sure you’re going to get burned Amber, but I don’t quite understand what you’re saying either. If you had some concrete examples, I might better be able to respond.

    “Maladaptive behavior” is not a description of what is “socially acceptable” behavior. That is covered in the “Deviation from Social Norms” piece. And the hardship we endure while struggling against social norms – namely, the discrimination and prejudices we face in the real world – fall under the “Personal Distress” part. Maladaptive Behavior is anything that negatively impacts our ability to pursue a happy, healthy, constructive life as a result of following our inner compulsions.

    Heroin use, for example, is maladaptive not because it is socially unacceptable and illegal but because it impairs our judgment, our function, and can ultimately kill us. In fact, those are the reasons it is socially unacceptable and illegal.

    I have no doubt that there are some trans-people who engage in behaviors that seem maladaptive. Prostitution, for example. But again we have to ask ourselves, did they undertake the behavior because something about being trans inherently causes them to want to do this, or did they do it because society as a whole discriminates against trans people and they couldn’t (or didn’t think) they could a job doing anything else? If it’s the former, then it’s maladaptive, but if it’s the latter, it’s actually part of the Social Distress element.

    I’ve heard tell of transsexuals who seemingly have been accepted by society in their role as women but who still engage in what probably is maladaptive behavior…drugs, alcohol, promiscuous sex, etc. But it’s hardly a universal feature of being trans. My bet is that when this stuff finally gets analyzed, we’ll find out there else going with these people all along.

  5. Abby, tiff might have been too strong a word. Like Lori said to me last night, it’s important that we can all disagree and yet remain civil…I hope this board continues to develop along those lines.

    I agree wholeheartedly with everything you’ve said here and in your last comment in the other thread. I think there must be a way to get gender dysphoria relegated to the realm of typical medical disorders, with the therapy and psychiatric side of things dealing with those Personal Distress elements that emerge because of it (which is exactly how homosexuality is now dealt with), but it’ll take a lot of educated, persuasive communication to get that done.

  6. Whew, I’ve got a lot to chew on, and much to agree with here.

    And yes, I’m enthralled we value and respect each other’s viewpoints on the subject while being allowed the opportunity to share our own thoughts on the matter. None of us here are active mental health professionals, and we’re all just trying to become further educated so that we can understand the rhyme and reason of this debate.

    Abby, in order for a URL (the http stuff) to be correctly linked, make sure there are no other characters on either side of it. Like the link above, I corrected it by moving the left and right parenthesis one space away from the link. Now it shows correctly.

    As for the issue of “Are We Maladaptive?” I believe Renee has brought up great points to consider and possibly a new approach to take on the matter. From what it looks like to me, we’re all on the same team here. No one wants to see the pseudo-science of Blanchard, Lawrence, Bailey, and Zucker anywhere near the DSM V. *big cough*

  7. Someone wrote: >> Maybe gender dysphoria is a physical ailment, as I’ve so often heard said, rather than a mental one.

    Actually, it is neither. If transwomen were (in the eyes of the GP they first present to) seen as WOMEN without estrogen, breasts or vaginas,instead of being seen (as their GPs do see them) as MEN who “want” to be women, or MEN who have a GID – then their problems would be a lot fewer.

    So that begs the question “What sex is a pre-transition transwoman?”. We should not have to look far for an answer –

    Assigning sex (as in “which sex is recorded in the doctor’s own paperwork?”) is a MEDICAL matter. And isn’t the entire PURPOSE of medicine is to best serve the patient’s health interest?

    And transwomen would be BETTER SERVED if their medical paperwork said female so that their doctors would see them as “disfigured women” rather than “men with GID”.

    The solution then lies in the doctors’ BECOMING WILLING to fix unavoidable medical mistakes (eg giving a person who will grow into being a transwoman a boy’s birth certificate wayback in very early life). The mistake may be unavoidable, but the mistake is fixable.

    Really the PURPOSE is medicine is to do easy stuff like this, stuff that HELPS people. Then all the OLD same-sex diagnoses can be used ( eg vaginal agenesis – well that is what it is in transwomen IF IF IF IF you believe that transwomen are best off when called “women” and not well served by being called “sick men”.)

    And the only thing that stops this happening is that GID is still in the DSM.

    As a matter of fact ALL genuine psychiatric illnesses (ie diseases of the MIND, not of the BRAIN) are equal opportunity. And therefore ALL references to sex and gender should come out of the DSM, not merely GID! It’s improper sex discrimination to keep ANY references to sex in the DSM.

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