Stella and Sasha on the Re-Psychopathologization of Trans Identities
October Live & Unfiltered Recap and Important Announcement
This month’s Live + Unfiltered focused on Genspect’s recent call to Re-Psychopathologize Transgender Identities, a campaign that’s generated both enthusiasm and resistance.
Rather than a “debate,” this was a welcomed good-faith exchange between Stella and Sasha. As you know, they share some of the same concerns about gender affirming care and cultural trends related to gender identity, however they differ in how to formulate public-facing language and what the proposed solutions should be. There were intense moments of disagreement and vastly different viewpoints on the Genspect campaign.
Below is a summary of these perspectives.
Stella’s view: the campaign restores clinical clarity
Stella described the campaign as a direct counter to WPATH’s 2010 “de-psychopathologization” statement, which reframed transgender identity as “innate, normal, and healthy.” She argued that this shift the and subsequent changes to the DSM and ICD discouraged therapists from treating distress and forced them to facilitating medical transition, normalizing medicalization as inevitable and virtuous.
The new Genspect campaign, she explained, aims to reintroduce a mental-health framework by recognizing when attempts to alleviate distress cross into pathological behavior. Drawing on the psychiatric concept of an Extreme Overvalued Belief, Stella framed today’s gender ideology as a cultural contagion—a socially reinforced idea that drives people toward self-harm.
“Identifying as trans isn’t pathological,” she clarified later. “Medicalizing your body as a result—that’s where pathology begins.”
For her, the real “madness” lies in a culture that has elevated this belief to unquestioned status. Therapists, she argued, must regain the courage to say when someone has lost their way.
Sasha’s view: the campaign is impractical and paternalistic
Sasha agreed that therapists need new language to describe what’s happening but questioned the campaign’s public messaging. The phrase “re-psychopathologization of transgender identification,” she noted, reads as though anyone who identifies as trans has a mental illness.
“In mental health, there’s almost no context where calling something a pathology is received as positive,” she said.
Sasha also pointed out that even Stella seemed uncertain about the campaign’s exact wording—evidence, in her view, of how easily the message could be misunderstood. Clinically, she emphasized that gender-related distress encompasses a wide range of people: from vulnerable teens swept up in social contagion to adults making reflective, if extreme, life choices.
“For some, transition is an extreme life strategy—but not all extreme choices are signs of a mental illness.”
Her concern was practical as well as philosophical: blanket language risks alienating the very people therapists most need to reach.
Clarifications and common ground
In response, Stella agreed the wording might need revision. She reiterated that she does not label all trans-identified individuals as pathological, but instead views the medicalization of identity as pathology.
Despite their differences, Sasha and Stella found clear overlap:
Therapists have lost the language to talk openly about gender distress.
Cultural forces play a major role in the rise of gender dysphoria.
The campaign would benefit from clearer, more compassionate communication.
“It’s the medicalizing, not the identifying,” Stella concluded.
Highlights from the chat
Participants raised valuable questions:
“If all the adults in your life tell you you’re trans, are you mentally ill to believe them?”
“Can we build momentum among young people who identify as trans but don’t medicalize?”
“How can therapists confront pathology without alienating their clients?”
Looking ahead: an announcement to close out 2025
After almost a full year of monthly Live + Unfiltered events, we’ve decided that our final two sessions will take place this November and December.
We’ve loved every one of these special live conversations. Having the chance to interact with you all in the chat has been wonderful. What began as an experiment has become a truly enjoyable monthly event with a great deal of energy and freedom to speak openly about our views.
To mark the end of this chapter, we’ve paused all billing and will be gifting free access to our remaining two Live + Unfiltered events to everyone who has supported us as paid members. We are so grateful for all the years of support and if you have any questions about your membership, please reach out to us and we’ll do our best to accommodate.
We hope you’ll join us for these final gatherings as we close out 2025 with the same honesty, curiosity, and good faith that have guided this project from the start.
Next Live + Unfiltered
Saturday, November 8 at 10:00 am ET / 3:00 pm London time. Stay tuned for meeting link and further details
Sincerely,
Sasha & Stella
Going to the gym when one feels conflicted is a healthy coping mechanism, but it can become pathological. Dieting is not necessarily a sign of mental illness, but for some people, it can lead to eating disorders. Sleeping is a necessary function, but when a person sleeps for 14 hours a day each and every day, their sleep is "disordered", pathological: they probably have an underlying physical or mental problem that needs to be addressed. A behavior becomes pathological when it goes from being a part of life to being a destructive, uncontrollable force that disrupts healthy functioning. But unlike dieting, exercise, sleep, and many other behaviors that can become pathological, there is no point upon which transidentification is a healthy, adaptive response. Transidentification is always pathological, a pathological cope or a maladaptive response that may or may not lead to mental illness down the line.
In that sense, it is more like substance use: there is no healthy use of cocaine, crack, fentanyl, etc. There are individuals for whom substance use and abuse cause no long-term illness. There are individuals for whom these substances act as temporary and useful copes--perhaps they ease a physical or mental pain--from which they move on. But because there are many individuals for whom engaging in substance use leads to substance abuse, which is pathological, then substance use should be regarded, in itself, as a pathological behavior. Not everybody who engages in this behavior will develop a full-fledged mental illness, but everybody who engages in this behavior is engaging in a pathological behavior. Pathological does not mean irrational or illogical (drinking to forget one's sorrows is not, in itself, an irrational choice; transidentifying, in the present zeitgeist and given certain gender norms, is not, in itself, irrational either), it means, in its simplest terms, unhealthy.
It is not necessarily true that repsychopathologizing trans-identification amounts to saying that anybody who identifies as trans is mentally ill. Having a pathological condition of any sort does not amount to being ill. A person with diabetes can live a healthy life even though they have a serious pathology: it would be accurate to say that they have an illness, but inaccurate to say they are physically ill. It would also be inaccurate to say that diabetes is not a pathology because some people with diabetes can and do lead healthy lives.
Must all good things come to an end? You two have been a lifeline. Thank you!!!