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.

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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.

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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.

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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.

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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?”

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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.

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Next Live + Unfiltered

Saturday, November 8 at 10:00 am ET / 3:00 pm London time. Stay tuned for meeting link and further details

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Sincerely,
Sasha & Stella