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.
Is it possible to create a safeguarding system around identity-driven permanent medical treatments (surgeries, x-sex hormones, minor transition) without repsychopathologizing the drive to make such changes?
Also, we're in a time of depsychopathologizing the pathological and pathologizing variants of non-pathology, like distress with bodily and emotional changes during puberty or even garden-variety neuroticism. Needing help doesn't need to carry stigma.
Hello from a Swede enjoying your content. I just found your pod and I am listening through everything. I really would like to listen to all the premium content. I cannot find a "become a paid subscriber"-button. Can you help me? Big thanks for a great pod. //K
Hi Karin! Welcome. We’re so glad you found us. We have currently paused subscriptions because we’re wrapping up our final Live + Unfiltered event in December, but soon we will make an announcement about how to access all our members-only content. For now enjoy the free podcast episodes and other materials here in Substack!
I love the conversations so thank you both. You are the best.
What I love about your approach is the acceptance and respect as well as your curiosity. I have got so tired of all the shouting and 'I am right' thinking.
I do think the word 'pathologise' is best avoided and I was concerned about this after the excellent conference. It was the one issue I felt uneasy about.
I think Dr Blanchard is correct to say that this cannot all now be put back in the box. What a shame it was so forced and dictated by Stonewall. I know other forces were already at play, but the no-debate, oven-ready set of rules were destined to not help trans people, in my view. Bad policy always causes division, and confusion, and this was a very unhelpful diktat.
So I hope the honest but non-confrontational, respectful discussions and evidence-based ideas, plus lovely humour, will continue to move things forward. More research and understanding are essential, plus training for therapists - that is not ideologically led. X
I'm wary of pathology-talk in the context of mental health because it is rarely as clear-cut as in (purely) somatic health. Even there, there can be a fine line between what an anatomy professor of mine used to call 'variations on normal' and strict pathology. But so much in mental health depends on our conceptualisation of self and world and the rich variety of (often very private) experiences informing that conceptual work that I think extra caution is warranted. Caution not just about pathologising but even about the practice of labelling. I sound like a post-modernist, I know, but my wariness is born not of a preoccupation with 'power structures' or a belief that objective knowledge is impossible, but a recognition that labelling our experience, while a necessary part of finding a foothold in the tumult of our lives, can often also lay the foundation of an edifice of false belief, can lead us to commit to one view rather than exploring many.
Perhaps what we need to talk about is, on one hand, the de-reification or de-concretisation of trans identity and, on the other, its re-complication from the simplistic narratives which dominate the public discussion and activism.
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!!!
Is it possible to create a safeguarding system around identity-driven permanent medical treatments (surgeries, x-sex hormones, minor transition) without repsychopathologizing the drive to make such changes?
Also, we're in a time of depsychopathologizing the pathological and pathologizing variants of non-pathology, like distress with bodily and emotional changes during puberty or even garden-variety neuroticism. Needing help doesn't need to carry stigma.
Hello from a Swede enjoying your content. I just found your pod and I am listening through everything. I really would like to listen to all the premium content. I cannot find a "become a paid subscriber"-button. Can you help me? Big thanks for a great pod. //K
Hi Karin! Welcome. We’re so glad you found us. We have currently paused subscriptions because we’re wrapping up our final Live + Unfiltered event in December, but soon we will make an announcement about how to access all our members-only content. For now enjoy the free podcast episodes and other materials here in Substack!
Looking forward to that!
I missed the livestream is there a recording?
Hi Lisa - our Live & Unfiltered events are not recorded but we posted a summary here: https://widerlenspod.substack.com/p/stella-and-sasha-on-the-re-psychopathologization
Thank you both for this!
I love the conversations so thank you both. You are the best.
What I love about your approach is the acceptance and respect as well as your curiosity. I have got so tired of all the shouting and 'I am right' thinking.
I do think the word 'pathologise' is best avoided and I was concerned about this after the excellent conference. It was the one issue I felt uneasy about.
I think Dr Blanchard is correct to say that this cannot all now be put back in the box. What a shame it was so forced and dictated by Stonewall. I know other forces were already at play, but the no-debate, oven-ready set of rules were destined to not help trans people, in my view. Bad policy always causes division, and confusion, and this was a very unhelpful diktat.
So I hope the honest but non-confrontational, respectful discussions and evidence-based ideas, plus lovely humour, will continue to move things forward. More research and understanding are essential, plus training for therapists - that is not ideologically led. X
Love you Stella and Sasha.
💐💝
I'm wary of pathology-talk in the context of mental health because it is rarely as clear-cut as in (purely) somatic health. Even there, there can be a fine line between what an anatomy professor of mine used to call 'variations on normal' and strict pathology. But so much in mental health depends on our conceptualisation of self and world and the rich variety of (often very private) experiences informing that conceptual work that I think extra caution is warranted. Caution not just about pathologising but even about the practice of labelling. I sound like a post-modernist, I know, but my wariness is born not of a preoccupation with 'power structures' or a belief that objective knowledge is impossible, but a recognition that labelling our experience, while a necessary part of finding a foothold in the tumult of our lives, can often also lay the foundation of an edifice of false belief, can lead us to commit to one view rather than exploring many.
Perhaps what we need to talk about is, on one hand, the de-reification or de-concretisation of trans identity and, on the other, its re-complication from the simplistic narratives which dominate the public discussion and activism.
Better to focus on ROGD or, as here, a redefinition instead of gender dysphoria/gender incongruence: https://www.observatoirepetitesirene.org/proposition-clinique
Friday, November 7, or Saturday, November 8?!
Saturday the 8th! I adjusted the typo. Thanks for asking! 👍🏼
Looking forward to the session @3pm on Saturday, November 8th. 😊
How can I watch the live on Nov 8? Is there a link?