GENDER DYSPHORIA IN ADULTS AND ADOLESCENTS AS A MENTAL DISORDER … BUT, WHAT IS A MENTAL DISORDER? A PHENOMENOLOGICAL/EXISTENTIAL ANALYSIS OF A PUZZLING CONDITION

Since the origins of humanity the possibility of an area existing beyond the binary subdivision of sexual genders has been incorporated into myth and symbolic representations as expressed through rite, from Plato’s Androgyne to Hermaphrodite, from the myth of Attis and Cybele to the figure of Venus Castina. At the same time different cultures have envisaged, and in some cases continue to envisage, outside any “pathologized” category, the possibility of there being a non-correspondence between an individual’s biological sex and their subjective experience of belonging to a given sexual gender: for example, the Neapolitan Femminiello, the “two-spirits” among American natives, and the Hijras, who still exist on the Indian sub-continent. Nevertheless, in the West today this existential condition is to some extent shaped, and somehow even produced, by a series of discourses, which are first and foremost medical/psychiatric and define and mold its very nature. Gender Dysphoria, the clinical taxonomic category which the American Psychiatric Association has recently adopted to replace the existing Gender Identity Disorder, refers to an individual’s affective/cognitive discontent with the assigned gender and the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender, which in many, but not all, cases also involves a somatic transition by cross-sex hormone treatment and genital surgery (Sex Reassignment Surgery) [APA 2013]. As Michel Foucault would have it, psychiatric knowledge molds bodies. In any case, the work of preparation and drafting of the recent edition of the DSM, the Diagnostic and Statistical Manual of Mental Disorders [APA 2013], has been accompanied by a lively debate on whether or not it is legal to include the condition within the ranks of Mental Disorders. The result of this debate was to keep the condition in the manual, therefore interpreting it as a manifestation of a Mental Disorder. In the present paper, we will analyze the main historical stages of the process of inclusion of this condition within psychiatric knowledge. We will, therefore, discuss the main problems that this inclusion produces, questioning the very foundations of psychiatric knowledge. Moreover, we will consider the exact nature of this condition within the framework of a phenomenological/existential approach, beyond the simplistic diagnostic criteria proposed by the American manual.