What happens when society, with the support of powerful institutions, the media, and the majority culture, labels a minority population as inherently disordered? When such categorization and stigma are weaponized to legitimize abuse and discrimination? A a new study highlights the legacy of one such example of pathology, focusing on transgender children in the UK.
Around the world, more and more transsexual (transgender) children are helping to live an authentic childhood. A global health consensus now recognizes trans identity, including childhood, as a welcome and valued part of human diversity. Where in the past childhood non-conformity was treated as “disordered” and transgender and intersex children were routinely subjected to coercive and harmful conversion practices, modern research confirms the importance of accepting and supporting transgender children in childhood.
in 2022 month of January. The World Health Organization has removed transgender identity from the category of mental health disorders, marking a significant global shift away from the pathologizing of gender diversity. However, the legacy of trans-identity pathologies continues to impact the lives of trans people, especially trans children. New research published in Children and society examines how pathology continues to impact the lives of trans children in the UK, draws attention to ongoing harm and reflects on priorities and institutional responsibilities for depathologising trans children.
Pathologization is a term used to describe the way in which authorities define non-standard identities as medically disordered. For example, until 1973 The World Health Organization considered homosexuality a mental disorder, and this classification legitimized societal prejudice and discrimination. In international medical standards, such as the World Health Organization’s International Classification of Diseases (ICD), gender diversity was clearly classified as a disordered and pathological category until the latest version, ICD-11, which entered into force in 2022. month of January. Until then, childhood gender diversity was considered pathological, and “Childhood Gender Identity Disorder” was classified under the category of mental and behavioral disorders.
Assumptions that mentally challenged gender minorities are characterized by poor mental health have meant that efforts to “help” such minorities have focused on harmful attempts to suppress or change their identities, rather than efforts to address areas of discrimination or persecution. Pathologizing gender practitioners believed that it was easier and better to (try to) change a child’s identity or expression than to reform the wider society to accept diversity (Gill-Peterson, 2018).
Movement for depathologization
In the twentieth century and now, trans communities from all over the world have fought against pathology. Depathologization refers to the “elimination of diagnostic classifications and clinical practices in which sexual, gender, and bodily diversity are perceived as mental disorder, disease, or malformation,” along with the recognition of diversity as a human right worth celebrating (Suess Schwend et al., 2018, p. 1594 .). Human rights advocates have emphasized that “medical professionals, policymakers, academics and practitioners must end the pathologizing of trans identities” (Inch, 2016, p. 193). Research has shown that the belief that trans people are mentally ill is the strongest driver of anti-trans prejudice, and continued pathologising legitimizes and reinforces discrimination (Winter et al., 2009).
Over the past decade, some progress has been made toward depathologization, particularly in some areas of health care policy. Positive gender approaches that celebrate diversity have been endorsed by leading global and national health authorities. in 2022 month of January. The World Health Organization (WHO-11) has removed transgender identity from the category of mental health disorder, marking a significant global shift away from the pathologizing of gender diversity.
After the entry into force of ICD-11 in 2022 in January, healthcare facilities worldwide are now tasked with implementing this paradigm shift in policy and practice. (World Health Organization, 2021). The depathologization of the World Health Organization at the global level will only be a significant step towards meaningful depathologization if global policy change is reflected in national and subnational policies, attitudes and practices (Murray, 2019b). O’Connor points out that “while the psychopathology of transgender people needs to be removed from the WHO’s ICD, it will take longer to change the social, political, and medical systems that continue to pathologize transgender people” (2019, para. 8). ).
The UK context
Even as the global medical consensus has moved toward transpositivity, affirming childhood gender diversity as part of human diversity to be celebrated, the legacy of pathologizing remains. Murray (2019b, sec. 5) describes the continuing influence of pathologizing on current trans health services in the UK and Ireland as “echoes of that dark past”, noting that “the continued treatment of trans identity as a mental health condition is damaging to our communities, young and old”. Examples of pathologizing can be seen in UK media discourse on trans youth, where the terminology of transness is described as a ‘plague’, ‘epidemic’ or referred to as ‘contagion’. Transness language as an epidemic or problem can be seen as an indicator of the pathology and transnegativity of UK society.
The paradigm shift from childhood gender diversity as pathological and problematic to childhood gender diversity as a valued or celebrated part of human diversity has significant implications for UK social policy in a number of areas. Now (from January 2022) with ICD-11 coming into force, it is crucial for us to understand how decades of transpathologisation have shaped UK society and how such pathology plays out in the lives of trans children in the UK today. Such an analysis can reveal areas of long-standing pathology among trans children and help identify priorities for incorporating depathologisation into UK social policy and practice.
Research focus: A new study published in Children and society aimed to improve understanding of the UK’s ongoing experience of pathologising. The study focused on parents with experience of raising a prepubescent child in the UK, a group that has a unique window into how childhood transience is viewed in UK society. The study asked:
1) How do families with transgender children experience the pathology of childhood transience?
2) What impact does the experience of pathologizing have on UK policy and practice?
Methodology:30 UK parents were interviewed to share their experiences raising 30 transgender children. Here, “social transition” refers to the family’s support of the child’s identity, usually accompanied by a name change. The children of these families socially transitioned at an average age of 7 years (3-10 years old), and at the time of the parents’ survey, their children were on average 11 years old (6-16 years old). Interviews with parents covered a wide range of topics, including family experiences, education and health care. Data were analyzed through reflexive thematic analysis (Braun and Clarke, 2006), with pathology identified as a central cross-cutting theme.
The study highlights the harm that pathologization has on trans children and their families, considering the impact at the individual, institutional and societal levels.
Experience with individuals: In families and local communities, parents encountered many pathological attitudes or assumptions that gender diversity in childhood is a problem or disorder. Pathologization at the individual level has caused great suffering, rejection and isolation, leading to family and community breakdown.
Experience working with institutions: At the institutional level, parents reported encounters with professionals who took a pathological view of childhood changeability. Such professionals have assumed power and authority, and this level of pathology has had a significant impact on the lives of trans children in areas such as education, law, and health care. Families encountered professionals who wanted a medical or psychiatric diagnosis before being willing to accept or respect trans children’s rights or treat childhood trans as a problem or concern. In many cases, pathological professional practice was not clearly mandated or part of formal institutional policy. Rather, in the absence of depathologizing institutional policies, professional practice was influenced by pathologizing attitudes and assumptions.
Public pathology: At a systemic level, parents noted a lack of clear political commitment to depathologizing trans children. Without leadership and a clear commitment to depathologizing, parents felt unsupported in their efforts to challenge pathological attitudes or practices at an individual or institutional level. Parents were frustrated that they were left alone to advocate for the depathologization of trans children, without any systemic support, despite the entrenched pathologies of society as a whole.
A failure of NHS leadership
Parents in this sample questioned why pathologization is so deeply rooted in the UK and why there seems to be little movement towards depathologising trans children. Parents spoke specifically about what they see as the NHS’s leadership in depathologising trans children. Parents in the UK contrasted the embedded pathologisation with systemic (and healthcare) efforts to celebrate and normalize trans children in other countries. The parents interviewed felt that the NHS and UK children’s gender services had failed to adopt or communicate a depathologising agenda. Parents held this institutional failure responsible for legitimizing and enabling the harm of permanent pathology across the UK.
As trans depathologisation commitments come into force in global health policy, the path to trans children’s depathologisation is practically unclear in the UK and beyond (Winters, 2022). Transgender children need to be protected from the ongoing pathology that requires active commitment, leadership and action. Transdepathologization must be considered a top priority for child rights and social justice.
More information and a full list of references can be found in the Open Access publication Children and Society:
Horton, C. (2022). Depathologising diversity: Experiences of pathologising trans children and families in the UK. Children and society.
For related publications by the same author: https://orcid.org/0000-0003-1944-4122
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