Transgender Woman Attacked in Astoria Queens
January 20, 2014
Trans Etiquette: When is a Compliment Not a Compliment?
February 5, 2014

Transgender Pathologization

By Kat Haché
NOTE: Content warning below.

Yesterday, I came across an article in the LA Times regarding the National Transgender Discrimination Survey’s study of the elevated risk of suicide in the transgender community.  To briefly summarize, the statistics are shocking:

  • 41% of transgender/gender non-confoming individuals have attempted suicide, a rate of 9 times the national average
  • The risk was higher for those who had suffered discrimination or violence
  • For those driven to homelessness, the risk was even higher, at 69%, for those refused medical care, 60%
  • For individuals who are “openly” transgender, or more often read as transgender, the risk is higher
  • Even transgender individuals at “low risk” have attempted suicide at a rate of 30%-40%
  • Suicide rates were lower in families that “stayed strong” after transgender individuals came out

Part of me finds these statistics shocking.  They are, after all, appalling, and certainly unacceptable.  However, as a transgender person, and one who is quite open about it (by choice, since I am privileged to not be read as trans, and because I am a transgender advocate), I am not surprised.  In fact, before I transitioned, I too, wanted to die.  I thought about how I would kill myself daily.  I would pray to be hit by a truck as I drove to the store.  I wondered what the most painless way to do it would be.  I stopped eating and engaged in self-harm.  I really, truly wanted to die.  This was before I even faced much discrimination due to being transgender – I wasn’t even out yet – but even so, knowing the road that lay ahead I was terrified.  I was terrified knowing that the world would hate me for wanting to be myself.

I am very thankful that I got past that point and that I sought help.  I am thankful that I began hormones and started transitioning.  Since that low point in my life, I am much more at peace with myself and my body, and I have become a much stronger, more well rounded individual.  I feel like a person.  Even so, there is a prevailing attitude that being transgender in of itself is equivalent to mental illness.  In other words, the problem lies within transgender individuals, and their desires to achieve self-actualization are misguided, and ultimately, futile, attempts to cure a disease that causes them to irrationally transgress socially prescribed normative gender identities (those which correspond to one’s designated sex at birth).  One need only look to the comments section for evidence of this attitude:



It doesn’t matter to these people and to our society that the actual “reality” of the situation (one that transgender people know quite well and have faced on a deeper level than these internet commentators could imagine) contradicts exactly what they are saying a few paragraphs above their ignorant attacks on those that they refuse to understand.  It is a symptom of the real disease at play here: transphobia.  Like with other social ills, transphobia is a disease that causes those affected to stigmatize those whose body, gender identity, and presentation defies their preconceived notions of normalcy.  I mean, after all, how would one explain the following comments about my gender identity?







(I could go on and on here; I’ve received no shortage of hatred like this.)

Yes, the problem in our society is CLEARLY transgender people and not those who attack us, even when we are total strangers.

This sort of thing is not uncommon in other forms of related social prejudice.  Pathologization of Otherized identities by inferring sickness or disability is an age-old practice.  Quoting Tobin Siebers in Disability Theory:

 “The pathologization of other identities by disability is referential: it summons the historical and representational structures by which disability, sickness, and injury come to signify inferior human status.” (Siebers 2008, 6)

It’s easy to see this pathologization at play with regard to an individual’s transgender status – the bizarre fixation on an individuals adherence to a socially constructed notion of “healthy” genital configuration congruent with one’s designated sex.  The rhetoric of “mangled” or “mutilated” genitals (words chosen for their connotations of deformity, words not chosen to describe other surgeries) that pervade the discourse surrounding transgender individuals, regardless of whether or not they have even had any sort of surgery to modify their genital configuration. Many have not, due to the prohibitively high cost of what is commonly known as “sexual reassignment surgery” or “gender reassignment surgery” – which is on average $20,000 for transgender women (who some refer to as “male-to-female”) and up to $80,000 for transgender men (who some refer to as “female-to-male”).  This cost is even steeper when you factor in the high rate of unemployment and poverty in the transender community, and their lack of access to adequate health insurance.  Even with health insurance, transgender health care is often denied as a necessity and described as cosmetic, despite being long established as necessary treatment for gender dysphoria.  The depathologization of gender dysphoria (formerly referred to as Gender Identity Disorder) is itself a recent development that long reinforced the societal association of transgender identity to pathology.  Like homosexuality and wandering uterus, also known as hysteria, it is the perception of deviance that creates the pathology, not the behavior that is perceived as deviant.

This perception prevents transgender people from being accepted in society, let alone understood.  It prevents us from equal access to necessary healthcare.  It prevents us from equal economic opportunity, and as the survey shows, it prevents us from equal access to a healthy, happy life.  We are defined, as Siebers says, as inferior human beings.  Our existence is not the result of pathology and should not be stigmatized.  If there is an illness we must combat, it does not involve transgender individuals attempting to achieve self-actualization.  It is the socially communicated intolerance and hatred of bodies and identities that deviate from the status quo.  It is that illness that plagues our society.  It is that illness that is killing my transgender brothers and sisters, not our efforts to assert ourselves against the onslaught of violence we face for daring to affirm who we are.

If we wish to address statistics such as those in the survey, and if we wish to save lives, we must deconstruct our normative notions of only certain bodies and identities as acceptable and prerequisite to full personhood.  We have to recognize the discourse surrounding transgender individuals and the negative representations of transgender identity as symptoms of a systemic intolerance of perceived deviance that deligitimizes, marginalizes, and even kills.  If we don’t, things will not change.  The only outcome that will result from forcing transgender individuals to conform to an identity that is not their own is a life of misery or death, as the statistics indicate.  If those spouting ignorant hatred of transgender individuals were truly concerned about their mental or physical health rather than their own comfort with the status quo, they would advocate the same thing that every reputable source in healthcare advocates for transgender individuals –acceptance in society, affirmation of our identities, access to our healthcare, and the same opportunity to achieve self-actualization as anyone else.


Siebers, Tobin. Disability Theory. Ann Arbor: University of Michigan Press, 2008.

  • My husband & I are truly gtraeful for your leadership. We are the extremely proud parents of a seven year old son who as he puts it, likes girl stuff. He has taught us more than we can convey about gender identity, tolerance & acceptance. We are very fortunate to be surrounded with a loving family & community. Currently, a very dear friend is helping me create a support play group to help support gender diverse children, educate families & our community. I’d like to believe I have half the bravery my son & other children like him carry ~ Deepest gratitude, Lisa Keating

  • Pingback: Open Letter: 200+ Trans Women and Transfeminine People Stand Against Calpernia Addams and Andrea James | The TransAdvocate()

  • christian_transgender

    OMG, this article is so timely. Yes, I am familiar with that LA Times article. I posted a few comments against the haters, but because the LA Times actually deleted some of my comments that were respectful and civilized although sternly rebuking, I turned to my Word Press Blog, pissed off that we are allowed to die like worthless garbage. My story does include a personal miracle (you don’t have to believe it) but it did actually happen the way I say it does. I think you all will be saying “Yes!” as you read this

    It is my own way of trying to offer strength and hope so that more of us choose life and not death. I myself keep having dark periods, being currently unemployed directly as a result of transgender discrimination and no so-called transgender legal group caring about it, beyond saying “We’re sorry dear.” I love how fast TransAdvocate loads up! Congratulations Cristin on the success!! I am so proud of your leadership!!!! Warning! It is very, very, long but please read it to conclusion. It will be real worth it (tell me what you think)..perhaps I need to split it up into two parts.

  • Stephanie-may The-Viking

    What most cisgendered people seem to miss is that even though the hardship persists in certain areas of the individual’s life, as a rule the ones who manage to reach the finish line become happy, stop thinking about what has happened to them (although it will always be a part of the road that led them to where they are) and merge into the background. If every person who went through the ordeal, the spiraling depths of dreaming constantly of death, the fight to be accepted, the damning struggle with their own appearance, and the path they walked while learning who they really are, stepped forward and revealed themselves there would be some very amazed, shocked and confused cisgendered people. I would say that anyone who openly has a problem with trans people to the point where they feel compelled to become involved somewhere, make comments and join into complex discussions about medical facts (which they are only too happy to ignore when it suits them) are the ones with a problem, because instead of getting on with their own lives and leaving everyone else to get on with theirs, they have to interfere. Thankfully the ones who tend to do this use syntax that labels them clearly as moronic, lack evidence to back up claims, fail to make any interesting or useful observations and obviously fail to realize that great breakthroughs have been made in universities over the past ten years that have started to identify several possible chemical and genetic roots of the condition. Personally I say that they aren’t worth listening to – we shall play chess while they play checkers, it is always the way these things work.

  • Joanie Azusa Jolie

    A thought came to me, many people talk about men thinking with their penises instead of their heads. Here we are thinking with are heads and not with our genitalia, because during fetal development our brains were written as the opposite sex. Still all anybody seems to discuss is our genitalia, as if genitalia trumps the brain.

  • NellStock

    This is an excellent article. It examines the causes of what should be an emotive subject calmly and rationally and illustrates the prejudice and hatred trans people face on routine basis. Though the cisgendered majority may have the numbers this article shows the sophisicated level of intellectual and moral argument members of the trans community bring to the discourse on our rights.

    • christian_transgender

      Yes! Of that may there be little to no doubt…….