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I think a useful frame for thinking about trans identification is as a culture bound syndrome. Some conditions obviously have a plain physical aetiology but other conditions are given shape by the culture of the time. For example, hysteria was a common diagnosis of a previous era but no-one suffers from it today. Similarly while people have always starved themselves historically for various reasons, ie religious martyrs, the modern form of anorexia as self-harm among mainly female adolescents is a recent culture bound syndrome - in a sense the cultural availability of the syndrome within the medical context of the time combines with the experience of the individual to give rise to the condition. This culture bound syndrome is hen active and in the modern age can be easily exported as happened with Korea which experienced a sudden arrival of anorexia as essentially a new condition. Note this means it's still very real.
Over time the experiences and language of how people to describe their state spreads and this is what I think is happening with trans. In adolescence significant anxiety and transition to the social world from childhood create a space of confusion and sometimes extreme anxiety in the self-space. The experience of feeling different from everyone else, not fitting in, is actually really common. Additionally some people have additional challenges around sexuality or gender non-conformity, or they may have dysfunctional family or have experienced abuse. In the past, people may have experienced this as more generalised anxiety, deep depression, self-destructive behaviours etc, in more recent times it has become expressed in new modes such as anorexia and direct self-harm. Because gender has become so salient it is now being expressed as gender dysphoria - the language and experience are given to the person by the culture and this reifies their self-experience in these terms.
Combined with the social contagion of the internet and in-group cult dynamics that give short term alleviation of the sense of difference and alienation then we see how the culture bound syndrome can spread.
It's not diagnosed today. Isn't it that some elements have been shifted to other diagnoses or removed from the DSM like homosexuality?
What we called "hysteria" in the 1800s is what we would now call a mixture between straight up mental illness, psychosomatic conditions, poorly-understood bona fide autoimmune diseases, and weird neurological bullshit like complex regional pain syndrome. There's probably other shit in there that is genuine that modern medicine doesn't understand yet.
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Could well be, there may be something underlying it, say extreme anxiety. It's not necessarily psychosomatic as it were. The culture bound syndrome gives expression to the underlying symptoms and as you note, the expression/diagnosis can change. I argue that gender dysphoria is potentially like that, something actually experienced by the self, but reified into a particular form. I'm also combining this with the idea of social contagion.
As for social contagion, it is well known that for adolescents in particular, conditions can spread among peer groups, including suicide, anorexia, and antisocial behaviour. I mean we aren't surprised by the positive side of this phenomenon re fashion, musical tastes etc so we shouldn't really be surprised about the negative side.
Another potential clue is that for young people, other mental health indicators such as self-harm and suicide have been increasing rapidly at the same time that gender dysphoria has been rising, again particularly for young adolescent girls, and corresponding to the use of social media. Along with anecdotal reports by teachers and parents of people in the same class coming out as trans around the same time and Lisa Littman's survey of parents showing that internet use was a precursor to coming out and I think you are seeing a pretty strong case for social contagion.
Just do a search of the number of trans/rainbow groups on discord. These internet spaces in addition are perfect in creating cult-like dynamics of conformity. This helps explain how gender clinicians at the Tavistock observed people's narratives to be almost scripted.
I think some of them were scripted, because such sites (organised or just a bunch of people like here) offer advice along the lines of "if you want to get X, then this is the line you have to give them".
The same way I see advice online about "if you're going to write in protest to your congresscritter, do it this way because otherwise it will be ignored".
So yeah, it doesn't seem out of bounds that clinics would get a lot of young patients reciting the same "I first knew when I was two, I didn't want to do this, or wear that, and my parents felt that I wasn't what I was assigned at birth and I have suicidal feelings about being forced to be this gender which I am not and I have body dysmorphia" narrative, because they've read "this is what you have to say in order to get the doctors to agree".
I absolutely agree with scripting. I’ve seen it somewhat in people seeking diagnosis of adhd as well. It seems like people sort of learn what kinds of statements are likely to get you the treatment you want (in adhd, it’s Ritalin, and quite often the IR form over the XR form). The issue is serious in psychiatry as too many don’t really question what they’re told, and therefore it’s fairly easy to game the system.
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