Should Psychiatrists Give A Patient Permission To Change Gender?
Posted by Dr. Vollmer on May 19, 2016
Jane wants to become John. She wants “top surgery” meaning she wants a double mastectomy. The surgeon requires a letter from a psychiatrist stating the patient can give informed consent. Yet, the surgeon does other procedures in which he obtains informed consent without the assistance of a mental health professional. In the surgeon’s mind, I suspect, is a fear of regret, resulting in a malpractice lawsuit, in which the letter from the psychiatrist serves as some protection. Further, for the patient to get insurance reimbursement, she/he needs a diagnosis of gender dysphoria, but who is to say that gender dysphoria is a mental illness? Yes, it causes suffering, but so does having body parts that cause distress. All of us need to decide what we accept and what we change, and perhaps, just perhaps, gender is no different. Perhaps Jane is not mentally ill, but only sees a way in which he can live in the world and be happier with himself. Perhaps Jane is navigating his world in a way that makes sense to him, and perhaps that is all that matters, given that Jane is an adult. The “Janes” of this world are a growing population; a population that gives some of us pause as to what the rules of the road really are. Jane reminds us that we are not restricted to our biological body parts and that change can happen, sometimes with happy outcomes and sometimes with sad outcomes, but this is what comes with decisions of adult life. If Jane wants help from a professional, that is an avenue that is open to him. To mandate that is simply absurd.