In many countries, the psychological pathway is an important practice in gender transition, especially where a diagnosis is needed in order to access medical treatments and legal recognition. This filter function is a source of debate for both professionals and trans people, particularly because of its potential for equating gender variances with mental illness. Despite recent changes in health communities' attitudes toward diagnosis for gender transition, this issue must be handled carefully, as it can also affect the dynamics of the clinical interaction. This study explores beliefs and attitudes toward diagnosis by addressing the subjective perspectives of 25 people in transition. Through a nonstructured interview, we sought to shed light on how a diagnosis of gender dysphoria is perceived and used, what position trans people take in relation to mental health practitioners, and the possible implications. Interpretative repertoires analysis showed that the diagnosis was experienced as a "constraint," described in terms of convergence toward or divergence from the individual's own identity. Positioning analysis found that the mental health practitioner was seen as either contributing to the denial of participants' identity and hindering their progress along the path to transition, or as supporting this process. The practitioner is also seen as an evaluator rather than an expert, because trans people know themselves best. The findings indicate that the diagnostic process may obscure or interfere with the most important function of the psychological pathway, namely, the creation of an affirmative space and shared objectives.
Public Significance StatementsThis study focuses on one of major issues in the field of gender transition, that is, the diagnosis. We collected narratives about beliefs and attitudes toward gender dysphoria by addressing the subjective perspectives of 25 people in transition. Our findings shed light on positionings and meanings associated with diagnosis and the psychological path which can enable mental health practitioners to rethink the implications of the diagnostic process in construing the clinical relationship.
The "normal-abnormal" continuum is one way to organize models of operational interventions, and to define various professional roles, especially in medicine, psychiatry, and psychology. In these fields the diagnostic process draws on the concept of normality to distinguish between healthy and pathological states and draws conclusions about prognosis, treatment, and cure. In psychiatry and psychology, unlike in medicine, diagnosis is often a problematic and controversial process because of the lack of clear boundaries between normal and psychopathological states. This has practical consequences for the work of professionals and the way patients are treated. In this work we make some epistemological observations about the relationship between diagnostic processes and normality. In particular, we consider some specific terms relating to the diagnostic process and the concept of "normality" in order to distinguish between the medical and clinical-psychological implications of intervention.
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