The History of Transness' Etiology and Diagnosis

(Citations Underlined)

Transness (specifically gender dysphoria/incongruence) has had a varied history with academic and governmental institutions, this can be traced quite accurately by assessing theories of it's etiology as posited by the DSM or of popular narratives among the psychological community. Such narratives have had three main variations in their existance; the first being that transness is a paraphillic condition (pre 1980s), the second being that it is an offshoot of homosexuality (1980-2013), and the third (what we believe today) being that transness comes from interaction between neuroanatomy, the prenatal environment, and psychological schemata (2013-). What is more relevant to this article however is the history of how these theories came to be.

The first phases of diagnosis (previous to the 1970s) were very focused on the aspects of crossdressing and feminine embodiment fantasy. In these years there was little to zero cultural basis or knowledge of what transness was or what its prognosis entailed; it most often manifested in husbands crossdressing in their wives clothing after repressing for many years. When these people were eventually caught in the act they were treated like perverts, going through the motions of cognitive behavioral therapy in order to attempt to 'undo' their urges. This was framed as a paraphilic condition, that these people were erotically attracted to the idea of themselves as the opposite gender. This was later coined as 'autogynephilia' by sexologist Ray Blanchard in the late 1980s.

The second phase of diagnosis stemmed from Blanchard's distinction between the autogynephilic transsexual and the homosexual transsexual. Blanchard's research in the 1980s and 1990s focused on researching differences in meta-attraction (attraction to oneself) between groups he later defined as homosexual transsexuals (gay men who believed they were women) and autogynephillic transsexuals (straight men who transitioned to satisfy their fetish). He later added to his researh with the term autoandrophilia for transgender men. This classification was even more unscientific than his claims about transexual women, stemming not from research at his clinic, but from his application of Freud and Jung's theory of penis envy to transsexual men. This theory stuck despite the few studies supporting it, and remains in the DSM-V as the name Transvestic Disorder (page 742). Despite the codification of transsexuality into two male subtypes, positive progress was made in the clinical purview, hormonal transition and sexual reassignment was emphasized as conversion therapies had shown themselves to be inneffective.

Our current psychological view of transness is based upon how it has been treated for the past four decades; the ability to perform sex ressaignment specifically has led to greater investigation into the etiology of gender identity and of gender incongruence. A recent study in 2016 examined the relationships between clinical therapy and etiological theory, and found that just as theory influenced therapy, the opposite was also true. The author of the study suggests that "new therapies can alter the landscape of medical theories in ways that feed back into the legitimacy and popularity of the therapy." (Andrew 11) Only now do we have a relatively consistent and logical theory of transness' etiology, and that is because of the ability to perform sexual reassignment and hormonal therapy.

A broader analysis indicates that while the narratives mentioned were popular, they did not represent the whole of intellectual diversity regarding the topic of incongruence's etiology. For instance, the idea that transness manifested from a difference in mind and body did not originate from the ability to perform sexual reassignment (1973) nor its popularity (1980), the procedure instead provided a treatment that legitimized the etiological theory. This is one of many cases in which it is important to recognize that etiological theory is not something developed in a vaccuum, it is influenced by the culture, the clinic, and the court of public opinion.