'Even the DSM recognises more than two'
Increased openness and wide public discourse has raised the profile of gender minorities, and mental health services are increasingly encountering individuals who are openly experiencing gender dysphoria. Clinicians may be unsure how best to respond. Dr Christina Richards, of the Tavistock and Portman Trust, encouraged reflection on gender’s entanglement in culture, and how a clinician’s attitude, awareness and assumptions may affect clinical work.
Like most traits, Richards argued, gender falls on a normal distribution curve, with few people falling at the extremes of masculine or feminine stereotypes. So, concrete psychological differences between the sexes are elusive. Yet our culture and, perhaps problematically, research designs force gender into a false bimodal distribution. Instead, Richards encourages the recognition of sex as a discrete category and gender a continuous one, allowing a more inclusive understanding of gender identity.
This view recognises that we all ‘do’ gender in different ways, albeit under the cover of culture. Whilst most people identify at a fixed point or range on one side of the male–female gender continuum, some identify with a range across the centre, or not at all. Therefore, adopting a binary gender, whether or not this matches one’s biological sex, is not the only option.
This perspective facilitates a more inclusive style of clinical work with trans and non-binary clients. A major clinical consideration is to be aware of poor past experiences of services, either personal to the client or within the legacy of harmful historic treatments. Showing a welcoming attitude as a service, using correct pronouns, asking if unsure… all this communicates respect and acceptance. The importance of considering whether or not an individual’s mental health need relates to their gender identification cannot be overstated.
Essentially, Richards urges clinicians to refer to gender services if necessary (rather than automatically), and to use the appropriate skills to treat the individual as you would with anyone else.
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