For Kate Millett.

I’m not offering you any solutions. From the start I have been speaking not to the educators but to the guilty.

~ Jean Genet, The Criminal Child

In 1973, the American Psychiatric Association decided to change what kind of homosexuality constituted a mental illness. Those millions of gay men and women who were, in the language of their liberation movement, “happy,” “healthy,” or “proud” – in the language of the psychiatrists, they were “homosexuals per se” – were to cease being mentally ill at once. But those fewer gays, those of us who were “disturbed by, in conflict with, or wish to change” our sexual orientation: we were still sick in the head. We suffered not from homosexuality per se, but instead from “sexual orientation disturbance,” brackets, “[Homosexuality].”¹ With the APA’s release of a new Diagnostic and Statistical Manual of Mental Illness in 1980, this disturbance was renamed to “ego-dystonic homosexuality,” or EDH. The less common term for EDH, though one still used, was “homosexual dysphoria.”²

Six years before this APA decision, the internationally famous transsexual Christine Jorgensen published her autobiography. In it, she recollects a party before her transition when a drunken Danish sailor whispered into her boyish ear, “Y’know, if I was a little queer, I could go for you!”

“Even now I can recall my feeling of shock and disgust,” Christine wrote. She could well have written “dysphoria.”

While the happy homosexual, the homosexual per se, has been essentially liberated from psychiatric oppression through disengagement with the discipline, there persists this pained remainder, doomed to more intractable fates.

Gay militants had detected even before the fact that the sanification of homosexuality would arrive with a fresh mental disability reserved for sad gays alone. They detested it. In a speech at the 1973 annual APA convention, media director of Gay Activists Alliance Ronald Gold railed against a quotation from “your latest well-publicized ‘expert’ in the field,” Dr. Lawrence Hatterer, that “it [homosexuality] most certainly is a sickness when it makes a person feel sick.” “The worst thing about your diagnosis,” Ron retorted, “The worst is that Gay people believe it.”⁵

It is a fact since lost to queer sensibility, though not lost to Ron, that an overwhelming majority of conversion therapies⁶ were voluntary.⁷ A sizable number of psychoanalysts like Dr. Hatterer had acquired powerful and moving careers, bibliographies, and clinical practices built entirely on their promise to cure homosexuals, to homosexuals. Their cure was simple (if extensive, expensive) talk therapy, and most agreed it could only really work on willing⁸ patients. The new gay sicknesses were manufactured as institutional protection for these analysts, while still mollifying the activists. “I like to think that later, when I was working on the DSM-III,” remembered Robert Spitzer, M.D., who composed the entry on ego-dystonic homosexuality, “I was very good at a kind of nosological diplomacy.”⁹

Analysts had by this time constructed a diverse, loose, but knowable portrait of the unhappy homosexual. The first kind of sad gay available for study, dictated Charles Silverstein, a gay psychiatry grad bravely out of the closet, to a panel of APA behaviorists in 1972, was “prison inmates.” That is to say, they were involuntary commitments. The second were “patients who were guilt ridden about their homosexuality.” That is to say, they were voluntary commitments. “It is not surprising,” Charles reflected on these two groups, tossing us to the psychiatric dogs, “that objective test results revealed many varieties of psychological impairment.”¹⁰

Institutionally committed gays have remained pathological into the 21st century. We could be “explicated,” as one of the last great conversion therapists Irving Bieber wrote, by “the process of identification.”¹¹ The other last great, Charles Socarides, elaborated: every homosexual man entering his practice had a “pronounced feminine identification.”¹² Well, some of us do – the ones who are women, at least: the ones who feel significant distress about it, and thus wind up crashing supine onto the analyst’s couch. By 1973 UCLA psychotherapist Robert Stoller had quit beating around the bush, writing plainly, “homosexuality can be roughly quantified according to the intensity of transsexual wishes.”¹³

The unfortunate womanhood of jailbirds, those unconvertible rejects of society, was frequently broadcast by such men as professional warning against the exceptional tolls of excessive homosexuality. In a characteristic article, Dr. Paul R. Miller analyzed 50 patients who had passed through the U.S. Medical Center for Federal Prisoners as “effeminate passive obligatory homosexuals.”

This was 1958. Paul had tacitly presumed the impossibility of cure, focusing exclusively on etiology. Others were more vocal. “Severely damaged personalities,” penned Dr. Peter Scott of Maudsley Hospital, London, “The very effeminate, self-advertizing, female-impersonating individual who talks in an affected manner, walks with a mincing gait, wears make-up and frilly underclothes… Psychological treatment, as compared to psychologically inspired handling, does not seem to be successful.”¹⁵ “The ideal patient for treatment is an offender,” reflected Dr. John Landers on his unusual 1954 group prisoner conversion effort at The Scrubs, “not a hardened recidivist.”¹⁶

It is rare to discover a reaction from these hard recidivists. Occasionally one scrupulous psychiatrist might slip a patient opinion in his case report. Thus we learn of “Richard,” who “exhibiting his feminine attire, wandered on the wrong beat and was picked up with the other girls and driven in a Black Maria to prison, where his true sex was discovered.” “Ever since the age of ten he wanted to be a girl.” The kicker: “Richard then talked about how prison made one more perverted.”¹⁷

In literary canon, however, the memory of prison femininity has been embodied in one man. Jean Genet was anticipating relégation, a French penalty of lifetime sentencing for serial petty offenders, after mincing out an antique bookstore in 1943 clutching a premier edition of Paul Verlaine’s poetry valued at $1,400. His fate was salvaged by, firstly, sympathetic mental evaluation from Dr. Henri Claude, who diagnosed him with “moral madness [folie-morale]”;¹⁸ and secondly appeal from wealthy avant-gardiste Jean Cocteau, a fellow homosexual who testified Genet was “the greatest writer of the modern era” after reviewing roughs of his debut novel scribbled on sack paper during prior incarceration at Fresnes Prison.

That debut was Our Lady of the Flowers. It was as the analysts would warn, a declaration of excess. Divine is an unapologetic, scatological, piss-drinking “girl-queen” who, hotshot philosopher Jean-Paul Sartre claimed in his adulating preface, is Genet herself. Genet was rather more opaque; Divine is “what for want of a trifle I failed to be.” Never to return to jail, Jean was soon reposturing as a muscular member of the French literati, a lie which held little conviction. His follow-up quasimemoir Miracle of the Rose recalled when he was “sixteen, a girl’s age,” a chicken incarcerated at Mettrey Penal Colony, tendering her holes to its pimps and toughs; such memories grew pained “as soon as I became a male.” (Yet even then, in scattered moments of frail hysteria, his recollections of the colony lay inside “the most sorrowful female head.”) On becoming bride in prison marriage to his man, Divers: “that night was the loveliest of my life.”

When Kate Millett, in her best-selling 1970 radical feminist treatise Sexual Politics, evaluated Jean’s novels as the only male writing deserving female approbation, a profound “satire on the heterosexual code” produced by a “formidable analytic mind,” it was no coincidence she reached for a medical vocabulary we have not wasted on homosexual men again since their virilizing liberation movement. “Jean Genet is both male and female,” she wrote. “The insouciant queen in drag… has made gender identity more than frighteningly easy to lose…”²⁰

The process of conversion therapy was, in this drag logic, the process of making gay men identify as men. Free gay men volunteering for conversion near the Stonewall era were, therefore, doubly embarrassed, to endure not only a psychoanalysis but a psychoanalysis so plainly designed for trans women. Eminent gay historian Martin Duberman, for instance, requested to be “fixed” into heterosexuality in 1965, only to be (much to his confusion) barked down by therapist Karl for being a straight lady: “You and your mother are not separate people, and that is why your gender identity remains faulty.”²¹ Karl was running at the forefront of his profession; “gender identity,” the newly dubbed, conspicuously trans nucleus of gay disability, had only been introduced to the literature by Bob Stoller three years prior. Before then, analysands learned their gender problem in a more abstract tongue, as with Edmund White’s unnamed narrator (himself) in A Boy’s Own Story circa 1956: “Paraphrasing Dr. O’Reilly, I added, ‘But you see, Daddy, I’ve internalized my mother…’” Were the macho faggot – a strict contradiction in terms – ever to resist the siren song of health and endorse his own madness, he necessarily had to subordinate himself before this feminine presumption.

Free transsexual women could not, by definition, be exempt from this process. Our initial psychiatric confrontation was virtually identical. Christine Jorgensen recalled her typical encounter with a first analyst, Dr. Reznick, who tried “to guide me away from these ‘feminine inclinations.’” Young professor Duberman had paid his therapist 20$ a session, at 3 sessions a week, which was “difficult for me to manage financially”; Christine later received “a bill for thirty-five dollars for a fifteen-minute consultation,” for which she claimed need to borrow money. Care of the queer middle classes was a legendary racket.

From this initial confrontation, however, diverged a transgender miracle. Rather than elaborating the torture of conversion over many years, as did Martin or Edmund, Christine rejected it immediately; Dr. Reznick was “not the man who could help me.” In this respect she – I dare suggest most transsexuals – held vaster self-possession and personal knowledge than a great many gays of her era. But also unlike the rising tide of gay liberationists, Christine then set about her clinical reentrenchment. She spent endless weeks in countless public libraries, reading copiously on the science of sex; she enrolled for a dental assistantship just to eavesdrop on endocrinologists speaking about glands; she squared down round after round of rosy-cheeked shrinks in hopes that someone, anyone with license, might verify her mental distress warranted some other meaningful intervention. The exact nature of this intervention was, as yet, unclear.

In this respect trans street bohemians of the lower classes were essentially similar. Lyn Raskin, a New York bird with the rare published diary, behaved more like a prisoner of record in her self-acknowledged promiscuity and fondness for gay sex, yet she too wandered in and out of clinics, anxiously pursuing some vague notion of intervention. Her futile reversal of the medical grasp on her condition is humorous enough to repeat:

When these ladies of the clinic at last stumbled upon our favored solution, it was rarely advertised as such. The pseudonymous Jane Fry, transitioning in a mental ward in 1968, remembered how “we [Jane with ‘Dr. Lowe’] finally came up with three alternatives for my treatment”: “The first was intensive psychotherapy,” the exact kind of conversion process already detailed; “the second was male hormone shots, and intensive psychotherapy,” the exact kind of conversion process already detailed; “and the third,” Ms. Fry proceeded soberly, “was female hormone shots and psychotherapy as a prerequisite for possible surgery.”²³ She uttered this final option so flatly, as if it were… well, the exact kind of conversion process already detailed. For her doctor ranked it below even that kindness.

Clinicians spoke of the postoperative transsexual not as a person returned to health but a patient in hospice care. “It is understood in medical ethics that if a disease cannot be cured an attempt should be made to improve the stress and inconvenience of the patient”:²⁴ this was Christine’s endocrinologist and psychotherapist, publishing jointly on “surgical transvestism” one year after her first operation in 1952. They held the tolerant liberal stance. For Bob Stoller, who had psychoanalytic training, this liberal ambivalence became even more pronounced: “if there were any psychiatric treatment that was even partly useful, it would probably be better than this disquieting ‘psychosurgery.’” “The general rule that applies to the treatment of the transsexual is that no matter what one does – including nothing – it will be wrong.”²⁵

Without general, repeatable, scientific pathways to health, conversion therapists entertained brief hope by gossiping specific, increasingly outlandish successes in transsexual cure. Bob praised one ex-transvestite for ceasing his dress-up after a psychotic break, brought on by his 1960s housewife granting his wish to be sodomized with a homemade strap-on.²⁶ A 1977 paper from University of Tennessee med school recounts a psychiatric exorcism, where “22 evil spirits” fled a previously transsexual body, causing its newly grown breasts to disappear.²⁷ These tall tales, singular, unverifiable, and downright folkloric, were final manifestations of our doctors’ despair.

The pessimistic view of transness as an end-stage cancer of the soul rapidly prevailed, entering the DSM as “Transsexualism” in 1980. This was my own, outdated diagnosis listed on my first clinical outtake form from 2018.

Hormones and surgery were palliative; cure was impossible; the only route left was prevention. In acquiescence to the incorrigibility of trans adulthood, a hip, groovy, post-Stonewall set of sexologists developed a new series of forward-thinking longitudinal studies in search of what they termed “the pretranssexual child.” Psychoanalysis had, after all, not only refined clinical homosexuality to a transgender disorder, but a disorder originating in family life.

Dr. Richard Green had “beads around his neck, long hair, and a full beard,”²⁸ remembered Karl Bryant, who about age seven had been driven by family to Richard’s clinical practice as a prospective pretranssexual. Dick was, however softly, touched by new-aged California hippie swagger: there was no metallic science in the way he jotted about his gender-deviant clinic-children as “sissies” and “tomboys”; in how jovially he compared our prepubescent struggle, in academic writing, to both the dramas and comedies of Shakespeare;²⁹ in how after therapy he took his “feminine boys” up to the clinic rooftop for rounds of horse and basketball. In the late 1960s, with ample funding from Playboy magazine, he initiated the largest study on sissies ever then attempted, 66 families in sum.

“My focus,” Dick wrote in 1969, “will be on what we might consider the prevention of transsexualism.” “I believe an effort should be made to make a psychiatric intervention during a life period in which gender misidentification may be reversible, thus saving the individual a considerable amount of subsequent distress… we need to focus on a pediatric population.”³⁰ While he often summarized his study as merely observational, in truth he agreed to routine conversion sessions with several of its families. There, his treatment notes verify, “My goal… was to discourage any support for his cross-gender behaviors, and encourage boyish behaviors.”³¹ A brief sampling of Richard’s work transcripts may otherwise speak for itself:

As these records suggest, Dick admitted some difficulty in distinguishing the transsexual and homosexual object. Trained by Bob Stoller,³³ his psychology exited a tradition in which “bisexual” meant hermaphrodite, “sexual identity” and “gender identity” were synonyms, and the word “male” had inoffensive consistency. “The differential labeling of transsexualism, transvestism, and homosexuality is not always clear-cut,” he bemoaned, “…diagnostic distinctions may be blurred. Unequivocal categorization may be difficult.” “We thought we were studying pretranssexuals [in the sissy boy study]. Ultimately, it appeared that pattern was probably prehomosexuality.”

There were, then, three patient miseries on which Dick and Bob counted themselves regularly attending, and all overlapped. One was transsexuality, whose conversion therapies and classification as mental illness they actively promoted. Two was childhood gender-variance, whose mental illness their studies helped create. Citing Richard’s books, in 1980 a new diagnosis of “Gender Identity Disorder in Childhood” (one 1976 proposal suggested “Gender Dysphoric Disorder”³⁴) entered the DSM – right beside Transsexualism, through which it was spookily woven, yet somehow never identical. “This disorder becomes continuous with Transsexualism,” the DSM tells us, only “in a small number of cases.” A lovely optimism. In this post-Stonewall psychiatric mainstream, there could be no such thing as a trans kid.

Finally, there was the old mainstay of self-hating gays. While ego-dystonic homosexuality developed as, technically, a distinct diagnosis, there had been constant professional insinuation of overlap with the trans condition. “Is the transsexual homosexual?” Harry Benjamin asked in his watershed 1966 textbook The Transsexual Phenomenon (featuring an appendix by none but the young Dr. Green). “‘Yes’ and ‘no.’” Harry then insisted that “he [‘the transsexual’] actually dislikes homosexuals,” a clinical mandate which had undeniable influence over the popular memoirs of Christine Jorgensen (who knew Harry as a “great friend”) and therefore countless others. Meanwhile Norman Fisk, lead psychiatrist at Stanford’s reorientation program, coined the term “gender dysphoria syndrome” in 1974 to net together “transsexuals,” “effeminate homosexuals” (who thought they were transsexuals), “psychotics” (who thought they were transsexuals), and “extreme sociopaths” (who thought they were transsexuals). This new disease cluster, he illuminates, “obviously liberalizes indications and requirements for sex conversion surgery.”³⁵ Under his new, open-minded guidelines, that surgery was given to less than 10% of his patient load;³⁶ but homosexual men were, at least, theoretically legitimate candidates.

Integration with the Gay Liberationists for these diverse transsexualities was understandably mixed. There was, at onset, a young and gay disordered mass, eager to plunder the depths of their own madness, explode the varieties and intensities of human feeling, and establish mental illness as “revolutionary sanity by the oppressed” (Flaming Faggots collective, 1973).³⁷ Their antihero Jean Genet had even returned from his grave, refashioned as a politico after years of silence, touring with Black Panthers following the first English stagings of his racially charged midlife plays. His friendly lesbian critic, Kate Millett, was herself involuntarily asylumized by family, after which she joined the Madness Network and advanced a deeply personal antipsychiatry through her speeches and writing.

Transsexuals of even the most unredeeming fates rode tall in this crowd. First and foremost were the girlies,³⁸ those “women [who] have tried to fight for their sex changes, or to become women of the women’s liberation,” as their de facto New York City leader Sylvia Rivera screamed it storming the 1973 Christopher Street Liberation Day rally.³⁹ (Identifications were not always so pure; Sylvia herself, on and off estrogens and methadone, called herself a woman, a man, a “yenta,” a “half sister,” and “just me, Sylvia.”⁴⁰) Broadly underage, Black, brown, street hooking, and regarded, only sometimes pejoratively, as “mentally-disturbed”⁴¹ by the liberationists, not every kiddie queen was politically active. But those who squatted with Sylvia at 213 East 2nd Street – Bubbles Rose Lee, Bebe Scarpinato, Bambi L’Amour, Andorra Marks, about fifteen kids (and five stray puppies) beside their patron saint Marsha P. Johnson – were.

Girlies, particularly Sylvia, laid down their bodies for just about any gay cause, but nothing brought them out like the prisons and asylums. On October 5th, Bebe, Marsha, and Sylvia (at minimum) turned out in protest against the “Bellevue Butcher Shop,”⁴² the psychiatric clinic where Sylvia had once spent several months restrained after an adolescent suicide attempt.⁴³ That month she managed to sneak in with gay activist Arthur Bell to interview a “black male transvestite,” the dancer Chris Thompson, held against will for weeks due to her “femme tendencies.” “What do you feel about the sort of thing that Sylvia is into?” they asked. “I think it’s beautiful,” Chris said. “I think I’m all for it.”⁴⁴

Jane Fry, after her mental ward transition, joined up with the “Gay Liberation League [sic],” who were the first to embrace her as a woman, a “den mother,” laughing that she was “the only straight member of their organization.” Their embrace, she suggested, saved her from suicide. Come Out!, the foremost publication of the Gay Liberation Front, gave space not just to trans writers, but prison writers, whose transness burst forth unrequested:

These words, formatted right above a poem by Sylvia, were written in 1971 by Christina Kempf (née Wheeler),⁴⁶ an Indigenous Cheyenne trans woman serving a life sentence after turning herself in for killing her rapist. She had contacted the Front in hopes of obtaining their official sanction, a comic misunderstanding of how this new grassroots counterculture operated. Having submitted an insanity plea at trial, been diagnosed with incipient schizophrenia after her tenth odd suicide attempt, moved in and out of asylums throughout her youth, it was the Gay Liberation Front which sought official sanction from her.

Christina had been recommended the harshest punishment (later commuted) as “rehabilitation” – her own writings make clear this was a conversion effort – but in fact the opposite occurred. The Chris Wheeler Legal/Medical Aid Fund, alternately referred to as the Homosexual/Transsexual Defense Fund, garnered at least 5,000$ for trans prisoner surgeries and lawyer’s fees. At Walla Walla she met an “adult consenting love partner,” her prison husband Andrew, who became her civilian husband, in deed if not in law, for the last twenty-eight years of his life.

These were the happy highlights, the chaotic joys of “anything-goes” participatory democracy in its earliest, most human, and therefore most politically inept stages. The full range of ordered gay radicalism would prove quite capably saturated with anti-trans sentiment. To Christina’s right there were the legacy homophiles, elder gay gentlemen whose continued activism into the ‘70s nonetheless integrated and crossed over with the young radicals. Babyfaced queers jeered from the audience at the outrageously homophobic psychiatrists the fifty-year-old Franklin Kameny would debate on public access T.V.; certainly they did not know that Richard Green, the psychiatrist they cheered who Frank courted for a scientific endorsement of same-sex marriage, was one of the more prestigious anti-trans conversion therapists in his field.

In the 1970s, Dr. Green found himself in the unlikely position of signing on with the gay radicals. “Many homosexual adults contend they are proud to be ‘gay,’” he wrote in 1974, “Their pride is not being challenged here.”⁴⁸ That prior year, he played a lead role in the reduction of homosexuality as a mental illness. Around this moment, distinctions between adult gay men and trans women became magically clearer to him. He edited his rhetoric accordingly: transsexualism might be “aborted” in gender disordered children, he asserted with renewed hope, such that they “evolve into adult homosexuals.”⁴⁹

Even to gays further in the vanguard of youth than Frank Kameny, this proposition had its charms.⁵⁰ There were self-styled “revolutionary effeminists” like Steven Dansky or Kenneth Pitchford of the Flaming Faggots collective, who penned letters, poems, and manifestos declaring a joyless gay militancy: an effeminist would vitally help women with “drudgery and childcare,” but must never crossdress, be masochistic, indulge camp humor, or contemplate transsexuality as more than “superficial decoration.”⁵¹ Thirty years later, Steven had become an LGBT therapist, where he, by his own admission, took on “a ‘gatekeeper’ role” to “assess the mental stability of transgenders.”⁵²

A slightly older few, like Marty Duberman and Ron Gold, knew intimately the emasculating harm of “reparative psychoanalysis” and its “gender identity disorder,” and had a stark reaction. Ron’s 1973 pro-gay protest speech before the APA affirmed their psychiatric view that, if “one [gay] partner is conceived as feminine,” this really was a “second-best parody” of heterosexuality.⁵³ (Thankfully, Ron liked his men male.) Marty, in the early 1970s, was at work on a one-act play about capital-T Transsexualism, which he recalled as “an unflattering portrait of a patient awaiting surgery.”⁵⁴ These were expressions of gay men working through their own intricate and perfectly justifiable “macho trips,” as Ron named it. It was less misogyny – such gay male activists got hip on women and moved righteously in the blooming radical feminist movement – than it was transmisogyny, specifically. Contempt for real versions of themselves who had believed they were sick slid into disdain for imaginary versions of themselves who had believed they were women.

Within what vestiges of Gay Liberation remained after 1980, paranoia about the integrity of gay male identity grew marked. Dr. Lawrence Mass, M.D., co-founder of Gay Men’s Health Crisis, wrote consistently for gay periodicals across that decade that “American psychiatry is simply engaged in a long, subtle process of reconceptualizing homosexuality as a mental illness with another name – the ‘gender identity disorder of childhood.’”⁵⁵ Within the newly developing academic field of queer theory, grandmother theorist Eve Sedgwick also took umbrage with the GIDC concept, accusing its purveyors of “a medicalized dream of the prevention of gay bodies.” This accusation occurred in her foundational 1991 essay titled “How to Bring Your Kids Up Gay”; it is never quite clear whether Eve might be using “gay” with the more anarchic texture of Jean Genet’s 1940s, but her language makes it tenuous.⁵⁶ She did not address the word “trans,” at fear of legitimizing the disorder.

When dust settled on Gay & Women’s Liberation, there was air to breathe for a kind of vulgar antipsychiatry, which was anti-trans in effect and spirit. Lord daddy of antipsychiatry, author of The Myth of Mental Illness Thomas Szasz, gave in 1979 a very warm review to Janice Raymond’s feminist anti-trans propaganda effort, The Transsexual Empire. He began:

Tom’s preference for the involuntary commitment of transsexuals is especially remarkable given how beloved he was in much of the gay subculture, interviewed by Larry Mass for Christopher Street and excerpted at length in the gay and lesbian supplement to Phoenix Rising: the voice of the psychiatrized. He had been calling homosexuality “natural” since at least 1970.

Similarly, New York Native, the premier gay magazine of New York throughout the ‘80s, was only too happy to namedrop Tom Szasz, or print claims from such feminist champions of gender-neutrality as Letty Cottin Pogrebin that,

This stigma of gender transition as conversion therapy weighs even on more contemporary historical scholarship from academic progressives, as when Emily Skidmore, in an award-winning 2011 essay on Jorgensen for Feminist Studies, claims Christine’s vomiting episode and suicidality demonstrates “an allegiance to heteronormativity.”⁵⁹ Need I go on?

Activist pressure of this kind has whittled homosexuality out of the DSM. “Ego-dystonic homosexuality” was stripped down to “Sexual Disorder Not Otherwise Specified” in 1987, subclass “persistent or marked distress about sexual orientation.” In 2013, once the last of the establishment conversion therapists were rotting underground, even this vanished. The only reference to the disability of homosexuality in the most recent DSM is a heightened rate of erectile dysfunction.

Transgender diseases have faced no such attrition, just silly wordplay. In 2013 activist pressures achieved what Stanford physicians had recommended four decades prior, a diagnostic collapse of gender identity disorders into “gender dysphoria,” because it was “more descriptive” and “focuses on dysphoria as the clinical problem, not identity per se.” This was what was listed on my surgical outtake form in 2021. “Gender dysphoria in childhood” remains a distinct “criteria set,” removed from its adolescent and adult varieties for no better reason than the ambition it should disappear. “Dysphoria” on its own has never been defined in the DSM. Used also for schizophrenia and major depression, it means something like Christine’s “grief and self-pity.”

For the better part of a century, doctors have been trying, and consistently failing, to cure our disease of transsexualism (so listed until 1994). They shall have to settle for curing our disease of grief and self-pity.

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