Milionis Charalampos
Department of Endocrinology, Diabetes, and Metabolism, 'Elena Venizelou' General Hospital, Elena Venizelou Square 2, Athens, 11521, Greece.
Health Care Anal. 2025 Mar;33(1):52-62. doi: 10.1007/s10728-024-00509-8. Epub 2025 Jan 9.
Historically, the transgender population has faced prejudice and discrimination within society. The purpose of diagnostic terms is to direct clinical care and facilitate insurance coverage. However, the existence of a medical diagnosis for gender nonconformity can exacerbate the stigmatization of transgender people with adverse consequences on their emotional health and social life. Whether transgenderism and gender dysphoria are indeed a psychopathological condition or even any kind of nosological entity is a contested issue. Many advocates of human rights, trans activists, social scientists, and clinicians support either the removal of gender incongruence from the list of mental disorders or at least its transfer to a separate category. Reforming the classification is an intermediate step toward depathologization and permits access to transgender-related care. Nonetheless, it partly preserves the stigma associated with abnormality and puts the availability of psychiatric care at risk. A more radical approach dictates that the classification of diseases serves exclusively medical purposes and must be dissociated from the respect for the legitimacy of one's autonomy and dignity. In the long term, only a swing in societal values can detach stigma from mental and physical illnesses. Enhancing collective respect for life, human rights, and diversity is the best way to achieve cohesion and well-being among members of society. Health professionals can be pioneers of social change in this field.
从历史上看,跨性别群体在社会中一直面临偏见和歧视。诊断术语的目的是指导临床护理并促进保险覆盖。然而,针对性别不一致的医学诊断的存在可能会加剧对跨性别者的污名化,对他们的情绪健康和社会生活产生不良影响。跨性别主义和性别焦虑症是否确实是一种精神病理状况,甚至是否属于任何一种疾病分类实体,是一个有争议的问题。许多人权倡导者、跨性别活动家、社会科学家和临床医生支持要么将性别不一致从精神障碍列表中删除,要么至少将其转移到一个单独的类别。改革分类是迈向去病理化的中间步骤,并允许获得与跨性别相关的护理。尽管如此,它部分保留了与异常相关的污名,并使精神科护理的可及性面临风险。一种更激进的方法认为,疾病分类仅服务于医学目的,必须与对一个人的自主权和尊严的合法性的尊重脱钩。从长远来看,只有社会价值观的转变才能消除对精神疾病和身体疾病的污名。增强对生命、人权和多样性的集体尊重是实现社会成员之间凝聚力和福祉的最佳方式。卫生专业人员可以成为该领域社会变革的先驱。