Gender dysphoria is typically construed as a medical concept. This understanding of gender dysphoria reflects how cisgender people interpret trans experience. This essay proposes an alternative concept of gender dysphoria for critical theory: on this account, gender dysphoria is alienation from cisgender forms of life. If the medicalized concept of gender dysphoria tacitly takes for granted, identifies with, and thereby reinforces cisgender patriarchal society, a critical theory of gender dysphoria instead approaches the issue from (...) the perspective of trans people, their lived experiences and social situation, to offer a critique of society. While the medicalized concept of gender dysphoria refers to a “distress” caused by living in the “wrong-body,” the critical concept of gender dysphoria refers to an alienation as a result of living in the “wrong (cisgender patriarchal) society.” The critical concept of gender dysphoria may become a tool capable of describing the necessary facets of trans experience necessary to form a political coalition. The paper concludes by claiming that trans subjects are the gendered analogue of Marx’s concept of the proletariat. (shrink)

PRECIADO, P. B. Dysphoria mundi. El sonido del mundo derrumbándose. 560 p. Espanha: Editorial Anagrama, 2022.

The original book chapter does not have an abstract. However, I have written an abstract for this repository: Religious life encompasses a wide diversity of situations for which the emotional tone is on a continuum from extreme euphoria to extreme dysphoria. In this book chapter, we propose the novel hypothesis that euphoria and dysphoria have distinctly separate functional consequences for religious evolution and survivability. This is due to the differential cognitive states that are created in euphoric and dysphoric (...) situations. Based on readings from religious studies and cognitive psychology, we propose that euphoria in religion is conducive to social bonding and situations needing lateral thinking and creativity; whereas dysphoria in religion is conducive to situations where precision and analogical reasoning are necessary. (shrink)

Dysphoria is a complex phenomenon which must be defi ned in the framework of different forms of affections. It belongs to the broader field of emotions, which are characterized by some essential features: i.e. movement, passiveness, tran-sitoriness, and reference to the others. All these four essential features of emotion are specifi cally altered in depression, whose phenomenology is presented in a clinical case. In discussing dysphoria, a first distinction is made between par-ticular and global affections. The fi rst (...) type encompasses emotions and feelings, while the second one includes humor, mood and temper. Dysphoria belongs to one of these global affective states: the humor, which has to do with the spatial dimension of existence. In dysphoria the patient experiences the world as oppressive and invasive of his/her intimacy; the others are lived as persons demanding answers or actions he/she is not able to fulfill. Finally, the phenomenology of dysphoria is analyzed through the four essential features described above and examples are given. (shrink)

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic (...) surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT. (shrink)

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and (...) essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

Talk of gender identity is at the core of heated current philosophical and political debates. Yet, it is unclear what it means to have one. I examine several ways of understanding this concept in light of core aims of trans writers and activists. Most importantly, the concept should make good trans people’s understanding of their own gender identities and help understand why misgendering is a serious harm and why it is permissible to require information about people’s gender identities in public (...) life. I conclude that none of the available accounts meets these essential criteria, on the assumption that the gender norms of femininity and masculinity are unjustified. But we can, and should, pursue the feminist project without “gender identity”. Such feminism can include trans people because it is possible to account for the specific harm of misgendering without assuming a claim to the recognition of our gender identities. I conclude that we should eliminate the concept of “gender identity.” To understand the phenomena that are putatively captured by “gender identity,” we are better off employing other concepts, such as “sexual dysphoria,” (assigned or aspirational) “gender roles,” and (internalised or endorsed) “gender norms”. These concepts can usefully replace “gender identity” in an individual evaluation of each of the trans people’s claims to inclusion into particular spaces. (shrink)

Biological sex should be “acknowledged” and “accepted”—but which responses to gender dysphoria might this preclude? Trans-identified people may factually acknowledge their biological sex and regard transition as purely palliative. While generally some level of self-deception and even a high level of nonlying deception of others are sometimes justified, biological sex is important, and there is a nontrivial onus against even palliative, nonsexually motivated cross-dressing. The onus is higher against co-opting the body, even in a minor and/or reversible way, to (...) make a false communication concerning one’s sex. Hardest to defend is the destruction of sexual–reproductive functions and causally downstream functions such as lactation: due to the transcendent nature of sexual–reproductive functions, an appeal to the “principle of totality” here is misplaced. This is not to say that social, and milder medical, transition is absolutely excluded even for severe unmanageable dysphoria, nor that subsequent to any transition, detransition is necessarily required. (shrink)

In clinical studies, childhood-onset gender dysphoria does not usually persist through puberty, at least if the child has not socially transitioned. If dysphoria persists into puberty, is it unlikely to abate without medical intervention? Many clinicians would give an affirmative answer. Gender dysphoria after puberty is often said to be "highly persistent.” The article examines whether this opinion is backed by good evidence, and concludes that it isn't.

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient’s well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a standard of medical care must not cause (...) dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria. (shrink)

Este artigo investiga as diferentes concepções de “Sujeito” de acordo com o corpus teórico do filósofo Paul B. Preciado. As categorias analisadas são: os processos subjetivos e técnicos de sujeição social e servidão maquínica na era farmacopornográfica; o sujeito Playboy e petrosexorracial; a Multidão, seus múltiplos devires e as micropolíticas de resistência à opressão; a metamorfose dos sujeitos em agentes revolucionários e os simbiontes políticos, postulados por Preciado em seu mais recente livro publicado, Dysphoria mundi. Como Preciado articula todas (...) estas concepções, considerando ainda as linhas de fuga da submissão, isto é, o horizonte filosófico de resistência onto-epístemo-política, metamorfose e até a possível superação da dominação capitalística? Os procedimentos metodológicos foram baseados na pesquisa bibliográfica (livros, artigos e crônicas), de modo a evidenciar o contraste, as semelhanças, diferenças e interstícios entre a teoria de Preciado e as suas principais referências. Os resultados obtidos indicam uma linearidade consistente entre-categorias, os desafios em materializar as teorias revolucionárias na realidade cotidiana, bem como estratégias práticas que contribuem para a organização ontopolítica proposta por Preciado. (shrink)

Philosophical and empirical research on bodily awareness has mostly focused so far on bodily disorders – such as anorexia nervosa, somatoparaphrenia, or xenomelia (body integrity dysphoria) – and bodily illusions induced in an experimental setting – such as the rubber hand illusion, or the thermal grid illusion. Studying these conditions can be illuminating to investigate a broad range of issues about the nature, function, and etiology of bodily experience. However, a number of psychoactive compounds can also induce a remarkably (...) wide variety of bodily effects that have received little attention despite their relevance to these issues. Some of these effects are similar to those associated with bodily disorders or experimental bodily illusions, while others appear to be unique. The purpose of this chapter is to provide an overview of these lesser known bodily effects of psychoactive compounds, and outline some ways in which they can bear on recent debates regarding bodily awareness and bodily ownership. (shrink)

Why has modern American conservatism committed itself to gender binaries? Examining why this new categorizing unsettles conservatives (and how they have reacted against teacher unions and transgender influencers), this paper turns to Nietzschean analysis. It finds that the unsettling of heteronormative gender norms resulted in a pivot by conservatism to perpetuate a new gender identity politics in which nonbinary and especially transgender people are scapegoated. Imagining a nihilistic interpretation of gender, conservatives have made “transgender” a signifier of amorality and barbarism, (...) envisioning themselves as warriors of normalcy. Conservative activists have named their frontier “radical gender ideology” while contesting the legitimacy of diagnosed gender dysphoria, revising its pathology, and alleging clinical gender transitioning is a financial ploy. As a result, bodies have become sites of contestation between doctors, trans activists, and groups that advocate against gender-affirming care. This paper traces the conservative movement from resentment to opposition on three fronts – pathology, pronouns, and restrooms. (shrink)

Gender-affirming healthcare interventions are medical or surgical interventions that aim to allow trans and non-binary people to better affirm their gender identity. It has been argued that rights to GAH must be grounded in either a right to be cured of or mitigate an illness—gender dysphoria—or in harm prevention, given the high rates of depression and suicide among trans and non-binary people. However, these grounds of a right to GAH conflict with the prevalent view among theorists, institutions and activists (...) that trans and non-binary people do not have a mental illness and that one can be trans and entitled to GAH without being depressed or suicidal. This paper challenges the orthodoxy that a right to GAH must be grounded in either of these ways and instead argues for a right to GAH grounded in a right to live and act with integrity. The standard view, which this paper explains, is that our rights to live and act with integrity ground a right to religious accommodation in many cases such as a right to not be denied social security due to one’s refusal to work a job on a holy day. This paper argues that if our rights to live and act with integrity can ground prima facie rights to religious accommodation, our rights to live and act with integrity ground prima facie rights to GAH. There are no data in this work. (shrink)

Florence Ashley has responded to our response to ‘Gatekeeping hormone replacement therapy for transgender patients is dehumanising.’ Ashley criticises some of our objections to their view that patients seeking hormone replacement therapy (HRT) for gender dysphoria should not have to undergo a prior psychological assessment. Here we clarify our objections, most importantly that concerning the parity between cosmetic surgery and the sort of intervention Ashley has in mind. Firstly, we show Ashley’s criticism of our comparison is insubstantial. We then (...) examine their comments regarding the analogy between abortion and HRT, and the language of informed consent. We also scrutinize the data upon which Ashley relies to defend the claim that informed consent without assessment always yields positive outcomes, finding this conclusion to be overstated. Finally, even if Ashley’s arguments were vindicated, the claim that the gatekeeping of HRT is motivated by hostility towards transgender people remains unsupported. (shrink)

According to some philosophers, gender is a social role or pattern of behavior in a social context. I argue that these accounts have problematic implications for transgender. I suggest that gender is a complex behavioral disposition, or cluster of dispositions. Furthermore, since gender norms are culturally relative, one’s gender is partially constituted by extrinsic factors. I argue that this has advantages over thinking of gender as behavior, and has the added advantage of accommodating the possibility of an appearance/reality dissonance with (...) respect to one’s gender. (shrink)

The “affirming” healthcare model for gender-distressed youth is endorsed by the medical establishment in the United States, but many European nations have retreated from it. This controversy would be expected to attract the interest of philosophers and bioethicists, with a diverse range of opinions appearing in academic articles. However, when philosophers and bioethicists have ventured into print, they have almost invariably endorsed the affirmative approach, which involves life-changing medical interventions on children with psychological problems. This is a sign that the (...) process of academic research and writing is not functioning as it should. -/- We recount the failure of philosophy and bioethics to address the issues raised by gender-affirming healthcare. We also offer an explanation of this failure, and in the final section make some recommendations for improving academic integrity. (shrink)

An examination of Sex and Gender under the most recent scientific discoveries in the areas of neuroscience, endocrinology, biology, psychology, medicine, and linguistics. Presented as part of the Conference "Gender: Ideology or Science?" at the "Accademia Tiberina," Rome, Italy, November 25, 2022.