Vivek Ramaswamy Turns Stigma Against Mental Illness On Trans Youth

Being transgender is not a mental disorder, but there are deeper implications for those who want to improve mental health treatment in this country.

by Evan Urquhart

Contrary to the remarks of Vivek Ramaswamy in the GOP debate last night, there is no mental disorder called transgenderism. That’s just a fact: The word is not in the DSM V, and in their explainer on gender dysphoria the American Psychiatric Association states, “Diverse gender expressions, much like diverse gender identities, are not indications of a mental disorder.”

That ought to be that, but of course it isn’t. In the debate, Ramaswamy repeated the party line of the modern GOP. “Transgenderism, especially in kids, is a mental health disorder.” Let’s break it down.

What does it mean for something to be a mental health disorder? In clinical terms, a mental disorder is a health condition involving mental functioning and/or behavior that causes the patient distress and/or difficulty functioning.

screenshot from the American Psychiatric Association

Is that what Ramaswamy means? A health condition that causes the patient distress and interferes with their functioning? When he holds his pointer finger aloft and says “Let me be clear: Transgenderism, especially in kids, is a mental health disorder,” is he saying, perhaps, that it is particularly important that kids receive timely access to mainstream medical treatments for this health condition? A few moments later he makes it clear that this is not what he means at all, saying, “But I’m sorry. It is not compassionate to affirm a kids confusion.”

Ramaswamy in that moment is making it clear he isn’t using mental disorder in the sense of a health condition involving changes in thinking, emotion, and/or behavior that impairs functioning, and deserves treatment. If he was using it that way it would hardly matter if being trans was considered a mental condition or not; the clear implication would be that it causes distress and needs to be taken seriously and treated in a mainstream psychiatric framework, according to established guidelines. Those guidelines clearly state that the only effective means of treating the distress of gender incongruence involves addressing the incongruence through a social and/or medical transition.

When the APA says being trans is not a mental disorder, they’re making a distinction between the distress caused by feelings of incongruence and the state of living as another gender, which is not inherently impairing or distressing (and, in fact, has been found to greatly reduce or eliminate distress stemming from gender dysphoria).

But Ramaswamy is using “mental disorder” in a completely different sense, a sense he makes clear is synonymous with confusion. This is partly a problem because trans people aren’t confused about their gender, but also because confusion isn’t a synonym for mental disorder. A mental disorder is a type of health condition. It can’t be cleared up by telling the person the hard truth or telling them to get over it. By conflating the mental illness and confusion, Ramaswamy is attacking that understanding of mental illness, and substituting a framework that blames patients for their illness and prefers moral hectoring to evidence-based treatments.

Ramaswamy’s attack on the trans community is, covertly, an attack on the mainstream medical view of mental disorders as treatable medical conditions. In place of this Ramaswamy offers a framework where sufferers are confused and wrong, in need of being confronted and corrected. This framework may sound a bit familiar, because it just so happens to be the basis of the stigma against people with mental illness.

It has been observed to death that Americans on the left and right are increasingly removed from one another, operating in separate spheres where neither facts nor values are held in common. In such circumstances, it becomes very important to be sure we’re understanding what we’re looking at when we observe the opposite side’s behavior and rhetoric. Ramaswamy isn’t just saying that being transgender is a mental disorder, he’s saying that mental disorders are moral failings to be corrected. This isn’t just about trans people, it’s also a rejection the ongoing attempt to bring mental health treatment into a modern medical framework seeking to help patients, and a call to return to a time when the only societal response to mental illness was punishment.

Like other GOP attacks on trans people, this lie that being trans is a mental disorder is a proxy for a larger cultural battle. Here, it’s a proxy for a much wider GOP battle against expertise, against mainstream medical knowledge, and against public health as a field based on empirical evidence and designed to improve people’s health outcomes. While it’s important to reiterate that being transgender is not a mental disorder, it is even more important to understand the larger implications of conservatives categorizing mental disorders as moral failures.