Health / MedicinePsychologyScienceTransgender

Born and Made to Live this Way, Part Two: The Insanity Plea

The target audience of this website is most likely familiar with the history of pathologizing LGBTQIA people as mentally ill. The Diagnostic and Statistical Manual of Mental Disorders, more colloquially referred to as the DSM, listed homosexuality until the 1970’s. Only in the past few years has the DSM’s focus on Gender Identity Disorder (GID) or, less stigmatizing, Gender Dysphoria (GD) shifted towards respecting patients and addressing medical access to affirmation. Still, in the non-LGBTQIA communities’ quests to find the origin of the LGBTQIA species, a number of questionable biomedical publications have surfaced to find the causal link between LGBTQIA identities and mental illness. Today I’ll be writing about a piece written by researcher Ravi Phillip Rajkumar in 2014.

Rajkumar writes about a wide breath of mental illnesses using perspectives from population and genetic data and literature reviews. His literature review article attempting to connect GD to schizophrenia via common sources of altered neurobiology, including Toxoplasma infection, published in Schizophrenia Research and Treatment has thousands of views, but only one citation. The paper made an initial splash of interest as Toxoplasma’s potential to manipulate host behaviors is a hot topic both in the field and in pop science (maybe you’ve heard of rats that don’t avoid cats). Interest in citing the paper is definitely muted by its source, Hindawi Publishing Corporation, whose journals have appeared on Professor/Librarian Jeffery Beall’s controversial predatory journal list. However, I believe, the content of the paper would be rejected by the scientific community even if it managed to get published in a high impact factor journal.


This file was provided to Wikimedia Commons by the UK LGBT Archive as part of the LGBT Free Media Collective coordinated by Wikimedia LGBT and WikiQueer

Every single stated aim of the paper is not met. First, the article aims to review previous literature showing schizophrenia occurs at a higher rate in the GD population than the general population. The previous literature doesn’t show this, but does show an elevated risk for a wide variety of mental illnesses, which has already been established as a symptom of living in a marginalized minority. The studies that do show increased levels of schizophrenia in the GD population have already been critiqued on statistical grounds for either how the data was collected or how large the population under study was.

Next the paper seeks to review previous literature showing schizophrenia patients exhibit GD symptoms and GD patients exhibit schizophrenia symptoms. Fortunately, “disturbed sense of gender identity” among schizophrenia patients is not a reflection on the experiences of GD patients. Many biological conditions have overlapping symptoms, but it does not logically follow that the origin of the conditions are the same without supporting evidence. Likewise, the reported decrease of symptoms of general mental illness among GD patients seeking hormone therapy tells us little about schizophrenia in GD patients.

Before making recommendations to further explore the common background of GD and schizophrenia, the paper delves into neurobiology possibly shared by both. To be brief, Rajkumar names a variety of circumstances under the umbrella of abnormal neurobiology that have been investigated as factors in a number of conditions and calls it a day: autism spectrum disorders, Toxoplasma infections, early childhood adversity, reduced dopamine, etc.

Let us say that this paper is completely correct and future research goes on to show there are neurodevelopmental conditions that can either manifest as GD or Schizophernia or both. Would that humanize GD and galvanize support for transgender civil rights under the banner that gender varying people deserve the same respect as people who are mentally ill? Granted mental illness is widely stigmatized, our laws are designed to protect sick people, even if they are not carried out that way, and our laws are not designed to protect the transgender community.


Toxoplasma and behavior:

Publishing dilemmas:

Gender Dysphoria in the DSM:

Original article:

Born and Made to Live this Way, Part One: “Baby We Were Born this Way”

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Born and Made to Live this Way: Part 3, Dad It's All Your Fault



Liz is a LGBTQ Medical and Science Writer. You can see more of her LGBTQ centered work in the Bi Women Quarterly and more of her science centered work at in the blog.

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