Abstract
Dear Editors,
The development of gender identity is a multidimensional and long process, beginning early in life until early adulthood. Adolescence is the period mostly characterized by the fluidity of gender identity; however, homosexual experiences are rare and do not often lead to gender dysphoria (GD; Leibowitz & de Vries, 2016).
A review of studies on children and adolescents attending gender identity clinics has corroborated that childhood GD does not necessarily persist in adulthood and that only 16% of children become adults with gender identity issues (Ristori & Steensma, 2016).
Recently in Greece, attention was focused on the Parliamentary Act/Law 4491/2017 according to which a person is allowed, by court order, to gender transition without the prerequisite of having received psychiatric treatment or having been subjected to surgery. Article 3 of the Act allows for gender identity transition by court order from age of 15 years onwards. There was a huge amount of newspaper articles and public debates compounding political, scientific and religious discourses.
The government side, welcomed by the LGBTI organizations, invoked the Resolution of the European Parliament Assembly (2048/2015). Opposition parties and conservative religious circles denounce practices leading to the use of gonadotropin-releasing hormone analogues for puberty suppression in adolescents who have GD, with potentially health-damaging results.
In the scientific field, there was also a split within the Hellenic Psychiatric Association being in favor of the act and regarding it as ‘mainly a social issue concerning citizens’ rights in the country’ (Hellenic Psychiatric Association, 2017). Their viewpoint is consonant with the significant shift regarding the conceptualization of the disorder, as reflected in the diagnostic criteria in Diagnostic and statistical manual of mental disorders – 5th edition (DSM-5, 2013). The shift from gender identity disorder to GD underlines the prevailing symptom of ‘psychological distress’ relating to high levels of stigma, discrimination and victimization leading to negative self-image, and increased likelihood of comorbidity with mental disorder (Knudson, De Cuypere, & Bockting, 2010).
Conversely, the Hellenic Society for Child and Adolescent Psychiatry (2017) – appearing more sensitive to processes inherent in adolescence, such as libidinal reallocations and identification processes, which can have an effect on gender orientation – was radically opposed stating that ‘we express our opposition and our concerns that the involvement of the young people in the process will exacerbate rather than improve their mental state’. In their announcement, they emphasized the cases of comorbidity between GD and autistic spectrum disorders, while evidence indicates that symptoms of depression and suicidality do not subside after medical procedures of gender transition (Glidden, Bouman, Jones, & Arcelus, 2016).
We are sorry to realize that in Greece such a sensitive issue, which is still a subject under discussion in the international level, divides the country in two. Splits as the abovementioned suggest that in some cases science cannot provide adequate and clear answers to multifaceted and complex psychiatric issues, which in turn may hinder policy decision-making. Controversies of this kind, however, leave little room for raising public health awareness, fighting stigma, psychoeducating the family and in general caring for adolescents who, in addition to GD, display intense psychological discomfort (Winter et al., 2016).
