Many studies demonstrate that transgender individuals experience serious emotional, behavioral, and physiological problems. Nevertheless, this behavior is considered by the Diagnostic-Statistical Manual (DSM), the most influential diagnostic reference in the world, as a normal sexual behavior. The reason for this misdiagnosis is correlational studies, which report that the brains of transgender people resemble their gender identity rather than their birth sex. However, extensive research, reviewed in Chapter 1, reveals that this claim lacks a scientific base. Moreover, this theory cannot explain several cardinal problems, such as the dramatic increase in the prevalence of this behavior, evidence indicating that this effect is strongly linked with social media and data suggesting that transgenderism, anorexia nervosa, and dissociative-identity disorder (DID) share common characteristics.
This book demonstrates that the inadequacy of the neurological explanation of transgenderism is a symptom of an acute theoretical crisis in psychopathology. This effect became prominent, particularly following the fall of psychoanalysis, which amplified the pseudo-scientific belief that the brain is the key to understanding behavioral disorders. While in the past this myth was limited to the explanation of psychosis, today it has spread to the entire spectrum of behavioral disorders. However, growing evidence challenges the validity of this explanation even with respect to schizophrenia. Examples include the fact that a significant percentage of schizophrenic patients display no brain abnormalities; the failure to identify a neurological defect specific to schizophrenia; and that many patients recover from this disorder without pharmacological intervention. In contrast, like gender-affirming hormone therapy for transgender individuals, medical intervention in schizophrenia comes with a wide range of harsh consequences. Yet, the scientific reputation of this theory remains intact.
Accordingly, in an attempt to resolve this theoretical crisis, a new theory, the Psycho-Bizarreness Theory (Rofé, 1989, 2000, 2002, 2010; Rofé & Rofé, 2020, 2021), which like Freud focuses on the understanding of bizarre/mad behaviors, is presented. This theory demonstrates that bizarre behaviors, such as transgender, neurosis, and psychosis, share several common empirical diagnostic criteria, which distinguish them from other behaviors. These behaviors are rational coping mechanisms, which some individuals intuitively adopt when confronted with an intolerable stressful situation and alternative options are either unavailable or too costly. People rationalize these behaviors, either by deceiving themselves that they suffer from a serious illness, thereby attributing their underlying causes to factors beyond their control (e.g., spiritual possession, the unconscious, and neurological impairments), or by a self-deceptive excuse that their behavior is normal and necessary for their own well-being and/or the social interest. Robert Aumann, the Nobel Prize-winning economist, noted that Psycho-Bizarreness Theory, “revolutionary as it sounds, fits well into the frameworks of economics, game theory and evolution” (Rofé & Rofé, 2020).
A multi-case study consisting of 30 case studies of bizarre behaviors, of which 20 cases are presented in this book and the rest in previous publications (Rofé, 2010; Rofé & Rofé, 2020), strongly support this theory. All these cases, consisting of nearly the entire spectrum of bizarre behavioral disorders (e.g., schizophrenia, panic disorder, agoraphobia, anorexia nervosa, dissociative identity disorder, OCD, and transgenderism), shared five major diagnostic criteria and the same etiology. Like a consumer’s decision-making process, the choice of a specific disorder in these cases was determined by an individual’s need to exercise control over their stressor, the availability of suitable means, and cost-benefit analysis. The dramatic increase in the prevalence of eating disorders and DID occurred because of their dissemination in mass media. Now the data suggests that the popularity of transgenderism is due to social media’s sanctioning of pseudo-scientific neurological studies. While the short-term consequences of transgenderism make it the most effective and cheapest pathological coping mechanism, the irreversible long-term consequences make it even more expensive than schizophrenia.
An additional advantage of the new theory is its ability to integrate all therapeutic methods pertaining to bizarre behaviors, including psychoanalysis, religious therapy, CBT, and drugs, under one theoretical roof. The theory suggests a new therapeutic method, Rational-Insight Therapy (RIT), which aims to induce patients’ awareness of the underlying causes of their maladaptive behavior, mainly by removing their self-deceptive beliefs. Simultaneously the therapy enhances the patient’s coping skills. In line with findings indicating that de-transitioned participants became much less gender dysphoric, and much happier than they were during their period of trans-identification, it seems that RIT can be effective for transgender people as well.
Chapter 1 of this book concerns the theoretical crisis in psychopathology. It reviews studies and clinical data regarding transgenderism and summarizes the main data that challenge the validity of traditional theories of psychopathology. Chapter 2 presents the essence of psycho-bizarreness theory and employs a multi-case study to demonstrate the validity of this theory. Chapters 3 and 4 introduce the sophisticated processes by which these people deceive themselves and an integrative therapeutic model as a curative solution.
