“Are you here for the mental health conference?” asked the security guard when I arrived at the Altis Grand Hotel. I hesitated in my response. No, I wasn’t there for a mental health conference, even though that was how the event had been advertised. I answered “yes” timidly, as there was a chance they wouldn’t let me in.
Once inside, I looked around to observe the immensity of wealth that a five-star hotel in Lisbon usually exudes (and I’m not just talking about the furniture). I went down the first stairs I found towards one of the hotel’s large panoramic rooms used for events.
“Mental Health – Europa Room,” said the sign indicating that I should turn left. A few steps later, I came across a woman who greeted me at the door with a smile on her face. Behind her were several white tables and other security guards dressed in the same uniform as her.
“Is this your first time?” she asked me in English.
I said yes, since I was only attending the second day of the conference. “I’m going to ask you to hand your bag to my colleague so we can search it.” Once again, I hesitated. I didn’t understand why they had to search my bag for an event of that nature. I told them I was a journalist, but they just responded with more smiles. I handed over my bag—which only contained my notebook, some cookies, and my wallet—and it was quickly returned to me.
I realized that this was the first step to getting into the room where the 11:15 a.m. debate, entitled “Panel discussion—the limits of psychotherapy,” was about to begin.
Step number two was to show the invitation they had sent me by email to attend this conference. They asked me again if it was my first day and handed me a blue silicone bracelet. It bore the real name of the conference – ‘The Bigger Picture Conference. Reframing the Future’ – organized by Genspect.
“No one is born in the wrong body”?
Genspect was founded in 2021 by Irish psychotherapist Stella O’Malley. As will become clear later, it is based on a conservative ideology. Insidiously, it disrespects the transgender community and undermines their rights—namely, the right to undergo medically assisted gender transition—which is in clear dissonance with the current values of integration and acceptance of this group.
The organization brings together several medical experts whose alleged goal is to “raise awareness of the dangers of the so-called affirmative approach, based on hormone administration and sex reassignment surgery for those suffering from gender dysphoria.”
But let’s take it one step at a time. At a time when we hear the terms ‘gender identity’ and ‘gender ideology’ used every day – often incorrectly to refer to the same thing – it is important to clarify that these two concepts have different connotations and that the correct term is ‘gender identity’. According to the glossary of the Commission for Citizenship and Gender Equality, this refers to “personal and profound self-recognition as a man or woman, as both, or as a trans and/or non-binary person.”
Gender identity does not necessarily coincide with ‘sex’, which is distinct from ‘gender’. While the former refers to the biological characteristics that define human beings as female or male, the latter concerns the social constructs, roles, behaviors, and expectations of what society considers ‘appropriate’ for men or women in a given culture.
More clearly, as can be read in the International Technical Guidelines on Sexuality Education – a document produced by the UN and the World Health Organization – sex is the “biological and physiological characteristics (genetic, endocrine, and anatomical) used to categorize people as members of the male or female population.”
But this is only part of a human being’s identity. It is the physical and/or biological part of the individual. Gender, on the other hand, is determined by how the individual feels and perceives themselves, as well as how they wish to be recognized by other people.
The term is often confused with so-called “gender ideology,” which is frequently used controversially to describe gender issues that diverge from traditional or conservative views.
According to an article by researchers Richard Miskolci and Maximiliano Campana, published in 2017 in the journal Sociedade e Estado, the term “gender ideology” first appeared in Catholic Church doctrinal texts in 1997, written by the then cardinal and future Pope Benedict XVI, Joseph Ratzinger.
Miskolci and Campana argued that these texts constituted “a key piece in beginning to design a powerful political-discursive counteroffensive against feminism” and against “women’s sexual and reproductive rights.”
According to the same article, the discussion intensified in Latin America in 2007 with the report of the Fifth General Conference of CELAM—the Document of Aparecida. In it, we can read that “gender ideology does not consider the differences given by nature and has led to legal changes that seriously harm the dignity of marriage, respect for the right to life, and the identity of the family.”
In short, “gender ideology” has been used as a derogatory term by conservative groups opposed to discussions related to feminism, sexuality, and diversity. Behind this pejorative use is the belief that “ideology” is part of a plan to destroy the traditional Christian family and heterosexuality. However, this is not a term recognized by academics, who instead use “gender identity.”
People whose gender identity does not correspond to the sex assigned to them and recorded on their birth certificate are called transgender. For example, a transgender man has a male gender identity, but was assigned female at birth. As stated in the ILGA Association pamphlet – ‘I am a person. For the right to gender identity’ – “there is a huge diversity of transgender people: of all ages, genders, professions, marital statuses, etc. What is still lacking are social and media representations that reflect this diversity, and this is, in fact, a major obstacle to the family, school, professional, and social integration of transgender people.”
This deep and persistent conviction that gender identity (self-identification as a woman or a man) does not match physical appearance and/or anatomy (physical phenotype), either completely or partially, is known as gender dysphoria or gender identity disorder. Transsexuality is a form of gender dysphoria, in which people persistently identify as members of the opposite sex to that assigned to them at birth and need to adapt their physical appearance to their gender identity through hormone therapy and/or surgical procedures that are not limited to genital surgery.
According to the aforementioned association, “some people feel this incompatibility between identity and body from childhood (primary or classic transsexuality), while others feel it later (secondary transsexuality). When identification with the opposite sex to that assigned at birth is continuous, it is unlikely to disappear, but it may take years before the person, for various reasons, accesses the transitional process—known as transition—from the sex assigned at birth to the one that is in accordance with their gender identity.”
It should also be noted that there are currently two terms that can be distinguished in this broad spectrum of gender identity: ‘transsexual’ and ‘transgender’. The former encompasses people who do not identify with the gender assigned at birth and who identify entirely with the ‘opposite’ gender and wish to live as such. They often feel discomfort with aspects of their anatomy and seek hormonal and/or surgical support for their gender transition. The second is an inclusive term that encompasses all gender identities and/or expressions that do not match the sex assigned at birth. It includes people who identify as transsexual, transgender, gender fluid, non-binary, among others. As a rule, they do not wish to undergo genital surgery, also known as sex reassignment surgery.
And it is precisely these medical issues that Genspect disapproves of. Here is what can be read on the organization’s website:
“We seek a healthy approach to sex and gender […]. We carefully analyze the harm that medical treatments can cause […]. We recognize that children and young people who question their gender tend to develop conditions such as attention deficit hyperactivity disorder or aspects of autism. We are also concerned about the disproportionate numbers of children and young people who are attracted to people of the same sex or who will identify as ‘pre-gay’ among other children and young people who choose to medicate their identity rather than allow their sexuality to develop. In this context, we advocate a non-medicated approach to gender dysphoria. -gay’ among other children and young people who choose to medicate their identity rather than allow their sexuality to develop. In this context, we advocate a non-medicated approach to gender dysphoria, supported by a high-quality evidence base.”
And further:
“We want to help create a society that supports gender nonconformity—one that does not require the heavy burden of medical treatment. We recognize that young gay, lesbian, and bisexual people are often not gender conform. Rather than suppressing hormonal urges with medication, we support an approach that allows adolescents to explore their sexuality with freedom and acceptance.”
The ‘eternal war’ between WPATH and Genspect
On October 17, Stella O’Malley wrote an article about the conferences organized by Genspect, highlighting two of its main purposes: “to shed light on the significant issues created by the World Professional Association of Transgender Health (WPATH) approach to treating gender dysphoria and to promote a broader and more accurate understanding of the complexities surrounding this issue.”
Genspect can be said to be WPATH’s main opponent. Formerly known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA), it is an interdisciplinary, non-profit organization dedicated to transgender health, favoring hormonal and/or surgical support for transition.
The team brings together professional, support, and student members who engage in “academic research to develop evidence-based medicine and strive to promote high-quality care for transgender, gender non-conforming, or intersex individuals internationally.”
Its mission is to promote evidence-based care, education, research, public policy, and respect for transgender health. In addition, WPATH seeks to achieve better treatments for gender dysphoria through professionals in the fields of medicine, psychology, law, psychotherapy, family studies, sexology, and other related fields.
That said, it offers an opportunity for professionals from these various specialties to communicate with each other in the context of research and seek treatments for people with gender dysphoria, including through the organization of biennial scientific conferences.
It is precisely these symposiums that motivate Genspect to spread its own mission. Whenever WPATH meets in a particular country or city, Genspect organizes an event in that same region with the aim of counterarguing what was previously stated by WPATH.
In the aforementioned article, the psychotherapist assumes that, in Genspect’s view, “gender dysphoria, although little researched, is no more unusual than any other manifestation of suffering that we humans resort to when trying to make sense of the world. WPATH has complicated the meaning of ‘gender’ and its poor-quality work has been completely discredited […]. Of course, there is a lack of knowledge in this field, but it has become clear to us that WPATH’s position is not helpful, as it conspires with the individual suffering from gender dysphoria, leading them to believe that they can, in fact, become another person, with a new body and a new identity. WPATH promotes the weakening of healthy bodies through unnecessary, radical, and reckless interventions.”
It has already become clear that Genspect is antagonistic to WPATH’s position, arguing instead that gender dysphoria is a psychological condition that should be cured through therapy, rather than through medical and surgical treatments.
“We do not believe that extreme body modification is an appropriate course of treatment for a psychological condition. Instead, we promote a non-medicated approach to gender dysphoria that advocates a less invasive treatment model first,” Stella’s article reads. “If WPATH were willing to listen to the many experts who have highlighted problems with their approach, Genspect would not need to follow them around the world, continually advocating for more realistic treatment options for gender dysphoria,” the therapist said.
In light of these accusations by Genspect, I contacted WPATH for a response. This was the response I received: “As a rule, we do not comment on other organizations, given the need to focus on our mission—promoting healthy gender care—and the standards of care that form the basis of our scientific recommendations, which are evidence-based.”
The conference that aimed to “reframe the future”
I had sent an email to the Genspect organization on September 20 requesting a press pass to attend “The Bigger Picture Conference: Reframing the Future,” taking place on the 27th, 28th, and 29th of that month in Lisbon.
They quickly replied that they “would be delighted to welcome me.” However, the email added the following information: “The event will take place in the São Mamede neighborhood of Lisbon, a few steps from the Lisbon Botanical Garden. To minimize the chance of disruptive disturbances, the location will not be indexed on our website and will only be shared with ticket holders 48 hours before the event. We understand that this may make planning difficult for participants, but this approach has prevented disorder at our previous in-person events.“
As expected, two days before the event began, they sent me another email with the address—the Altis Grand Hotel—and a request: ”To avoid possible disruptions at the event, we ask that you not share this information. Also, please note that for reasons of discretion and security, the name of the event on the venue signage will be ‘Mental Health Seminar’ instead of Genspect.”
I arrived on the second day of the conference around 11:00 a.m. I had missed the first four debates. After passing through the organization’s various security checks, I entered the large hall. Hundreds of people were walking around, eating and drinking while chatting. As far as I could tell, I was the only Portuguese person there.
I was surprised by the number of people around me, especially since tickets for this conference cost around 500 euros, and up to 2,000 euros for groups. Later, I learned that the vast majority were there to follow the work of Genspect or the guest speakers.
Before sitting down to listen to the debate that was due to start at 11:15 a.m., I took a look around the venue. On the table at the entrance, there were several white stickers that we could use if we wanted to display our name. To the sticker, we could add a circle identifying the group to which we belonged: yellow for parents or family members; green for the media; orange for researchers or experts in the scientific field; and blue for people who were in the process of detransitioning. Books, pamphlets, brochures, and even mere pieces of paper were scattered on the other tables in the room.
However, it was their content that caught my attention. There were stickers being distributed free of charge with the inscription: “No one is born in the wrong body.” There were books, costing 30 euros and up, which claimed to be the help parents needed to “save” their children from gender dysphoria. There were pamphlets advertising churches that “provide a safe and reflective place to explore what it means to be gay, lesbian, bisexual, and Christian through meetings, prayers, retreats, and conferences.”
Stella O’Malley and psychiatrists Susan and Marcus Evans took the stage for the first panel discussion. Listening to the explanations of these three members, I quickly realized that the conference was dedicated to “parents who sought help for their children.”
“I have long been proud to be a mental health professional. It is my love and my work. But in truth, this has been a terrible journey. Parents have really been betrayed by mental health services,“ said Marcus Evans. ”The practice of mental health is due to our limitations. And having been in this field for so long, I have realized that, from time to time, the limitations of our craft push us toward a manic idea that we have the solution to everything. Psychiatry has a history of desperate, unproven solutions and often an overvalued idea of what psychiatry can do. We are limited, which makes this a painful situation for parents, who are faced with a kind of feeling of betrayal.”
Applause and questions from the audience followed.
The microphone was passed around until it reached a mother who was clearly moved. “First of all, I have to thank Stella. She changed my life and helped me save my daughter,” she began, referring to her daughter’s gender dysphoria. “I am so grateful that you recommended Susan and Marcus’s work to me, because you are fabulous.
I feel we were blessed with an excellent therapist, and believe it or not, I want to share this with everyone: one of the best things our therapist did was tell my daughter to have sex.”
As the debates progressed, I began to realize that the approach was always the same: to use medical and scientific language to essentially classify transsexuality as a mental illness, calling it gender dysphoria.
Speakers such as clinical psychologist Jaco Van Zyl conveyed the message that the environment in which a child grows up can cause them to “develop certain frustrations, making them more vulnerable to transformation and experiencing gender dysphoria.”
I can say that everyone around me felt almost a connection with the speakers. Some of the psychiatrists told stories of “15-year-old girls who started hormone treatment for gender reassignment.” Whenever such a testimony was heard, the mothers, fathers, and guests present looked on with mindless disapproval.
After lunch, we gathered again in the room for the second part of the conference. The speaker was Sarah Phillimore, a lawyer specializing in children’s rights. But before she took the stage, Stella O’Malley took advantage of the introduction to ask the audience a question: “How many of you here are going to vote for Donald Trump?” The overwhelming majority raised their arms, making their position clear. “And how many are going to vote for Kamala?” she asked ironically. Two or three people responded. Once again, the political position of those present was clear.
I was at the conference for seven hours. At the end, I went to see Stella O’Malley in the hope that she would give me a short statement. The psychotherapist and director of Genspect agreed without any problem.
I began by asking her about the importance of this event taking place in our country’s capital, to which she replied: “We thought it was very important to promote a non-medicated approach to gender dysphoria. WPATH was here in Lisbon and promoted its mission at another conference. We believe that a non-medicated approach causes less harm. We prioritize physical and mental health.“
She added: ”We believe that there are many ways in which people suffer from gender dysphoria and that there are many ways to alleviate it, to mitigate it. That’s why we’re here and we have speakers from all over the world. And I think it’s very important that an international group with this kind of experience comes together to draw attention to the harm that a certain way of thinking is promoting. People need to listen. And I want to say, specifically, that Portugal can learn from the mistakes of the past. There are other countries that have been down this road but have now turned away from it and no longer promote this approach to gender care.”
I asked the psychotherapist why Genspect portrays gender dysphoria as a mental illness. Stella compared it to other disorders, such as anorexia. “I am a psychotherapist. As with obsessive-compulsive disorder, anorexia, anxiety, or depression, there are many ways to make people feel better. Gender works the same way. It is no different from any other manifestation of distress. Yes, of course, you can medicate, but there are other ways, such as psychotherapy. Or perhaps better social skills, deeper quality relationships, deeper quality friendships.”
Finally, I mentioned the issues raised by Jaco Van Zyl, who spoke of children growing up in toxic family environments who, according to him, may experience gender dysphoria for that reason. My question was, in the case of two siblings living in the same environment, why one might want to change gender and the other might not. However, I felt that the psychotherapist strayed a little from the subject. Here is her answer:
“Social contagion is a well-established phenomenon. For example, anorexia is greatly affected by the environment, as is suicide. If there is anorexia in a school, other students are much more likely to develop anorexia. The same applies to self-harm. Self-harming behavior causes more self-harming behavior, especially among teenage girls. This is the group with the highest contagion rate, and this is due to several psychological reasons.”
In order to counter this thesis, I contacted the transgender poet and activist André Tecedeiro by email.
As a trans man, I began by asking him how he felt about the fact that there are psychologists, psychiatrists, and other professionals who characterize transsexuality as a mental illness. “I think it’s unfortunate that there are people who devote their time and financial resources to fueling hatred against trans people […]. I don’t give credibility to psychologists, psychiatrists, and other professionals who characterize transsexuality as a mental illness, as it ceased to be considered a mental disorder in 2018 by the World Health Organization (WHO). A health professional who is six years out of date cannot be a great expert on this subject. Homosexuality and masturbation were also once considered mental illnesses, and today that seems bizarre to us.
For Tecedeiro, it is urgent to demystify the idea that transgenderism is a choice. “No one chooses to be transgender,” said the activist, explaining that “statistics show that most transgender people know their gender at the same age as cisgender people—around three years old. But unlike other children, adults don’t believe what they say because it doesn’t meet their expectations.”
André revealed that he never felt like a girl, but ended up being socialized as one. “At 37, I made my gender affirmation and was able to really start living. Many people did not react well. In fact, in the beginning, only three or four reacted naturally.” I asked him if, as Stella O’Malley and Jaco Van Zyl stated, there are external and/or environmental factors that can cause someone to experience gender dysphoria. The activist’s answer was clear: “There is not a single study that confirms this hypothesis.”
In short, according to Catarina Lucas, psychologist and director of the Catarina Lucas Center, the World Health Organization (WHO) and other health organizations recognize gender dysphoria as a health issue that requires specific attention and care, but do not consider it a mental illness.
It is important to understand that gender dysphoria is not caused by a mental disorder, but rather by the incongruity between a person’s birth sex and gender identity. It is considered a medical or psychological condition because it can cause significant distress and impact the mental health and emotional well-being of people who experience it.
As André Tecedeiro concludes: “A transgender person may choose to have many surgeries or none at all. It depends on the person, the degree of suffering they experience with their body, their financial possibilities, and their access to healthcare. Unfortunately, few trans people have sufficient resources to survive, as they face more difficulties in accessing education, work, and well-being.”
At this point, it must be noted that Genspect is an organization with clearly conservative positions on transsexuality and, given everything that is currently known on the subject, clearly out of touch with reality. The WHO has determined that transsexuality is not a mental illness. Transgender people are not mentally ill. To argue that they are is a shocking and serious position, but one that unfortunately spreads, especially among right-wing conservatives, and throughout the world.
Lisbon (2000). Graduated in Culture and Communication Studies from the Faculty of Letters of the University of Lisbon. She later attended the Journalism course at the School of Technology, Innovation, and Creation. She has worked in media outlets such as the GERADOR Cultural Association, NiT Magazine, and SIC Notícias. She is currently a journalist at Notícias ao Minuto. She writes sporadically for other independent media outlets, such as BUALA. Her career has involved social media management, writing reports, news articles, and interviews, as well as moderating events and debates on a wide range of topics. Among her personal interests, she highlights her love of writing, traveling, and fighting for a better society, particularly with regard to gender equality.
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