The ‘Real’ Transgender Citizen: Diagnostic Practices of Gender Dysphoria and Citizenship Eligibility in Pakistan

ABSTRACT

Emergent meanings of gender dysphoria in medical consultations between transgender people and psychiatrists in Pakistan attempt to answer the question- who is genuinely transgender? The use of biomedical models to investigate the ‘realness’ of trans experience has orchestrated complexities of care as psychiatric evidence of gender dysphoria becomes the gateway to citizenship. Psychiatrists become accessories of state bureaucracy as assessors of legitimate citizenship claims in relation to the Transgender Persons (Protection of Rights) Act 2018. I follow the developing meanings of gender dysphoria as it becomes socially imbricated with Sunni Muslim medical ethics regarding the ‘natural’ body. Even as gender variant citizens discover their selves as political participants, their bodies need to correspond with biopsychological truths of citizenship in an infrastructure of suspicion. How does the sociality of the medical encounter make space for proving or denying gender dysphoria as a genuine psychic state? This paper looks at the varied ways in which doctor-patient interactions become a place of evidence production to satisfy state legislative demands of citizen psychology. Using an interdisciplinary approach that draws on legal literature and medical anthropology, I explore diagnostic practices and expectations of gender dysphoria to explicate the meaning of transgender health within psychiatric care.

Acknowledgments

This paper was first presented at the Psychology and the Other Conference held at Boston College in October 2023 where I participated with funding from the Department of Anthropology at University of Virginia. It has benefited immensely from the audience’s comments as well as feedback from my advisors: Dr. Igoe, Dr. Weston, Dr. Mentore and, in particular, Dr. Patel. My research for this paper was funded by the Wenner Gren Dissertation Fieldwork Grant and the University of Virginia Graduate School of Arts and Sciences. I am endlessly grateful to my interlocutors for sharing intimate stories with me and for their patience with my questions as I tried to make sense of things.

Disclosure statement

No potential conflicts of interest are reported by the authors(s).

Additional information

Funding

This work was supported by the Wenner-Gren Foundation [9938].

Notes on contributors

Uzma Zafar

Uzma Zafar is a Ph.D candidate in the Department of Anthropology at the University of Virginia. He holds an LL.B (Honours) from the University of London, UK and is an attorney of the High Court of Lahore, Pakistan. His writing, teaching and legal practice draw on an interdisciplinary approach to law and medical anthropology, concentrating on areas of public health, citizenship and human rights in South Asia.