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“We generally trust what other people say about their own mental states,” wrote Ashley, a fellow of the McGill Research Group on Health and Law. “If someone says, ‘My arm hurts,’ we typically grant credence to their claims.

“We have this trust in people’s self-reports of their mental states because we hold mental states to be within the purview of people’s epistemic authority — authority over knowledge.”

“If I were to doubt that person’s claim without serious reasons to believe otherwise,” Ashley wrote, “I would be committing an injustice because I would unjustly fail to recognize their authoritative knowledge of their own experience of the world.”

We have this trust in people’s self-reports of their mental states because we hold mental states to be within the purview of people’s epistemic authority — authority over knowledge

The assessment requirements is predicated on the idea that there are “true” trans people, and “false” trans people, Ashley said in an interview with the National Post. “There are people who aren’t fully trans phobic but who have this kind of very visceral suspicions of trans people and are afraid to move away from the medical model.”

“And the illness model is, ‘Well, we have to figure out what this illness is because there is this underlying ‘disease’ we have to cure.” The medical establishment, said Ashley (who prefers the gender-neutral pronoun “they”) has failed to keep up “with our evolving understanding of transitude — the fact of being trans — as part of normal human diversity.”

And while psychotherapy is no longer a condition of treatment, the line between assessments and psychotherapy can be seriously blurry at times, Ashley said, “especially among practitioners who favour lengthier assessments.”