“I am a 21st Century Schizoid Man”The Social Role Construction of “Mentally Ill Patient” and Other Contested Identities among Transgender Individuals in China

Transgender and gender diverse (TGD) individuals in China navigate a distinctive socio-cultural stress ecosystem shaped by collectivist values and conservative public discourse. While minority stress theory is well-established, the specific processes of identity negotiation under Chinese familial, institutional, and societal pressures remain underexplored. This qualitative study conducted in-depth, semi-structured interviews with ten TGD individuals in China. Data was analyzed using grounded theory, progressing through open, axial, and selective coding, informed by social role theory and labeling theory. Analysis revealed four dynamically interconnected social roles: the “Mentally Ill Patient” (characterized by pathologization and internalized stigma), the “Marginal Person” (experiencing systemic and familial exclusion), the “Pretender” (employing concealment as a survival strategy), and the “Helper” (fostering community mutual aid and resilience). These roles are not static but fluid, illustrating how external labeling and role expectations are internalized, negotiated, or resisted. Mental health challenges among TGD individuals in China must be understood as a dynamic process of negotiating identity and stigma within a collectivist structural context. The findings extend minority stress theory beyond Western paradigms, highlighting the urgent need for affirming, community-informed support systems that move beyond pathologization to empower resilience and agency. This manuscript is currently under review at Sex Roles (Springer Nature).