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If a man comes to a psychiatrist and claims to be George Washington, Julius Caesar, or Jesus Christ, the psychiatrist will make every effort possible to restore the patient to sanity so that he no longer suffers from these delusions. He won't humor their delusions by helping them pretend to be Washington, Caesar, or Jesus.
In contrast, if the same man comes into the shrink's office and says that he's really a woman, rather than doing the rational thing and doing his best to convince the poor loon that he in fact is not a woman, the shrink is supposed to indulge the patient's delusion, i.e. out come the scissors and the silicon implants, and the injection of estrogen.
Why the difference?