Gender Prison: Liberation Day

On Saturday, December 1, 2012 the board of trustees of the American Psychiatric Association approved the changes in the Diagnostic and Statistical Manual of Mental Disorders, which will now be known as the DSM-5 (as part of the dumbing down of America, it was apparently found necessary to stop using Roman numerals).

Among other changes, such as the revamping of the autism disorder spectrum, the new version of the manual no longer classifies people who are transgender or gender non-conforming as mentally disordered. Additionally compulsive hoarding will now be in a category of its own and PTSD will be moved into its own chapter, with more sensitivity to children and adolescents.

Until now, the term “gender identity disorder” has been used to diagnose people who are transgender. For conservatives, this has provided rhetorical carte blanche to describe the entire trans committee as disordered, delusional, and mentally ill. In some cases, this diagnosis has even been used to discriminate against trans people, with claims that they are unfit parents or employees, as examples. On the other hand, insurance companies have been more willing to cover the expenses associated with transition under this language, because treatment for a disorder is considered medically necessary, rather than cosmetic.

The final editing process will take place until December and the new manual will be released at the APA annual meeting in San Francisco in May and take effect then.

This does not mean that transgender people are totally excluded from the DSM-V. We will henceforth be diagnosed as having gender dysphoria…which is what I recall from pre-DSM-IV days. Gender dysphoria concerns the "emotional distress that can result 'from a marked incongruence between one's experienced or expressed gender and assigned gender." This new classification allows for affirmative treatment of the distress without the stigma of a disorder.

In July the APA called for new guidelines to ensure the best course of treatment for transgender patients. In August the APA took a stand on the necessity of transgender civil rights:

The American Psychiatric Association:

  • 1. Recognizes that appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments. 2. Advocates for removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment.3. Opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician.

The American Psychiatric Association:

  • 1. Supports laws that protect the civil rights of transgender and gender variant individuals. 2. Urges the repeal of laws and policies that discriminate against transgender and gender variant people.3. Opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.

    4. Declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon these individuals greater than that imposed on any other persons.

There has not yet been a lot of commentary by transgender activists, but there has been some.

The transgender community and civil rights advocates have long been polarized by fear that access to sex reassignment (SRS) procedures would be lost if the GID classification were revised.

Transsexual individuals are poorly served by a diagnosis that both stigmatizes them unconditionally as mentally deficient and undermines the legitimacy of sex reassignment procedures that have been easily dismissed as 'elective' and 'cosmetic' by insurers, governments and employers. GID reform is not a question of less stigma versus improved SRS access, it is a question of less stigma and improved SRS access.

--Kelley Winters, GIDReform.org

Homosexuality was declassified as a disorder in 1973. Last year the European Parliament passed a resolution calling for the World Health Organization to stop classifying transpeople as mentally ill. The WHO's International Classification of Diseases is under review and a new list is expected to be finalized in 2015. The WHO classified homosexuality as a mental illness until 1990. Perhaps on some future Human Rights Day (which was yesterday) the WHO could honestly promote their belief in those rights for all.
Will this help us transpeople in our struggle for dignity and respect, not to mention equal rights? We'll have to stay tuned in order to find out. We do know that our identity is never a disorder in and of itself. Maybe now we can get on to dealing with the other issues we may have.

The National Center for Transgender Equality is celebrating its 9th year of existence tomorrow. we may get commentary from that direction then.

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Robyn's picture

All psychiatric diagnoses occur within a cultural context. We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.

--Jack Drescher, APA

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