Transgender advocates seek new diagnostic terms

[natina]

Transgender advocates seek new diagnostic terms




SAN FRANCISCO (AP) - Does a woman who strongly believes she was meant to be a man have a mental condition or a medical problem? Is a man who cross-dresses in need of psychological help? What about a boy who pretends to be a girl in make-believe games and chooses only female playmates?
The nation's psychiatric establishment is wrestling with these questions, among others, as it works to overhaul its diagnostic manual for the first time in almost two decades. Advocates have spent years lobbying the American Psychiatric Association to rewrite or even remove the categories typically used to diagnose transgender people, arguing that terms like Gender Identity Disorder and Transvestic Fetishism promote discrimination by broad-brushing a diverse population with the stigma of mental illness.
"The label of mental defectiveness really places a burden on trans people to continually prove our competence in our affirmed roles," Kelley Winters, a Colorado scholar who has helped lead the push for changes, said. Although the association's new Diagnostic and Statistical Manual of Mental Disorders is not scheduled to be printed until the end of the year, the updates are taking shape after three rounds of proposed changes. Professionals who have been part of or closely observing the amendment process say the latest wording, while not going as far as many advocates wanted, respects the broader shift in society's understanding and acceptance of what it means to be transgender since the last major revision of the manual was published in 1994.



"All psychiatric diagnoses occur within a cultural context," New York psychiatrist Jack Drescher, a member of the APA subcommittee working on the issue, said. "We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories (of male and female.) We wanted to send the message that the therapist's job isn't to pathologize."

The most symbolic change under consideration so far for the manual's fifth edition, known as the DSM-V for short, is a new name for Gender Identity Disorder, the diagnosis now given to adults, adolescents and children with "a strong and persistent cross-gender identification." In the manual's next incarnation, individuals displaying "a marked incongruence between one's experienced/expressed gender and assigned gender" would be diagnosed instead with "Gender Dysphoria," a term that comes from the Greek word for emotional distress.
While the shift may seem purely semantic, switching the emphasis from a disorder that by definition all transgender people possess to a temporary mental state that only some might possess marks real progress, according to Dana Beyer, a retired eye surgeon who helped the Washington Psychiatric Society make recommendations for the chapter on "Sexual and Gender Identity Disorders."
"A right-winger can't go out and say all trans people are mentally ill because if you are not dysphoric, that can't be diagnosed from afar," Beyer said. "It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes." Persuading the psychiatric profession to redefine who and who does not qualify for its care has historical precedent as a civil rights issue. In 1973, the APA, responding to pressure from the gay and lesbian community, concluded that same-sex attraction alone was a normal part of human experience, not an illness.

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[yodajazz]

But a major problem, is that if transexualism is not considered to be a mental or physical disorder, then HMO's and the government (Medicaid), would not be required to provide coverage to change people's physcial conditions, (such as hormones). It might be then considered as simply cosmetic proceedure, to make that person happy. How do you get around that? For example what about a t-person who wishes to get training to make thier voice sound more gender appropiate, and so on?

[danthepoetman]

Yes, “gender dysphoria” is a good definition, I suppose, as it has come to be suggested. “Dys” in ancient greek simply means “bad” or "bad state" as the “eu” from “euphoria” means “good”, for what it’s worth. I find that the problem lies in the fact that the psychological evaluation will always be established by mere human beings, and therefore always subjected to some form of prejudice, as minute as they can be, and even from health professionals. We unfortunately still don’t have enough data from hard sciences. Endocrinology is being sollicitated for answer as well as neurology nowadays. And we should be hopeful, because no two other sciences are actually making more progress. The problem with neurological researches is obvious: we just can’t experiment on people’s brain, like in some silly sci-fi movie. But the most recent techniques of brain scanning are allowing us to make many new discoveries. There’s no doubt in my mind that we will soon find the biological cause of transsexualism, and establish once and for all that it is neither a mental health issue nor a social one, but a purely biological condition. My hunch is we will find, as some researches have already tended to show, that the brain has indeed gender characteristics, and that transsexuals were right all along to express a gender dysphoria.
I suppose I answered your question, yodajazz: the determination of a biological cause will weigh much more on any kind of authorities (governmental or medical) than any psychological designation. In the mean time, we could say that a defined psycho-somatic condition should warrant the same care as any purely psychological illness. I think the difference transgender advocates are seeking is in the appreciation of what that condition represents, rather a state to be cared for than a sickness to be cured.

[nina_lisa]

But a major problem, is that if transexualism is not considered to be a mental or physical disorder, then HMO's and the government (Medicaid), would not be required to provide coverage to change people's physcial conditions, (such as hormones). It might be then considered as simply cosmetic proceedure, to make that person happy. How do you get around that? For example what about a t-person who wishes to get training to make thier voice sound more gender appropiate, and so on?

every country is different. But a small boy that is born blind, or with no legs, is still helped medically?

It is a physical condition, where a birth defect is corrected medically.

[danthepoetman]

every country is different. But a small boy that is born blind, or with no legs, is still helped medically?

It is a physical condition, where a birth defect is corrected medically.

Once again, I find myself in sync with Nina Lisa. A biological condition is a physical state, not an illness. If such a condition requires some medical interventions, it should be all the more necessary to do so than for an illness.
The main idea in such designation is in my opinion to exclude as much as possible any potential for prejudice in naming what transsexualism is. But I repeat that we are soon to find that this condition is indeed biological and need to be address as it is, an inadequacy between a brain of one gender and the body of another.