I normally lurk far more than I post on these forums, but this thread caught my interest - at least in part because I recently had quite a long conversation with my therapist about almost exactly the topic.
Amy Sez:
QuoteI am militant about it because I realize the DSM as currently written is more political and based on stereotypes, then an effective diagnostic tool. I want it changed because I know how insurance companies have used it to justify exclusions. It needs to be changed.
I have a few thoughts regarding the current DSM-IV TR edition, and how it is interpreted by many (especially and including insurance companies).
First off, the actual diagnostic criteria are not particularly based on stereotyping. In fact, the language is extremely broad, and legitimately can, and does, include transfolk who do not fit into traditional social gender stereotypes.
However, where people often get hung up is the 'narrative' that is wrapped around the diagnostic criteria - which in fact is the language that Amy seems to take real (and legitimate) exception to. I agree that if interpreted in a literal fashion, the narrative description can be seen as not only offensive in the stereotypes it projects, but downright wrong. The most offensive language is that used to describe young transfolk (when I say young, I mean children younger than adolescence), which clearly reflects a series of gender stereotypes from the 1960s.
The narrative around adults is much more subtle in its wording, and tends to speak in terms of persistence, focus and a few other attributes that are legitimately descriptive of a fairly broad swath of transfolk. (Not necessarily all, but a reasonable cross-section)
When I discussed this with my own therapist a few months ago (yes, we occasionally explore topics such as the language of diagnosis and philosophy - but that's a different conversation), he pointed out a few key aspects of interpreting the DSM that he uses as guiding principles:
- The DSM is intended to descriptive, not prescriptive
- It is primarily a lexicon for communication between professionals (This is particularly significant - like medical or technical jargon, the DSM is aimed primarily at specialists, and as such is easily misinterpreted by others outside of the domain)
- The narrative aspects are supposed to give a non-specialist practitioner a starting point for further research into a specific topic. The DSM is not encyclopedic in nature - it's more akin to those "dictionary-encyclopedia" crosses you can find in bookstores - further, and real, research is needed to comprehend any given topic in detail
My advocacy around the DSM (and it applies to the SOC as well) is along these lines:
1. The DSM is misinterpreted too easily. There needs to be a much clearer distinction between the narrative and diagnostic sections for a given condition. {This applies across the board in the DSM}
2. The cautionary notes around interpreting the DSM need to be much more prominent. (I think the most interesting is on pg. xxxvii of the preface right now - easily breezed over)
3. I believe that GID needs to be present in the DSM for descriptive reasons - primarily to give the practitioners that we are approaching for assistance (medical and psychological) a common language to understand each other. {Again, I have had the privilege of having a therapist who is very open with me about what he communicates with my doctor(s), and the precise language used}
4. The DSM has to be clear about the fact the 'narratives' are meant to provide some basic, but very limited, insight into the kinds of patient narrative that are often typical for someone with a given condition. (It is not right now)
5. The DSM should make it clear that although it is a decent lexicon, it is not a substitute for ongoing research and literature study on the part of practitioners.
Taking GID out of the lexicon puts both transfolk (us) and the medical practitioners we are asking to assist us in our journeys into a very awkward spot indeed. As much as we like to insist that we know what we are asking for (and most of us do), we do have to respect the fact that we are asking for treatments that many practitioners could see as contrary to their view of the various oaths and professional codes they are bound to.
That said, similarly, there is a necessity to agitate for remedy either legislative or otherwise where organizations such as insurance companies are concerned (especially in the United States, and to some degree in Canada as well). They are arguably mis-applying the DSM by being unduly rigid and literalist in their interpretation of it. (One can raise the same criticism of the way the religious right wing treats the DSM - and transsexuals in general - but that's a different rant altogether)
....anyhow ... just a few thoughts on the topic du jour.
- Michelle
