Psychiatrists and the DSM

[Melissa-kitty]

There have been several threads relating to psychiatry, GID, and the DSM. I'll be going to a talk this week by an "activist" on reforming the DSM. It got me thinking about the DSM and on how I see it, as a practicing psychiatrist. I actually open the book up and use it about three times a year, before talking to lawyers. The only other time I use it, is when I am dealing with a condition that I don't know well. In my everyday world of dealing with mood and psychotic disorders, substance abuse, and medical disorders, it just isn't that useful. Researchers certainly don't use the DSM. It seems a resource for clinicians just starting out. But more than that, it seems a political and public relations document. It is certainly influential with judges, politicians, and the media. That is, non-expert society. It may play a strong role in changing how society views certain aspects of humanity, such as homosexuality. The science behind the DSM categories seems variable, depending on the diagnosis. Pretty light in the sexual disorders. As has been pointed out in other threads, there is a wide difference in opinions in psychiatry and psychology, much of it rather discouraging. It will be interesting to see how the process goes in rewriting this section.

[seldom]

I thought I was the only person who even mentioned the reform of the DSM on this board.
Make no question about it.  The DSM-IV-TR regarding GID needs to be scrapped completely.  Taking out the word disorder and replacing it with distress would be a start.  Getting rid of the misogynistic dated storylines COMPLETELY (this has been repeaditly abused by mental health professionals, I have heard horror stories from people who did not go to specialists).  Clearly state the medical necessity of HRT and SRS.  Without many other aspects being dropped, no progress with regards to insurance companies can be made. Basically drop ANY commentary of sexuality. Who one likes should not determine treatment at ALL.  Hopefully this time around the DSM gets it right, because they have completely messed up the DSM-III and the DSM-IV.  Luckily trans people and gender identity specialists are finally speaking up about how this section is a problem.

I could go on and on.  Trust me, as a lawyer, this document has done more HARM then good regarding TS. It has blocked our access to treatment, caused issues with therapists of all stripes, and is the source of our insurance issues.   The only good it does is a code to use for HRT, but most SMART doctors do not use it anymore regarding HRT for trans people. 

This APA roundtable was a gaint leap in the right direction:
www.tsroadmap.com/info/div-44-roundtable.html

I would say drop everything and adopt the ICD-10 definition for transsexuality, which is broadly written and easy to follow, and does not contain a single stereotype.  And have the clear treatment course be HRT and SRS. 

I do come from the expert stance,  lawyers are societies masters of language, trust me, the DSM-IV is used as a legal document with regards to insurance and in the court of law.  Without question the manual needs to change.  Hopefully the DSM-V will change. 

[Berliegh]

What is DSM?

[rhonda13000]

Thank you for presenting your perspective. It is reassuring to see that a mental health professional is not content with the status quo.

I have nothing substantive to offer, given that I am only an aircraft technician, but if I might humbly and solemnly proffer some 'emanations from the heart',...

I'm more familiar with the DSM III than IV, but seemingly...I don't know....much is left unpresented and unexplained.

I am viewing this from the perspective of a woman who has been 'burned' repeatedly by members of the profession and accordingly, possesses a very jaundiced view of the same.

The document....lacks....and some treat it like an icon and as an immutable, reliable standard of measurement....

I do not at all have your expertise and training and it is not my intention to be presumptive; be not offended by anything which I say.

It seems for some to be a 'tool of convenience and expedience' for 'pigeon-holing' suffering human beings quickly, when the desire to actually effectively and compassionately treat them is undesired or distasteful somehow...

"Just look it up in The Book, categorize them and dispose of them."

I've witnessed and been a victim of that mindset on numerous occasions in the past.

It strikes me as small-minded and heartless. Some pathologies I know, are rather glaringly obvious and really require no great labor in generating an accurate diagnosis. You know what the sufferer is afflicted with and how to properly treat them and in that situation, expediency is appropriate.

But as I mentioned in another thread, some things ostensibly seem 'clear and cut' but in actuality, they are far from being obvious and simple.

It strikes me as dangerous to over-simplify something as staggeringly complex and interrelated as human behavioral manifestations, etiologies and co-morbidities.

That seems especially so for US. TS does so much damage and creates many 'spin-off' and secondary co-morbidities - and these may add to co-morbid conditions which have nothing to do with TS, be they organic or cognitive and complicate the treatment process considerably.

Transition and HRT initiated a massive cascade of concomitant healing and maturational processes; accordingly, a number of major co-morbid conditions rectified themselves without ancillary or independent treatment.

But some [great anger] clearly have not and must be addressed as 'separate entities' seemingly, from a laywoman's imperfect perspective.

I am not discouraging expediency nor efficiency in treatment of mental health issues, but I am gently and humbly saying that human behavior is often far more complex and interrelated than some would like and be content in believing.

[Robyn]

Diagnostic and Statistical Manual of Mental Disorders

[Berliegh]

Diagnostic and Statistical Manual of Mental Disorders

Thanks Robyn. It's obviously an American presentation of the same kind of mental health properganda that we see in the U.K. Far too much enphasis is put on psychitry in the U.K and it usually acts as a brick wall between patient and surgeon.

[rhonda13000]

Diagnostic and Statistical Manual of Mental Disorders

That is a very nice photograph that you have for your avatar, Robyn.

It possesses beauty and warmth.

[Berliegh]

Diagnostic and Statistical Manual of Mental Disorders

That is a very nice photograph that you have for your avatar, Robyn.

It possesses beauty and warmth.

your pic is very nice as well Rhonda......no comment about me, so I must look pretty bad....lol

[Tay]

What bugs me the most about the current incarnation of the DSM (aside from its unclear description of autism, but that's another topic) is that GID is ONLY recognised in occurring in ftm or mtf patients.  Which means that those of us who have severe issues with our birth sex, but do not identify as either male or female are royally f*****, if you know what I mean. 

For a 20 year old, mostly healthy, female-bodied person who is not married and has no children and is not ftm, a hysterectomy is basically considered a non-option.  I came within moments of doing myself serious physical harm last week because of the fact that I had my period.  I wanted to give up on everything, curl up and die because I was so overwhelmed with feeling *wrong*.

The DSM needs to include the rest of us in GID, too.

[Lisbeth]

Thanks Robyn. It's obviously an American presentation of the same kind of mental health properganda that we see in the U.K. 

It's the American equivalent of the ICD-10.  For the Americans who don't know what that is, it's the International Statistical Classification of Diseases and Related Health Problems, revision 10, published by the World Health Organization in 1992.