In Support of Removing GID from the DSM...

[Shana A]

I believe that it doesn't belong in the DSM, having it there adds a stigma of mental illness to who we are. Trans is a natural variation, it has existed throughout history. What I see as the real disorder is society's intolerance of our existence.

Z

[Julie Marie]

I believe that it doesn't belong in the DSM, having it there adds a stigma of mental illness to who we are. Trans is a natural variation, it has existed throughout history. What I see as the real disorder is society's intolerance of our existence.

Z

I couldn't agree more.

We have bought into the whole "God made you that way so..." idea.  If we follow that logic we'd have to go to the shrink to get a letter to change our hair color or to even practice good hygiene.  After all, God didn't make soap or hair color.

There's a common misconception that if the majority of people say something is abnormal then it is, which is absurd.  There are countless times in history where the majority of people at the time believed a certain thing to be fact and were later proven wrong.  And a lot of people have suffered because of this "majority is right attitude", the foundation of which has always been ignorance.

The average Joe out there thinks if you can't see it, it doesn't exist.  The idea that someone who has a brain gender different from their physical gender is beyond their comprehension.  They can't see gender in the brain so therefore we're mentally disordered.  Once our brains are imprinted, there's no changing that.  We may be able to fight it but we can't change it, at least not yet.

But what is really insane is the idea there is a one normal and everyone should fit that concept of normal.  There isn't any two people exactly alike, not even identical twins.  And the biggest difference in identical twins is their personalities.  Yet society insists we all act the same.  If that isn't mentally disordered, I don't know what is.

We need to stop defending who we are and start focusing on the real problem, intolerance and the source of that intolerance, phobias - a mental disorder, common yes, but still a mental disorder.  Imagine a world where phobias don't exist. 

[rejennyrated]

Well I've now read the draft and in the main it seems just as bad as the previous version.

It is worse, if you happen to be intersexed in some way because previously intersex people escaped the formal diagnosis of a menatl disorder, at least they did if the intersex condition was known at the time of transition, but now it seems that we are all to be lumped in the same boat - so not only intersexed but mad as well  Brilliant!

It definitely should be removed IMO.

[tekla]

Something about being careful what you wish for because you just might get it comes to mind.

[Julie Marie]

The DSM-V draft version has been published and is available for commenting here http://www.dsm5.org/Pages/Default.aspx

"It is proposed that the name gender identity disorder (GID) be replaced by "Gender Incongruence" (GI) because the latter is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one's assigned gender."

Effectively, they are admitting that the expectations society has about how to live your life can cause unhappiness in those who don't meet societal expectations.  It's not what's inside that's bothering you, it's the outside stuff.

For now, it looks like gender identity will remain in the DSM in one form or another.  But what is interesting is their "exit clause:

"The term "sex" has been replaced by assigned "gender" in order to make the criteria applicable  to individuals with a DSD (Meyer-Bahlburg, 2009b). During the course of physical sex differentiation, some aspects of biological sex (e.g., 46,XY genes) may be incongruent with other aspects (e.g., the external genitalia); thus, using the term "sex" would be confusing. The change also makes it possible for individuals who have successfully transitioned to "lose" the diagnosis after satisfactory treatment. This resolves the problem that, in the DSM-IV-TR, there was a lack of an "exit clause," meaning that individuals once diagnosed with GID will always be considered to have the diagnosis, regardless of whether they have transitioned and are psychosocially adjusted in the identified gender role (Winters, 2008). The diagnosis will also be applicable to transitioned individuals who have regrets, because they did not feel like the other gender after all. For instance, a natal male living in the female role and having regrets experiences an incongruence between the "newly assigned" female gender and the experienced/expressed (still or again male) gender."

This makes it clear that one's happiness is crucial to a mental disorder diagnosis.  If you're unhappy, you have a problem.  It doesn't matter why you are unhappy.  It's like telling someone in a POW camp who is being tortured that they need to accept the fact they are tortured every day and find a way to be happy with that rather than trying to find a way for them to escape.  Escaping, however, would be their exit clause.

I will now be able to say, "I used to be mentally disordered then I had vaginoplasty and now I'm not."  Kinda silly.  But when you consider most post transitioners stop therapy, the shrinks have nothing to lose by saying you no longer have a mental problem.

We still have to get employers to recognize it and include it in their insurance coverage.  That will be a lot tougher.

[Alice]

I must say I have always disliked these conversations.

I always considered myself as a mental problem as a knew I was physically fit. My mind was breaking down and I was having suicial thoughts that I could not push away. The transition or die thing was put in front of my face and I had to at least try to see if it worked for me. As it turned out it did not and I lucky found another way out.

Alice

[Just Kate]

I've been thinking a lot on this topic.

Many here seem to avoid the scientific definition of a mental disorder because of the stigma.  It seems they say, "X is a mental disorder.  I don't like having a mental disorder.  Therefore X must not be a mental disorder."  So let me play the same game below.

If GID were removed from the DSM on the basis of it being a physical/medical condition, that would mean people with GID would have to seek out a medical solution.  Let's also assume the only medical solution seems to be hormones/surgery, etc. 

This means if the person doesn't want the accepted medical solution, he is stuck without treatment.  He cannot go to a psychologist except for generalized depression, because the psychologist will no longer consider his GID a mental disorder, and just continue to refer him to a doctor for surgery, etc.

It means someone like me, or someone who wishes to not transition to any degree, will be left out in the cold, unable to obtain treatment.  It also means that fewer psychologists will be researching new treatment methods (that don't involve transition) for GID.  After all, why research something not in your field?

It also means that anyone who recognizes they have GID will feel the only way to treat it is to go through the surgery, but we know that not everyone with GID needs complete transition to feel happy and in fact, some even regret it.

We are unnecessarily pigeon-holing a "cure" if we turn it into a medical condition.  Most doctors want something they can sit with you, run a test, determine the diagnosis and prescribe a treatment.  They aren't going to help you if you don't follow their accepted treatment regime, and they most likely aren't going to help you with the mental component of this condition - which brings us back to the psych.

Anyway, I'm not really worried about it happening this way because by the current definitions of what it means to have a mental disorder, GID fits the bill.  Stigma or no, it ain't gonna change unless one of two things happen:

1) The current definitions of mental disorders changes in such a way it doesn't include issues that are pervasive, cause distress, and are different than the society norm.
2) An incredibly accurate medical-based test is developed for the determination of GID, and a one size fits almost everyone medical solution is put into place.

I say fat chance to the first one, but the second one could come in time.  Until then, expect to remain "crazy".

[Julie Marie]

If GID were removed from the DSM on the basis of it being a physical/medical condition, that would mean people with GID would have to seek out a medical solution.  Let's also assume the only medical solution seems to be hormones/surgery, etc.

When I was going through my physical transition my insurance company did not cover surgery or hormones.  Transsexualism was considered a mental disorder and they would have paid a portion of my therapy forever but not one cent toward hormones and surgery.  GID being in the DSM did nothing to help provide medical coverage for me and it's the same with most TSs out there.

This means if the person doesn't want the accepted medical solution, he is stuck without treatment.  He cannot go to a psychologist except for generalized depression, because the psychologist will no longer consider his GID a mental disorder, and just continue to refer him to a doctor for surgery, etc.

Transvestic fetishism (TF) is still considered a mental disorder and probably will be for a long time.  It is considered to be a paraphillia, not a sexual disorder.  As far as I know, no one is fighting to have it eliminated from the DSM.  Non transitioning TGs would probably be classified as TF so you could still get therapy.  And even if they removed all gender incongruence from the DSM, anyone can walk into a therapist's office and say they are having problems and get insurance coverage.

What you seem to miss is there are degrees of gender related dysphoria.  Those who identify their dysphoria coming from anything but being TS can remain in treatment as long as they want because there is, as of this writing, no identified "cure".  The proposed DSM-V states that anyone who has "successfully transitioned" no longer has a mental disorder - surgery between the legs cured the mind.  That's why I believe that should be removed from the DSM.

We are unnecessarily pigeon-holing a "cure" if we turn it into a medical condition.

We, as a society, are all about finding cures.  How can it ever be considered unnecessary when we come up with a cure?  That is the ultimate goal once a problem is identified.

They aren't going to help you if you don't follow their accepted treatment regime, and they most likely aren't going to help you with the mental component of this condition

If you are diagnosed with cancer and it causes you stress, anxiety and/or depression, there's no way your doctor will tell you not to see a therapist or join a support group. 

It seems a lot of your fears are unfounded.

[Just Kate]

It is a good thing it doesn't worry me.  It is not likely at all to ever be removed from the DSM.  I was just doing a thought experiment if it were. 

On one of your points though, TF is not TS of course, and TF does not equal non-transitioning TS either.  My getting psych treatment for TF would be like getting treatment for a condition I don't have.  I'd like to be treated for what I do have which might be more difficult if the convention defines what I do have as exclusively a medical condition involving hormones and surgery.  But then again I'm dealing in extreme hypotheticals here.