For those who think it's okay for TG to be a mental disorder

[Tammy Hope]

maybe I'm a victim of the culture but I personally can't work up an outrage that i might have a "mental condition" - i tend to think i do.

the only thing i really struggle with is the distinction between a mental defect that was born of a birth defect (like, for instance, autism) and a mental defect that arises from a "normal" brain falling into disorder (as in multiple personalities or bipolar)

That said, I'm ok with copping to having a "mental problem"

If that makes me somehow ill-informed or something then so be it.

My only reply regarding BIID is that, while yes one must be compassionate, that falls in the same category as those who think they are, for instance, vampires - there is no biological mechanism (at least, not one yet identified) under which one might normally develop in the womb into a vampire are a limbless torso, whereas there are well identified processes for gender differentiation.

That makes all the difference in the world to me.

[brainiac]

'Cause Julie Marie wants to see it, here goes...

Let me preface this by saying that I think the DSM-IV is a highly flawed diagnostic tool that desperately needs a revision. That said, I do not think that GID should be taken out of the next DSM (even if it should be revised).

In response to Sarah:
Criterion A:
A strong and persistent gender identification.

Firstly, if you don't accurately tell your diagnostician about what you're going through, I think it's fairly obvious that they will not be able to appropriately diagnose you. If I go to my GP and complain of leg pain, while I DON'T tell her about the severe headaches and arm numbness I've been having, do you think she's going to know what's really going on?

Secondly, "strong and persistent" identification is not necessarily defined as the things you said. Acting it out is an unfair way to judge it, as you can identify with a gender without feeling able to express it. Wanting and imagining that you are the correct gender is a CONSCIOUS identification--and denial can really strongly interfere with that. I know it did for me. There isn't a hard and fast definition for how persistent the thoughts need to be-- that simply wouldn't make sense to put in there.

(not merely a desire for any perceived cultural advantages of being the other sex).
I believe that you misinterpreted this line. If you read it as, "there must be no cultural advantages to transitioning", then yeah, EVERY SINGLE PERSON would fail the diagnosis, because there are SOME cultural advantages to being either male or female. The point of this is to make sure that the person truly identifies as their perceived gender, rather than transitioning FTM just to get higher wages, for example.

Criterion B:
Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

Really? You had ZERO dysphoria about your body not being what it was supposed to, the way you were viewed as the wrong gender by others? You didn't feel pigeonholed into the wrong gender roles?

Lucky you. From my own experience and everything I've heard from other trans people, those feelings of dysphoria are very common. I'm wondering, though, how you figured out that you were TG if you had no dysphoria...?

Criterion C:
The disturbance is not concurrent with a physical intersex condition.
As I think you know, this is there to exclude any other cross-gender identifications for which we already understand the underlying cause. This is the problem with the vast majority of mental disorders-- we DON'T understand the underlying cause, and more often than not, that cause is both physical and social-- caused by the interaction of the social environment and life experience/stresses and inbuilt genetic risk. The claim that TG is biological and therefore should not be in the DSM ignores the fact that mental illnesses are ALL biological AND social--they are affected by what you experience and what you've been dealt biologically. If you take GID out of the DSM, you might as well take out schizophrenia, major depression, and ADHD-- all of these mental illnesses have strong links to genetics and are therefore biological.

Criterion D:
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Not sure if you knew this, but this criterion is in about half of the disorders in the DSM. This line effectively says, "if it doesn't cause problems, it's not a disorder." You misinterpreted this one, too. It doesn't mean that you don't have relationships at all; it doesn't mean that you can't be functional in a work environment. It means that whatever the mental disorder is is causing some sort of problem in your life. Dysphoria is exactly that sort of problem.

I find it hard to believe that you felt zero distress around living as the wrong sex, or else you wouldn't have transitioned.

[Steph]

I still don't understand why there is such division over this topic.  Well I can, and I can only surmise that it's those who are being denied their human rights that want to change all of this.  Sure take it out of the DSM and make it a regular medical condition that can be handled by your family doctor;

Hi doc,
Hi Joe, what can I do for you today, what seems to be the problem.
Well it's like this doc, I think there has been a mistake and that I should have been born a woman and not a man.
Oh really Joe, and whats make you think that?
(and so on, and so on - you get the drift)
Well joe, we can solve that problem.  First I'll prescribe HRT, to feminize your body, and then we'll get you scheduled for surgery...

I'm sure doctors will jump at that.

Why do we need to change medical practices to satisfy social stigmas, it makes no sense, surely we should be changing social stigmas.  And I would not be so naive as to think that removing GID from the DSM would automatically remove the stigmas, you will still be TS.

One thing I do know is that the apparent normal brain I was borne with decided at some point in time that the body that carried it was not right, it should have been a female one not male.  As time went on I became so obsessed with changing my body that I turned to self mutilation to try a correct what I perceived as a mistake.  It almost had tragic consequences.

Assume that one has to have satisfy the conditions of the DSM IV TR to be labeled Gender Dysphoric, hence you must be Mentally Ill or have a Mental Disorder.  I have lifted the relevant text from the DSM IV TR page 578 and assigned a corresponding analysis to each of those Criterion.

There are two components of Gender Identity Disorder, both of which must be present to make the diagnosis.  There musty be evidence of a strong and persistent cross gender identification, which is the desire to be or the insistence that one is, of the other sex (Criterion A).

"Evidence for who?"  I never told my psychiatrists anything about my 'strong desire' or 'desire' to be a female or insistence that I was a female or better still, we can discount 'insistence' because I never once voiced it to any one so lets discount that, shall we?

So if you didn't tell your psychiatrist why you were there, didn't he ask you why you needed therapy?  Why you needed to see him, did you just drop in, did you expect him to guess?  If a person is going to be less than upfront with their therapist how can you honestly expect them to make a diagnosis.  You didn't see their notes, so you honestly can't relate what he was thinking, what he based his diagnosis on.

So am I, the exception to the rule?

- You very well could be - we have no way of knowing.

Did my psychiatrist not follow the correct procedures? Or am I stark raving mad for doing what I did?

- Again - we have no way of knowing.

How about, I manipulated the information to the desired outcome? Well, I'm giving you an honest account

- We have no way of knowing - since you mentioned it you very well may have manipulated information. Crazy people do crazy things.

My experience with both my psychiatrists was completely different than yours, probably completely different from Julie's but these experiences have nothing to do with GID being listed in the DSM.

Steph

[Just Kate]

Assume that one has to have satisfy the conditions of the DSM IV TR to be labeled Gender Dysphoric, hence you must be Mentally Ill or have a Mental Disorder.  I have lifted the relevant text from the DSM IV TR page 578 and assigned a corresponding analysis to each of those Criterion.

[...]

Because if there is one exception there are others.  Therefore the diagnosis for Gender Dysphoria is fatally flawed.

Kind regards
Sarah B

I'll play.

Let's say you in fact, TRULY, do not fit any of the current diagnostic criteria for Gender Dysphoria.  What does that mean?  It means you don't have gender dysphoria.  Fine, I can handle that.  You got surgery and were even recommended for it - fine I can handle that too.  Why is it then that because you DON'T have a mental disorder it means that this mental disorder you DON'T have SHOULDN'Tt be diagnosed?  I hope that wasn't too many negatives.  I'll put it more simply.  Why do you want to remove GID as a mental disorder if you don't have it?  Is your interest purely altruistic, looking to right the wrongs of the DSM?  Perhaps you feel similarly about schizophrenia, or anti-social personality disorder (both of which I assume you don't have) and are out crusading for them too.

[Fencesitter]

Dear Cindy,

I love your thoughts here.

But now, because there are no gatekeepers, someone goes in, with cash and gets GRS.  It turns out they have multiple personality syndrome.  Only one of the eight people inside wanted it, the rest are looking up good lawyers.

I get what you mean here, and it's a very valid point, and I've read about this happen in a medics' journal and well the poor client got themselves into a GID by transitioning as it was just the "hosts" at that time (personality fragments operating in the outside world) that were opposite sex but not the whole multiple system (all people forming the multiple personality) summed up. Opposite-sex hosts experience the typical GID symptoms if they have any connection to the body at all. But there's also other cases where the multiple personality disorder just got worsened by concurring transsexualism, and transition helped a lot as the multiple personality personality disorder was just a coping mechanism for gender dysphoria plus trauma.

Both these cases could be found in the International Journal of Transgenderism or how it was called, but I don't know if I can find these cases again there. Now it's relatively easy to clock a psychotic when they have an active phase, as their thinking and reasoning is somewhat deranged and illogical then, a bit like in a dream - a friend of mine gets such attacks once in a while and what she tells me then is always very WTF???. But you cannot easily clock a host in a multiple system if the host does not tell you that there is a multiple system, is clever, seems normal and has good control over the multiple system, which is usually the case. Also, multiples are usually highly intelligent (IQ 130 or more) which may help them fool most therapists. I know a couple of them, personally, two of them are good friends of mine.

I believe that a great deal of shrink time that I have spent, is simply ruling out these types of pesky issues.   

Sure. Psychotics are easy to rule out when they have their "phase", but multiple personalities... ouch. Tricky.

Now, I suppose the issue could be made that "well, you could still require tests for that."  But the truth is, most of the arguments seem to have a large component of "We hate the idea of gatekeepers", and not that it is of and by itself a mental disorder.   

You cannot rule out a host of a multiple personality by "testing" them if they're obstinate, usually they are very clever and have read some of the specialists' books before the tests are made, or even read about the tests themselves in specialists' books and which answers are expected from them. You need to be both highly intelligent and creative to develop multiple personality disorder at all, so multiple systems can often trick out their therapist if they want to. Especially as they know that it's a test they fear to fail. And multiple systems are most functional when it gets to tricky or dangerous situations and "tests" which are important to them, not in every-day life... That's the whole point of a multiple system, being created by extreme situations and being specialized for dealing with extreme situations, not for routine stuff. And they have decades of routine with not outing themselves as being multiple or raising suspicions. Usually, multiples don't let themselves go and switch visibly from one personality to the other unless they feel 100% secure and just let happen whatever comes. And they'll be especially controlled and suspicious in a situation with a therapist who wants to find out whether they're multiple or not.

Unless they are openly multiple and expose honestly what's going on inside to rule out making a big mistake for their life. Which is usually not easy for multiples as they tend to be very suspicious due to very bad experiences they had.

But I get your point of reluctance to gatekeepers and you may be right here. Gatekeepers are annoying, but they're important. E. g. some of the multiples may profit from the delay by thinking it all over and debating with the other people inside them whether they shall do it or not. Or they just change their host and getting hormones etc. is not important at all any more for them, or they don't remember having trans stuff going on at all. So they cancel their dates at the therapist or just don't show up any more.

Further, I haven't had anyone respond concerning people with BIID, Body integrity identity disorder.   An interesting perspective comes from sufferers of BIID or body integrity identity disorder.  I'll repeat it, inconvenient though it is.  "They have a condition where they feel that their bodies are "wrong" and try to have limbs either cut off or paralyzed.  The condition hasn't been in the dsmv, which makes it very difficult to treat, because there are no standards at all-talk therapy and pills don't work.  They have been trying desperately to have it INCLUDED.  Before you say it, Google it and read up.  They feel that it is part of their "core" experience and cannot understand why surgeons won't do it, and people don't accept it.  I'm sure that most of us would have an immediate response that we (transsexuals) are different, more pure, more something-anything that makes us better than them.   Not that it would ever make a difference in how I feel, it still adds to the perspective.  I suspect that after reading a few articles about them, you will have the same attitude toward them that many people have toward us.  I'm sorry, but my personal, visceral reaction is "Damn, they're nuts!"   Sorry, It is hard not to feel this way, not experiencing nor really being able to empathize with their feelings.  I just can't do it.  Just as many non-transgendered can't with us.  I don't pretend to know how they should be treated, except that it should be with extreme kindness and consideration."   

I think BIID is as valid as GID, and it seems to be a body mind map problem in many cases. I don't get anyone wanting to get rid of a limb, but I can kind of relate to that and think it has a lot of parallels to transsexualism, at least in some cases. You could say I have a BIID concerning my breasts as a part of my GID, and I would not object to that. I would not call anyone having a BIID as being "nuts" for this.

[Julie Marie]

And I would not be so naive as to think that removing GID from the DSM would automatically remove the stigmas, you will still be TS.

And when homosexuality was removed from the DSM gays & lesbians were still gays & lesbians.  They just no longer had a mental disorder stigma attached to them.  And they could take that to the society that discriminated against them because it believed they had a mental problem and flip them the bird. 

[Steph]

And when homosexuality was removed from the DSM gays & lesbians were still gays & lesbians.  They just no longer had a mental disorder stigma attached to them.  And they could take that to the society that discriminated against them because it believed they had a mental problem and flip them the bird. 

Errrr that's because being homosexual is a sexual preference and not a mental disorder, no similarities what so ever.  Your turn

Steph

[Calistine]

The thing with gays and lesbians though is that they do not need expensive hormones and surgery to be covered by insurance. We do(for the most part)

[brainiac]

The thing with gays and lesbians though is that they do not need expensive hormones and surgery to be covered by insurance. We do(for the most part)

Right. The point is that we need treatment. That's what a mental disorder really says, if you take it at face value instead of buying into the stigma.

[Calistine]

I don't agree that being transsexual is a mental disorder, but I don't mind it being in the dsm because it will get us the treatment we need. Plus most gender therapists with a brain these days are good enough at their job to know we aren't lunatics I'm hoping.

[Fencesitter]

Anyway, I don't see where the problem is about having a "mental disorder".

I mean, a close friend of mine was diagnosed with "schizoid personality disorder" - sounds like schizophrenia but has nothing to do with it, no frigging halluzinations, voices talking to you or whatsoever. He explained this to me, and I read up the disorder and thought - okay, he's like that, but it's just normal human variation, why is that even called a disorder?

"Schizoid personality disorder" means you are an introvert, hardly make your emotional reactions visible to other people, are much into stuff you do alone and phantasy stuff in the broad sense, have rather few friends than many, you're not good at socializiing and you don't get along with kids. I mean, what's wrong with that? Okay, not everybody is like that, and it's not 100% normal/usual, but it's absolutely okay. You're a nerd, but where's the problem with that? Sure, you need to know that person well to capture their emotions unless they tell you right away how they feel, but what the heck? And I was like - THIS is called a personality disorder? As most other personality disorders are much more extreme and some of them help develop behavior like serial killing or extremely criminal behavior etc., for example narcissistic or antisocial personality behavior.



This is when I lost my trust in mental shrinks (again). I'm sure they see "schizoid personality disorder" as a mental disorder because not being able to "read" another's emotions well if you're not best friends and know the person very well makes them freak out. They live on reading their clients' emotions, and if it does not work - then they freak out and of course the client must be very disordered. And lots of mental shrinks together developed the "schizoid personality disorder". Yeah. My friend's the best friend you could imagine, a really nice guy, honest, reliable, intelligent, funny, I'd risk my live for him and he'd risk his for mine... you just need a lot of time to get behind his emotionally even facade and I don't care about him being a nerd. I have known him for 8 years or so, and if my friend can be called disordered for being a nerd, then I'm disordered too, just out of solidarity.  PERIOD! As transsexuality is probably regarded as more "deranged" by the mental shrinks than sheer nerdiness.

Just to give you an idea how culturally biased, non-objective and close-minded the DSM can be. And ruled by powers. Don't take this sh*t too seriously. The Dilberts, Trekkies and Computer nerds  of our planet might take over in the future and then, the DSM might lose it's "schizoid personality" disorder. It's more a question of power than anything else.

[Calistine]

The mental disorder part I think is not that we are crazy for presenting the way we do, but that the mental disorder is the body dysphoria and hormones and surgery are the treatment.

[rejennyrated]

Right. The point is that we need treatment. That's what a mental disorder really says, if you take it at face value instead of buying into the stigma.

Nope. I did not NEED treatment. I WANTED treatment because I saw other people getting it and being happy afterwards and I WANTED to have what they had. There is, in my mind, a difference.

If the treatment had been brain modification, then as I already said, I would have lived with what I had and not taken the treatment.

In order to get what I wanted I employed a combination of skillful distortion and taking matters into my own hands (which I wouldn't recommend as I now realise how dangerous it was particularly as I later turned out to have an undisclosed partial intersex condition which meant that the standard dosages actually resulted in DANGEROUS blood levels for me.)

The distortion consisted of telling the doctors ONLY what they wanted to hear and carefully editing out anything which didn't fit their current theories. Having already had one doctor try to stop me because I was honest with him in my later teens I was determined that the second time I was going to get through, and I did in record quick time.

Nearly 30 years on I feel I have justified my actions, but I still maintain that this is merely an intricate from of cosmetic surgery. It has not changed who I am one jot. I was no more or less female after the surgery than I was before it. It has just made it easier for a few other people (those few who see me naked) to see that, and it has recently, and thanks to the UK law changing, allowed me to apply to the legal system for legal recognition of that.

My point is that if GID is a disorder then so is ALL desire for cosmetic surgery. That, to my mind is irrefutable. I wanted the appearance of my genitalia changed, someone else wants a different appearance to their nose. It is the same thing EXACTLY to me.

All I personally want to see is consistency here. If this is to be a discorder then make all the other elective surgeries into disorders. If not then find another form of words which, whilst allowing a diagnosis does not end up stigmatising those with the condition.

[Tammy Hope]

as far as stigma goes - I feel like I am a lot LESS stigmatized by being thought of as a person with a mental disorder than I would be if I was widely considered a "pervert" who was doing this when I didn't need to.

Not speaking here of logic, but perception - because it is how you are perceived that leads to stigmatizing, not how you ARE.

One unrelated point about the angle that this is basically ramped up cosmetic surgery. i see what you are saying and don't entirely dispute it, but I think perhaps I would refine it by comparing it to plastic surgery which corrects what the person perceives as an unbearable flaw. Say the woman who lost a breast to a mastectomy and has an implant....or someone who's badly burned or injured in an auto accident and seeks plastic surgery to repair the damage...a child born with a cleft lip...

Yes, that could extend to the person who's just so obsessed with her oversized nose that she can't be happy with herself but the former examples are much better comparisons, IMO.

Do I NEED breasts and a vagina to be a woman? No, I really don't.

I don't NEED to remove the hair from my body or wear makeup or acrylic nails to be female either - but I find myself in considerable mental distress when confronted with the possibility that these things will not be so. Natal women are not overly distressed when their legs get hairy or their nails are not pretty - but I do.

The same instinct that drives me to recreate, as much as possible given my circumstance, a female presentation - and grieves me when for whatever reason I cannot - is the same instinct that makes me want to modify my body, only writ much larger.And it's not just for public appearance. I shave parts of my body no other person (save a medical professional) is ever likely to see because I want it feminine.

Is that normal? is it disordered? I don't have answers to these questions...but I do think it is something other than simple vanity of the sort that drives a lot of elective plastic surgery.

[Cruelladeville]

*Anyway, I don't see where the problem is about having a "mental disorder"*

Try getting a job as an employee in say Banking, Govt, Law, Medicine, Aviation, Marine....and/or a whole host of other ultra conservative industries...

If it's clearly stated and on your record that you be menatly ill....

[Miniar]

"Schizoid personality disorder" means you are an introvert, hardly make your emotional reactions visible to other people, are much into stuff you do alone and phantasy stuff in the broad sense, have rather few friends than many, you're not good at socializiing and you don't get along with kids. I mean, what's wrong with that?

it's not just being an introvert or "hardly" making your emotional reactions visible.
What you described does not seem enough to cause problems with "living in human society, which is what you need to call it a disorder.

I looked it up.

"People with SPD are seen as aloof, cold and indifferent, which causes some social problems."
"Because of their lack of communication with other people, those who are diagnosed with SPD are not able to have a reflection of themselves and how well they get along with others."
"Those people who have SPD are happiest when they are in a relationship in which the partner places few emotional or intimate demands on them, as it is not people as such that they want to avoid, but both negative and positive emotions, emotional intimacy, and self disclosure."
etc. etc.

We human beings are social animals.
We rely on others in society to function.
Without emotional attachment to other individuals of the same species, there's no "social" structure.

We are geared towards having emotional reactions, needs and attachments.
With Far less than normal of these, problems arise.
Lack of empathy, lack of being able to associate with others, etc.

Which sounds and awful lot like it would make functioning in society "harder" than it is for others.
Which is the base definition of a disorder.

My point is that if GID is a disorder then so is ALL desire for cosmetic surgery. That, to my mind is irrefutable. I wanted the appearance of my genitalia changed, someone else wants a different appearance to their nose. It is the same thing EXACTLY to me.

Just cause you didn't have dysphoria doesn't mean other people don't.
Just means that you didn't.

If this was all about cosmetics for me, then I wouldn't be after it.
I'm terrified of surgery. The thought of it is enough to make me feel physically ill.
But the thought of living any longer as a lie, as something I'm not, with all these things that are not me still attached to this body, is even worse.
I honestly do not think I would have made it past age 30 without these steps taken to correct my flesh to match my mind.

The dysphoria was starting to kill me.
That means, that the dysphoria was actively, negatively effecting my ability to live a functional life via psychological distress.
That means, that the dysphoria was, and probably still is, a disorder in my life.

[rejennyrated]

Just cause you didn't have dysphoria doesn't mean other people don't.
Just means that you didn't.

Well clearly I actually was dysphoric otherwise I wouldn't have wanted to change things. My point is actually the reverse of what you have assumed namely that someone not liking their nose or small breasts seem to me actually just as much a case of dysphoria as hating your genitals - which both I and you evidently did.

My beef is purely that this is singled out because it is socially borderline in its acceptability, whilst other forms of dysphoria such as the nose job, breast job, or tummy tuck are regarded as "understandable".

I think people put genitals in some sort of special category as if they define you in some way or other, whereas as an unashamed bisexual feminist I strongly refute that. For me genitals do NOT define a person. You are male with or without surgery just as I was always female. The surgery pretty much helps us to feel good about ourselves, but it doesn't actually make us something which we weren't already.

[Miniar]

Purely cosmetic surgery isn't considered "understandable" by anyone I know as such.
Most people I know simply gawk at each other and go "why would you risk {insert potential complication and pain here} for something so superficial?"
I've even gotten that exact comment in regards to my chest.

Even more so, people who have "extensive" cosmetic surgery. Not just a little nip here and tuck there, but a complete re-haul of their appearance, they don't got the "understandable" label either. They get a "there must be something wrong with him/her".
Why?  Because it's a complete re-haul.
Because it's extensive.
People tend to think those that opt to have extensive, purely cosmetic surgery, must have some deep-seated insecurities and possibly even hatred of themselves.

i.e. dysphoria of some sort

Which again, if it negatively affects your quality of life by interfering with your ability to function in society, would be a mental disorder.
(There is even a disorder connected with plastic surgery called Body Dysmorphic Disorder.)


And a nose job doesn't mean you literally remove your ability to breed, or that you take hormones or even any medication for the rest of your life.

Combining the hormone therapy, the change in wardrobe, and the surgical alterations of the flesh, and other small things, and a transition is more compatible to getting a complete re-haul of appearance, though it's even "more" than that as it's a life-long investment of time, money and so on, in the form of "continued" treatment.

[rejennyrated]

All absolutely true Min! I'm not disputing the facts.

But then I had already changed my wardrobe a long time back, and I took hormones long before I had even formally sought medical help towards the surgery. Yes I know better now! But back then the potential dangers weren't so widely known.

Because of my IS condition I was probably sterile anyway even though I didn't know it at the time. Interestingly BOTH my male cousins turned out to be so. One is Klinefelters, the other is also PAIS but unlike me he is not trans. Clearly our family has some genetic flaw.

Thing is, as far as I can see you and I aren't that far apart in pov.  We are in a way arguing semantics here. It's just that I object to what I perceive as the selective nature of the formal label of disorder. I would like to see GID treated as routinely as other forms of bodily dysphoria, and yes of course because of the reproductive impact it is something that has to be approached with a degree of caution. But I think that is something for each individual to weigh up for themselves.

That's the trouble with threads like this, and indeed diagnosis labels. We can all only talk from our own individual experiences, which are all subtly different.

[Steph]

....

Because of my IS condition I was probably sterile anyway. Interestingly BOTH my male cousins turned out to be so. One is Klinefelters, the other is also PAIS but unlike me he is not trans. Clearly our family has some genetic flaw.
...

Being Intersexed is a whole different kettle of fish.  Generally speaking folks with an IS condition do not suffer the same or any disforia for that matter.  See:

http://www.isna.org/faq/transgender

If you indeed have an inter sex condition then one would understand your thinking about this topic.

Steph