The APA and the transgender community ~ A diary of links ~

[Shana A]

Thu Apr 28, 2011 at 12:11 PM PDT
The APA and the transgender community ~ A diary of links ~
by CA TreeHugger

http://www.dailykos.com/story/2011/04/28/971126/-The-APA-and-the-transgender-community-~-A-diary-of-links-?detail=hide

In 2010, at the insistence of the transgender community, the World Professional Association for Transgender Heath released the following statement regarding proposed changes to the American Psychiatric Association's infamous bible of "mental disorders", DSM-V.

    The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide. The expression of gender characteristics, including identities, that are not stereotypically associated with one's assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative. The psychopathologlisation of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being. WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people.

WPATH did not have the courage to point to the shameful records of certain members of the relevant committees on DSM-V, but they are well aware of the outrage in the transgender community over selection of Drs. Kenneth Zucker and Raymond Blanchard as chairmen.

[caitlin_adams]

I'd be interested to see what my learned friends here at Susan's think of this.

I agree that not all expressions of gender that differ from cultural norms associated with the sex of the individual should be pathologised. There are plenty of people that cross gender lines as a form of cultural expression and I acknowledge and, indeed, support that.

I also agree that gender incongruence should not be psycopathologised. This places gender incongruence in a pejorative light. To me it undermines the legitimacy of the condition and implies that it is the mind and not the body that should be treated when we all know that the only successful treatment for gender incongruence is to treat the body.

But conversely I do believe gender incongruence (a condition that can be cured by hormonal or hormonal and surgical intervention) is a medical condition and not merely a form of expression.

I think by simply labeling it a form of cultural expression it undermines the serious nature of the condition, the dire need for many to receive treatment (and the sacrifices they make to do so) and the need for government (or private health insurers for those that live in the U.S.A.) to support these individuals just as they do those who suffer from other medical conditions such as AIDS, chronic fatigue syndrome, cancer or various forms of physical intersexuality (which, given recent studies that suggest the size of the BSTC region of one's brain acts as a physical indicator for those who identify with the gender typically associated with the opposite chromosomal sex to which they are born, could actually include gender incongruence).

I believe that there is a difference between those transgressing gender norms as a form of expression and those with gender incongruence and I believe it does everyone a great disservice by conflating the two. No one from either group should be discriminated against, society should accept people from both groups, but I believe they are fundamentally two different reasons for superficially similar behaviour.

[JungianZoe]

I think Caitlin is spot on in identifying the delicate nature of the problem at it presently exists, a "damned if you do, damned if you don't" situation.

On one hand, we all know that we're not crazy.  We're just people with the same loves, hopes, insecurities, and wishes as everyone without gender struggles; we're simply a variation of the human condition.  Most of us live happy and productive lives before, during, and after transition (despite how media may portray us).  Our condition is not a form of psychopathology.

That said, any foray into an undergraduate abnormal psychology course teaches that mental disorders are construed along the four D's: distressing (to the client), deviant (to society), dysfunctional (causing disruptions in one's everyday life), and dangerous.  Of those, deviance is the shakiest point to argue in our case, as many behaviors can be considered culturally deviant without any form of pathology attached.  If deviance is defined simply as "not the norm for one's culture," then female construction workers would be deviant.  As I said in the paragraph above, we're simply a variation of the normal human condition.  But to varying degrees, the other three D's fit us.  GID (or gender incongruence as the proposed changes call it) can be very distressing to the sufferer, dysfunctional when it prevents us from our normal routines or functioning in society, and dangerous if it leads to suicidal ideation.

So now the argument is whether we want to view our condition under the disease model (as a diagnosable psychopathology) or, as the APA did for homosexuality in 1973, simply normal.  Many parts of the western world with socialized medicine can move to a normality model with little disruption to the current system so long as government and medical practitioners still accept transsexualism as a real condition with a real treatment regime that's covered by national insurance.  But in the US, where we already fight against insurance companies who refuse any payment whatsoever for any issue related to transsexualism, the normality model would be a HUGE step backward (and let's face it--in the current political climate, we're likely going to be slaves to the private insurance system into the far distant future).  No diagnosis by the medical community means no treatment, period.  We need to be labeled and we need to be pathologized, then we need to start screaming for insurance parity, probably accompanied by some bloodshed and mass sensationalism, in order to have any hopes of turning insurance companies' ears to our needs rather than to their executives' bonuses and posh retreats.

It really is a tricky situation with no easy answer...