Susan's Place Transgender Resources

There was a heated debate in the IRC chat one side saying that TS is a mental disorder and the other side saying it was a medical condition so i decided to put the matter to a vote and solicit a wider opinion. syndrome being a medical condition and Dysphoria and disorder mental.

Emma-
Would you be so kind to add 'Gender Expression Deprivation Anxiety Disorder' (GEDAD) to the list of choices?

Thanks!
-Emerald  :icon_mrgreen:

Quote from: Emerald on May 27, 2007, 06:52:40 PM

Emma-
Would you be so kind to add 'Gender Expression Deprivation Anxiety Disorder' (GEDAD) to the list of choices?

Thanks!
-Emerald  :icon_mrgreen:

Yeah, gee dad, what happened?

QuoteIf you were to name GID which term would you use

QuoteBenjamins syndrome

I think I like the syndrome the best as, as far as I can tell, it is most fitting. An it seems proper to credit Benjamin.

As for calling this condition a mental disorder... that is not the way to win my friendship. :P

Mind you, as much as this thing has (and does) muss up my life ... ^*shrug*

If I were to rename Gender Identity Disorder, I'd name it Gender Dysphoria.  It seems more appropriate to me.  But I agree with Tink.  We go with what the establishment uses to make life more simple.

Cindi

QuoteI usually go by what is listed on the DSM since this is the only official, recognized manual that gender therapists (are supposed to) use to diagnose GID.  Of course, you can always call it whatever you imagine it to be..........never mind.

but isn't that pandering to those that wish to discriminate against us by accepting your position and being thankfull for any crumbs they wish to throw from thier table ? ???

Because it's most common to hear GID, I believe it's a good idea to stick with or close to that.  But I make a habit of telling people I have been diagnosed with GID, Gender Identity Disphoria.  I think 'disorder' sounds like there's a problem that needs fixing, while 'disphoria' sounds more like something that, while its occurrence is rare, does not constitute a problem that needs fixing, only acknowledgment.

Yes, you could say this is wordsmithing, spin-doctoring, making politically correct language, etc.  But at least it gets me the chance to point out that, while TG is somewhat unusual, there's no harm in it.

At least, that's my reasoning (YMMV)...

Karen

I vote to label it as a mental disorder, but subset under a form of anxiety. Most people I've seen suffer from this had no problems getting on in life except for the stress they suffered from being unable to find a place they fit in. Which led to anxiety and panic attacks in many cases. Put a person on HRT and give them surgery, and the attacks seem to go away for most people. That's good enough for me.

being transgender is not a mental disorder of any kind. If anyone does some research on how gender is determined during prenatal development, they will see that is entirely possible for any one of a number of scenarios play out after the child is born. We are considered to have mental disorders because that is what the puritanical shrinks thought back in the day. Since that was the word of a few folks with degrees it was accepted as the truth. Now we get to be labeled as something that still keeps us emotionally distraught as a community because people refuse to believe us when we say we were born this way.


My $.02

Unequivocally, medical anomaly.

I have experienced too much hard empirical evidence, to conclude otherwise.

It's been a bitch.

what is wrong with being mentally insane?  do you honestly think that "healthy" people go about cutting off their genitalia, attempting suicide, living in a horrid state of depression or hating themselves?  do you get the joke?   ;)  probably not.  i have a very dark sense of humor or so i've been told.

gid, that's what three psychiatrists diagnosed me with.

QuoteUnequivocally, medical anomaly.

Yesee, that is what I always assumed? But then, I ask this question, and I always get the opposite answer I expect if it is simply a medical problem. A medical problem is fixed thru drugs (HRT) and surgery (SRS). But, if you were given HRT and then SRS, would you be happy if you did not change your gender role too? Most people would not seem to be from my observations.

It seems to me there is definitely a stress related disorder that comes from people not being able to be seen in the gender role of their choice. HRT and SRS enable people to reach that goal, but SRS and HRT do not seem to mitigate the problem of and by themselves.

As someone that has a very fluid gender role in society, changing a gender role has never seemed a necessity for me, or for many other queer people. We are more comfortable existing outside of the confines of the rigid roles established for the two gender types over millennia.
But transgendered people have a real problem existing outside of those walls, feeling most uncomfortable if not accepted as they so deign themselves to be.

If there is a mental incapacitation that occurs in transgendered people, it seems to be that
the world views sex and gender as the same, whereas transgendered people do not ascribe to that idear. At least not until they go thru HRT and SRS, as prescribed. So maybe gender dysphoria is a label created by the non-trans population to explain something that they don't understand, or cannot comprehend.

Quote from: Tink on May 28, 2007, 06:45:35 PM

Quote from: Emma_J on May 28, 2007, 03:49:29 AM
but isn't that pandering to those that wish to discriminate against us by accepting your position and being thankfull for any crumbs they wish to throw from thier table ?

Sometimes it's much better to have a few crumbs than nothing at all.  I live in one the States which has had specific laws to protect TS individuals from discrimination.  This law didn't go into effect until 2003, but what about before that time?  what did TS people use to do then?  well, they took advantage of those crumbs and used them to their benefit claiming handicapped status, receiving public benefits, obtaining protective status in employment, housing, ect....all this because of their mental disorder. ;)


tink :icon_chick:

Dayam Tink!  I wish I would have known that!  Maybe I could have made life a little easier for myself ;)  Actually, I'm very happy I didn't need that sort of help.  I managed on my own somehow.  Sometimes I don't know how... but I did.

I have always done a bit of wordsmithing with the SRS thang.  When confronting a doctor for the first time, I tell them that I had GRS. Then they ask "what's that?"  And I respond with "Gender Reassignment Surgery."  And when they still have a blank stare on their face, I finally relent and just mutter "sex change operation."  It might be easier just to tell them that in the first place, no?

Cindi

Quote from: Katia on May 28, 2007, 10:28:50 PM
what is wrong with being mentally insane?  do you honestly think that "healthy" people go about cutting off their genitalia, attempting suicide, living in a horrid state of depression or hating themselves?  do you get the joke?   ;)  probably not.  i have a very dark sense of humor or so i've been told.

gid, that's what three psychiatrists diagnosed me with.

This is all historical fact, except for the hatred portion. In general, I hated my life and not myself.

And through this and.....other things which have occurred during my transition/healing, I have been seen by numerous psychiatrists and counselors, and not one judged me as being possessed of mental defect.

In fact, after a certain auto-surgery was accomplished and I voluntarily went to the hospital for prophylactic anti-biotic treatment and was admitted, I took an opportunity to read my chart.

It said,


"Patient is transsexual/GID."
"Patient is highly intelligent and knowledgeable."
"Psych consult not indicated."


I have never been more sane in all of my life, than I am now.

I have a serotonin issue and it is indeed, being treated; has been treated over a number of years, but the remediation of this condition did little to stanch or attenuate the relentless harassment of my TS.

The only remediative or palliative 'treatment' of that which has tortured me for so many years, has been transition and HRT.

The mere fact that staggering and vast improvements in cognitive and emotional processing were observed after the initiation of hormonal correction [HRT and surgery], speaks volumes.

I was astounded.

Quote from: rhonda13000 on May 29, 2007, 04:26:41 AM

This is all historical fact, except for the hatred portion. In general, I hated my life and not myself.

And through this and.....other things which have occurred during my transition/healing, I have been seen by numerous psychiatrists and counselors, and not one judged me as being possessed of mental defect.

In fact, after a certain auto-surgery was accomplished and I voluntarily went to the hospital for prophylactic anti-biotic treatment and was admitted, I took an opportunity to read my chart.

It said,


"Patient is transsexual/GID."
"Patient is highly intelligent and knowledgeable."
"Psych consult not indicated."


I have never been more sane in all of my life, than I am now.

I have a serotonin issue and it is indeed, being treated; has been treated over a number of years, but the remediation of this condition did little to stanch or attenuate the relentless harassment of my TS.

The only remediative or palliative 'treatment' of that which has tortured me for so many years, has been transition and HRT.

The mere fact that staggering and vast improvements in cognitive and emotional processing were observed after the initiation of hormonal correction [HRT and surgery], speaks volumes.

I was astounded.

Thats so nice rhonda. I have always thought there was something within HRT that our body needed (yes most probably E). Everyone always has said that once they gone on HRT there mental state improves. I am so glad iot worked for you.

Alice

QuoteIn the central nervous system, serotonin is believed to play an important role in the regulation of anger, aggression, body temperature, mood, sleep, vomiting, sexuality, and appetite. Low levels of serotonin may be associated with several disorders, namely increase in aggressive and angry behaviors, clinical depression, obsessive-compulsive disorder (OCD), migraine, irritable bowel syndrome, tinnitus, fibromyalgia, bipolar disorder, anxiety disorders[citation needed] and intense religious experiences[1].

http://en.wikipedia.org/wiki/Serotonin
Very intresting Rhonda.

I have to put a word into this thred because it is a question i oftern ask my self. I have had it from a very earley age and think im insane. I am a woman traped in a mans body. I have no gender role but wish people could see who i am. I hate my body and wish i could chang it. I havnt voted cus i cant and dont know the awnser

I can't really win here...

It needs to be a medical/mental problem in order to get medical treatments, so it ends up being a "disorder." But it's not a disorder, IMHO.

And personally, I resent the whole idea of classifying this at all. I know it's a necessary evil in our society, but the whole thing is driven by the fact society thinks we're nuts, as no one in their right mind would want to, omg, change their sex! It MUST be a mental disorder, or it must be a hormonal imbalance in the womb, or...

Hey, I need to be a girl. Sue me. I actually don't believe it's a medical condition at all. Or a mental one. It just IS. But don't tell society that or they'll take my hormones away :(

I wanna see "Hair Pigment Dysphoria" in the new DSM or SOC. The idea that someone would want to change the colour of the hair they were born with, which their chromosomes dictated, just because they'd feel more like themselves... is just crazy! It must be a faulty gene somewhere, or a mental disorder, or... see what I mean?

But, I'll pick Gender Dysphoria... as it's not a disorder or syndrome - I'm just not happy with my assigned gender role/body.

~Kate~

The hormones could still be prescribed to counter a "chemical imbalance" from not having the proper organs to produce them. It is all about semantics.

I believe it is a medical condition not a mental defect.

I don't like it being considered a mental disorder, nor do I believe same sex attraction to be a mental disorder. It's the way we are. If anything, I believe that modern society has a severe case of gender identity dysfunction, with its rigid adherence to the binary gender system.

zythyra

It is hard that our minds do not agree with the body it reside in, but a Mental Disorder, NO.

Sarah L.

IF of 90% of the population, it is hard wired binary in the brain, meaning they are not in between either in gender or sex, then they can't have a disorder about that moreso than us.

The problem is that in general, people tend to generalize their own views on others; this is regardless of the subject. Its not called the tyranny of the majority for nothing.

Myself, I think gender dysphoria is perfectly appropriate. Its not overtly medical and express that it is the incomfort about your own gender and how you got to live up to it for society's sake, that causes all the other problems (which are highly variable from one person to the next).

Then shouldn't it be gender-based social-dysphoria?

Just a thought. :)

Quote from: Tink on May 27, 2007, 06:59:17 PM
I usually go by what is listed on the DSM since this is the only official, recognized manual that gender therapists (are supposed to) use to diagnose GID.  Of course, you can always call it whatever you imagine it to be..........never mind.  >:D

My choice:  Gender Identity Disorder

GID is a mental health label meaning "Gender Identity Disorder."  My therapist lists my condition as 302.85, meaning I have GID.  But I do not have GID; I have GD.  That stands for "Gender Dysphoria" and is not a disorder.

Quote from: Karen on May 28, 2007, 09:45:13 AM
But I make a habit of telling people I have been diagnosed with GID, Gender Identity Disphoria. 

I do not think trying to conflate the two terms is a good idea.  It doesn't really communicate what the problem is.  Dysphoria is profound unhappiness.  I am not unhappy that I identify as a woman.  What I am unhappy about is other people who disagree with me.

Quote from: Thundra on May 28, 2007, 11:19:41 PM
It seems to me there is definitely a stress related disorder that comes from people not being able to be seen in the gender role of their choice.

For a condition to be a full-blown "disorder," it has to negatively affect the person's ability to function in society.  I don't think most of us qualify that way.

Quote from: Tink on May 27, 2007, 06:59:17 PM
I usually go by what is listed on the DSM since this is the only official, recognized manual that gender therapists (are supposed to) use to diagnose GID.  Of course, you can always call it whatever you imagine it to be..........never mind.  >:D

My choice:  Gender Identity Disorder


tink :icon_chick:

Of course most therapist working in the field have ignored the DSM for quite some time, and the only reason even the SoC recognizes the coding is because it has to. They largely view the GID diagnosis as prejudiced and inaccurate.   Even the SoC uses the less prejudiced ICD-9 definition, which is Transsexuality.  Also if you read some of the dialog for the DSM-V it will probably lose the stigma of a "mental disorder" and will probably be considered a "syndrome" with psychological aspects.  Basically if you are thinking the DSM is any way accurate, you really need to read it clearly, and have a better grasp on the technical language.  We are not crazy people, we are not disordered.

The DSM-IV Gender identity disorder needs to rot in hell.  I really wonder how many TS have actually read what the DSM-IV says. 

GIS - Gender Identity Syndrome. 

You do realize if this were considered a medical syndrome it would help remove insurance barriers right?  You do realize it would legitmize TS not as a mental disorder (mental disorder = crazy), but as an honest to goodness birth defect or something close to it. 
Anything with "disorder" in the title is not helpful to us.  Just because the DSM says it, does not make it right.  The DSM-IV is extremely prejudiced as it stands. 

For a condition to be a full-blown "disorder," it has to negatively affect the person's ability to function in society.  I don't think most of us qualify that way.

Exactly, thus why GID is NOT a good definition and the underlying problem of the DSM-IV

You also realize the DSM-IV states that transsexuality is not effectively treated with HRT or SRS, which goes against nearly everything known about TS.  I could go on, but the DSM-IV GID entry is a HUGE issue, and honestly anybody who thinks the DSM-IV is fine really needs to read through the entry CAREFULLY. 

For the record:
Disorder/Dysphoria = Mental Defect
Syndrome=Physical defect

You choose.  I think if we really want to move the medical establishment FORWARD, we need to drop the dysphoria and the disorders, get this recognized as a syndrome.  If you knew how important these words were and how technical medical language is, neither dysphoria nor disorder helps us out with regards to medicine or the insurance industry.  A syndrome...well it would help greatly, because it means we are born with it, and the condition is physical.  Both Dysphoria and disorder imply mental conditions. 

(Just to let everybody here know, ALL intersex conditions are considered SYNDROMES.  Because it is something you were born with.  This is why insurance companies often cover sexual re-assignment for intersex conditions.  I could go on, but neither dysphoria or disorder helps our case, it would have to be called a syndrome, especially if you believe this is a physical condition.  Why?  Because syndrome is the medical terminology used for birth defects.  BOTH dysphoria and disorder are terms used for mental conditions.  Syndromes are specifically physical conditions.  These terms are important, because it is these terms that determine exclusions in insurance policies and how the larger medical establishment understands something.  This is why many advocating for TS and the DSM-V want to change the term disorder, and not include the word dysphoria, because opinions have shifted away from this terminology.  Making it a syndrome would help, because it would imply the condition is physical.) 

The whole syndrome thing.
While its probably that being a TS is caused by some physical defect.
Declaring it to be true right now would be going much further
than the current science can lead us.

That's why it got put in the psychology manual to begin with.

Even if they found out that some genes cause the "syndrome", or some defect caused by low testosterone made it more likely for someone to  be a TS. Would all TS have this defect, this gene? What if they test you and you don't have it!! Does that invalidate how you feel?

There could be another gene, another rarer defect, a multi-factorial array of factors that all lead to being a TS that have not yet been discovered yet. There could even be no discernable medical reasons (some things are idiopathic, no known causes) for the next 100 years for your personal case;
that doesn't mean there isn't one, but that could be the case.

In fact, that's still the case now. The syndrome bit IS jumping the gun with current knowledge and it shouldn't even matter. The important thing is how you feel before you've dealt with your problem however you call it, and how you feel after you dealt with it. In the end, that's what important in
the real world.

^*shrug* I am one of those that describing it as 'disorder' would seem to be very apt. But, HBS sounds better and, I think, seems more fitting overall.

^*shrug*

maybe this has been said already...i think that 'disorder' and 'syndrome' are both innacurate for the very reason that the oppression or exotification of any other minority doesnt make them a disorder. i guess what im saying is that just because we are striving to be something we were not born as and arent percieved as by others doesnt make us disordered, it makes us differant. i like being trans. i dont like having things thrown at me from moving cars, or being threatened for being a '->-bleeped-<-got' but i like the transition from something i dont like to something i do. thats growth. i like growing.
i understand that psychologically, anything that causes 'a significant negative impact on a person' and all that..and that a syndrome is medical, and they have done minor research as to brain sizes and all that...but is it really either? i think its just another path that we have followed...

Quote from: Amy T. on May 29, 2007, 03:36:29 PM
The DSM-IV Gender identity disorder needs to rot in hell.  I really wonder how many TS have actually read what the DSM-IV says. 

I've read it and concur with its definitions and classifications.
It's GID for me too.

I think there are both physical and mental aspects to it.  At least for myself, there are definite physical aspects that you can see just by looking at me which were all present even before HRT.  A few of them are:
lack of adam's apple
wider pelvis
sparse body hair
female facial structure (bone)
hormonal anomalies (My body started endocronologically changing from male to more female all by itself)
shorter height (Than both parents and my brother.  My bro is actually over 6" taller than me.)
extra soft skin (softened further with hrt)
female muscles (shape and strength)

I think the mental component is caused by being forced to live in the incorrect gender role.  This was due to being physically being seen as male.  As I have said before, the dysphoria is the mental component that is caused by the incongruence of physical characteristics within the body.

Quote from: olyra on May 29, 2007, 05:12:48 PM
i guess what im saying is that just because we are striving to be something we were not born as ...

I beg to differ. The whole reason WHY I am doing this garbage is because I was born as. ^*shrug* I was born half and half with a boy bod and girl brain/mentality.

But that is it in a nutshell, regardless of what this is called.

Regardless of syndrome, disorder, dysphoria  or other, my personal preferences are to have HB's name in the description somewhere. It seems fitting to me.

Sand in the wind (=

P.s. Hello there Olyra

To say that something is a "mental disorder" does not mean that it is non-biologically caused or "all in one's head."  For example, depression is classified as a mental disorder yet it is clearly biologically caused for many individuals.  I think the rejection of that classification steams from the negative attitude that exists in our society towards individuals who suffer from conditions that effect the brain.  There is an unfortunate belief that individuals have complete control of their brains and whenever something in the brain is atypical, that the person is somehow at fault.  People with depression, ADHD, autism, etc, are more often accused of "making it up" than individuals with other disorders.  It's unlikely that this attitude will change anytime soon.

 
  Since I know for certain that this condition occur within the womb and is not caused by any nurturing device. I say that this is a medical condition. Just like some people are born with ambiguous genitalia, some people are born with the wrong gender. Since the man who researched this condition did it with such great respect and dedication to our community, I think that we should honor him with our known condition as the Benjamin Syndrome or Benjamin's Syndrome. :)

Sincerely,
Traci

Traci, even if things happen in the womb, it doesn't mean all TS's will be linked to these event. That's why saying that this proves TS in general is caused by this unique case is very iffy, the cause could be medical, but multi-factorial. As I say, what if your a TS and you don't have that flavor of defect, are you delusional? Does it matter if we know the precise medical cause, or it there are any. Does it change how you feel?

I think for a lot of people it is a closure point of the why and how we became who we are. I am sure that within the next 20 years we will get a better scientifically based explanation than what we currently have.

Gender Identity Disorder  :P

Quote from: Yvonne on May 29, 2007, 10:22:42 PM
Gender Identity Disorder  :P

Gender Incongruity Disorder.   ;)

Quote from: Tink on May 29, 2007, 06:54:26 PM

Quote from: Amy T. on May 29, 2007, 03:36:29 PM

Quote from: Tink on May 27, 2007, 06:59:17 PM
I usually go by what is listed on the DSM since this is the only official, recognized manual that gender therapists (are supposed to) use to diagnose GID.  Of course, you can always call it whatever you imagine it to be..........never mind.  >:D

My choice:  Gender Identity Disorder


tink :icon_chick:

Of course most therapist working in the field have ignored the DSM for quite some time, and the only reason even the SoC recognizes the coding is because it has to. They largely view the GID diagnosis as prejudiced and inaccurate.   Even the SoC uses the less prejudiced ICD-9 definition, which is Transsexuality.  Also if you read some of the dialog for the DSM-V it will probably lose the stigma of a "mental disorder" and will probably be considered a "syndrome" with psychological aspects. Basically if you are thinking the DSM is any way accurate, you really need to read it clearly, and have a better grasp on the technical language. We are not crazy people, we are not disordered.

Is this a personal attack, Amy?  FYI,  I work in the medical field, I have read the DSM more than once, and I am very familiar with technical language.  I stand by what I said previously.  However, based on what I have read from you on different threads, it is pretty obvious to me that you and I do not suffer from the same disorder.

tink :icon_chick:

Thats the problem with the DSM.  It is too inflexible, too inaccurate.  It is built on a very narrow view of TS that is built on misogynistic views on femininity.  So what my gender identity issues took on a nerdy feminist leaning, does that make me any less TS? No.  Is this unusual or wrong? No it proves that having these narrow definitions that the DSM reinforces that there are major issues with the DSM itself.  If anything the DSM needs to be brought up to do date, and be put into context with current understanding.
Additionally the sexuality aspect of the DSM-IV needs to be dropped period.  I could go on with how this alone is a huge issue with the way the DSM-IV is written. 

The problem with the definition and the course of treatment is the fact it is MY people, LAWYERS, who determine exclusions.  As long as the DSM stands as it is written, as a DISORDER, especially when the course of treatment of HRT and SRS is stated as ineffective, I will have a major issue with the DSM.  But that is just the start of my issues with the DSM-IV.

Also I will say the issue with the DSM is the fact that transsexuality effects everybody differently.  Some of us do not fit clearly into the box the DSM-IV describes.  Everybody has a different life experience, and this effects everybody differently. While you may fit into the box of the DSM quite well, quite a few of us do not.   

On other boards, with younger TS, we often call this the "barbie" excuse. If you are on the trueselves board (which I have noticed takes a much heavier Transfeminist leaning, and tends to skew much younger) you would realize the major issues with just this section of the DSM.  If you didn't play with Barbie or extremely girly toys when younger, you were not TS. The very poor therapist have used this as an excuse to block treatment.  It comes from this part of the DSM:

In boys, the cross gender identification is manifested by a marked preoccupation with traditionally feminine activities. They may have a preference for dressing in girls' or women's clothes or may improvise such items from available materials when genuine articles are unavailable. Towels, aprons, and scarves are often used to represent long hair or skirts. There is a strong attraction for the stereotypical games and pastimes of girls. They particularly enjoy playing house, drawing pictures of beautiful girls and princesses, and watching television or videos of their favorite female-type dolls, such as Barbie, are often their favorite toys, and girls are their preferred playmates. When playing "house", these boys role-play female figures. Most commonly "mother roles", and often are quite preoccupied with female fantasy figures. they avoid rough-and-tumble play and competitive sports and have little interest in cars and trucks or other no-aggressive but stereotypical boy's toys. They may express a wish to be a girl and assert that they will grow up to be a woman. they may insist on sitting to urinate and pretend not to have a penis by pushing it in between their legs. More rarely, boys with Gender Identity Disorder may state that they find their penis or testes disgusting, that they want to remove them, or that they have, or wish to have, a vagina.

I could go into the problems with just this particular section. Tear it down by its inherantly misogynistic tendencies and discrepancies.  When I was younger I read Nancy Drew books, and I strongly identified with Velma from Scooby Doo.  This was before I was really clear on my gender identity while younger (and trust me it is not uncommon for TS to be unclear on there own gender identity issues at a young age, honestly when I was young I felt I was an alien or fairy or something put into a boys body and a mistake had been made, it was just how my young overly imaginative mind processed things).  I didn't know why I related, I just did.  I could go on about my entire childhood and the issues I faced, if you put the pieces together you would realize that even at a young age I faced this issue, it just manifested in ways outside of the narrow definitions of the DSM.

I could go on, this is not a personal attack.  My issue is with the narrowness of the DSM and those who buy into it as the only definition of TS.  Most therapist at this point have thrown it out and so has the SoC. They realize that TS as a group are as complex and diverse as women themselves. The only thing with the DSM in the SoC that is used is the code, the definition and diagnostic tool they use fall outside the DSM to encompass a better and more flexible understanding of TS.  The diagnostic elements and the descriptions have all but been abandoned for good reason.

Does this mean this issue does not effect me, far from it.  It just means I have been able to grasp the inherent issues with the DSM and the way it describes things.  I see it for the misogynistic and prejudiced claptrap it really is.  I see the inherent problems in the way it addresses things.  But most THERAPISTS who specialize in gender identity issues, see huge issues with the DSM.  That is why the SoC were changed.  They also have issues with it being called a disorder.

While you may fit into the box of the DSM, I see huge issues with it.  I am not the only TS who has huge issues with how the DSM describes things. I read through it and see that it is wrought with stereotypes, prejudice and misogyny.  While you may fit nicely into that box, not everybody does.   

You were saying earlier you preferred the older SoC, the truth is the SoC moved on for a reason, largely because it moved beyond stereotypes.  You may fit into these neat little boxes.  But every individual is different, and the DSM to me is flawed for this reason, TS is not as narrow as it portrays.  Not all TS women play with barbie when they are younger, and not all TS women fit into narrow definition, just like how not all women in general do not fit into narrow definitions.  We are all different.  As it stands the DSM-IV lacks flexibility, it sees TS through a very narrow lens. 

Like I said, I don't suffer from a disorder.  I suffer from a physical condition, a syndrome.   I plan on treating my physical condition, even if the DSM calls it a disorder.  According the the DSM-IV, SRS and HRT as a course of treatment are called into doubt, including for you.  I seriously doubt that is actually the case, alas, another flaw with the DSM.

I am not saying ALL of the DSM is flawed.  Trust me I fit into quite a bit of the diagnosis.  (Peer ostracism, effeminate behaviors and speech, social avoidance and detachment, avoidance of rough play, disgust of genitials when I was younger for example).  But the truth is, as it stands there is significant problems with the DSM-IV.  There needs to be significant changes as it is currently written, it does need to be brought in line with the SoC.  The stereotypes need to be dropped, I am sorry but Barbie should not even be mentioned.  The DSM needs to reflect the SoC.  It needs to recognize that HRT and SRS are effective treatments, and the course of treatment from the standards of care needs to be written in. 

I am militant about it because I realize the DSM as currently written is mostly 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 also realize that while we may suffer from the effects of depression and anxiety, we do not suffer from a lifelong disorder where we cannot function in society.  Out of everything in the DSM, this is the one diagnosis that is most effectively treated, yet the DSM does not state the treatment as effective. 


Just because I do not see it as a disorder, does not make me any less TS.  You see yourself clearly fitting into a box.  I see the box itself as an issue.  The thing is I am not suffering from any disorder.  I am a TS female, I am suffering from a physical defect that can be treated to a point. 

Just because I do not fit well into the neat little misogynistic archaic box of GID that some TS seem to be attached too, does not make me any less TS.  The way I see it, is that the SoC and other diagnostic tools that have moved away from the old definitions have come a long way in recognizing the real issues.  A TS woman can be as much a militant feminist lesbian as Julia Serano as the classical architype of a woman trapped in a mans body.  It could be somebody who is outspoken, or it could be somebody who chooses to live in the obscurity of deep stealth. 

The point being is TS and gender identity issues do not come in narrow ranges.  As it stands the DSM-IV presents a very narrow and very outdated way of viewing things and the way it is currently written would exclude many TS.  There would be several TS, who are now happy and without regret that would have never gotten treated if the DSM-IV was used and the SoC did not exist.  That is why the SoC are followed and the DSM is largely ignored with regards to TS with regards to many gender therapist.  That is why the DSM-V will probably be pretty close to the SoC, and the "disorder" term will probably be dropped. 

Don't question my gender identity, or my dedication, my gender identity issues, or the fact I am Transsexual. Because I will take that is a personal attack.  I am extremely critical because I don't take things for face value.  If I did, would I even be posting on this board.   

We are still both TS according to the SoC.  The difference is I come from a modern perspective on these issues, and you seem to be content with fitting into and accepting  the archaic definitions that I view as misogynistic and trans-misogynistic. To me the SoC was a HUGE improvement because it dropped the stereotypical aspects that were previously there and adopted a clear cut definition of TS that took into account how much diversity there is with how transsexuality effects us, as well as how diverse the personalities of women themselves can be. We are all a bit different, TS women, are a diverse group, with diverse personalities.

You like the old SoC and the DSM-IV because you fit clearly into it.  Quite a few of us do not however, in fact view those old definitions as problematic because they do rely on stereotypes.  Please recognize that.  That does not make us any less women, or any less TS.  Also understand that there are huge issues with the DSM-IV, and just because you seem to fit with the DSM, does not mean the criticisms are not well justified. 

Hear, hear!

From some of the official descriptions it is often too hard to see that this is ultimately not a mental disorder but rather a neurological condition that can be alleviated by medical treatment. This is a real problem.

On the other hand, it is understandable to some extent that it is labelled the way it is: the ultimate causes of the syndrome are still not really understood that well, so it is easier (not to mention safer) to describe it in terms of symptoms. Also, and more importantly, some of the symptoms can also be caused by real psychological disorders. Since the treatment is really quite radical (you cannot reverse GRS or some of the effects of HRT), it is important to start with ruling out these disorders -- even though some of the currently suggested diagnistic criteria are rather flawed.

  Nfr

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

I say drop the narrative altogether.  The SoC did and it was all the better for it.

Again, I stress, the sexuality portion as it is currently written, is extremely flawed as well. 

The DSM-IV regarding GID is extremely flawed.  This is something that can be clear, simple, concise and descriptive.   I think the 6th edition of the SoC does a very good job.  It is not perfect, but it is as close as it is going to get to being an effective diagnostic manual.   I would prefer it if the DSM just had in big words: Refer to current edition of The World Professional Association for Transgender Health Standards of Care. 

I have read so many instances of the DSM-IV being used as the lone diagnostic criteria and as a result the therapist using it against their transgender patient.  These were often therapist who were unaware of the SoC, with very little expereince with gender identity issues.  It is part of my core arguement against the DSM, most trans folk DO NOT fit clearly into the narrative and that the sexuality aspects of the DSM is problematic. 

I could go on deconstructing the issues with the DSM-IV.  Like I stated earlier, most competant gender therapist have long since tossed it aside in favor of the SoC.         

I picked Gender Identity Disorder.  After I shared TG issues with my wife she has referred to me as having mental illness.

This Labor Day weekend my youngest daughter asked me if TG was a genetic disorder.  I was not sure what answer to give her.  However that term sounds better than mental illness.

why do we even bother with this discussion?  fact is, they're all stupid labels.  if a person is considering blowing their brains out because of this dysphoria, disorder or whatever, i really don't give a damn how you call it.  what difference does it make? ???

Quote from: Katia on May 30, 2007, 06:46:40 PM
if a person is considering blowing their brains out because of this dysphoria, disorder or whatever, i really don't give a damn how you call it. 

I call that painful... very painful.  Sorry Katia.

Quote from: Katia on May 30, 2007, 06:46:40 PM
why do we even bother with this discussion?  fact is, they're all stupid labels.  if a person is considering blowing their brains out because of this dysphoria, disorder or whatever, i really don't give a damn how you call it.  what difference does it make? ???

It had to be you, you, you, and only you....Ditto! :) (subject closed by me at least )


tink :icon_chick:

Quote from: Ell on May 30, 2007, 11:19:36 PM
where would we be without the standards of care? if they hadnt been there, i personally would have been reaching for something without a diagnosis. rather than transitioning, id probably be in a hole somewhere. yes, the established medical community is going to be able to make some money from our suffering. well? they dont work for free. and in return, we get standards of care, ongoing research, medical legitimacy as viable patients in need, rather than weirdos, and most importantly, we get a chance, at least, to become ourselves. i say thats a pretty fair deal.

I agree.  Some of us, like myself, come from countries like Argentina where the DSM and the Standards of care are the only guidelines gender specialists rely upon.  Without these guidelines we couldnt get into treatment, receive hormone therapy and genital surgery.  It would result in the suicide of many trans girls.  I chose gender idenity disorder too.

Quote from: Pia on May 31, 2007, 12:28:00 AM

Quote from: Ell on May 30, 2007, 11:19:36 PM
where would we be without the standards of care? if they hadnt been there, i personally would have been reaching for something without a diagnosis. rather than transitioning, id probably be in a hole somewhere. yes, the established medical community is going to be able to make some money from our suffering. well? they dont work for free. and in return, we get standards of care, ongoing research, medical legitimacy as viable patients in need, rather than weirdos, and most importantly, we get a chance, at least, to become ourselves. i say thats a pretty fair deal.

I agree.  Some of us, like myself, come from countries like Argentina where the DSM and the Standards of care are the only guidelines gender specialists rely upon.  Without these guidelines we couldnt get into treatment, receive hormone therapy and genital surgery.  It would result in the suicide of many trans girls.  I chose gender idenity disorder too.

I do agree there needs to be guidelines for medical treatment, but that does not mean it has to be classified as a mental illness (as it is now).
I personally have very few issues with the SoC, but even the SoC are moving away from the "Gender Identity Disorder" and mental illness concept. 
It is a medical condition, but it is NOT a mental illness.  I am not mentally ill, and neither are you.  Having guidelines for treatment is important regarding the ability to access care.  But treating it as a mental disorder, well that lends its hand toward further stigmitization and is a big reason why insurance companies in the US do not cover this.

I could go on, but I think very few people voting for Gender Identity Disorder have a grasp on the problem of it being called Gender Identity Disorder or it being considered a mental illness.  It certianly is a medical condition that needs treatment guidelines, but it being  considered a mental illness is more harmful then helpful.   

Gender Identity Disorder

Trust me I know how it is to be closeted.  Being closeted about who we are is what causes many of the issues with regards to depression.  The thought that to become who we are it would be devastating.  The thought that it could not be done.  But above all else the shame, the guilt, the fear, over who we are and how society views us.  Ultimately who we are wins out.  We are men and women with the wrong bodies.

By the way here is the 2003 APA roundtable on gender variance and transsexuality.  It suggests that the DSM-V will likely be the biggest leap forward for trans people with regards the medical establishment.

http://www.tsroadmap.com/info/div-44-roundtable.html

This is easily my favorite section, and represents a huge leap forward in thinking:

The very name, Gender Identity Disorder, suggests that cross-gender identity is itself disordered or deficient. It implies that gender identities held by diagnosable people are not legitimate in the sense that more ordinary gender identities are, but represent perversion, confusion or defective development. This message is reinforced in the diagnostic criteria and supporting text that emphasize difference from cultural norms over distress, and Daryl talked about many of those a minute ago. Under the premise of "disordered" gender identity, self-identified transgender women and transgender men are reduced to mentally ill "men" and "women" respectively. This intent is underscored throughout the supporting text in the GID section, where the subjects are offensively referred to by their natal sex and not by their own experienced gender.
Distress and impairment became central to the definition of mental disorder in the DSM-IV, when a generic clinical significance criterion was added to most categories, including criterion D of Gender Identity Disorder.
Unfortunately, no specific definition of distress and impairment is given in the GID diagnosis. The supporting text in the DSM-IV-TR lists relationship difficulties and impaired function at work or school as examples of distress and disability with no reference to the role of societal prejudice as the root cause. Prostitution, HIV risk, suicide attempt, and substance abuse are described as associated features of GID, rather than consequences of discrimination and shame. The DSM does not acknowledge the existence of healthy, well-adjusted transsexual or gender variant people or differentiate them from those who could benefit from medical treatment. GID currently makes no distinction between the distress of gender dysphoria and that caused externally by prejudice and discrimination.
Conflicting language in the DSM serves to conflate cultural nonconformity with mental illness and pathologize ordinary behaviors as symptomatic. The Introduction to the DSM-IV-TR states: "Neither deviant behavior .... nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of dysfunction."
However, in the supporting text of the GID diagnosis, behaviors that would be ordinary or even exemplary for natal women and men are presented in Criterion A as symptomatic of mental disorder. These include passing, living and a desire to be treated as ordinary members of the preferred gender. And I'll stress the word "ordinary". Adopting ordinary behaviors, dress and mannerisms of one's own experienced gender is termed "preoccupation" for diagnosable adults and adolescents. It is not clear how these same behaviors can be pathological for one group of people and not for another.

and this:

Consequently, medical coverage for sex reassignment surgery procedures are extremely rare in the U.S. today. Since gender dysphoria is not unambiguously defined as a condition to be treated, procedures that relieve its distress are all too easily dismissed as cosmetic and elective by insurers, employers, HMO's, and governments. In order to receive medical and surgical treatments, gender dysphoric people must first receive a referral from a mental health specialist who has completed a psychosocial evaluation. Referral for medical services require a diagnosis of GID. Consequently, GID has become a desired "admission ticket" for transgender and transsexual people seeking medical treatment.
It is quite difficult to develop an authentic therapeutic relationship with a client when the initial diagnostic evaluation casts the clinician in the role of gatekeeper who controls access to medical treatments. In response to this, they're are emerging treatment philosophies based on a model of educated self-determination, where gender variance is respected and clinicians serve as advocates and educators as well as evaluators of mental health. For example, in the early 1990's the Tom Waddell Health Center here in San Francisco, developed a new culturally competent approach to the treatment of gender dysphoria for homeless individuals. It incorporated the following principles, which were adopted by the Denver based Colorado Coalition for the Homeless Stout Street Clinic in 1999. And they are:
· Assuming that most TG people are sane and responsible
· Recognizing cultural/social factors that affect care
· Promoting a respectful, non-pathologizing approach
· Rejecting a label of TG Identity as sexual perversion
· Adopting a model of informed consent and harm reduction for treatment
In conclusion, we would like to propose that GID be replaced in the nosology of mental disorders with a diagnosis based on distress, and having the following characteristics:
· Defined unambiguously by distress with one's physical sex characteristics or their associated social roles.
· Excludes social gender nonconformity and ordinary, normal behaviors and expressions as symptomatic of mental illness.
· Excludes consequences of societal prejudice or intolerance as symptomatic
· And excludes reference to sexual orientation as symptomatic
· It should clearly differentiate those who are diagnosable and may benefit from treatment from those who are not
Just as DSM reform reduced stigma and fear surrounding same sex orientation thirty years ago, reform of the Gender Identity Disorder diagnosis holds similar promise today. It is possible to define a diagnosis that both reduces the stigma of gender difference while legitimizing the medical necessity of sex reassignment treatment for gender dysphoria with criteria that are clearly and appropriately inclusive. Thank you so very much.



In 2011 we will realize how this 2003 APA roundtable was historic.  The year the DSM-V appears, we will be seen not as mentally diseased individuals, but individuals who need medical care, but are sane functioning human beings.  While there is psychological EFFECTS from transsexuality as a result of incongruety, we are not mentally ill and it is clear from this roundtable the DSM-V will not treat us as mentally ill, and there will be clear medical guidelines that state the medical necessity of HRT and SRS. 


So basically if you read this Gender Identity Disorder will become Gender Identity Distress.
Distress is not a mental disease, but rather a psychological side effect from a physical condition. 

Who are we trying to fool?  We're mental, insane, crazy, out of it, off the wall, disordered, whacked out ~laugh~  does it matter what I think?  I'm sure the gender specialists don't.  At least I'm where I want to be now even if they call me "mental".  Gender identity disordered gal here.  ~laugh~ :laugh:

I'm with you Butterfly.
So i'm crazy, metal, insane I don't care. >:D
Let the sane people be afaird, I plan to be happy. ;D
Jillieann

ROFL!   ;D  I have to agree with Butterfly and Jillieanne.  Be aware, there's nothing more twisted than a mentally ill fairy!  LOL  ;D  >:D

tink :icon_chick:

Oh my I'm glad your on myside ........ I'm on yourside.
Jillieann

I like GEDAD,

Deprevation of gender expression - though I feel dysphoric when i can't express myself any which way.

QuoteDistress is not a mental disease, but rather a psychological side effect from a physical condition.

Very nice!  I concur completely.

The more I think about this thread, I'd add that calling it syndrome is slightly better than disorder, however it is only a step. I don't wish to have my life defined as merely a medical condition. Who I am is also a conscious choice, a political understanding and a spiritual awakening to the complexity of gender. It is demeaning to have that reduced to a disorder or syndrome.

zythyra 

Quote from: zythyra on June 03, 2007, 09:06:52 PM
The more I think about this thread, I'd add that calling it syndrome is slightly better than disorder, however it is only a step. I don't wish to have my life defined as merely a medical condition. Who I am is also a conscious choice, a political understanding and a spiritual awakening to the complexity of gender. It is demeaning to have that reduced to a disorder or syndrome.

zythyra 

Do we consider it a disorder or syndrome based upon the emotional stigmas that go along with being TG/TS? If this is the case, then could it be possible that the syndromes or disorders aren't from being TG/TS but from shame, guilt, and embarrassment that we go through due to societal expectations? If that is possible then wouldn't being TG/TS just a part of the human condition just as being gay or lesbian is? If this were determined then we would lose some support for our prescriptions and procedures as they are currently dealt with. So that brings the question of do we hang on to old ideals and stereotypes in order to work the system or do we recognize being TG/TS simply as who we are and nothing more?

QuoteDo we consider it a disorder or syndrome based upon the emotional stigmas that go along with being TG/TS? If this is the case, then could it be possible that the syndromes or disorders aren't from being TG/TS but from shame, guilt, and embarrassment that we go through due to societal expectations?

Renae, you've brought up an important point. I believe it's very difficult to separate the pain of being transgendered from the traumas we experience by societal and external pressures. Imagine if from early childhood our gender differences were celebrated, and we were encouraged to openly express our gender without fear of negative repercussions!

Of course, I don't wish to see things classified in a such a way to deny a person the medical treatment they need and desire, but as the system is now, most insurance policies don't cover medical treatments for TS and TG people.

zythyra