Susan's Place Transgender Resources

Gender Incongruence to replace Gender Identity Disorder - maybe!

Anyway, the APA DSM-5 diagnosis team has posted its proposed revisions and notes on chances coming up in the new DSM-5.

Here's the linkies.

Oh, and you can click on the tabs labeled, "Proposed  Revision," "Rationale," "Severity," and "DSM-IV"

Proposed  Revision is an outline of the changes they would like to make. Rational contains reasons why they changed what they did as well as notes. Severity is just a basic set of questions for psychatrists to ask to figure out how sever it is. DSM-IV (4) is there for a reference point.


Gender Incongruence (in Adolescents or Adults)
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193# (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193#)

Gender Incongruence (in children)
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=192# (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=192#)

Wow! This is great stuff!

QuoteThe change also makes it possible for individuals who have successfully transitioned to "lose" the diagnosis after satisfactory treatment. This resolves the problem that, in the DSM-IV-TR, there was a lack of an "exit clause," meaning that individuals once diagnosed with GID will always be considered to have the diagnosis, regardless of whether they have transitioned and are psychosocially adjusted in the identified gender role.

I liked this bit in the rationale:

Quote3. It has been recommended by the Workgroup to delete the "perceived cultural advantages" proviso. This was also recommended by the DSM-IV Subcommittee on Gender Identity Disorders (Bradley et al., 1991). There is no reason to "impute" one causal explanation for GI at the expense of others (Zucker, 1992, 2009).

As if, in the case of MTFs, being female had any long-term "cultural" advantages in the real world.  I would say that, practically speaking, it could put you at a cultural disadvantage, glass ceiling and greater chances of being a victim aside.  It's good that this is actually being considered for removal.  I imagine FTMs would also have their own issues with this...but I'll leave that for them to comment on.

I dunno though...maybe it's just my own cynicism at work. :)

Quote from: Renate on February 11, 2010, 06:15:05 AM
Wow! This is great stuff!

What they are saying in effect is surgical intervention addressing the genitalia (or other areas) will cure the disordered mind.  That of course means the problem does not lie in the mind but rather in the body.  It's what many of us have been saying all along.  And if it is a physical problem and not a mental problem it doesn't belong in a book of mental disorders.

I will take from this something I posted on Zoe Brain's blog and here in another thread,

"I will now be able to say, 'I used to be mentally disordered then I had vaginoplasty and now I'm not.'"
Most people would scratch their heads hearing that. 

And it's the brilliant minds of the task force, reparative therapist Ken Zucker (http://en.wikipedia.org/wiki/Kenneth_Zucker) included, who allowed me to come to this conclusion.

Quote from: Julie Marie on February 11, 2010, 12:50:49 PM
I will take from this something I posted on Zoe Brain's blog and here in another thread,

"I will now be able to say, 'I used to be mentally disordered then I had vaginoplasty and now I'm not.'"
Most people would scratch their heads hearing that.

It makes perfect sense if the disorder of the mind was caused by stress relating to not having a vagina. Wouldn't it be lovely if we could cure all metal disorders so easily?

JulieMarie

If that is what they are saying then it is a positive step forward.

Whatever problems I have in my mind emanate from the ugly bit between my legs.

I'm sure that it the same for most people im my position.

Sadly, I trust these weasels about as far as I can spit.

Just remember, this is only a draft.  You'll have to wait til 2013 to see the approved publication.

Whilst I like the fact that the new exit clause means I no longer get included in the diagnosis I am still of the opinion that total removal is by far and away the best option overall, because as many others have already observed the logic of curing a mental disorder by treating the body seems just a teeny bit cockeyed!

It might seem cockeyed, but I don't see why that's a problem. One could just as easily say that it seems cockeyed that a condition whose only symptoms are stress, social discomfort, and possibly suicide should be called a medical condition rather than a mental disorder. But who cares? Unless one stigmatizes one over the other, it shouldn't matter on either account.

Nature loves creating exceptions to our rules. In a world that has animals that photosynthesize and plants that don't, indeed a world that has humans with female brains that produce male gametes, why should we have any problem accepting the possibility of a mental disorder that is treated by conventional medicine?

"The world of our imagination is narrower and more special in its logical structure than the world of physical things." -- Max Born

Gender Incongruence seems to subtly move the disorder from the mind to the body, which lines up better with how my mind frames this whole situation.

Hmm... Interesting.

It's sounding like "Yeah, it's not a disorder... but there's nothing physical we can diagnose on, and the written guidelines for your treatment have to go somewhere, so we might as well as leave 'em in the book with all the other things we can't physically diagnose in it..."

Lovin' the exit clause. I dig that. "Problem solved" for those that transition fixed the issue, and (also importantly) the oppertunity for continued help for those that transition did NOT fix the issue.

Look at the sections it is still right next to.....

It is obvious that it is still considered to be sexual dysfunction and paraphillia by the committee.

Crap that is less crap is still crap.

You can call a big steaming pile of dog crap whatever you want, it never changes the fact that it smells in the sunlight.

Quote from: Vision on February 12, 2010, 08:35:47 AM
Look at the sections it is still right next to.....

It is obvious that it is still considered to be sexual dysfunction and paraphillia by the committee.

Crap that is less crap is still crap.

1) Definitely not a paraphelia -- Gender Incongruence is listed separate from those.

2) There is active discussion of moving it elsewhere altogether...

Quote from: DSM5 Draft
19. The subworkgroup has had extensive discussion about the placement of GI in the nomenclature for DSM-V, as the meta-structure of the entire manual is under review. The subworkgroup questions the rationale for the current DSM-IV chapter Sexual and Gender Identity Disorders, which contains three major classes of diagnoses: sexual dysfunctions, paraphilias, and gender identity disorders (see Meyer-Bahlburg, 2009a). Various alternative options to the current placement are under consideration.

Interesting point about other sections within the Sexual and Gender Identity Disorders (http://www.dsm5.org/ProposedRevisions/Pages/SexualandGenderIdentityDisorders.aspx) category -- consider the following:

Quote
*Sexual and Gender Identity Disorders with No Change from DSM-IV
     625.8 Female Hypoactive Sexual Desire Disorder Due to a General Medical Condition
     625.89 Male Hypoactive Sexual Desire Disorder Due to a General Medical Condition
     607.74 Male Erectile Disorder Due to a General Medical Condition
     625.0 Female Dyspareunia Due to a General Medical Condition
     625.89 Male Dyspareunia Due to a General Medical Condition
     625.8 Other Female Sexual Dysfunction Due to a General Medical Condition
     625.89 Other Male Sexual Dysfunction Due to a General Medical Condition
     302.70 Sexual Dysfunction Not Otherwise Specified
     Substance-Induced Sexual Dysfunction

So ...  I guess there are a bunch of other mental disorders that might be treated through conventional medicine. How about that?

There is an analog to physics. The brain is a body part, last I checked.  The only reason we put the treatment of its dysfunction in a different scientific category than the rest of the body is because we have such a limited understanding of how it really works.

Well, there is also the problem that what is a solution for one may not work on the next person.  It's not like a broken bone where there is a standard way to treat it, and it seems to get better all things being equal.

Quote from: Teknoir on February 12, 2010, 07:47:58 AM


Lovin' the exit clause. I dig that. "Problem solved" for those that transition fixed the issue, and (also importantly) the oppertunity for continued help for those that transition did NOT fix the issue.

The exit clause exists because the gatekeepers, or psychologists know that we're not coming back post-op anymore, because many of us didn't need them in the first place except to get our letters etc. Since we're not a source of further income to them, they've got nothing to lose by saying that we're cured. Plus, now they can say we're normal and "fixed" all because of them!

Can we ever win?

Quote from: juliekins on February 12, 2010, 04:32:15 PM
Plus, now they can say we're normal and "fixed" all because of them!

They must love transpeople. There are so few mental disorders that can actually be fixed. It must be a really depressing job being a shrink... and then suddenly you have a set of patients whom you can appear to cure (becuase they weren't really crazy to start with) - no wonder they want to keep the condition in the list... It gives them at least one thing they can at least appear to succeed with.

Or am I being cynical again? ;)

Quote from: pheonix on February 12, 2010, 01:58:56 PM
1) Definitely not a paraphelia -- Gender Incongruence is listed separate from those.

2) There is active discussion of moving it elsewhere altogether...

Sorry but i have to disagree:

Gender Identity Disorders
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
302.6 Gender Identity Disorder Not Otherwise Specified

Paraphillias
302.4 Exhibitionism
302.81 Fetishism
302.89 Frotteurism
302.2 Pedophilia
302.83 Sexual Masochism
302.84 Sexual Sadism
302.3 Transvestic Fetishism
302.82 Voyeurism
302.9 Paraphilia Not Otherwise Specified


.85 comes right after .82 - .84 and before .9 so it is definitely right in the middle of them.

Cynic is just a word that dreamers thought up to describe realists.

Well, it's still listed in a book of mental disorders.  And society still creates stigmas for people they think are mentally disordered.  And it still thinks discrimination of the mentally disordered (and anyone else who isn't "normal") is okay.  So as long as it remains in the book, it will be that much longer before society begins to accept the physical condition soon to be labeled (maybe) gender incongruence.

If you like the prejudice and are okay with the discrimination then you can be happy with the new proposed changes.  If not, then you have a lot of work to do.

As for me, if the proposed exit clause stays, I'm cured.  ::) Now all I have to do is get the rest of society convinced I'm no longer crazy.

Quote from: Julie Marie on February 12, 2010, 05:59:30 PM
Well, it's still listed in a book of mental disorders.  And society still creates stigmas for people they think are mentally disordered.  And it still thinks discrimination of the mentally disordered (and anyone else who isn't "normal") is okay.  So as long as it remains in the book, it will be that much longer before society begins to accept the physical condition soon to be labeled (maybe) gender incongruence.

If you like the prejudice and are okay with the discrimination then you can be happy with the new proposed changes.  If not, then you have a lot of work to do.

As for me, if the proposed exit clause stays, I'm cured.  ::) Now all I have to do is get the rest of society convinced I'm no longer crazy.

I'm probably going to get in trouble for saying this, but.

I think the trans community itself does FAR more damage to our public perception than the medical community could ever do.

I'm not going to name names or go into any specifics, but there are a LOT of people in the transgender community including here on susans who would not be behaving normal in the context of either gender, arguing that normal is subjective (which is true) and thus excusing the behavior.

I think people should be free to do what they want to be happy as long as it isn't actually hurting anyone, but the facts are that we live in a society that does have expectations and does have a subjective sense of normality and I think that the "transgender community" is more harmful in our acceptance in mainstream society than being in the DSM could ever be.

Well, there is also the problem that what is a solution for one may not work on the next person.  It's not like a broken bone where there is a standard way to treat it, and it seems to get better all things being equal.

Right.  Because we don't understand the brain well enough.  I'm not suggesting we ever will, by the way.


..many of us didn't need them in the first place except to get our letters etc.

I definitely did not need counseling.  It was such a complete waste of time and money.  Most expensive letter I ever bought. :\

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Quote from: Ashley4214 on February 12, 2010, 06:32:52 PM
I think the trans community itself does FAR more damage to our public perception than the medical community could ever do.

I'm not going to name names or go into any specifics, but there are a LOT of people in the transgender community including here on susans who would not be behaving normal in the context of either gender, arguing that normal is subjective (which is true) and thus excusing the behavior.

For society, normalcy can be simply defined as the familiar.  A large section of society fears the unknown and feels they must control it by defining reality unrealistically in hard-edged black and white terms.  Within the parameters of those rules they have "truth" and feel safe.  If you challenge their truth they can react violently because you have, in effect, threatened their safety.

The catch-22 is the only way to get inside the "box of normalcy" is to be visible and be harmless and let the b/w peeps get used to you.  You have to take your lumps to be free of their wrath, unfortunately.

In my opinion, the goal of the gender rights movement should be to get people used to the fact that gender is not binary, so that all of us -not just one narrowly defined segment of the gender spectrum- can be safe and have equal footing in this world.  So I feel pretty strongly that people who kind of hang out in gender's gray areas, and thus stand out, actually do a lot of good for the cause.  Much more, in fact, than those who disappear into the woodwork.  Those who become invisible don't do the rest of the trans community any good, until/unless they become visible again.

But that is fine and their prerogative.  In fact, if that path becomes a possible choice for me, I'm not going to say I won't take it.

Quote from: Jen on February 12, 2010, 06:47:22 PM
In my opinion, the goal of the gender rights movement should be to get people used to the fact that gender is not binary, so that all of us -not just one narrowly defined segment of the gender spectrum- can be safe and have equal footing in this world.  So I feel pretty strongly that people who kind of hang out in gender's gray areas, and thus stand out, actually do a lot of good for the cause.  Much more, in fact, than those who disappear into the woodwork.  Those who become invisible don't do the rest of the trans community any good, until/unless they become visible again.

The problem comes with those of us who are trans but are actually perfectly happy and content with the gender binary and don't like being made out to be total freaks by the segment of the transgender community that wants to push the boundaries and defy normal far beyond simple binary gender.  ::)

I don't want to be visible, I hate being what I am, what do I or other people who feel as I do get out of the association with the highly visible side of the transgender spectrum?

It's like the old question of what do gays and lesbians get out of being associated with transgender, and with the same answer, nothing.

Quote from: Ashley4214 on February 12, 2010, 07:56:18 PM
what do I or other people who feel as I do get out of the association with the highly visible side of the transgender spectrum?

That's sort of what I was trying to explain ~.^  Not that I feel anything I said should necessarily ring true for you, I was just giving you a different perspective.

How do non-conforming people help you?  By being visible yet harmless, they effectively, bit by bit, open people's minds that gender is more complicated than they thought, and that it is okay.  If enough people aren't out there opening minds though, it's not going to have a global effect.

That doesn't mean anybody should be expected to fight or be out there, but we should respect and be thankful for those who do.

If it's worth anything, I happen to conform pretty well to the gender binary too.  Not by choice, it's just the brand of gender I've been handed.

Quote from: Jen on February 12, 2010, 08:16:25 PM
That's sort of what I was trying to explain ~.^  Not that I feel anything I said should necessarily ring true for you, I was just giving you a different perspective.

How do non-conforming people help you?  By being visible yet harmless, they effectively, bit by bit, open people's minds that gender is more complicated than they thought, and that it is okay.  If enough people aren't out there opening minds though, it's not going to have a global effect.

That doesn't mean anybody should be expected to fight or be out there, but we should respect and be thankful for those who do.

If it's worth anything, I happen to conform pretty well to the gender binary too.  Not by choice, it's just the brand of gender I've been handed.

I guess I don't agree. Most normal people, certainly most normal people my age, if they pay any attention at all to transgender community nonconformity it's that of ridicule. And I wouldn't care except that when they find out my situation all they'll have to go on to start with is the way non-conformists behave.

I hate being what I am
Get over that, and the rest comes easy.

After all I don't let some gun tottin' person define my life, why let others define yours?

Quote from: Jen on February 12, 2010, 08:16:25 PM
That doesn't mean anybody should be expected to fight or be out there, but we should respect and be thankful for those who do.

If it's worth anything, I happen to conform pretty well to the gender binary too.  Not by choice, it's just the brand of gender I've been handed.

I happen to agree on both counts.



Now what I do not understand in all of this is that Gender Incongruence sounds like a rather benign term, a descriptive term that is less "judgmental" sounding than GID.  However, as Julie pointed out, it is in a book of mental disorders.  If fixing a person's body is the primary cure, how can they consider this a mental disorder?   And since it is (sort of) no longer considered a mental disorder, what will this do to the question of insurance coverage or lack thereof? 

Personally, I am sure they have seen way too many people be fixed by a surgical procedure to doubt the effectiveness.  However, the inclusion, the exit clause, and the rest seem to me to be nothing other than a CYA operation and a money making scheme.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fganjataz.com%2F01smileys%2Fimages%2Fsmileys%2FloopyBlonde-blinking.gif&hash=4545ddf8251cf9c32ae6074d56e48bc34a755857)Kristi

heh ya nothing is set in stone but i doubt the draft will change much.  i'm loving the distinction the committee has made between transsexualism & shall we say ->-bleeped-<-? not "better" but for damn sure different which is something some of us have been saying for years & years.

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193# (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193#)  (click on 'rationale')

emphasis mine.

"16. Although the DSM-IV diagnosis of GID encompasses more than transsexualism, it is still often used as an equivalent to transsexualism (Sohn & Bosinski, 2007). For instance, a man can meet the two core criteria if he only believes he has the typical feelings of a woman and does not feel at ease with the male gender role. The same holds for a woman who just frequently passes as a man (e.g., in terms of first name, clothing, and/or haircut) and does not feel comfortable living as a conventional woman. Someone having a GID diagnosis based on these subcriteria clearly differs from a person who identifies completely with the other gender, can only relax when permanently living in the other gender role, has a strong aversion against the sex characteristics of his/her body, and wants to adjust his/her body as much as technically possible in the direction of the desired sex. Those who are distressed by having problems with just one of the two criteria (e.g., feeling uncomfortable living as a conventional man or woman) will have a GIDNOS diagnosis. This is highly confusing for clinicians. It perpetuates the search for the "true transsexual" only, in order to identify the right candidates for hormone and surgical treatment instead of facilitating clinicians to assess the type and severity of any type of GI and offer appropriate treatment. Furthermore, in the DSM-IV, gender identity and gender role were described as a dichotomy (either male or female) rather than a multi-category concept or spectrum (Bockting, 2008; Bornstein, 1994; Ekins & King, 2006; Lev, 2007; Røn, 2002). The current formulation makes more explicit that a conceptualization of GI acknowledging the wide variation of conditions will make it less likely that only one type of treatment is connected to the diagnosis. Taking the above regarding the avoidance of male-female dichotomies into account, in the new formulation, the focus is on the discrepancy between experienced/expressed gender (which can be either male, female, in-between or otherwise) and assigned gender (in most societies male or female) rather than cross-gender identification and same-gender aversion (Cohen-Kettenis & Pfäfflin, 2009)."


GIDNOS diagnosis huh?

GIDNOS = a non-transsexual GID considered as GID-Not Otherwise Specified

While it's true they may acknowledge a "clear difference" in the rationale, one certainly doesn't have to be "Über Transsexual" to get diagnosed as GI with the proposed changes.  There seems to be much less obstruction between diagnosis and moving on to figuring out how best to treat the person, which seems to be left open-ended.

I like all of that.  Focus on treating the patient according to their needs rather than focusing on whether they are worthy of a certain path of treatment -seems like a winning plan to me. :D

GIDNOS seems to me to be getting phased out with the proposed changes, though it's possible I'm just getting cross-eyed with sleep deprivation.

Does anybody else think it should be "Gender Incongruity" rather than "Gender Incongruence?"  It just rolls off the tongue better. :)

Quote from: Julie Marie on February 11, 2010, 12:50:49 PM
What they are saying in effect is surgical intervention addressing the genitalia (or other areas) will cure the disordered mind.  That of course means the problem does not lie in the mind but rather in the body.

Extreme paraphilias (a mental disorder in the DSM) are often treated by castration.  Does the fact that the removal of the testes provide relief from the disorder imply that it is not a mental disorder?  No it doesn't.  I'd be careful making the assumption that treating the body disqualifies something as a mental disorder.

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Post Merge: February 13, 2010, 03:45:38 AM

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Quote from: Alyssa M. on February 12, 2010, 02:54:28 PM
Interesting point about other sections within the Sexual and Gender Identity Disorders (http://www.dsm5.org/ProposedRevisions/Pages/SexualandGenderIdentityDisorders.aspx) category -- consider the following:

So ...  I guess there are a bunch of other mental disorders that might be treated through conventional medicine. How about that?

Basically yeah... you are making the case already.

My Exit visa was stamped and actioned nearly three decades ago.

As for people pushing the gender boundaries I think I may have to respectfully disagree slightly. It may be different in the US - but here in the UK the trans community is actually most often ridiculed precisely BECAUSE they are so ultra stereotypically normal! Sometimes almost a gender carriacture.

If you look around you (at least in the UK) you will find loads and loads of men and women who aren't in any way trans and yet don't really fit the gender binary either... because it isn't a binary - it's a continuous spectrum, and what's more a continuous spectrum where more people exist towards the centre than at the ultra extreem ends.

After living most of my life as a postop woman, widely accepted at face value, I can assure you that even now that I am "out" I pass pretty darned well and one of the things which most people identify as something which makes them forget that I actually have a trans past is the fact that, as they put it, "I'm not afraid to break the rules on occasion." Which is something that they all see as normal and healthy.

So maybe I'm misunderstanding the original comment by Ashley, but personally I think just being yourself and being comfortable with that is the real way to both the exit visa and indeed mass acceptance.

Quote from: rejennyrated on February 13, 2010, 05:59:07 AM
My Exit visa was stamped and actioned nearly three decades ago.

As for people pushing the gender boundaries I think I may have to respectfully disagree slightly. It may be different in the US - but here in the UK the trans community is actually most often ridiculed precisely BECAUSE they are so ultra stereotypically normal! Sometimes almost a gender carriacture.

If you look around you (at least in the UK) you will find loads and loads of men and women who aren't in any way trans and yet don't really fit the gender binary either... because it isn't a binary - it's a continuous spectrum, and what's more a continuous spectrum where more people exist towards the centre than at the ultra extreem ends.

After living most of my life as a postop woman, widely accepted at face value, I can assure you that even now that I am "out" I pass pretty darned well and one of the things which most people identify as something which makes them forget that I actually have a trans past is the fact that, as they put it, "I'm not afraid to break the rules on occasion." Which is something that they all see as normal and healthy.

So maybe I'm misunderstanding the original comment by Ashley, but personally I think just being yourself and being comfortable with that is the real way to both the exit visa and indeed mass acceptance.

There is defying normal gender roles, which is fine and common to the point of it being actually uncommon to completely conform to gender norms. Then there is defying even normal gender nonconformity.

For instance, being interested in sports and cars is gender nonconformist for females. That's not what I'm talking about.

Ironically I think what I'm talking about in part is the same thing you're talking about only under different names.

I don't really want to get into exactly what I'm talking about as far as behavior or views that defy even the normally abnormal, because several here on the forum do it and I'd rather not get into too much trouble.

But no, that's not what I was talking about.

oh ok then... I did think I might have missunderstood you. So thanks for clarifying :)

A man walks into his boss's office and says he's tired of being the janitor.  He works hard, fixes everything that's broken in the building and gets no respect.

His boss says, "You're right.  I'm going to promote you to maintenance engineer, and put a plaque on your door with your name and the title 'Maintenance Engineer' on it."

He thanks his boss and walks out of the office feeling great about his promotion.  What he missed was he didn't get a raise and he was still doing the same job.  Only his title had changed.

We are getting "promoted" from gender identity disorder to gender incongruence.  But nothing else has changed, unless you've happily transitioned.  And you'll have to go to a book of mental disorders to prove you no longer have a mental disorder.  ???

BTW - Anyone who wants to be considered having a mental disorder is free to do so.  All you have to do is walk into a therapist's office and say you are unhappy.  They will find what's wrong with you and let you pay them to treat you.  But please don't argue on behalf of the rest of us who don't want that stigma attached to us.  We'll do just fine without it.

If you think about it, according to the new guidelines, the exit clause is happiness, isn't it?  You can transition, find you are happy enough without surgery and stop there and still be "psychosocially adjusted in the identified gender role" can you not?

Thinking about this some more I think I understand (I don't know about agree with yet) the belief that there is a fundamental difference between somebody who can stop short of surgery and be happy and somebody who can't.  Just because of the tension that exists, I'm not going to go into the details.

For myself, I can't see stopping short of surgery being an option.  Because of the trajectory I'm on, right now I'm plenty happy.  If I were to lose inertia, however, I would very quickly cease to be happy.  I can't see that changing until I'm 100% female.  But who knows, I might surprise myself for all I know.

I have a therapist I really like. She helps me a lot with things, some unrelated to gender issues. That doesn't mean I am mentally ill. My physical condition will be cured soon. I do have psychological issues that stem from having to deal with the physical condition, which I think is normal considering the nature of the affliction. Once the physical condition has been fixed however, that will go a long way towards healing any associated psychological trauma.

There does seem to be a fundamental difference because there are so many variations and ways of looking at this. The only right one is what's right for you, which is why it's impossible to quantify for everyone. There are many types and many cures. Sometimes it's fatal. Sometimes the cure is worse than the disease. I feel quite binary personally, although born on the wrong end physically, which is why I will never feel complete without surgery. That will cure my medical condition, but we all have to determine our own path to happiness.

I'm just going to pick this one bit out, though a similar sentiment runs through many of the posts on the last page:

Quote from: Julie Marie on February 12, 2010, 05:59:30 PM
Well, it's still listed in a book of mental disorders.  And

society still creates stigmas for people they think are mentally disordered.

And it still thinks discrimination of the mentally disordered (and anyone else who isn't "normal") is okay.  So as long as it remains in the book, it will be that much longer before society begins to accept the physical condition soon to be labeled (maybe) gender incongruence.

[Um ...  emphasis mine ...]

Here's a suggestion:



Okay, what the hell? Doesn't this seem like the heart of the problem? What the hell is wrong with society -- with some of us -- that we're so damned prejudiced against people with mental disorders and afraid to be labeled with that awful stigma? One might hope that in realizing that society has problems in the way it tries to force people into gender boxes they don't belong in, one might also realize that society (or at least many segments of our society) has a couple of other problems like, oh, I don't know, racism, sexism, classism, discrimination on the basis of national origin, looks, age, physical or mental disabilities, and even -- what a shock! -- whether someone has a mental disorder, even ones with clear and treatable physical causes, even ones that are "Due to a General Medical Condition" (according to the DSM).

Instead of saying, "Hey, I'm no freak, I'm not 'mentally ill,'" [which having a condition listed in the DSM does not imply -- there's a very important, if sometimes hazy, distinction between mental illnesses and mental disorders,] why don't we ask "What the hell is your problem with people with mental disorders?"

As I said in another thread on this subject, many, many people -- as in, closer to half of the population than to one percent -- have or have had diagnosible mental disorders, as listed in the DSM. In fact, it might be a lot higher than that. Depression triggered by really bad times in a person's life is still a mental disorder. It's like being sick: everyone gets sick from time to time; a very large portion of the population will have a serious, even life-threatning, illness or injury at some point in life. It doesn't define them as people, and neither should having or having had a mental disorder. It's simply a condition that causes anguish and loss of functionality, and that might indicate benefit in seeking treatment of a mental health professional, though many times you don't need it.

I'll agree that trans folk of all types often do harm to our own public (though I think it's fairly rare since most people aren't paying attention anyway). But perpetuating bigotry on the basis of mental health issues doesn't solve that problem; it only aggravates it.

Thank you Alyssa! The bigotry against people with mental health issues was really starting to get upsetting.

Quote from: FairyGirl on February 13, 2010, 03:39:59 PM
I have a therapist I really like. She helps me a lot with things, some unrelated to gender issues. That doesn't mean I am mentally ill. My physical condition will be cured soon. I do have psychological issues that stem from having to deal with the physical condition, which I think is normal considering the nature of the affliction. Once the physical condition has been fixed however, that will go a long way towards healing any associated psychological trauma.

There does seem to be a fundamental difference because there are so many variations and ways of looking at this. The only right one is what's right for you, which is why it's impossible to quantify for everyone. There are many types and many cures. Sometimes it's fatal. Sometimes the cure is worse than the disease. I feel quite binary personally, although born on the wrong end physically, which is why I will never feel complete without surgery. That will cure my medical condition, but we all have to determine our own path to happiness.

That puts my own thoughts into words better than I could.  Thank you :).

I feel I am in a very similar place as you, Chloe.

Anyway, this is such a gray area issue.  Most ways of looking at it have some validity.

Um and Alyssa, my oddball way of looking the whole thing is that a mental disorder is a brain issue- just like brain cancer is a brain issue.  The only real difference is stigma.  I'm so used to being stigmatized I don't even understand the aversion to it anymore.

With regard to the question of whether gender incongruity is a mental or physical problem, well I feel the answer is "yes," but I'll let y'all figure it out.  I'll go along with whatever the consensus turns out to be I think.

Sometimes I have a real problem with being able to see both sides of an argument.

Jen, I with your rejection of mind/body dualism. (Well, that's what you were implying.) It's obvious to me that there's a physical cause (though our present understanding of it is at best partial), and that there are significant mental consequences for those that have not transitioned.

Food for thought: the proposed and current definitions of "mental disorder" in the DSM:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465 (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465)

Quote from: Natasha on February 12, 2010, 10:36:26 PM
heh ya nothing is set in stone but i doubt the draft will change much.  i'm loving the distinction the committee has made between transsexualism & shall we say ->-bleeped-<-? not "better" but for damn sure different which is something some of us have been saying for years & years.

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193# (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193#)  (click on 'rationale')

emphasis mine.

"16. Although the DSM-IV diagnosis of GID encompasses more than transsexualism, it is still often used as an equivalent to transsexualism (Sohn & Bosinski, 2007). For instance, a man can meet the two core criteria if he only believes he has the typical feelings of a woman and does not feel at ease with the male gender role. The same holds for a woman who just frequently passes as a man (e.g., in terms of first name, clothing, and/or haircut) and does not feel comfortable living as a conventional woman. Someone having a GID diagnosis based on these subcriteria clearly differs from a person who identifies completely with the other gender, can only relax when permanently living in the other gender role, has a strong aversion against the sex characteristics of his/her body, and wants to adjust his/her body as much as technically possible in the direction of the desired sex. Those who are distressed by having problems with just one of the two criteria (e.g., feeling uncomfortable living as a conventional man or woman) will have a GIDNOS diagnosis. This is highly confusing for clinicians. It perpetuates the search for the "true transsexual" only, in order to identify the right candidates for hormone and surgical treatment instead of facilitating clinicians to assess the type and severity of any type of GI and offer appropriate treatment. Furthermore, in the DSM-IV, gender identity and gender role were described as a dichotomy (either male or female) rather than a multi-category concept or spectrum (Bockting, 2008; Bornstein, 1994; Ekins & King, 2006; Lev, 2007; Røn, 2002). The current formulation makes more explicit that a conceptualization of GI acknowledging the wide variation of conditions will make it less likely that only one type of treatment is connected to the diagnosis. Taking the above regarding the avoidance of male-female dichotomies into account, in the new formulation, the focus is on the discrepancy between experienced/expressed gender (which can be either male, female, in-between or otherwise) and assigned gender (in most societies male or female) rather than cross-gender identification and same-gender aversion (Cohen-Kettenis & Pfäfflin, 2009)."


GIDNOS diagnosis huh?

GIDNOS = a non-transsexual GID considered as GID-Not Otherwise Specified

By the old rules maybe, but look at the last part in detail.

The current formulation makes more explicit that a conceptualization of GI acknowledging the wide variation of conditions will make it less likely that only one type of treatment is connected to the diagnosis. Taking the above regarding the avoidance of male-female dichotomies into account, in the new formulation, the focus is on the discrepancy between experienced/expressed gender (which can be either male, female, in-between or otherwise) and assigned gender (in most societies male or female) rather than cross-gender identification and same-gender aversion (Cohen-Kettenis & Pfäfflin, 2009).

It means GID and GIDNOS will both fall under the heading of GI and that individuals will be treated based on individual needs based on the severity of their GI.

This means that rather than perpetuating the search for the "true transsexual" to meet specific criteria for a specific treatment method, instead the current definitions of GI will allow for a broader spectrum of people to experience what we formerly called GID and vary their treatment accordingly.

In a nutshell, the new changes will mean that more treatment options will be connected with the diagnosis of GI!

NEAT!  So our therapists will no longer feel forced or brainwashed into thinking that transition is the only way to fix GID for everyone.  That is a definite positive move.

Quote from: Ashley4214 on February 12, 2010, 07:56:18 PM
The problem comes with those of us who are trans but are actually perfectly happy and content with the gender binary and don't like being made out to be total freaks by the segment of the transgender community that wants to push the boundaries and defy normal far beyond simple binary gender.  ::)

No worries, those peeps that self-proclaim as 'freaks' e.g. 'mental cases', 'crazy', 'bonkers', 'cuckoo', 'nuts', 'deviant' will stay so once the DSM-5 is approved.  Those people that self-identify as 'freaks' will have their chance to remain a "freak" for life in just a few short years from today.  Their wish has been the DSM psychiatrists' command.  It's a done deal.  They asked for it.  They brought this upon themselves & now they've got it.  I fancy they will be celebrating from now on with all the other self-declared 'freaks' whilst people like me remain in the normal, boring part of society.

Me? very happy to be wholly female & part of that latter 'boring & normal' group. :laugh:

Quote from: Alyssa M. on February 13, 2010, 05:08:40 PMWhat the hell is wrong with society -- with some of us -- that we're so damned prejudiced against people with mental disorders and afraid to be labeled with that awful stigma?

The problem with society is they think we all need to fit into a certain mold so we're all the same.  People who are different scare them.  So they expanded the list of real mental disorders, such as pedophilia, to include anything the masses doesn't get, considers weird or is freaked out about. 

As long as you being different doesn't hurt anyone, why should anyone else care?  And is being different sufficient reason to classify your difference as a mental disorder? 

It all stems form societal phobias (a mental disorder found in the DSM). "If we accept gays, lesbians, trangenders, etc, it will be the end of a civilized society!  :o  Morality will become a thing of the past! :icon_nervious:  Satan will take over the world!  :icon_peace:" 

That's where the real problem lies.  But it's easier to try to change a few than the masses.  So our solution is to make anything the masses thinks weird a mental disorder.  :police:

Ummm... They are accepting us. And treating us. With surgery and hormones. They are not boogey men out to get us and they have certainly not done any of the horrible things that were predicted by people.

We are not in there because we are different or because society hates us. That's just rediculous. We are in there because every symptom of gender dysphoria (or whatever it's supposed to be called) is a mental one. The only people fit to recognise those symptoms are mental health proffesionals.

People can still transition. The world didn't end. You're being over dramatic.

Quote from: Julie Marie on February 14, 2010, 01:03:31 PM
And is being different sufficient reason to classify your difference as a mental disorder? 

No, but if it is accompanied by distress that is persistent then yes.

The way I read the revision is this, if you feel distress over the disparity between your internal gender identity and your primary and/or secondary sex characteristics then you have GI.  If you don't feel distress then you can be considered mental disorder free.   

This also means neither surgery nor hormones are necessary to obtain a "cure."  Only whatever it takes to make you feel better.

I like the change, it seems like a better and more reasonable approach.  I only worry with all the open-endedness that there will be more of a tendency for psychs to ask people that happen to already know without any doubt that they must transition to "prove it" moreso than we already did before.  I found that aspect beyond annoying.  I'd hate for it to be worse for future peeps.

Quote from: Birdie on February 14, 2010, 02:39:11 PM
Ummm... They are accepting us. And treating us. With surgery and hormones. They are not boogey men out to get us and they have certainly not done any of the horrible things that were predicted by people.

We are not in there because we are different or because society hates us. That's just rediculous. We are in there because every symptom of gender dysphoria (or whatever it's supposed to be called) is a mental one. The only people fit to recognise those symptoms are mental health proffesionals.

People can still transition. The world didn't end. You're being over dramatic.

If the they you are referring to is society in general, they definitely are NOT accepting us.  Every year there is held a Transgender Day of Remembrance.  Why?  Because of all the violence trans people have to face. 

If you are trans you are many times more likely to be the victim of violence than the average person. 

You are far more likely to be unemployed or under-employed if you're trans. 

Many states do not have any trans rights and those that do typically do not enforce them.  In some states you can be fired just because you're trans and it's perfectly legal. 

A high percentage of trans people have been fired once they came out.   Of those who are employed, most do not get medical coverage for transitioning.

Many trans people are rejected by family and friends and co-workers simply because they are trans. 

I wouldn't exactly say we are accepted.

As far as dysphoria is concerned, show me someone who lost their job, their family, their friends, who is discriminated against, who has to live with prejudice who isn't a bit dysphoric about that.  The dysphoria is the result of how we are treated.

What you're saying is like saying if you are unhappy you're locked in prison and being tortured you have a mental disorder because the guards of the prison say we do.

I don't accept the word of someone who says they are a professional just because they have a plaque to prove it.  These so called gender specialists learned about gender identity issues from us.  We taught them all they know about gender incongruence.  So who really is the expert?

Quote from: Julie Marie on February 14, 2010, 06:19:20 PM
If the they you are referring to is society in general, they definitely are NOT accepting us.

Nope, I was refering to the doctors in charge of the changes to the DSM, as well as the doctors that treat us and refer us to the myriad of specialists that we require. All of the issues you mentioned are issues that I'm acutely aware of, and none of them are the fault of our doctors. Redefining the condition is not the solution to transphobia.

QuoteWhat you're saying is like saying if you are unhappy you're locked in prison and being tortured you have a mental disorder because the guards of the prison say we do.

I'm sorry if I gave the wrong impression. That's not the message I was trying to get across. What I'm saying is if you are at risk of self harm, depression, self-esteem problems, family breakdowns, nervous breakdowns, social disorders, anxiety disorders or suicide because you hate your body, a gender therapist is going to be more help to you than a GP. Also, there is no physical test for Gender Whatever, so unless we want our diagnosis to hinge on our GPs measuring our finger lengths and carrying angles (you have to admit that's a funny mental image) we're going to need to rely on the opinion of people who have far more experience treating Gender Whatever, atleast until there is some serious evidence backing up our claim that it is a biological issue.

QuoteI don't accept the word of someone who says they are a professional just because they have a plaque to prove it.  These so called gender specialists learned about gender identity issues from us.  We taught them all they know about gender incongruence.  So who really is the expert?

All doctors learn about medicine from studying patients. That's pretty much where all medical knowledge comes from. Is there a better way for them to learn about us? Is learning about our condition directly from us a bad thing? I don't actually understand what you're angry about here.