There's been a lot of talk of late about GID and it's listing rightly or wrongly in the DSM.  As many know the DSM is in review and many if not all members here should be concerned about the outcome.

So lets say that you are on the panel that is looking at GID.  What are your recommendations and why?

And lets try and keep the "I'm not crazy, who do they think they are!" replies down to a bare minimum.

-={LR}=-

I would recommend that it be excluded. I don't think enough is known about the feelings that are diagnosed as GID and the causes of them to include it. Not enough hard science goes into it. There is too much baggage and politicising involved in the creation of the DSM and really I think it is a waste of space on your book shelf. I don't think it helps anyone.

I also dislike how the DSM can be used by people without clinical training and incompetent or inexperienced mental health professionals to decide who is and who isn't in 'the club' when clearly it is not comprehensive enough. It gets viewed as the only truth when in reality it is fallible and should only ever be seen as a guide at best. There is an assumption that the people that write it have all the knowledge. They don't. It is a best they could do all things considered kind of thing.

I think the DSM works best as a classification, not a coding tool i.e. the trained professional makes a 'diagnosis', then uses the book to give it the right code which is understandable by other health professionals That is to say the book should not be a diagnostic tool itself, mearly a simple shorthand. I suspect this is really the intent of the DSM. It is given too much emphasis. It should be clear that this is not a difinitive list of mental disorders, it is just a way of giving some of them a code. It does not take account of the complexity of mental illness.

My recommendation is more research, think about it next time. Consider abolishing the DSM altogether or produce better guidelines for it's use. I would also recommend transparency in it's creation.

I'm not concerned about the diagnoses being required to get certain treatments as it does not apply in my country (we don't follow it here, it is mostly an American toy).

More of an insurance device than a toy.

My insurance excludes GID so having it in the DSM is retarded for me. I think it needs to be removed due to the fact that its not a mental disorder. They cannot prove it physically so it must be mental right? And since they hold the keys, they are going to fit us all into tiny little boxes they define with no wiggle room for error.

Its so silly to even try to group people together like that. We are all unique, just like everybody else.

Sorry, my choice of words was a bit off hand. I do realise that it can have a significant impact on things like insurance in your country. Just wanted to note that it was not a universal thing.

Not having it in the DSM would mean a lot of insurance money would not have to be paid out, and they would be all over that.

The way some people behave on these forums I can subscribe to the fact that it is a mental and physchotic disorder, perhaps we should all be locked up in Guantanemo bay when the last terrorists are finally released and the key thrown away.

If I was a Physchiatrist reading some of the posts, I would never reccommend anyone for treatment.

Rather than the medical profession arguing and debating what and how transsexualism is classified a better use of time would be to agree a harmonized and standard treatment, which is applied uniformally across the globe and to get insurance companies to agree that it is a treatable illness covered by insurance.


Buffy

While I agree more research is needed, I think GID should remain as a valid mental disorder.  Other mishaps of the mind are included in the DSM for which there is a biological base, I don't see why GID should be excluded - especially since there isn't conclusive research showing a biological component yet.

I think defining it and its common traits (even the unpopular ones) is very important.  That will be difficult to do as the GID experience seems to vary from individual to individual, however there are some definite common traits. 

With regard to treatment, transition might be the only viable treatment at present, but coming to greater understanding of the disorder might provide more avenues of treatment.

It somewhat depends, regarding insurance. The ICD codes, not DSM, cover visits to my endo and my hrt prescriptions. As long as there is a formal process under WPATH and the American system is as messed up as it is, some plans will cover care and some won't. Having it in the DSM isn't a guarantee of coverage, nor is not having it a guarantee that there's no coverage.

As for non-Americans -- well, the DSM matters, because it influences the ICD.

LR, there have been several threads about this (largely about the Zucker involvement) -- so you find some discussions by using the search function. As for me, I don't know whether it is better to leave it in or take it out. For me it hinges on whether it's a legit medical condition or psychological disorder, or just a normal variation in human experience; i.e., it depends what you call "normal."

G.I.D. is not a mental disorder, it causes mental disorders.
That is why so many of us are crazy. 

*Disclaimer* I'm not saying GID is compatible to schizophrenia in any other way than stated here within. No, I'm not saying we're dangerous to the health of others but sometimes, untreated, GID can lead to suicide. I'm simply drawing this analogy for the reference to genetics. */disclaimer*

I've started this answer repeatedly;
The thing is, there's no way that I can organize this inside my head that makes me think that my issues aren't "mental" at least as well.
That is to say, yes, I believe the problem originates from a biological standpoint, but so do a lot of things. Depression for one is considered to run in the family and as such should have a biological component, but no one's going to argue that depression isn't in the mind as well. Same goes for a lot of other mental disorders and issues, schizophrenia can be inherited, and no one's going to argue that that is not a mental illness.

I don't enjoy the idea that I'm mentally ill, no one does, but at least then it's written, black on white, that I have this problem and that it's not just something I've "thought up" or some matter of personal belief. My problem being that my mind doesn't match my body is documentable, verifiable, and something that I can ask for help with. I didn't choose it, create it, or any such thing.

Then there's that question. If it is simply a biological thing and not a mental thing what so ever then Why does it affect me mentally? Would I be able to expect mental support through the system and not just "here, have a pill" reactions?

I have another biological problem. I have fibromyalgia, and a part of that is overwhelming and chronic fatigue and pain, as well as a foggy-like mental state. The pain is physical, the fatigue is physical, and you can argue that the fog is physical, but all these things combined cause me emotional, intellectual, and otherwise mental problems. I have a near constant feeling of inadequacy simply because I can not keep up with most other people. I get so tired and worn out at the end of the day that I have moments where I just break down into tears and fall asleep as a consequence of that simply because there's nothing else I "can" do.
My fibromyalgia is a physical diagnosis, but a part of it's manifestation, the depression, the feelings of inadequacy, issues with language (sometimes I loose words, sometimes I say the wrong one, sometimes I'm not even sure what language I'm speaking), etc, etc, etc, all of that, is a mental manifestation.
A mental problem.

I don't like having mental problems.
No one does.
No one likes to admit to themselves that they do.
The insane don't know they're insane and all that.

But... I can't deny that all this stuff that goes on in my head is mental, and with GID the manifestation seems solely mental. That is to say, there doesn't appear to be anything "Physically" wrong with any of us that warrants a sex-change.
Our genitals work.
We don't all suffer horrible physical pain from this.

If a condition, even if physical in origin, manifests solely as mental issues, then shouldn't we consider it mental? Like we do with many conditions, that manifest as mental problems, inspite their suspected/proven physical origin.
Schizophrenia is genetic...

Just for the record. Schizophrenia, in some cases, does appear to have a genetic component. And although schizophrenia is more fully explored than probably any other mental illness with the possible exception of Depressive Disorder, there are still only perhaps 3-4 generations of people that can be surveyed in terms of possible hereditary causation.

Many people who develop schizophrenia have no apparent hereditary connections to it. The vast, as in 97% or so do not develop paranoid-type schizophrenias that cause violent reactions to others. Most of the people (and there have been a lot) of schizophrenics I have worked with are rather docile, sometimes cause harm to themselves, tend to smoke an inordinate amount and are much of the time locked away in an internal environment that pretty much closes them off for great periods of time to the world that surrounds them.

The other truly amazing thing that's been discovered with schizophrenics (at least the samples who've experienced fMRIs) is that they use, on a regular basis, close to 100% of their brain capacity whereas "normals" use only somewhat less than 20%.

Schizophrenic symptoms can be very disconcerting to those who do not work closely with schizophrenics and often cause fear that the schizophrenic will cause harm to another. Like I said the instances are extremely rare for that.

Of all the sections of the DSM, perhaps the most used and certainly the sections that have the most evidentiary compilations are those that deal with schizophrenia (and other psychotic disorders), various depressive disorders and bi-polar disorders (mood disorders.) In those regards the DSM is an extremely valuable resource for clinicians. Another such encyclopedia is Kaplan & Sadock's Synopsis of Psychiatry an extraordinary concise and fully-fledged reference for professionals.

In point of fact in the opening statements of the DSM, often missed by those who are looking for a particular diagnosis to either research or see if they qualify for inclusion for that diagnosis, is the fact that the DSM allows clinicians to speak a universal language and to compare notes and observations on patients in a way that can allow a clinican who speaks only French, for instance, to discuss cases with one who speaks only American, for instance.

According to the DSM itself, the purpose is not to pathologize but to treat effectively.

This is definitely true of the disorders I listed above. It's less true of the many personality disorders, anxiety disorders, somataform disorders, factitious disorders, sexual disorders, gender id disorders, impulse-control disorders and adjustment disorders that also comprise sections of the DSM.

Every revision of the DSM brings into play the interests of insurance corporations and also pharmaceutical corporations for the purposes of treatment, payment, medication therapies (some of which need disorders for which they can be prescribed) and there is a huge influence of things like profit and income (where is there not?) in the putting together of the DSM. There are also political issues and cultural issues that partake of the process as well.

Is DSM some "perfect and unbiased" textbook? No, but then it was never meant to be. It's major purpose was to list defining parameters and provide that common language/common definition reference for clinicians. As well it is NOT a "book of treatment" although it does have notes that indicate the places one can find possible treatment approaches for it's various listings.

That doesn't mean that lay-readers cannot understand it (although it does take some study to do so) nor does it mean that all clinicians use it in ways that mirror it's stated intent for usage.

One's feelings about GID or any of the other GI disorders and syndromes notwithstanding the DSM can be extraordinarily useful for clinicians, and it compiles huge gobs of information and research that are mostly unpracticable for a clinician to sit and read in full and still be able to do her or his work as well.

Babies and bathwater as ever. The DSM is NOT some horrendous "Protocols of the Elders of Zion"-like tome. And regardless of your thoughts up there at the top, Nicky, it is most certainly used in NZ and most other places where mental health clincians work and practice. It may not form the basis in all of those places for diagnosis of GID, but it is used, a lot.

Nichole 

Quote from: Buffy on May 26, 2009, 12:53:20 AM
The way some people behave on these forums I can subscribe to the fact that it is a mental and physchotic disorder, perhaps we should all be locked up in Guantanemo bay when the last terrorists are finally released and the key thrown away.

If I was a Physchiatrist reading some of the posts, I would never reccommend anyone for treatment.

Rather than the medical profession arguing and debating what and how transsexualism is classified a better use of time would be to agree a harmonized and standard treatment, which is applied uniformally across the globe and to get insurance companies to agree that it is a treatable illness covered by insurance.


Buffy

So say the first gendertherapist that examined me and the behavioral scientist of the gender clinic. I have still gained much from treatments so it is not so simple.

What Buffy, Interalia, Miniar and Nichole said I'll second.

I think the biggest issue here is along the following lines. Some just don't want anyone telling them what to do or how to do it or how to go about doing things.

There seems to be a fair amount of I'm me, I'm special, put me at the front of the line and I'll write my own treatment plan; going on here.

I've had some dealings with the DSM. As others have stated its a resource tool. Designed to provide a common language for those who treat those with GID. It does give a "lower level" therapist the ability to say, "this case is beyond my expertise. I'm sending you to a "shrink."

The DSM isn't perfect, nothing scientific is perfect. The updates though are meant to add for public use, what the medical community has discovered since the last edition.

A little more fuel for the fire. Why do I have this feeling that those most oppossed to the DSM and SOC type documents have also never read them for themselves?

Along the lines of those who go it alone. I wonder what a survey of those dissatified with SRS, FFS or other GID surgeries would show. If asked, and verified, did you stick to standard protocols? Or did you take short cuts? ie self medicate, forge letters. Have you lied to your therapist about other psyc.. issues? Depression, bi polar, addiction etc?

Is the therapist that has themself as a client, a fool?

Probably so... the DSM isn't perfect, but at least serves as a starting point.

Mich'

Nichole,

I gather from your comment that you would have GID remain in the DSM. If I am correct in that, why is GID different from homosexuality that it should be in there? I'm not suggesting they are the same, just wondering what the criteria for inclusion would be, and whether at some point after a change in societal mores it might merit removal, even if you think it should remain in now.

Also, while I can't argue with your assertion that the DSM isn't intended to pathologize, I get the feeling that many people don't understand that, which is part of the reason that it was important to remove homosexuality. (Or maybe I'm misunderstanding history.) Anyway, I'm curious about your thoughts.

One other thing -- what exactly does it mean to "use 20% of your brain capacity"? Is that measured by volume? Does that mean there are parts that are never used, or just that at any time 4/5 of your brain is idle? It's one of these things you hear about, but is not usually stated very clearly.

~Alyssa

Quote from: Alyssa M. on May 26, 2009, 06:56:36 PM
One other thing -- what exactly does it mean to "use 20% of your brain capacity"? Is that measured by volume? Does that mean there are parts that are never used, or just that at any time 4/5 of your brain is idle? It's one of these things you hear about, but is not usually stated very clearly.

~Alyssa

My understanding that everyone uses the majority of their brain from the white to the grey matter, to the musculature to the aquaducts.  Sure, neurons, or what we consider the "thinking cells" of the brain are hardly the majority of brain matter, the rest of the brain is just as important in ensuring those neurons are functioning properly.

The 10% thing is a myth - not sure Nichole's 20% number.

Quote from: Miniar on May 26, 2009, 08:15:59 AM
I don't like having mental problems.
No one does.
No one likes to admit to themselves that they do.
The insane don't know they're insane and all that.

But... I can't deny that all this stuff that goes on in my head is mental, and with GID the manifestation seems solely mental. That is to say, there doesn't appear to be anything "Physically" wrong with any of us that warrants a sex-change.
Our genitals work.
We don't all suffer horrible physical pain from this.

If a condition, even if physical in origin, manifests solely as mental issues, then shouldn't we consider it mental? Like we do with many conditions, that manifest as mental problems, inspite their suspected/proven physical origin.
Schizophrenia is genetic...

Wow that was well said. I agree so much with what you said.  I would like to ask a question though.

Do physical needs cause mental needs? In other words is there a physical problem we are not conscious of that is causing a mental condition that we are aware of?

I have always wondered why a person born physically male would

a)desire cross sex hormones
b)acquire them
c)take them and
d) love them

and vice versa for a female born person.

It makes no sense to do this. The masses may be curious what it is like to be the opposite sex but they don't require hormones. I gotta have em. There has to be a physical need that is causing my mental state to find and take these wonder drugs. There must be something driving that need.

Think about when you are hungry. I mean starving. Like you have not eaten in a week. That physical need will change your mental needs and in turn change how you behave. You will be driven to find food. Nothing will stop you and until that need is met, your 1 goal will be to find food.

Being TS is like that for me. Until I have HRT in my SYSTEM all I think about, want, plan for and do is figure out a way to get it, and get it into me. I'm driven and cannot stop the process. I'll go mad if I'm denied. I go nuts without me E. Its all I want when I'm off of it and I love it when I'm on it.
Why?

I say it is a physical need that drives the mental process.

Quote from: Alyssa M. on May 26, 2009, 06:56:36 PM
Nichole,

I gather from your comment that you would have GID remain in the DSM. If I am correct in that, why is GID different from homosexuality that it should be in there? I'm not suggesting they are the same, just wondering what the criteria for inclusion would be, and whether at some point after a change in societal mores it might merit removal, even if you think it should remain in now.

In terms of how the book and its definitions are currently used then yes, I am all for keeping the GID component in the DSM, and adding the biological findings of the past 10 years, that Zucker and Blanchard resist mightily, to give a fuller picture of the natural occurrence of transsexuality/->-bleeped-<- as part of human variance.

If it were currently socially acceptable and passable at this time I'd be all for removal and making a classification that would cover "disorders of being treated like pariahs within a binary culture."  

I'm thinking that we are not quite yet to that point, Lyssa.

In the meantime we do need coverages for at the least medication costs and at least minimal transitional changes to be covered by insurances and alleviated by medical professionals. The gatekeeping, covering my ass-ness of interactions between medicos and shrinks in terms of GID is going to take some time to dismantle and remake. In the meantime anything that gets people assisted in their transitions and getting info that they need is a net help, imo.

We need the professionals to change the ways they look at us. Not for them to just say "good riddance." BTW, not all "homosexual disorders" have been removed from the DSM. Wouldn't surprise me if Blanchard isn't pushing for a new one to be added: "homosexual transsexuals" and to exclude again all TSes who are "heterosexual" in his taxonomy or "bisexual" which he rejects as even being possible. 

QuoteAlso, while I can't argue with your assertion that the DSM isn't intended to pathologize, I get the feeling that many people don't understand that, which is part of the reason that it was important to remove homosexuality. (Or maybe I'm misunderstanding history.) Anyway, I'm curious about your thoughts.

Lots of people, including FontheF and others of their ilk, many therapists or at least therapists in training and transsexuals use the book to pathologize, at least if they can, lots of people.

There's a point that the practitioner needs to see that the "diagnosis" isn't the person and that no one ever exhibits every symptom in any "diagnostic manual." In and of itself that should clue a lot of TSes that if you get 7 of15 (for instance) over a period of 6 mos (whatever) that's usually enough to confirm a diagnosis. Having 15 of 15 is usually taken as prima facie evidence that the patient has read the manual and is claiming symptoms she doesn't actually have. Just the way diagnosis works.

But diagnosis, like it or not often pathologizes on the basis of socio-cultural prejudices (homosexuals were one.) Here's another possibility.

Young man presents to child/adolescence therapist. He's 12 y/o,  his parents are AA, father and Cauc, mother. Family reports 3 family moves of 200 mi. + in 12 years and ct. has attended six schools.; Two were for moves and 4 were conduct related. Hx of violent anger, throwing objects, breaking things at home, fights at school and "disrespect" for authority figures both at home, school and within the community.

Child is not adjusting to his new school environment and is characterized by teachers and non-communicative, non-cooperative and hostile. Of 120 school days so far in the school year, Ct has been absent 10 and in ISS 86 due to fights and being disruptive to school discipline and order.

The child will often be "diagnosed" with anti-social personality disorder. Yet, teasing for his "mixed race" parentage, repeated family moves during childhood and his general inability to reach some level of "safety" to build relationships, have a solid base of operations for his psyche and life etc. would make me discard that almost immediately and refuse to list such a diagnosis. 

Why? Even though he fits the criteria? Because to label a young man of color with ASP at 12 is to condemn him to eternal relegation to society's margins. He will never get the groundings he needs and his bitterness and isolationn and alienation, and resentment will grow, not decrease with that diagnosis.

Like it or not a practitioner who's actually dedicated to "doing no harm" must take into acct things such as that. An adjustment disorder is much more humane, gets him treatment and not censure and leaves the child a chance for change and a decent life. It's far more important for the patient to be helped rather than diagnosed. What I have to do is be able to use the book to do so.

Alas, the nuance is lost on many. Most, it seems to be lost on people with deeply religious viewpoints and many transsexuals ourselves. (That is not necessarily odd, some of the least accepting drug addicts are those that are using AA/NA to recover.  

QuoteOne other thing -- what exactly does it mean to "use 20% of your brain capacity"? Is that measured by volume? Does that mean there are parts that are never used, or just that at any time 4/5 of your brain is idle? It's one of these things you hear about, but is not usually stated very clearly.
~Alyssa

What I meant with my statement was that under various stimuli while in an fMRI machine tested schizophrenics show close to or at 100% "lighted" areas without visible indications that they are being "psychotic" at that time.

"Norms" show about 20% "lighted" areas under the same conditions. The evidence appears to lead one to a couple of possible notions. 1) That psychosis may well be involved with psychic overload of the synapses in an overwhelming way. 2) That more brain areas appear to be able to be used than "normal" folks ever seem to find uses for. Schizophrenics do find uses for those areas. 

Schizophrenics do find uses for those areas. 

But perhaps they are not good uses.  Any mechanic knows that any engine run at 100% burns out very fast indeed.  That people may be only using 20% at any given time, does not mean its the same 20% over and over, or does it?

Most things need more research.  Given what is available, structural differences in male & female brains, homosexuals, transexuals, etc, maybe it should be reclassified as a medical issue, like intersex (to me, it seems like a form of intersex, but that's my personal view, clouded by my rational approach to forming my opinions).

As it is now in the U.S., it serves no insurance purpose to list it in the DSM.  Insurance here is a mess anyway.  Defending it for that reason is pointless.