Mental Health Professionals use this manual when working with patients in order to better understand their illness and potential treatment and to help 3rd party payers (e.g., insurance) understand the needs of the patient.Do you bit your nails? Well that could be listed in the DSM under Obsessive Compulsive Disorder (300.3). Do you smoke pot? That is also in there (292.89) (See below for a video about smoking cannabis). Most people think that the DSM list mental illness, but it does not, it is a list of problems that a person might see a therapist for. And therein lays the problem for trans-people, the stigma of being diagnosed with something in the DSM.
AllPsych On-line
The APA is in the process of coming out with another addition of the DSM, version 5. Last spring (2010) they scraped the name Gender Identity Disorder (GID) and relabeled it Gender Incongruity (GI), now this spring they are calling it Gender Dysphoria (GD). For crossdressers they changed the name to Transvestic Disorder from Transvestic Fetishism. So what is the proposed change in the DSM, not much. It is still has a sex stereo typed view of gender and while GI had an exit clause, GD does not for an out trans-person like me. If you want to transition and be assimilated back into the closet, then you can lose the GD diagnosis. For crossdressers, sorry you went from having a fetish to a disorder.
Kelly Winters has an excellent write up about the changes here.
I don’t think there’s any question that there is a whole lot in the DSM that shouldn’t be in there, behaviors pathologized that shouldn’t be. The transgender condition provides an interesting challenge, though, for a couple different reasons.
ReplyDeleteAs it is the “T” in LGBT, there’s a temptation to compare it to sexual orientation as regards the DSM. And they eventually got off of their asses and took homosexuality out of the DSM *clap-clap*, so shouldn’t the transgender condition come out too? Maybe, but here’s the difference. There is nothing inherently painful about being homosexual. The pain and anguish that some homosexuals experience doesn’t come from the fact that they are homosexual, it comes from the fact that other people are douchebags about it. Certainly, trans-people deal with douchebags as well, but unlike homosexuals, those douchebags aren’t the sole source of our pain. The condition itself is painful. Even if everyone in the world were nice to us, having the wrong body is still a source of discomfort. And anyone trans knows that’s a pretty mild way of putting it.
On a different level, thinking somewhat pragmatically, we’re slowly seeing an increase in the number of medical insurance companies that will pay for gender reassignment surgery, and that is a very very good thing. If there is no inherent problem, if it not an intrinsic source of pain and discomfort, then the surgery would be considered elective, cosmetic, not necessary. I very much disagree, and I’m sure many other transsexuals do as well.
Not saying I have an answer, but it is a sticky situation where we should tread lightly and think long-term.
RC
Rhiann
ReplyDeleteWhat you have said is true, but there are other ways to get treatment and surgery without having to be diagnosed with GID or GI or GD or whatever the APA ends up calling it.
Kelly Winters discusses the alternatives in the web page that I mentioned. Also Moonhawk River Stone said "Moonhawk River Stone, a transman and psychotherapist in the Albany, N.Y., area, puts it bluntly: "Using a psychiatric diagnosis to help people access health care is like calling a plumber when you need an electrician. 'Gender Identity Disorder' is an inadequate and inappropriate descriptor of transgender experience.
"My approach as an original thinker on this issue is not to storm the barricades of the DSM but to get people to change their thinking," he adds. "Developing a new paradigm that allows people access to health care and to be able to move on productively with their lives is what's really important. I think it's more fitting for transgender people to access health care through development of an overarching ICD-9 medical diagnosis"—a more general clinical description—"that would allow people access to care."
Well, that certainly sounds nice, hopefully one day it won’t feel so necessary to play the game to get treatment. I’m in complete agreement with you that there is a serious disconnect between the nature of the label and the actual condition. In what other situation does a psychiatrist say, “You clearly have a psychological condition; I’m recommending genital surgery.” Something’s a little off there.
ReplyDeleteI too have resented the idea that there’s something wrong with my mind. Rather, there’s something wrong with my body. I don’t have a mental disorder; I have a physical disorder which I think of as descended ovaries and clitoral gigantism. Naturally, that’s what I’m interested in correcting.
Thanks for the links. Take care,
RC