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Should Doctors Still Consider Transgenders to Be Suffering a ‘Disorder’?

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders will soon be published, and with it come a slew of updates for medical professionals on what, exactly, “disorders” are. Whether somebody’s mental state is considered a disorder isn’t a silly little matter of clarifications; it can have consequences on insurance coverage, power of will questions, and stigmatization. The debate rages on for whether things like shopping addictions and binge eating should be included as official disorders, but for our kind, whether transgender people should be included — for “suffering” from a gender identity “disorder” — is a heated exchange.

Reports the NYT:

The debate over gender identity, characterized in the manual as “strong and persistent cross-gender identification,” is already burning hot among transgender people. Soon after the psychiatric association named the group of researchers working on sexual and gender identity, advocates circulated online petitions objecting to two members whose work they considered demeaning.

Transgender people are themselves divided about their place in the manual. Some transgender men and women want nothing to do with psychiatry and demand that the diagnosis be dropped. Others prefer that it remain, in some form, because a doctor’s written diagnosis is needed to obtain insurance coverage for treatment or surgery.

“The language needs to be reformed, at a minimum,” said Mara Keisling, executive director of the National Center for Transgender Equity. “Right now, the manual implies that you cannot be a happy transgender person, that you have to be a social wreck.”

Dr. Jack Drescher, a New York psychoanalyst and member of the sexual disorders work group, said that, in some ways, the gender identity debate echoed efforts to remove homosexuality from the manual in the 1970s.

After protests by gay activists provoked a scientific review, the “homosexuality” diagnosis was dropped in 1973. It was replaced by “sexual orientation disturbance” and then “ego-dystonic homosexuality” before being dropped in 1987.

“You had, in my opinion, what was a social issue, not a medical one; and, in some sense, psychiatry evolved through interaction with the wider culture,” Dr. Drescher said.

By:           editor editor
On:           Dec 18, 2008
Tagged: , ,

  • 24 Comments
    • aingeal
      aingeal

      We covered this topic for a couple of weeks in my sexual dysfunctions class (I’m a psych grad student) this past semester. Even had a panel of an MTF, FTM, and their sexologist counselor come speak. One argument that was made was that a sign of mental health is seeking to correct and alleviate distress and fully realize one’s personal identity. So in that light, a transgenered person seeking sex-reassignment surgery doesn’t have a “mental disorder,” but is showing signs of mental health.

      Dec 18, 2008 at 11:18 am · @ReplyReply to this comment ·
    • sam
      sam

      If one considers oneself in the “wrong” body, isn’t that a medical issue? I thought that was kind of the point. Perhaps the DSM-V isn’t the place for it, but I can’t really think of a better place for it.

      Slightly off-topic follow-up question: What does the trans community (in general) think of people with Body Integrity Identity Disorder, e.g.?

      Dec 18, 2008 at 12:10 pm · @ReplyReply to this comment ·
    • Tara
      Tara

      @aingeal: That assumes that people who are not TS are not happy as well.

      Dec 18, 2008 at 12:14 pm · @ReplyReply to this comment ·
    • Mike
      Mike

      I have to admit to being totally baffled by this. What does being able to be happy have to do with having a disorder? If trans people have a condition that they themselves wish to change (i.e. the wrong biological sex), doesn’t that mean that they themselves identify their bodies as “disordered”? This has nothing to do with whether they can be happy people or not, only whether they suffer from a condition that requires treatment. Homosexuality doesn’t require treatment, so it’s not a disorder. But surely being stuck in the wrong body is a condition that most people would want treated, no? You might be a happy, well-adjusted person stuck in the wrong body, just as you might be a happy, well-adjust person with cancer, but wouldn’t you want both conditions fixed, if they could be?

      If people are worried about their disorder having a stigma associated with it, surely the solution is to work for tolerance and acceptance of the disorder, not to pretend it _isn’t_ a disorder.

      Dec 18, 2008 at 1:07 pm · @ReplyReply to this comment ·
    • Natalie Murray
      Natalie Murray

      There is nothing wrong with my mind now that relates to gender identity, and the only thing I had going on before transition was the sheer stress that came with it. My problem has nothing to do with a mental condition at all. It has everything to do with being born with bits that were not correct for me, a simple birth defect with far ranging effects.

      My big beef with the whole DSM thing is the continued pathologization of it by people like Zucker, Blanchard and Lawrence, all of whom are on the panel that’s doing the review of the area of the DSM that pertains to gender identity. These same people like to go around insisting that people like me are either a hyper-homosexual male or a male so in love with the idea of himself as a woman that he pursues surgery. In short, the misguided theory that each and every MtF transsexual woman did it for sexual thrills. Worse than this, they are insisting that we’re all a bunch of pathological liars for denying this. Apparently, too, trans people are only suitable for living on the fringes of society, or well suited to prostitution.

      Wake up and smell the coffee, you three! I pursued this because this is about WHO I AM, not because of whom I want to share a bed with. It’s identity that is at the core of this whole issue. How Blanchard, Zucker and Lawrence were ever even considered for this panel, let alone chosen for it, or (in the case of Zucker), put in charge of it, is totally beyond me. Has any thought been given to listening to those that actually have to deal with this horseshit every day of their lives? From the sounds of it, not at all.

      But trans people have had enough. Some of us are taking things into our own hands and suggesting/conducting/participating in studies that will properly show what we’re about, instead of relying on 1960s data or venturing into bars and interviewing a half dozen drag queens. The BBL idiocy is going to be shut down for good by nothing more than the facts, as related by trans people themselves, in properly performed and reviewed studies.

      Dec 18, 2008 at 1:36 pm · @ReplyReply to this comment ·
    • David Dust
      David Dust

      I don’t think Transgendered people should be considered to have a “disorder”.

      However, “Hot Tranny Messes” should be locked away forever.

      Dec 18, 2008 at 2:55 pm · @ReplyReply to this comment ·
    • Raphael
      Raphael

      If you expect insurance to cover reassignments, then leave it in the damn manual.

      Really, people. Let’s try to de-stigmatize mental illness in general. If you declassify it on some idealogical ground, you’re going to make life more difficult for many transgendered people.

      Dec 18, 2008 at 4:56 pm · @ReplyReply to this comment ·
    • Boo
      Boo

      Mike- if out bodies are disordered, then the problem is in our bodies, and as such it does not belong in the DSM.

      Raphael- Leaving the diagnosis in to get insurance coverage is a political rationale, not a scientific one. Is the DSM about accurate science or creative ways to get funding?

      The current edition of the DSM defines mental disorder in such a way that childhood GID dfinitely does not meet its own criteria of mental disorder (Because the distress is caused by social noncomformity, which the DSM says is not to be taken as evidence of mental disorder. GID is the only exception to this rule in the entire DSM, but no reason is given as to why it should have this special status.) and you can make a very strong case the that the adolescent/adult version doesn’t either. Zucker et al, however, have shown themselves to be quite content at merrily ignoring this raging contradiction.

      Dec 18, 2008 at 7:43 pm · @ReplyReply to this comment ·
    • julian
      julian

      I dislike being placed in the same category as fetishism.

      Dec 18, 2008 at 9:08 pm · @ReplyReply to this comment ·
    • joe
      joe

      Answer to title: No.

      Dec 19, 2008 at 12:19 am · @ReplyReply to this comment ·
    • Hader ibn Fateh
      Hader ibn Fateh

      Homosexuality is traditionally deemed forbidden by Islamic law. The Qur’an, the central text of Islam believed by Muslims to be the revelation of God,[5] is explicit in its condemnation of homosexuality.[6][7] The Qur’an proclaims Islam as the “religion of nature,” and sanctifies and encourages sexual intercourse within marriages only. Specific verses condemning homosexuality include:

      “We also (sent) Lut: He said to his people: “Do ye commit lewdness such as no people in creation (ever) committed before you? For ye practise your lusts on men in preference to women : ye are indeed a people transgressing beyond bounds.” And his people gave no answer but this: they said, “Drive them out of your city: these are indeed men who want to be clean and pure!” But we saved him and his family, except his wife: she was of those who legged behind. And we rained down on them a shower (of brimstone): Then see what was the end of those who indulged in sin and crime!”[7:80–84 (Translated by Yusuf Ali)]

      “The people of Lut (those who dwelt in the towns of Sodom in Jordan) rejected the messengers. Behold, their brother Lut said to them: “Will ye not fear (Allah)? I am to you a messenger worthy of all trust. So fear Allah and obey me. No reward do I ask of you for it: my reward is only from the lord of the Worlds. Of all the creatures in the world, will ye approach males, And leave those whom Allah has created for you to be your mates? Nay, ye are a people transgressing (all limits)!” They said: “If thou desist not, O Lut! thou wilt assuredly be cast out!” He said: “I do detest your doings.” “O my Lord! deliver me and my family from such things as they do!” So We delivered him and his family,- all. Except an old woman who lingered behind. But the rest We destroyed utterly. We rained down on them a shower (of brimstone): and evil was the shower on those who were admonished (but heeded not)! Verily in this is a Sign: but most of them do not believe. And verily thy Lord is He, the Exalted in Might Most Merciful.”[26:160–175 (Translated by Yusuf Ali)]

      “(We also sent) Lut (as a messenger): behold, He said to his people, “Do ye do what is shameful though ye see (its iniquity)? Would ye really approach men in your lusts rather than women? Nay, ye are a people (grossly) ignorant!” But his people gave no other answer but this: they said, “Drive out the followers of Lut from your city: these are indeed men who want to be clean and pure!” And We rained down on them a shower (of brimstone): and evil was the shower on those who were admonished (but heeded not)!”[27:54–58 (Translated by Yusuf Ali)]

      “And (remember) Lut: behold, he said to his people: “Ye do commit lewdness, such as no people in Creation (ever) committed before you. Do ye indeed approach men, and cut off the highway?- and practise lewdness (even) in your councils?” But his people gave no answer but this: they said: “Bring us the Wrath of Allah if thou tellest the truth.” He said: “O my Lord! help Thou me against people who do mischief!””[

      Dec 19, 2008 at 12:38 am · @ReplyReply to this comment ·
    • LappyDappy
      LappyDappy

      ***The Qur’an proclaims Islam as the “religion of nature***”

      There are more generous, less violent religions of nature than Islam.

      Dec 19, 2008 at 1:15 am · @ReplyReply to this comment ·
    • Rowena
      Rowena

      Why is there always some religous creep who drags along texts that are totally irrellevant to modern society?
      If you’re so concerned about all the problems that Western society throws on your path, what the hell are you doing in it? We don’t force you to live according to the “laws” of mormon or others!
      This issue is about TransGender, which is NOT homosexuality!
      [End of rant]

      In answer to the title: No!
      TransSexuals: the ones SUFFERING from their GID should be helped and GID is a disorder.
      TransGenders is a too vague term and includes those who seek bodily changes for sexual gratification. They don’t even want their primary sexual attributes changed (hence the she-males). They enjoy having both gender characteristics and flaunt it. They ride along on the same train that is supposed to help the real problems, yet at the same time they are also the ones that shout the hardest for “equality” and appear on shows like “Jerry Springer”. Those ones have a different mental disorder!

      Just my 2 cents.

      Dec 19, 2008 at 4:56 am · @ReplyReply to this comment ·
    • Boo
      Boo

      Hader- you appear to be somewhat confused. This is a discussion about the DSM, not the Koran.

      Dec 19, 2008 at 7:14 am · @ReplyReply to this comment ·
    • Natalie Murray
      Natalie Murray

      Hey Hader!

      This isn’t about a religious issue. It’s completely medical, and neither your Koran nor any other ancient, irrelevant text applies here.

      Dec 19, 2008 at 10:08 am · @ReplyReply to this comment ·
    • Adrian
      Adrian

      Trans issues are very serious…I have such a hard time understanding why anyone would find someone’s desire to have surgery in order to better represent the image that they desire to have would be consider a disorder.
      Why can’t we allow trans individuals to become the person they always dream of becoming?
      We allow people to get all sorts of surgeries (cosmetic and/or reconstructive) that changes a person’s life for the better, why should sexual reassignment surgery be any different?

      There has always been a third sex and it’s time people, medical insurance companies, public rest-rooms etc get used to it!

      The real disorder is believing there should only be straight men and straight women in this world.

      that’s just my 2 cents

      Dec 19, 2008 at 12:56 pm · @ReplyReply to this comment ·
    • xrk9854
      xrk9854

      Adrian: I am NOT a third sex! People born transsexual KNOW what their gender is. I am female! Please respect my gender.

      I was not a man with a “mental disorder”.

      I was a woman with a physical problem.

      I had a brain-body mismatch and I fixed that

      So to answer the title of the article: NO!

      People born transsexual are NOT the problem. Society is the one with gender dysphoria, they are the ones that can’t handle the fact that transsexualism exists. Society, and psychiatrists, need to stop pathologizing a normal biological variant (transsexualism). As Riki Wichins said the APA suffers from GenderPathoPhilia.

      Dec 19, 2008 at 3:10 pm · @ReplyReply to this comment ·
    • Adrian
      Adrian

      @xrk9854:
      didn’t mean any disrespect. please email me and educate me on the matter. I would like to hear how you define gender. Is it by chromosome make-up (xy xx, etc), genitals, or a person’s statement of what they feel their gender is?
      I would be very appreciative if you could shine some light on the subject since I’ll be dedicating a week on transgender issues on my blog in January.
      thanks in advance for your help.

      Dec 19, 2008 at 3:28 pm · @ReplyReply to this comment ·
    • zythyra
      zythyra

      Being transgender isn’t a mental disorder, and shouldn’t be in the DSM, however, there needs to be some way for it to be listed in medical references so transsexuals can qualify for insurance for treatment, surgeries, etc. Society also needs to get over its transphobia, so that people can be able to live as ANY gender (binary or otherwise) without persecution and discrimination.

      Dec 19, 2008 at 5:06 pm · @ReplyReply to this comment ·
    • Zoe Brain
      Zoe Brain

      The distress caused by having a brain (actually the lymbic nucleus) cross-gendered (in some ways) compared to (most or all of) the rest of the body is a very real and serious psychological condition, comparable to the distress caused by some hideous congenital anomalies, coupled with biologically-based sexual dysfunction. But the neural mismatch itself is not, it is a natural variation caused by any of a number of genetic predispositions, coupled with an anomalous hormonal environment in the womb. Both the genetic, and the hormonal anomalies are necessary, either on their own has no effect. We think. We’re not absolutely sure, it’s just that we have lots of good evidence for this, and only a paucity of extremely poor evidence against.

      Until the distinction is made between the congenital biological variation that is acute transsexuality, and the syndrome of distress it causes, then the social stigma and moral opprobrium will remain. Worse, effective treatment may be withheld, either because of unfounded doubts as to its effectiveness, or concerns that anyone who is “mentally ill” cannot possibly give informed consent for radical surgery. Such problems exist today, simply because GID in its totality is erroneously seen, and described in the DSM’s later incarnations, as purely a psychiatric concern.

      Now to attempt to answer Adrian’s question. Courts in Australia have looked at the gestalt, the totality of the situation, as there’s no single easily defined touchstone.

      Go by genitalia? But that can change due to accident or medical intervention.

      Go by genitalia at birth? But there are rare Intersex conditions that can result in feminised genitalia at birth changing to masculinised genitalia later. Some can even impregnate women and become biological fathers.

      Go by chromosomes? xx=F, xy=M? There are Intersex conditions where xx people have fathered children, and xy people given birth. And there are xxy people, some of whom have fathered children, others of whom have given birth. And mosaics, people with both xx and xy (and x and xxy and…) cell lines in their bodies.

      The one area that seems to correspond to the self-reported gender with 100% accuracy involves certain brain structures – determinable only by autopsy – and just possibly fMRI scans. Certainly “self reporting” has a strong biological correlation. So as long as there’s no glaringly obvious psychiatric disturbance involving psychosis, it’s the best single measure we have.

      Dec 20, 2008 at 2:14 am · @ReplyReply to this comment ·
    • ML
      ML

      I agree with xrk9854.
      I changed my body to represent what I always known to be.
      A woman.
      In a world where men and women existed, I always wanted to be A WOMAN, not a transgender.
      There’s not such a ridiculous thing as a 3rd sex.

      Dec 20, 2008 at 11:16 am · @ReplyReply to this comment ·
    • Adrian Acosta
      Adrian Acosta

      @Zoe Brain:
      Zoe I absolutely loved your reply. very educational. I would love to talk more on the subject and possibly include some of your writing on my blog if that’s ok with you.

      It’s been my experience that because transgender individuals are always fighting to be seen as one of two sexes, male or female, they often get offended when someone from the outside sees them as a different gender then that which they think they are. This always makes it hard to have an intellectual conversation on Trans issues.

      I think what’s at the root of the trans rights movement is a fight of labels between the outside world and the trans individual. I can see how it would be hard for someone who is not Trans to see a person that was born with xy chromosomes, was born with a penis, and lives his life as a woman telling people that she is a woman. The non trans person had already accepted society’s label of Male for that person, so the Trans person saying that she is female is directly challenging that which was already defined.

      I think that we need not focus on whether we are male of female but focus on the fact that we are healthy individuals that have goals and aspirations in life…and one of those goals is to have a physical match to the mental image we have of ourselves. If modern medicine, and surgical procedures can provide that then how can it be a disorder.

      thanks Zoe

      Dec 20, 2008 at 11:48 am · @ReplyReply to this comment ·
    • xrk9854
      xrk9854

      @Adrian: Gender identity is the only 100% sure way to define gender. Zoe pointed out the problems with chromosomes and genitalia. Everyone (including you!) have a gender identity. It’s just that your gender identity matches the body you were born with. As a result you take your gender for granted. People born transsexual never take it for granted. We live with this crazy conflict until we can transition and correct things. If you would like to know more I suggest this page of Lynn Conway’s website:

      http://ai.eecs.umich.edu/people/conway/TS/TS.html

      Dec 20, 2008 at 11:48 am · @ReplyReply to this comment ·
    • Zoe Brain
      Zoe Brain

      Thanks Adrian, and by all means use whatever you like in your blog.

      I’ve been invited by a number of professors at the Australian National University to give talks to medical and psychology students on just this matter, as part of their courses. I’ve also given lectures at the University of Western Sydney on the sociological, rather than the biological aspects. So although I lack any qualifications in either medicine or psychology, in this one particular area, the qualified experts think I have particular expertise and insight.

      A summary of my research can be found at
      http://aebrain.blogspot.com/2008/06/bigender-and-brain.html
      But it’s a fast-moving field, and although the article is only 6 months old, a lot more evidence confirming the conclusions I drew in it has come in since.

      Transsexual people are strongly gendered, but a significant number of Intersexed and non-Intersexed people are not. So although Transsexuals fit a binary model of gender extraordinarily well (for if they didn’t, they wouldn’t suffer the distress they do), we must be aware that the binary model is an approximation that fits most, but not all. It doesn’t fit everyone. Most Intersexed people in particular fit a binary model, but some don’t. We must be careful to respect Intersexed men as being men, Intersexed women as being women, but also that minority of Intersexed people who identify as neither.

      Many transsexual people, being strongly gendered, and having had their masculinity or femininity questioned in the most disrespectful terms by others, object to any “in-between’ category, a category they have often been forced into by others; “men, women, transsexuals”. Which is exactly wrong, the opposite of what the situation truly is. It’s because they fit the binary model so well, so much so that even having a cross-gendered body is insufficient to coerce them into an inappropriate gender “box”, that they have the issues they do.

      We must not force people into arbitrary boxes against the principles of medical facts, objective biology and even common humanity, strictly on ideological grounds.

      Dec 20, 2008 at 8:44 pm · @ReplyReply to this comment ·

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