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23 Comments

  • sioraiocht

    And why shouldn’t they? The way I see it, at least for transexuality, is that people were born into the wrong body. It’s not a “bad thing” in the moral sense, but it is certainly a big problem. Reassignment surgery seems to be a cure (or treatment) that has been quite successful.

    There’s no shame in being transexual, but this is the stupidest battle to fight. Why not instead focus on having health insurance plans cover “treatment” (i.e. hormones and reassignment surgery?).

    Yes, I know people get upset that homosexuality has been listed as a disorder. I would say that gender identity and sexuality are not the same. In fact, they are completely orthogonal.

  • CitizenGeek

    I agree with Sioraiocht. The APA is a big supporter of LGBT rights, basing this support on all the research they’ve done.

  • adam k.

    well said, no.1.

  • Oaklander

    Well, here is another thing to think about: In order to get gender re-assignment surgery and HRT, you need to be Dx with this “disorder”. So if the APA did NOT list it as a disorder, they couldn’t diagnosis it, nor treat it. it would be outside their scope of practice. So it’s possible that the members of the APA are very sympathetic to the Trans population, but need this mechanism to provide services. The language is off-putting, but I don’t see a way around it yet.

  • Wes

    It’s not necessarily true that transgender people feel like they were born into the wrong body, but perhaps were assigned the wrong gender at birth. And if there are ways to make your physical appearance, your performativity, more convincing of how you feel your true self is, why should you have to be diagnosed with a disorder??

    Do women who want breast implants, so that they appear more feminine, need to be diagnosed with a disorder??

    Of course, not all trans people feel this way – and that’s part of the issue. There are tons of ways to arrive at being trans. It shouldn’t be necessary for you to have to be diagnosed with a disorder to change your physical appearance with surgery.

  • sioraiocht

    @Wes: It is true, in my original post I singled out transexuals specifically because of the distinction that you are making.

    Nevertheless, your question about breast implants is a valid one. Does someone who wants some cosmetic surgery necessarily have a disorder? No. But some people get some elective cosmetic surgery, and then can’t stop. They keep seeing flaws and trying to correct them. That IS a disorder.

    Now people that feel they were assigned the wrong gender may fall somewhere in this spectrum of extremes. Also, transgendered people usually need help of some sort. There are certainly issues with coming to terms with being transgendered and deciding how to approach it. In that sense, perhaps they do need or should seek treatment, just as someone with depression should (another psychological disorder).

  • kevin (not that one)

    I see this less as an issue of trans-liberation and more of an issue about how our health insurance coverage denies us the necessary treatment we deserve.

    I don’t think being trans should classify someone as having a “disorder”, but most health insurance companies or state agencies won’t provide treatment otherwise. The only option outside of that is paying for treatment 100% out of pocket and going to Thailand…which isn’t such a bad alternative if you can afford it.

    I think, however, many MTFs and FTMs are just choosing not to go for full gender-reassignment surgery for their own seperate reasons.

  • Alec

    As I understand it, not all transgendered individuals would actually be diagnosed with gender identity disorder.

    Is being transgender a mental disorder?

    A psychological condition is considered a mental disorder only if it causes distress or disability. Many transgender people do not experience their transgender feelings and traits to be distressing or disabling, which implies that being transgender does not constitute a mental disorder per se. For these people, the significant problem is finding the resources, such as hormone treatment, surgery, and the social support they need, in order to express their gender identity and minimize discrimination. However, some transgender people do find their transgender feelings to be distressing or disabling. This is particularly true of transsexuals, who experience their gender identity as incongruent with their birth sex or with the gender role associated with that sex. This distressing feeling of incongruity is called gender dysphoria.

    According to the diagnostic standards of American psychiatry, as set forth in the Diagnostic and Statistical Manual of Mental Disorders, people who experience intense, persistent gender dysphoria can be given the diagnosis of Gender Identity Disorder. This diagnosis is highly controversial among some mental health professionals and transgender people. Some contend that the diagnosis inappropriately pathologizes gender variance and should be eliminated. Others argue that, because the health care system in the United States requires a diagnosis to justify medical or psychological treatment, it is essential to retain the diagnosis to ensure access to care.

    It should also be noted that simply because gay and lesbian sexual orientation has been removed as a disorder does not mean that people do not experience psychological stress as a result of their sexual orienation, for whatever reason (usually religious in nature). Psychologists still assist people who experience persistent stress related to their sexual orientation, and that’s a very controversial area, from what I understand, in terms of treatment possibilities.

  • DK

    This isn’t an all or nothing proposition. AFAICT, the protesters want to make transitioning a medical matter, rather than a psychiatric one. They want the M.D. front and center, and the Psy. D. playing at most a supporting role.

    Socially, psychiatric conditions have a lot more of a stigma than medical conditions. When the psych establishment tells America that transgenders are perfectly fine mentally and that gender expression is not something that needs to be policed, it will go a long way towards acceptance. It was the same way with homosexuality.

    Of course, the amateur psychiatrists may just get replaced by the fascists who think fat people and smokers should be fined for “dragging down the economy”, but we’ll cross that bridge when we come to it.

  • DK

    It’s not like a lot of them are getting anything covered now anyway. I know a lot of transsexuals, but I only know one single transwoman whose (work) insurance directly covers everything including SRS. Everyone else lucky enough to still have insurance is receiving hormone therapy for “depression”.

  • Oaklander

    @Alec: If they are not distressed, then they are able to manage it without the help of surgery or HRT. Of course it is distressing to not have your body agree with your self image! Maybe our culture interprets “disorder” as “your a crazy bitch”, but that is not the intent. To a therapist, a diagnosis is “Ok, this is something in my scope of practice that I know how to deal with” (i.e. suggest to their doctor that they start HRT). It isn’t a name-calling judgment.

  • Oaklander

    @DK: I work with one FTM, and our insurance has covered both chest surgery and HRT. (I don’t know if they are doing bottom surgery).

  • Alec

    @Oaklander: My point is, by its own terms, the mental health community doesn’t classify transgendered identity as a mental disorder. Which is what makes this a bit silly, to my mind, because there’s a “sexual disorders not otherwise classified” diagnosis for those who have unwanted same-sex attractions that interfere with their mental health, for whatever reason. I realize it isn’t a name calling judgment, but I’m just pointing out that it doesn’t even encompass everyone who identifies as transgendered.

  • getreal

    The American medical association took many years before it stopped classifying homosexuality as a sickness now it is time for this to stop classifying Transpeople erroneously.

  • Tara

    I believe it has more to do with Zuker than any other thing.

    Look into it.

  • Zoe Brain

    MedPage today summarised it accurately:

    “One DSM issue that is drawing close attention from outside the
    psychiatric community is what to do with gender identity disorder.

    The condition — in which people, often during childhood, realize that their biological gender does not match what their minds tell them is now included in DSM-IV as a sexual dysfunction alongside pedophilia and sexual sadism.”

    You can see how that plays in Peoria.

    Transgenderism is like homosexuality – a difference, not an illness.

    Transsexuality on the other hand *does* require a diagnosis – just like cleft palates or other congenital anomalies that cause deep distress to the patient. Just not a psychiatric one, because there’s no evidence of mental illness.

  • michael_elliott

    @kevin (not that one):

    okay, i have a question about this.

    i recently sat in on a PFLAG meeting with a transgendered person who said that MOST insurance companies do not cover anything for gender transition. and because of this, he was denied things like a routine physical…and transwomen he knew were denied histerectomies (even when needed for a health complication, not related to transitioning) until they took the insurance company to court.

    so, from my perspective, all these posts about “we need it to be classified as a disorder so insurance will pay for a transition”….what are they talking about? if it’s very rare that an ins. company covers it, seems like that’s not a logical part of the conversation

  • michael_elliott

    sorry kevin (not that one)!

    i didn’t mean to direct that comment at you!

    i guess you are the person i hit reply under.

    my mistake!

  • Alec

    @michael_elliott: I don’t think it is solely about insurance coverage. I don’t think many physicians will agree to surgery or treatment unless and until there is a diagnosis and a recommendation from a psychiatrist.

  • sophia

    @Alec: yeah the whole thing is just a bureaucratic nightmare. i received very little psychiatric care during the process of obtaining hormone treatment and SRS.

    it’s just a bunch of hoops i had to jump through to prove i was qualified for these treatments. in fact i found it was best to avoid any additional psychological issues i might have been having (ie: depression caused by not living in my target gender) because that hindered the treatment process.

  • Michael Ejercito

    And why shouldn’t they? The way I see it, at least for transexuality, is that people were born into the wrong body. It’s not a “bad thing” in the moral sense, but it is certainly a big problem. Reassignment surgery seems to be a cure (or treatment) that has been quite successful.
    It is clearly a disorder.

    I can understand why some of them do not feel like it is a disorder- transgenderism does not cause death or physical ailment, unlike eating disorders. And for the most part, it does not prevent them from continuing gainful employment, unlike some other mental disorders.

    Still, is not reassignment surgery for those with transgenderism akin to liposuction for those with anorexia nervosa?

    And one more thing. I have heard that sexual orientation is not chosen. How can one choose gender, and yet sexual orientation be immutable?

  • Alec

    @Michael Ejercito: And one more thing. I have heard that sexual orientation is not chosen. How can one choose gender, and yet sexual orientation be immutable?

    No one is denying that they’re born with the physiology of one sex. But we recognize a mismatch; they identify as members of the opposite sex. There’s no “choice” involved in their identity; their association with the opposite gender usually begins way too early for that to even be conceivable, from what I understand.

    Also very distinct from sexual orientation. Many FTM and MTF transgendered people are attracted to members of the physiologically opposite sex.

    Fairly distinct concepts.

  • Dani

    Nothing is chosen. The physical gender is set, the mental gender is set, and the sexual orientation is set. It just doesn’t always line up as text-book and can get really confusing and really depressing.

    I can’t wait to see what happens in the DSM-V but I do see advantages in keeping it as a “disorder” for a number of reasons. America is a bureaucracy at heart and a declaration of gender identity disorder probably helps get the doctors doing something. I think the insurance companies just don’t want to pay for anything unless it is life threatening (thus covering depression and not gender identity disorder.)

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