Protesters To Call For Reform Of Gender Disorders At American Psychiatric Association Convention

OTOH

There are those of us who need this diagnosis in order to have our health insurance cover treatment -- if we have it, that is!

I agree, the treatment should be on the medical side, rather than the psychological side, but we have to go with what we have.

I would like to see the financial statements of those who're advocating removal of GID -- and who's had SRS already. I bet most of the advocates are well off and didn't have to scrimp and save for decades (or can't afford it at all!).

Listen to "TransTalk" every Monday from 4-5pm ET on http://www.falconradio.org beginning January 11th!

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by: Marlene @ Sun May 17, 2009 at 18:14:45 PM CDT

We need *a* Diagnosis

Just the way people born with cleft palates need one too. They're not considered "mentally ill" because of the distress their somatic condition causes.

We - and the APA - have been treading on thin ice for decades now. The patient has to be diagnosed with a "mental illness" in order to qualify for surgery, but anyone with a severe "mental illness" cannot possibly give informed consent. There is a basic contradiction here, one that everyone has ignored because "the system works". Well, it's only a matter of time before someone notices, and legislation is passed to prevent surgery. The "mental illness" argument has already been used to abolish long-existing human rights.

We have to do something about this. Now is a good time. We have enough evidence from MRI scans and autopsies to make our case.

There is no situation so complex it can't get even worse

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by: ZoeB @ Sun May 17, 2009 at 19:43:13 PM CDT

[ Parent ]

...

First off, if you please, what "long-existing" human rights have been abolished using a mental illness argument?

Second, I agree with the need for reform, but what then should the diagnosis be? I haven't seen any ideas on what it should actually be, only people saying it should be changed. To what?

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by: Eshto @ Sun May 17, 2009 at 19:57:44 PM CDT

[ Parent ]

*sigh*

I included the link to gidreform.org in the diary, Eshto, specifically the website spells out what many of us would like to happen to the GID diagnosis.

Also, the advocacy is for treating what is now called GID to one that treats trans conditions as natural human diversity instead of as disorders, psychosexual pathologies, or psychopathologies, and treating transsexuality as a physical condition (pathology) that requires medical treatment instead of treatment as a mental health disorder. And, that is included in the diary above too.

Also, if you select the Pam's House Blend tags at the bottom of the post for Gender Idenity Disorder and GID, you can find other posts that discuss issues with the GID diagnosis.

I don't mean to be rude, but did you not read the last three paragraphs of the diary or select any of the links before commenting?

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~~Autumn~~

As if there were safety in stupidity alone.
--Henry David Thoreau

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by: Autumn Sandeen @ Sun May 17, 2009 at 22:00:43 PM CDT

[ Parent ]

Hi Autumn

I did read the website. It doesn't seem to offer any concrete scientific ideas for a new diagnosis. And the end of your blog post offers a very vague definition: "diversity". That isn't scientifically or medically helpful.

I mean no offense, but all this seems a bit too nebulous to form a scientific consensus around. Doctors need well defined criteria for diagnosing mental and physical afflictions, and for dispensing drugs and surgery to correct them. I read all this to my partner who has a Master's degree in counseling psychology (with a background in LGBT studies so he is very sympathetic to this cause). He agreed it doesn't offer any concrete way of diagnosing people as being transsexual. He also said psychology isn't concerned with celebrating human "diversity". It is concerned with treating maladaptive behaviors.

And the way I always understood the Gender Identity Disorder diagnosis, in regards to transsexual people it is supposed to refer to the distress caused by NOT being allowed to transition to the preferred gender; I always understood it as not applying to the state of being transsexual, itself. That's why transitioning is accepted as a valid treatment.

Otherwise, if the APA really thought being transsexual itself were a mental illness, they would truly be calling transsexuals mentally disturbed and telling them they should live with the sex they were born with, rather than helping them transition to the preferred sex.

I also think you are running the risk of reinforcing the considerable stigma attached to mental illness in general that already exists.

Oh and don't worry about being rude Autumn, I'm doing my best to learn about this, and education others. If I get something wrong and you have to call me out on it, then I am thankful for the information and growth experience.

:)

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by: Eshto @ Sun May 17, 2009 at 22:45:02 PM CDT

[ Parent ]

Well...

...The thing is that if the idea for the criteria for a new diagnosis comes from non-medical professionals, it won't be adopted. Just ask those who are pushing HBS.

We can give folk ideas of what trans people would like to see in new diagnosis, but we can't act as psychologists, psychiatrists, and medical doctors and write the diagnosis up, or name it for them.

For sure though, we want the stigma of "disorder" removed from the diagnois for transsexuals, and crossdressing labeled in some way as a kind of gender variance, and not as "transvestic fetishism."

As "transvestic fetishism" is used now, it's strictly a diagnosis for men to enforce social norms of dress -- and that's because women are free in our society to dress in male clothing without being seen as crossdressing.

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~~Autumn~~

As if there were safety in stupidity alone.
--Henry David Thoreau

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by: Autumn Sandeen @ Sun May 17, 2009 at 23:42:09 PM CDT

[ Parent ]

So if I understand:

So what you are offering is not a set of specific criteria, but more of a broad lens through which to view transsexuality. I dig it. For what it's worth, I completely agree, and I think there is a perfectly strong logical/scientific/historical case to make for that view.

No matter what the APA decides I will continue suggesting to others that it's how they should see it too. Of course that will just be through casual conversation and through my activist artwork. I wish I had some pull in the psychiatric/medical community but that's my partner Gilbert's thing (though I know Gilbert will advocate for this view as well and already does).

Thanks.

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by: Eshto @ Mon May 18, 2009 at 21:00:26 PM CDT

[ Parent ]

Specific Ideas for Harm Reduction of the GID Diagnosis and Removal of TF

Thanks, Eshto, for raising some common questions about the current GID diagnosis and proposals for reform.

At the APA Annual Meeting, I presented a specific proposal for harm reduction and redefinition of GID for the DSM-V. It was co-authored by clinical psychologist and community advocate Dr. Randall Ehrbar, and a summary is posted on the GID Reform Advocates Blog site.

Those who do not conform to their assigned birth-sex, either by inner identity or outer social expression, are labeled as mentally disordered by the American Psychiatric Association in the DSM-IV-TR. The current diagnostic categories of Gender Identity Disorder and Transvestic Fetishism pose barriers to civil justice and access to medical transition care for gender variant people.

We stressed four main points--

- Reform and harm reduction of the Gender Identity Disorder diagnosis, which currently stigmatizes  nonconformity to assigned birth-role as mental illness and sexual disorder while actually contradicting social and medical transition.

- Reduction of stigma of mental disorder and sexual deviance in the diagnostic criteria, supporting text, title and placement of the current GID diagnosis.

- Removal of the defamatory Transvestic Fetishism category,  which equates expression of femininity by birth-assigned males, including many transsexual women, with paraphilia/sexual deviance.

- Public policy statements from the APA elected leadership that difference is not disorder, affirming the medical necessity of transition care, and recognizing social gender transition.

On another topic, thanks for the promotion, Autumn, but I was a research and development program manager and technology strategist the last few years of my corporate career. I was also very active in LGBT policy and education development at my company and others, and I have published and presented scholarship on DSM issues for nearly 15 years.

Kelley Winters
GID Reform Advocates
www.gidreform.org

 

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by: kelleywinters @ Fri May 22, 2009 at 03:45:31 AM CDT

[ Parent ]

Oh that figures...

...I got your job title wrong. :P

And, I could have just called and asked what your job title was... D'oh!

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~~Autumn~~

As if there were safety in stupidity alone.
--Henry David Thoreau

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by: Autumn Sandeen @ Sat May 23, 2009 at 12:02:43 PM CDT

[ Parent ]

Aside from Autumn's suggestion...

How about the ICD diagnosis shifted from its current location to a different one.

Note that it can be removed entirely from the DSM without affecting anything in terms of getting medical services covered, because it is still in the ICD (transsexualism).

N99, for example, as opposed to the F group classification.

My issues with the gidreform groups are particular to the appropriation and ethnic and cultural insensitivity of the groups themselves -- they have adapted over the years in terms of learning things, but, all too often, man of those who advocate for such forget that there is a great need for mental health counseling among the trans population -- just not for GID itself.

http://www.dyssonance.com  Breaking all the rules...

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by: dyssonance @ Sun May 17, 2009 at 22:39:19 PM CDT

[ Parent ]

diagnosis = bad?

We need a diagnosis just the way people born with cleft palates need one too.

seconded

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by: unexpectedficus @ Sun May 17, 2009 at 20:25:04 PM CDT

[ Parent ]

Yo, Zoe...

i respect your opinion, and would like very much what you desire to happen.

But as i posted on my blog, i am having a very hard time trusting 'gender rebel activists' (for lack of any other way to phrase it) to not throw the baby out with the bathwater if given the chance.

Are you talking about what it is you know, or just repeating what it was you heard?

Grace Slick

www.anonymous-t-girl.blogspot.com

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by: Anonymous T-Girl @ Sun May 17, 2009 at 21:40:13 PM CDT

[ Parent ]

Please see exactly what...

...gidreform.org and gidreformnow.com are advocating at before jumping to too many conclusions about what these activists want to accomplish. Basically, you really need to know what exactly is being advocated by these advocates before commenting on whether what activists are advocating for is "good" or "bad," or whether what these activists are calling for is "radical." And hey, it's on the web, and you can easily find out exactly what these activists -- of which I am in agreement -- actually want.

I think you will be surprised at how reasoned and reasonalble what GID Reform NOW and GID Reform Advocates want to accomplish.

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~~Autumn~~

As if there were safety in stupidity alone.
--Henry David Thoreau

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by: Autumn Sandeen @ Sun May 17, 2009 at 22:11:26 PM CDT

[ Parent ]

Well

Not to put too much pressure on you Autumn, but you're a celebrity now. You are now the go-to gal for information on this subject for many in the LGBT community.

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by: Eshto @ Sun May 17, 2009 at 22:58:59 PM CDT

[ Parent ]

Thank you...

But i have read them. My issue is that what they are attempting to obtain may disregard ways the current system can be used against itself for trans benefit.

i could be wrong, and in fact i hope so. Like anyone, sometimes i am.

But just because i have an opinion different from yours or concerns not shared by you doesn't mean i have no idea what i'm talking about. It's a little condescending for you to insinuate as such.

Are you talking about what it is you know, or just repeating what it was you heard?

Grace Slick

www.anonymous-t-girl.blogspot.com

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by: Anonymous T-Girl @ Sun May 17, 2009 at 23:12:37 PM CDT

[ Parent ]

Well, when you referred to the folks...

...advocating for GID reform, as "radical gender activists" -- people who I completely agree with on the take on GID -- you literally used the exact same phrase that Peter LaBarbera used to describe me when he did some fundraising for his website. I get tired of being called the same names -- indirectly this time of course, and not directed specifically at me as an epithet -- by trans people, as well as by classic transsexuals, as I've been called by people with the religious right.

And, I know Danielle Askini, Kelley Winters, Masen Davis, Cecelia Chung, Mara Keisling, and Cindi Creager personally -- among the many others who I personally know who organized the event, or are going to be speaking there tomorrow -- and I know none of them as "radical gender activists." These are mainstream, progressive folk in the trans movement (with the exception of Cindi Creager, who as far as I know isn't trans).

Especially mainstream is Kelley Winters -- she was a VP at Hewlett Packard before she retired last year. She's about a mainstream a person I've now heard referred to as a "radical gender activist" as I've ever met.

My point is that I personally know who is advocating the GID Reform positions, which of them wrote the positions in the first place, and who is behind organizing this event. If this wasn't a mainstream transgender event, the trans "names" who are going to be at this event wouldn't be organizing the event, or speaking at the event.

My apologies for being seemingly condescending to you. I see, in the way I worded what I said above, where it could be taken that way -- I certainly wasn't attempting to be condescending, for sure. However, I should have worded what I said in a way that that would have better reflected my intent not to be condescending. So, you have my sincere apologies.

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~~Autumn~~

As if there were safety in stupidity alone.
--Henry David Thoreau

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by: Autumn Sandeen @ Mon May 18, 2009 at 00:15:32 AM CDT

[ Parent ]

Wait a minute.

i said 'gender rebel activists'. And i even used ' ' and then specified 'for lack of any other term'. i am an 'atheist activist' as an example.

It was the only phrase i could think to describe people who A.) believe gender is a choice and not inherent within the mind, and B.) care strongly enough to engage in public protest.

If that was somehow insulting, then i am sincerely sorry. i didn't mean for it to be.

i did not say 'radical gender activist'. 'Radical' carries evil conservative connotations with me. You put those words in my mouth, three times to be exact. You are wrong in claiming 'i literaly used the exact same phrase' as someone else.

i have never heard of Peter LaBarbare. And i will not be jumped on and placed in a choke-hold of suspicion for the acts committed by 'classic transsexuals' or anyone else. i am my own woman, and owned by no one group or mentality. i will not be crucified by proxy, just because i share a trait, real or imagined, with someone else in the past.

The women attending are great. At first i was excited reading the material. And then the more i read, the more concerned i got with a few opinions of some supporters.

You personally know the women speaking, and i think that's great. But i don't personally know you, so that makes no difference to me. If my worst fear fails to materialize, then i am relieved and greatful for the changes they enact. If my worst fear is realized, then i will personally be set back in my transition.

i voiced my concern in a couple of places, even though it was outside the general concensus. But as i said at Bilerico, lesson learned. i won't do it again. It's not worth it.


Are you talking about what it is you know, or just repeating what it was you heard?

Grace Slick

www.anonymous-t-girl.blogspot.com

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by: Anonymous T-Girl @ Mon May 18, 2009 at 00:52:09 AM CDT

[ Parent ]

What I would like to happen....

I'll quote from the situation here in Australia, and the Re Kevin case.

At paragraph [270]: 'But I am satisfied that the evidence now is inconsistent with the distinction formerly drawn between biological factors, meaning genitals, chromosomes and gonads, and merely "psychological factors", and on this basis distinguishing between cases of inter-sex (incongruities among biological factors) and transsexualism (incongruities between biology and psychology)'.

At paragraph [272]: 'In my view the evidence demonstrates (at least on the balance of probabilities) that the characteristics of transsexuals are as much "biological" as those of people thought of as inter-sex'.

At paragraph [136]: 'I agree with Ms Wallbank that in the present context the word "man" should be given its ordinary contemporary meaning. In determining that meaning, it is relevant to have regard to many things that were the subject of evidence and submissions. They include the context of the legislation, the body of case law on the meaning of "man" and similar words, the purpose of the legislation, and the current legal, social and medical environment. These matters are considered in the course of the judgment.  I believe that this approach is in accordance with common sense, principles of statutory interpretation, and with all or virtually all of the authorities in which the issue of sexual identity has arisen. As Professor Gooren and a colleague put it:-

"There should be no escape for medical and legal authorities that these definitions ought to be corrected and updated when new information becomes available, particularly when our outdated definitions bring suffering to some of our fellow human beings".'

In short, unshackle the science from the politics. Let those who are transgendered (rather than transsexual) not be pathologised for "mental health thought crime", for the heinous sin of being diverse. Much as being gay was de-pathologised.

And let those whose congenitally cross-gendered neurology is such that they need a body to match be able to obtain that treatment on the basis of a physiological, rather than a psychological, condition, the same way other cases of congenital physiological anomalies can.

And most of all - let those people who were surgically mutilated as infants to conform to societal expectations not be considered "mentally ill" if they object as adults to their past (mis)treatment.

In summary - to act on the basis of our current best guess as to the facts. This also happens to be in accordance with basic humanity, but I confess that that to me is a secondary consideration. I prefer unpleasant truths to pleasant lies. Right now, we have unpleasant lies.

There is a significant danger: that "transgender" will be seen as a "normal human variation" requiring no treatment, and that transsexuality will be "morally mandated out of existence", with surgery and hormonal treatment being seen as purely voluntary cosmesis, or worse, denied altogether. Transsexuality as we know it should be pathologised, as not having the right shaped body - even if social role is corrected - causes significant distress. Much as having a hare lip - even in a society where such things are not mocked - should be pathologised.  

There is no situation so complex it can't get even worse

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by: ZoeB @ Mon May 18, 2009 at 06:08:27 AM CDT

[ Parent ]

Yeah.

"There is a significant danger: that "transgender" will be seen as a "normal human variation" requiring no treatment, and that transsexuality will be "morally mandated out of existence", with surgery and hormonal treatment being seen as purely voluntary cosmesis, or worse, denied altogether."

Reading it in such a stark fashion makes me feel like i'm going to throw up.

And here i had a night's sleep to get over it...

Are you talking about what it is you know, or just repeating what it was you heard?

Grace Slick

www.anonymous-t-girl.blogspot.com

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by: Anonymous T-Girl @ Mon May 18, 2009 at 08:32:22 AM CDT

[ Parent ]

Great post, Zoe!

And as is often the case, I completely agree. I certainly view my own transsexualism as a pathological condition. My brain didn't "run right" on a female hormonal balance and testosterone began correcting the problems almost instantly following my first dose. In my case, there was definitely a brain-gonads mismatch.

In my view, any condition that requires medical treatment is, by definition, a pathology, whether a birth defect, injury, or disease. Transsexualism is not psychological, and it belongs under a medical category.

I think there's enough evidence to call it a neurological intersex condition. Any psychological/mental/emotional issues that arise in a person who has this condition are secondary to it, caused by having the condition and by society's reaction to it, just as a person diagnosed with cancer can develop mental health issues as a result.

Of course, because there is no medical test which is capable of detecting transsexualism, and it being a self-diagnosed condition, there is a need for psychological screening. As such, it should be listed in the DSM, just not as a mental disorder.


Tax the Christian Taliban!

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by: Wolfgang @ Mon May 18, 2009 at 12:54:20 PM CDT

[ Parent ]

Health Insurance

Marlene wrote, "There are those of us who need this diagnosis in order to have our health insurance cover treatment -- if we have it, that is!"

Indeed, if we have it, and if it covers mental health. Many insurance plans don't, and even more specifically exclude "any treatment related to sex change." I'm lucky to get my endo visits and bloodwork covered. I have to pay for everything else out of pocket though.

Tax the Christian Taliban!

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by: Wolfgang @ Mon May 18, 2009 at 13:39:25 PM CDT

[ Parent ]

Do not accept anything less than FULL freedom

Allowing the APA to hold us hostage in exchange for a pill  or operation or whatever is like actioning away our self respect and dignity.
God made me purposfully as I am. Just as our homosexual brothers and sisters before us proclaim, I am a whole person and am not mentally ill.
Those who would allow the APA to classify us as mentally ill for some perceived remedy are throwing away the lives of all transgender youth to come.

###########

Resolution by the International Foundation for Gender Education (IFGE) Board of Directors to the American Psychiatric Association (APA)

Whereas people are naturally endowed with a wide diversity of gender expression, identities, and sexual orientations;

Whereas, the distress felt by gender non-conforming people is fundamentally due to social prejudice and heterosexism, and is not a characteristic of their identities;
Whereas diagnosis of psychological disorders has been used as a form of social control;

Whereas, the inclusion of normal variations of behavior as diagnostic criteria has been widely used to justify discrimination against gender non-conforming people by individuals, governments, and corporations; and has resulted in material harm to people;

Whereas, the principle responsibility of medicine is to "Do No Harm;"

Therefore, be it resolved that we find the American Psychiatric Association to have a responsibility to ameliorate this harm, and hereby call for the following remedies:

(1) We hereby call on the Board of Trustees of the American Psychiatric Association to issue a declaration stating that: Gender variance, and gender non-conforming behavior do not constitute a psychological disorder;

(2) We hereby call on the American Psychiatric Association to remove the diagnosis of so- called "Transvestic Fetishism," which explicitly pathologizes gender non-conforming behavior, from their Diagnostic and Statistical Manual;

(3) We hereby call for the reform of any diagnosis that can be made solely based on gender non-conforming behavior, specifically including "Gender Identity Disorder in Children."

Resolved this day May 15, 2009 by the Board of Directors of
The International Foundation for Gender Education

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by: kellib @ Sun May 17, 2009 at 18:28:52 PM CDT

Great finish, terrible start

Filling committees with people from off the street is bad scientific practice. I've read on the Blend a number of persuasive articles about how biased people in leadership positions have led to bad psychiatry/nosology/whatever you call it. Adding in people with opposite biases won't lead to better psychiatry. Let the facts rule.  

What a day, what a day for an auto-da-fe

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by: revbob @ Sun May 17, 2009 at 23:41:37 PM CDT

A much different view

I appreciate all the views that have been raised here and elsewhere regarding arguments for the inclusion/exclusion of gender spectrum differences in the DSM, and also those who claim that their condition is a natural variation of human expression.

Because I was exposed to the potent estrogenic drug diethylstilbestrol (DES) during my mother's pregnancy, I don't see my condition as being a mental illness, a natural variation of human expression, or as a lifestyle choice; I see it as the logical outcome of prenatal exposure to estrogens during the period of development when my gender identity was being formed. And further, I consider it to be iatrogenic. (physician-induced)

Because of the proliferation of many chemicals that act like hormones in every compartment of the environment at increasing rates especially following World War II, I think it is very dangerous to make the claim that all the gender and sexual variation we have seen in the last few decades is "natural." Gender difference is natural, but what we are talking about here is a difference in degree.

I - and others I know who have been prenatally exposed to DES - have a range of health problems and concerns that are not just limited to the gender issue. As a consequence, I feel that the entire treatment protocol should be medicine-centered with an M.D. being the coordinating (and ultimately gatekeeping - based on medical health) figure. There is far too little clinical data on transgender people in general, and it has resulted in very poor health care for the community. I'm not saying psychologists have no place, just that they would function better as advisors and advocates rather than as they have traditionally functioned: as gatekeepers to treatment.  

But to have someone like Zucker chair the committee on gender identity disorders is practically bordering on institutional insanity. The APA wants to stick their heads in the sand, and pretend all this endocrine disrupting evidence doesn't exist. In the parlance of Korzybski they are mistaking the map for the territory. They think their model of gender - that there are men and women and nothing in between - is the same thing as the reality in the population, which we all know is decidedly NOT the case.

So in my opinion, my condition is entirely a medical affair. And yes, I do think there should be surgery on-demand. When anyone can name another (any other) medical condition where you must prove your psychic sanity before you get treatment, then I might change my opinion. But given that there were over 12 million cosmetic surgeries performed last year, without a single one of them being sanctioned by the psychological establishment, my response to the APA and all its gatekeeping efforts is simple: we don't need you. I want real medical care, not psychobabble.

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by: Christine Johnson @ Mon May 18, 2009 at 23:52:44 PM CDT

Cosmetic Surgery vs. Medical Transition

Christine wrote, "But given that there were over 12 million cosmetic surgeries performed last year, without a single one of them being sanctioned by the psychological establishment, my response to the APA and all its gatekeeping efforts is simple: we don't need you."

Good point. Cosmetic surgeons just perform a criminal background check and briefly interview the potential client. Maybe that's enough.  

Tax the Christian Taliban!

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by: Wolfgang @ Tue May 19, 2009 at 10:27:42 AM CDT

[ Parent ]