APA Comes Out In Favor Of Trans Civil Rights

In the Task Force on Gender Identity and Gender Variance...

123 page report I found the the section on Access to Sex-Segregated Facilities interesting because it talks about prisons, homeless shelter, transitioning at work, restroom and to publicly supporting the rights of transgender people.

Equal access to resources is a social justice issue that is particularly salient for pre- and postoperative transgender people who need access to sex-segregated facilities, including public restrooms, emergency or homeless shelters, prisons, dormitories, and athletic facilities. Each setting poses some unique issues. For example, transgender people who are incarcerated are generally placed "according to their biological genitalia" (Giresi & Groscup, 2006, p.43; Edney 2004). A male-to-female transgender person who has not had genital surgery would likely be incarcerated in prison facilities for males, thereby placing her at greater risk for sexual abuse and other violence (Peterson et al., 1996), not to mention the psychological impact from the inmate's perspective that she is a woman in a men's facility. However, placing inmates in facilities consistent with their gender identity also may not be safe. For example, female-to-male transgender men without, or even with, genital surgery are similarly at risk for sexual assault when placed in a male facility (Peterson et al., 1996). This is an example of the ways in which the needs of male-to-female transgender people and female-to-male transgender people may differ, and not simply mirror one another. Alternatively, sometimes transgender inmates are isolated or placed in special units, but this often means that they are excluded from recreational, educational, and occupational opportunities, and being kept in solitary confinement effectively increases the severity of their sentence (Edney 2004; Minter, 2003). Additionally, transgender prisoners may receive inadequate or inappropriate medical care (Edney, 2004). In the case of shelters, solutions to this issue might include providing individual placement in alternate facilities (such as hotels) and providing training to shelter personal on how to address these issues (e.g., directly addressing the concerns of other shelter clients and establishing a policy that all who identify as women are welcome).

There are many variations on the dilemmas posed by sex-segregated facilities, including whether to allow abused transgender women to use shelters for abused biological women, given that many of the residents of the shelter will have been abused by biological males and may be upset by their presence. Solutions to this issue include providing individual placement in alternate facilities (such as hotels) and providing training to shelter personal on how to address these issues such as directly addressing the concerns of other shelter clients and establishing a norm that all women are welcome. Access to facilities becomes a particularly challenging issue for persons transitioning on the job (for example, at what point in the transition should individuals use the restrooms consistent with their gender identity) or attending university (for example, what is the appropriate housing situation, locker room or sports team affiliation?)

These examples illustrate a number of dilemmas facing transgender people using gender-segregated facilities. While not every transgender individual will face the issue of prisons or shelters, most transgender people do face the issue of which restroom facilities to use. The situation is particularly difficult for those who have not fully transitioned or may never transition fully. Given the expense, risks, and technological limitations of genital surgery, many transgender men who fully transition may not have genital surgery. There are very real concerns about which restrooms transgender should use, in which dormitories they should reside, and in which gender they should compete in sports. The list of difficult situations is daunting.

Truth be told, many of these situations can be resolved with a combination of compassion, justice, accurate information, and common sense-ingredients that are sometimes lacking in decision-making processes.While these usually are not situations that APA can affect directly, APA can adopt resolutions-publicly supporting the rights of transgender people to appropriately gendered treatment-and can file amicus briefs in relevant court cases on behalf of transgender people. Additionally, APA can provide guidance to therapists who are working with transgender clients to advocate on their client's behalf and to help them navigate these situations.

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by: Diana CT @ Mon Aug 18, 2008 at 08:51:19 AM CDT

I'm still very concerned

Especially by this line

• APA should encourage more research into gender identity and expression, including the reliability and validity of diagnostic criteria for gender identity disorders;

Still calling them disorders... and Dr Zucker seems quite adamant in limiting who he considers fit the criteria rather than self-identification. That means all this seeming progress could end up being only to a limited group that fit whatever definition they create.

Of course that depends on a lot of things. I won't judge this without more data.

Having Zucker etc on board that they do makes me wonder at the seeming dichotomy between this message and their reported views.

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by: battybattybats @ Mon Aug 18, 2008 at 09:14:08 AM CDT

I strongly disagree

I strongly disagree with you that we should be concerned about the use of the word "disorder."
If there is a real dissonance between your gender identity and your physical body, that can be reasonably called a disorder. I have a huge problem with the way people stigmatize mental disorders, and I can understand why many transgender activists are opposed to this terminology. But that alone does not justify declassifying it as a mental illness.

Furthermore, if there is no gender identity disorder, there is no reason for insurance companies to cover the costs of reassignment surgery or hormonal treatment. Doing so would make these treatments entirely unaffordable to most transgender people, and would cause far more harm than good.

I'd rather destigamtize ALL mental disorders and help people gain access to the treatments they need.

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by: rdm24 @ Mon Aug 18, 2008 at 12:06:53 PM CDT

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Agreed

I am a FtM transsexual. I've been on hormones almost 2 years and would like to have top and genital surgery eventually. Top surgery is affordable for many. Genital surgery can cost $20,000, sometimes more. Knowing insurance would help pay for it would go a long way to allowing FtM's to get any and all surgery they desire.

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by: Kesnit @ Tue Aug 19, 2008 at 07:27:56 AM CDT

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But does it?

Does insurance pay for it?

Is it a current situation that would be put at risk if it were depathologised or is it a hope that may or may not ever come to pass?

And is the pathology hindering the chances of getting an inclusive ENDA? If so it might mean that many are gambling the capacity of others to get jobs and earn the cash for their surgery in the hope that one day insurance would cover it?

Wouldn't that make it all just a gamble?

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by: battybattybats @ Wed Aug 20, 2008 at 08:45:46 AM CDT

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I'm very concerned about the bearer of the message

From the press release:

Contact: Kim I. Mills

Mills is a former 'education director' for HRC.  

And, before that, she was at the AP (not APA, but AP). Here is her analysis of the place of trans people in the gay community as it appeared ( http://endablog.wordpress.com/... ) in a piece she authored in 1994:

The gay community has long allowed other sexual outcasts to ride its coattails, from transvestites and transsexuals to bisexuals and leather fetishists. But it is now trying to distance itself from pedophiles.

Which came first?  The Mills or the Aravosis?

The 'education director' of HRC from the era in which we pretty well know that no real education was done about trans issues is disseminating info related to work being done by a group of people, some of whom we know do not have trans people's best interests at heart.

That gives one confidence about the integrity of the process, doesn't it?

>^..^<

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by: KatRose @ Mon Aug 18, 2008 at 09:49:21 AM CDT

Not having our cake or eating it too

I have very mixed feelings about the word "disorder" being associated with transfolk. Right now, we are getting the short end of the stick on both fronts. We are being labeled as having a "disorder" but yet our disorder is not being covered by almost all insurance.

If we are crazy, help us financially. If you don't want insurance to pay, then you MUST get rid of any stigmatizing titles like "disorder". Personally, I would welcome a title like disorder if it allowed me to finish my transition. We have enough double-edged swords to worry about in this life. Either help us or stop saying we're crazy.

Also, I don't have the numbers, but I was always told that transitioning for people with gender dysphoria has one of the highest rates of success (i.e. leading happy, productive lives) of any procedure in medicine. Isn't that kind of success worth doing a double-take for?

No matter how thin you slice it, it's still boloney.

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by: atrivialgirl @ Mon Aug 18, 2008 at 21:22:55 PM CDT

How about a new disorder then?

Rather than Gender Identity Disorder how about one that lists it as an anatomical or neurological disorder? Because essentially for those who are in strong need of surgery that's what the science seems to say it is, their brain neurological anatomy appears to be at odds with their physiognomical anatomy.

Of course their are neurological differences in gay people
but they don't require surgery and we don't know how much neurological differences there may be in the rest of the transgender spectrum and GLBTQI communities.

The problem with it being classed as a mental disorder is that it seems to be plain innaccurate.

Being classed as a mental disorder means insurance co's are much more likely to approve pharmacuetical treatment rather than surgical treatment.

Many complain that insurance co's aren't paying for it anyway so how well is the disorder tag really working for anyone? How many insurance companies in number total or in proportion of the market cover SRS and hormones now?

Also is the disorder tag helping prevent civil rights recognition? In which case the hope that the disorder tag will help some gain treatment via there insurance comapny could well be responsible or partially responsible for the majority being unable to earn enough to afford either the treatment or any sort of insurance at all!

I agree all mental illness does indeed need to be destigmatised, especially considering how common mental illness is (1 in 5 Australians will have some at some point in their lives last I heard) but the essential question is 'is this label helping more than it hinders or vice versa?'

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by: battybattybats @ Mon Aug 18, 2008 at 23:09:01 PM CDT

What about endocrine disorder?

My former partner's doctor prescribed her hormones under the code for "endocrine disorder, unspecified" with positive results (insurance paid for both visit + scrip).

I wonder if trans*people might be able to make wider use of this sort of move? I feel it places the problem in the right place (hormones/body parts, not "crazy") and allows a direct inlet to accommodation (at least for hormonal treatment) within the traditional medical system.

I agree that classifying gender identity incongruence as a mental disorder is counterproductive in the move toward recognition and acceptance. It encourages a dismissive attitude toward "those kooks." I think it also plays a role in the fear of gatekeeping procedures hindering medical progress as a result of an individuals' honesty about serious mental illness with a mental health care provider (or maybe that was just my ex-wife).

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by: DC @ Wed Aug 20, 2008 at 02:05:53 AM CDT

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