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Transgender London |
DSM ReformWhy it is So CriticalAs we plod along in our daily lives, we often forget that we are victims of definition. That definition is the one established by the APA (American Psychiatric Association) in the DSM (Diagnostic and Statistical Manual of Mental Disorders) relating to GID (Gender Identity Disorder). This very definition places the transgender community in a poor position both on the health and social fronts. The major problem is that the DSM identifies all transgender activity within a single reference. This is a failure to recognize that the Transvestic Fetishist, the Crossdresser or the Transgender are not the same as the transsexual. As people who are trans, we recognize these differences and we also accept that not everyone has Gender Identity Disorder as characterized by Gender Dysphoria. Basically we know that the transsexual will suffer this malady almost daily if not continuously while others within the community may not suffer it at all. The definitions place all under a single classification and that classification is as a mental disorder which everyone in the community knows is simply not true. Being gender variant is not a mental disorder. This situation has further fueled argument that effective treatments are cosmetic and elective in nature and not essential for treatment of GID. This has played very well into the hands of the detractors of GID treatment; often on the Religious Right as well as government and insurance companies. This classification therefore allows for further classification as a sexual disorder including sexual paraphilia and androphilia. Despite the very vocal support by a very very tiny but highly influential people both within and without the trans community, the transgender community at large outright reject both of these theories. The reasons for their resistance to change is highly suspect; perhaps to individual career accolades rather than serving the trans community? It is an open guess at best. The current classification as a sexual disorder has created many many barriers for transgendered people. For the transsexual it has been used as a tool by governments and insurance companies to deny the often life saving surgical procedures needed to alleviate the Gender Dysphoria. At the same time it has also been used as an argument against inclusion in Human Rights legislation. So, legally governments and insurance companies see this as a mental disorder where in fact it is not. This of course has led to many other contrary situations regarding employment, housing, healthcare and legal standings. All of these and more are basic human rights issues. So why hasn't it changed? First one has to look at the declassification of homosexuality back in the early 1970's the GID definition still stands largely intact despite some interim changes of wording. These changes have created further confusion due to ambiguity. This ambiguity of course has allowed for narrow interpretations of the definition of GID as well as narrow interpretations of law. Within the transgender community itself, many have held that change should not occur because removal of GID will then be used as a tool to prevent SRS from being prescribed. It is the opinion of this writer that this is simply not the case. In fact, I believe removal of GID as a mental disorder will actually open the doors for proper treatment as well as human rights improvements. One has to recognize that WPATH (World Professional Association for Transgender Health) are by and large the acknowledged experts in transgender. Their mandate is to promote proper care, treatment and research to further improve the lives of transgender people. It is essential to realize that many of its members are also members of the APA as well as various medical bodies. In short they are at the fore and the proponents of proper treatment and care. To this writer's knowledge, not one SRS (Sexual Reassignment Surgery) surgeon anywhere in the world will perform SRS without being totally assured that the patient has met the guidelines of the HBSOC (Harry Benjamin Standards of Care) as they are defined by WPATH. Removal of GID as a disorder will open the doors to increased health care as the barriers currently in place will be removed. This will increase the influence of WPATH and thus the effectiveness of treatment. The arguments of mental disorder will no longer be valid as an excuse for denial of health care either independently or in conjunction with insurance coverage. Governments will be forced to recognize that transgender is not a mental disease and therefore subject to the same protections under the law that any normal citizen can expect. As the APA revises the DSM for its fifth edition, let us hope that real progress is made. Let us hope that GID is removed altogether or at the very least redefined as an anxiety. However even in this last case it still could keep some doors closed; doors that should be open. It is time that we in the transgender community were treated as equals with the same dignity and respect afforded any person in society. It is simply the right thing to do. It is within the power of the APA to start that process. The question to be answered is; will they? Kimberley January 2009 |
This site was last updated 08/11/10