Published by the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM) creates a standard for diagnosis amongst mental health professionals. The current version is the DSM-IV-TR, but the APA is currently working on the DSM-V slated for publication in May 2013. But what does the DSM have to do with gender?
Currently, the DSM records Gender Identity Disorder (GID) as the diagnosis for people along the trans* spectrum, listing the following criteria: long-standing and strong identification with another gender, long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex, the diagnosis is not made if the individual also has physical intersex characteristics, and significant clinical discomfort or impairment at work, social situations, or other important life areas. Most doctors and insurance companies are only willing to treat or to pay for physical transition (hormones and surgery) when presented with this concrete diagnosis.
But how does it affect the community when GID is a disorder—a word which implies something is clinically wrong—and listed within a book which is a guide to diagnosing mental illness? There is a stigma around mental illness, one which dictates if you are diagnosed with any mental illness, you are somehow weak, somehow less of a person. Allowing this classification to stand then, associates that stigma with the community and allows the community to remain something to be “fixed” instead of accepted. Being trans* becomes something clinically irregular, something which can be explained away as an imbalance in the brain to be rectified, as homosexuality was originally considered until removed from the DSM in 1973, which acted as a stepping point in the fight for equality.
Along this line, over the past couple of years, a debate has been happening about whether GID should be listed in the DSM or not. A couple of weeks ago, the APA announced it will be changing the terminology from GID to Gender Dysphoria in an attempt to take away the stigma associated with calling it a disorder. There is no way to determine exactly how this will affect the community. Dropping the word disorder could lead to a more understanding public, though still having Gender Dysphoria listed in the DSM-V could undermine that. But the main problem with removing the classification from the DSM completely would be the potential for insurance companies to refuse to pay for procedures which are not considered medically relevant but are instead judged to be cosmetic. Because transitioning is often an expensive and physically demanding thing, having this assurance creates an easier way for trans* people to move within a system which has not quite adapted to fit our needs.
When homosexuality was removed from the DSM, it allowed for the transformation of the climate around homosexuality, creating the opening needed for progress towards equality. But how should the trans* community seek to find the same balance when there is so much to consider? The community needs time to learn and grow, to develop the individuals willing to fight for recognition. We need healthcare to be able to approach that fight. There isn't a large base of trans* individuals willing to be out there educating and sharing, especially those who have yet to come into themselves and need the resources to be able to transition. It's a tricky dynamic. So much of transition is physical and expensive and necessary. So where do we draw the line between trying to develop the community and make it stronger for the fight or seeking respect for the community? What are your thoughts?
For more information on the announcement, check out The Advocate.