Questioning Transphobia

New Scientist magazine has published a lengthy article – Psychiatry’s civil war – about the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders and the “open conflict [which] has broken out among the upper echelons of US psychiatry” regarding the attempt to “extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs”.

(Note: Since the article was posted, the American Psychiatric Association has announced that the publication of DSM-V will be delayed until May 2013 to “allow more time for public review, field trials and revisions”.)

The whole article is worth reading, but in particular it has this to say about the redefinition of gender identity:

We are who we say we are

Is history repeating itself? That’s the question facing psychiatrists considering how gender identity should be defined in DSM-V. The APA has a legacy of uneasy relations with the lesbian, gay and transgender community, having included homosexuality in the DSM’s list of psychiatric disorders until 1973. Some transgender activists want issues of gender identity kicked off the list of mental illnesses too.

These activists are up in arms over the membership of DSM-V’s sexual and gender identity disorders work group, in particular the selection of Kenneth Zucker of the University of Toronto, Canada, as its chair. Zucker is reviled by some transgender activists for his work on therapy to reorient children who feel that they were born into the wrong sex. An online petition objecting to the work group’s composition has more than 9500 signatures.

The group is nevertheless likely to recommend changes that could actually ease tensions. One of these is a change in the name of a diagnosis that as currently phrased is inherently offensive to transgender people. “‘Gender identity disorder’ falsely implies that the gender identities of gender variant people are in themselves disordered,” says Kelley Winters, founder of GID Reform Advocates.

The work group has not yet revealed its proposed name, but “disorder” will be dropped. “We’re sensitive to issues of language,” says Zucker. One possibility is “gender dysphoria”, which focuses on the inherent distress of people living in a body that doesn’t match their identity.

That would not satisfy those transgender activists who want issues of gender identity removed from the DSM altogether. But others argue for the retention of a renamed condition to make it easier for those distressed by the mismatch between their identity and their bodies to seek assistance, and also to help those who need sex-change surgery to get it paid for. Even now, many transgender people face problems when insurers refuse to recognise the treatment as a legitimate medical expense.

My opinion on the binary options mentioned in the last paragraph is somewhere between the two viewpoints: I would be more than happy for any mention of gender identity to be dropped provided that trans people are not, as a consequence, denied access to timely, appropriate and free medical treatment. Transitioning needs to be refocused away from a gatekeeping approach to one of facilitation and support.

Additionally, New Scientist has also published an op-ed companion piece – Time’s up for psychiatry’s bible – which suggests that:

With the advent of the internet, there is no longer any compelling need to rewrite the diagnostic criteria for the whole of psychiatry in one go. Yes, diagnoses should be revised as new scientific findings come in. But for this, specialists can be assembled when necessary to address specific areas that have become outmoded. Their suggestions can be posted on the web for comment. More research can be commissioned, if necessary. And when consensus is reached, new diagnostic criteria can be posted online.

Similarly, standing panels could periodically review issues that cut across the whole of psychiatry – such as the inevitable shift away from checklists of symptoms towards a system based on measurements of the underlying biological and psychological determinants of mental health.

Apparently there is resistance to this move towards such a “living document” because such a transition (no pun intended):

[...] would have hurt the APA’s coffers, as a book that becomes a required reference is a big earner; DSM sales since 2000 exceed $40 million.

Which rather leaves me wondering exactly where the APA’s real priorities lie: in providing a framework that would actually help the people who need it, or generating arguably obscene profits at the expense of our health and wellbeing.

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(Curtsey to Martha T.G.O. on the TGEU listserv for the heads-up)

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Cross-posted at Bird of Paradox

ETA, Monday, October 12: Those people who are still subscribed to Mr Hambridge’s STP Facebook group have received the following message:

After due reconsideration and-> most valued advice from Transpersons, Intersexual persons or those who work in conjuntion with them, in majority<-it as been agreed and/or decided to cancel the above rally for this years STP 2012 campaign.

I understand that, as a consequence, the proposed counter-protest has also been cancelled.

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We are a group of trans activists who wish to make known our concerns about a demo, claiming to support the depathologisation of trans people, in London on 17th of October. The facebook group for the demo can be found here:

http://www.facebook.com/event.php?eid=147494409183

The description of the event reads:

“Being transgendered is not a mental illness. We are simply part of the diversity of humanity. Gender Identity Disorder is therefore not a valid diagnosis. Homosexuality we removed as a mental health diagnosis in 1987. For us to achieve true liberation and recognition we need to throw off this unjust stigma. We are not ill, just different”

A large number of people were invited by the demo organiser, a non-trans man by the name of Dennis Hambridge, and some of us were initially concerned by the rationale for the demo. In particular, we were worried that campaigning for the removal of Gender Identity Disorder as a medical diagnosis without proposing an alternative mechanism by which transsexual people would be able to access medical transition resources was premature and dangerous, especially in a climate where NHS primary care trusts need only a minimal excuse to deny funding for our hormonal and surgical procedures. We do not support the labelling of our gender identities as disordered, and realise that our relationship with the medical community is far from ideal, but do not wish to support a movement which may give the impression that we seek complete divorce from the medical community.

These concerns were put to the Facebook group by a number of trans activists. Rather than address them, Mr Hambridge entrenched his position, making claims that gender dysphoria was an artefact of society and the medical community, and that removal of any form of classification of gender dysphoria by the WHO was “non-negotiable”.

In moves more reminiscent of the actions of transphobic radical feminists than supposed allies of trans people, Mr Hambridge started deleting some of the comments from those trans people who were concerned about our future access to hormones and surgery. Subsequently he banned a number of those trans people from the group, silencing them in that space.

To reiterate – Mr Hambridge, who is organising a demo which is allegedly supporting the rights of transsexual people is using his position as a group organiser to silence and shut out the voices of the very people he claims to support.

In light of Mr Hambridge’s intransigence and refusal to listen to the voices of actual transsexual people, we are calling on all activists who support the concept of transsexual people having a say in our own medical care to boycott this demo. We further call on Mr Hambridge, who is not trans himself, to stop claiming to speak on our behalf when he is ignoring our protestations and silencing our voices, and to call off his demo.

Please spread this open letter widely.

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Cross-posted at Bird of Paradox

TGEU has issued a statement in support of the international campaign by the Trans Depathologization Network for the removal of the Gender Identity Disorder category from the international diagnosis manuals (the DSM and the ICD).

The five demands of the STP-2012 campaign are as follows:

1. The retirement of GID from the international diagnosis manuals (their next versions DSM-V and ICD-11)
2. The retirement of sex mention in the official documents
3. The abolition of the binary normalization treatments to intersex people
4. Free access to hormonal treatments and surgery (without the psychiatric monitoring)
5. The fight against transphobia: working for education, social and labour insertion for trans people

In addition, TGEU is calling for these additional actions:

• The creation of an alternative non-pathologizing category in the ICD 11, recognizing that our gender identities are not mental health disorders while still enabling hormonal and surgical medical assistance to be provided for those trans-people who seek such assistance.
• The funding of hormonal and surgical medical assistance for trans people by national health insurance.
• The creation of processes for changing legal name and gender without compulsory treatment or any form of diagnosis.

TGEU also adds:

In 2008 the Steering Committee of TGEU already published a declaration, stating “that the stigmatization, which in part is grounded in the mistaken assumption that gender variance is prima facie a medical disorder, is discriminatory” and demanding that “[a]ny revision of the DSM and the ICD must be carried out with full compliance to the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity” (see Yogyakarta Principle 18 “Protection from Medical Abuse”).

The Steering Committee of TGEU very much welcome and support the position taken by the Council of Europe’s Commissioner for Human Rights, Thomas Hammarberg, in his Issue Paper “Human Rights and Gender Identity”:

“The first aspect in discussing health care for transgender persons is the existence of international and national medical classifications defining transsexuality as a mental disorder… Such classifications may become an obstacle to the full enjoyment of human rights by transgender people, especially when they are applied in a way to restrict the legal capacity or choice for medical treatment… Alternative classifications should be explored in close consultation with transgender persons and their organisations. From a human rights and health care perspective no mental disorder needs to be diagnosed in order to give access to treatment for a condition in need of medical care.”

Campaign Background:

The campaign “Stop Trans Pathologization: Goal 2012″ of the Trans Depathologization Network aims at initiating and monitoring actions directed against the “Gender Identity Disorder” category in international classifications of diseases, especially focusing.

The revision of the DSM IV will finish in 2012 with the publication of the new DSM V. The Network has intensified its actions, and decided to have coordinated demonstrations and other actions demanding the depathologization of trans identities in as many cities as possible around the globe always in October until the year 2012.

A joint action among French and Spanish trans groups in 2007 was the starting point of the Trans Depathologization Network. Since then they have broadened their scope and have continued organizing demonstrations against trans pathologization in every October. In 2008, already 11 European cities participated in joint actions. This year the set date for demonstrations in cities worldwide is October 17th. To date, more than 80 trans organizations and allies from more than 40 cities in Africa, the Americas, Asia and Europe have confirmed their participation or expressed their support and many more are expected to join in over the next few weeks.

Click here to download a PDF (in English) of the TGEU’s supporting statement

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Cross-posted at Bird of Paradox