Bay Area Reporter, CA, USA
Transmissions: What's in a name?
by Gwendolyn Ann Smith
[Photo: Dr. Harry Benjamin]
Next May, the fifth edition of the Diagnostic and Statistical Manual
of Mental Disorders, or DSM-V, should hit bookshelves. While much has
been made about some of the individuals involved with the creation of
this update and their history around transgender care, there are some
changes coming that could benefit those of us who identify as
transgender, with perhaps a caveat.
For one, the term "Gender Identity Disorder," which crept in during
the last edition, is going away. Indeed, this is being moved out of
sexual disorders and into its own space, with the new title, Gender
It is worth noting, however, that the term "gender dysphoria" is
hardly a new one. It is credited to Dr. Harry Benjamin, who released
the book The Transsexual Phenomenon in 1966, and had treated Christine
Jorgensen, whose gender transition in 1952 sparked a public
fascination with transsexuality during the years of President
Eisenhower and beyond. The term "gender dysphoria" is a very common
one both within the language of the community as well as in any number
of publications for use by psychiatric and other medical
Conversely, Kenneth Zucker, Ph.D., who also has a long – if not nearly
as stellar – history in transgender care, coined gender identity
disorder. Zucker's involvement with controversial psychologist J.
Michael Bailey, as well as his own work surrounding reparative therapy
for homosexual and transgender youth, have made him a rightful target
of decades of criticism.
I should note that Zucker and his protege Ray Blanchard, Ph.D. – known
for his use of the "Phallometer" to measure the penises of transwomen
in order to qualify or disqualify a patient for care in the notorious
Clarke Institute of Toronto – served on the DSM-V Workgroup for Sexual
and Gender Identity Disorders. This has led many people to be quite
critical about the work done within the DSM-V. It also makes me a bit
happier to see some of the proposed changes made in spite of Zucker
The change from gender identity disorder to gender dysphoria is not
important because it puts Benjamin over Zucker, as much as I
personally may prefer the former over the latter.
Nor is the value of accepting a single term to describe the nature of
being transgender, rather than using Gender Identity Disorder and
Gender Dysphoria interchangeably, what matters here.
Rather, what is key is losing the word "disorder."
Now it might seem that the loss of the word "disorder" from a text
named Diagnostic and Statistical Manual of Mental Disorders wouldn't
matter, but it does. This changes the mindset surrounding transgender
people and their treatment.
Under the gender identity disorder model, the label essentially says
that transgender people are mentally ill. That the "disorder" is a
mental issue – and even though the treatment has a physical cure, the
problem is still a mental deficiency more than anything else.
As gender dysphoria, the issue is more focused on the physical state.
Those who are classified with gender dysphoria will be those
displaying a "marked incongruence between one's experienced/expressed
gender and assigned gender."
It may seem a simple case of semantics, and perhaps at the heart of
things it is, but the goal is to change the overall view of this as a
disorder and more of a natural state of being.
Homosexuality, too, was once an illness in the DSM. It, too, changed
over time in the eyes medical and psychiatric professionals, and was
eventually dropped altogether. We may indeed be seeing this as one of
many steps before transgender issues are removed from the DSM in some
future edition. Certainly this is changing it from a condition that is
"treated and cured" by a gender transition into something that is
mitigated by therapeutic assistance, including the potential for
As such, we get to the caveat I mentioned at the beginning of this
column: as we see this becoming a smaller part of the DSM, we also
risk seeing transgender people losing a diagnosis that can provide
them medical care as well as legal standing. That transgender people
were listed in the DSM in the first place helped to see laws against
cross-dressing and "impersonation" fall off the books. This is part of
what has allowed us to get hormone treatments, surgery, and other
That said, I am glad to see it move out of the realm of "disorder" and
into something else. I look forward to people not thinking transgender
people are mentally disordered due to our presence in the DSM-V – even
though some will assume us mentally disordered regardless.
Yet I would like to see advocacy done to make sure we do see the needs
for those of us who do require hormones and surgery considered – not
as a "medical disorder," but as a medical necessity. There really
should be a process in place for those who need such care, even as the
process of removing language that labels us "disordered" continues.
The DSM was the outgrowth of the United States census, and started
with only one category. By 1917, the Statistical Manual for the Use of
Institutions for the Insane – a precursor of the DSM – had 22
categories. Today there are more than 350 categories. The updating of
the manual is from all accounts a laborious, sometimes political, and
Things may yet change between now and publication – but it looks like
we may indeed no longer be "disordered." This is as it should be.
Gwen Smith is frequently disorganized, but not disordered. You'll find
her online at www.gwensmith.com.
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