[Commentary] [USA] Diagnose this!
Stephanie Stevens
Transmissions
Diagnose this!
by Gwendolyn Ann Smith
Published 06/16/2011
[Illustration <http://bit.ly/lZPMOg> ]
One thing that many transgender people have struggled with is the
assumption that they are crazy. We internalize the fear that our
cross-gender feelings may be a sign of some psychosis, all the while
society tells us there must be something wrong with us for associating
with the opposite gender – let alone wanting to inhabit some form of
"third-gender" space.
When I was a young trans thing, I scoured the books at the local
library, and what little I could find was all very clinical,
discussing transgender identity in the language of psychosis, and
explaining my very being as a disorder. Even with all of my
eccentricities – and coming from a family that is no stranger to same
– it left me feeling that there must be something very wrong with me.
As I began to seek care, I found myself firmly placed on the couch of
my nearest gender therapist. After some time with her, with a second
therapist, and even going through the Minnesota Multiphasic
Personality Inventory test, it was determined I was sane – sort of.
You see, tucked in the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders is a diagnosis for people
like me. Its section number is 302.85, and in language you or I might
comprehend, that's gender identity disorder in adolescents or adults.
It is perhaps a great irony that transgender people can be determined
to be perfectly sane, yet at the same time certified with a disorder
under the DSM. For those seeking gender reassignment surgery, in fact,
it's a requirement: you have to be determined to fall under 302.85 for
care.
DSM-IV is what is in use now. It was new when I was starting out, and
considered an improvement over the DSM-III r. Nevertheless, there were
many who were already then fighting to see that 302.85 ended up on the
scrap heap, alongside the homosexuality diagnosis that was removed
with DSM-II. If not removed, many wanted the section at least revised
into something that still allows for transsexuals to get treatment,
without otherwise stigmatizing transgender people.
Now DSM IV is in the process of revision to DSM V and things seem a
little haywire.
In steps Kenneth Zucker, Ph.D. and Ray Blanchard, Ph.D. Both come out
of the Clarke Institute in Toronto, Canada, a place notorious to
Canadian transgender people for hostile treatment.
Zucker is known for his work done to "cure" gender variant youth,
through methods that make the National Association for Research and
Therapy of Homosexuality endorse him. Meanwhile Blanchard pushed the
use of a plethysmograph (a device that registers the turgidity of the
penis when the subject is exposed to sexual material) in his
evaluation of possible surgical candidates.
Zucker is chairing the workgroup on sexual and gender identity
disorders, while Blanchard chairs the Paraphilias Subcommittee. I
doubt you even need to guess how this will turn out.
First, good old section 302.85 gets a new name, becoming Gender
Dysphoria. A lot of the language remains the same, though some
additional language has been added. There has been intense lobbying
around 302.85, so one might think that even with folks like Blanchard
and Zucker in the mix, perhaps things won't be that bad.
But there's more than section 302.85 to worry about. In DSM-IV there
is also section 302.3, otherwise known as Transvestic Fetishism. Here
is where the ride gets rocky.
Blanchard has proposed that 302.3 be renamed to Transvestic Disorder
for DSM V. While he intends to keep the current criteria – sexual
urges toward cross-dressing that impair other functions – he wants to
go a step or two further, adding in his pet term, autogynephilia. In a
nutshell, autogynephilia can be phrased to mean that any transsexual
woman who is not sexually attracted to males is nothing more than a
sexual fetishist.
Lest FTMs feel excluded, Blanchard and colleagues have also recently
cooked up the term autoandrophilia, and have sought to expand the
diagnosis to otherwise ensnare those of all gender nonconformance. To
add insult to injury, a new section, 302.3 2, would have a specifier
that states that 302.3 is not cured, but only goes into remission.
So while 302.85 remains around – albeit narrowed – 302.3 is widened,
presumably to capture even more people and keep them viewed as
mentally disordered. People whose only presumed reason for being
pathologized is that they do not fit rigid definitions of "male" and
"female" behavior are not only pathologized, but pushed toward
reparative therapies that have long since fallen out of fashion with
all but the most twisted treatment providers.
From where I sit, I see no good reason for such a move. There is no
need for a diagnosis, particularly an open ended one, on people who
are not hampered by their gender identity. All I see are a pair of
sexologists who are attempting to push disputed theories into
practice, no matter who they hurt in the process.
This is just plain wrong.
So what can be done about it? To be honest, I'm not sure much can.
Zucker and Blanchard are likely to force through as much of this as
they can, and I really don't think the voice of the people will be
heard very loudly or very well. Nevertheless, consider a visit to
http://www.dsm5.org and speak out.
It's not transgender people who are crazy, it's the proposed definitions.
--
Gwen Smith is not too crazy about being crazy. You can find her online
at www.gwensmith.com.
--
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