In 1973, the American Psychiatric Association (APA) removed homosexuality from its list of diagnostic criteria for mental illnesses, in the Diagnostic and Statistical Manual for Mental Disorders (DMS), the standard guide for identifying mental disorders in both the U.S. and Canada. This was a major early victory for LGBTQ rights. However, despite this, two particularly troubling diagnoses remain: Transvestic Fetishism (TF) and Gender Identity Disorder (GID).
These diagnoses, which govern how transgender and gender non-conforming people interact with mental health providers, reflect stereotypes rather than actual people – and, with perverse irony, often hurt the people they’re supposed to help.
TF is categorized as a paraphilia – or sexual fetish – just like pedophilia. This reinforces stereotypes of cross-dressers as sexual predators. In addition, one of the criteria for a TF diagnosis is “over a period of at least six months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviours involving cross-dressing.”
This feeds into the stereotype of cross-dressers as people who dress that way for sexual pleasure. However, people cross-dress for much more varied reasons than just sexual thrills. Furthermore, it’s not really clear why, medically, only heterosexual males can be diagnosed with TF.
The rules for diagnosing GID focus even more on these rigid gender stereotypes, especially in children. Criteria for GID in children assigned male at birth include “aversion toward rough-and-tumble play” and “rejection of male stereotypical toys, games and activities.”
This ignores the full range of human possibility. It’s entirely possible to be a woman and feel like a woman while enjoying “rough-and-tumble play” or “male stereotypical toys, games and activities.” In fact, not only would I wager that it’s possible, I’d also wager that you have interacted with such a person today.
Although the APA claims the DSM does not say anything about treatment, only diagnosis, the way the DSM frames these issues in terms of traditional gender stereotypes.
The real irony, though, is that this policy legitimizes stigmas around gender-variant behaviour by linking them to the stigmas around mental illness, which can only hurt those who need mental health services.
When declassifying homosexuality as a mental illness, the APA acknowledged that social factors were often responsible for depression, shame and other issues that led some lesbian, gay, and bisexual people to seek help from mental health sources. Why then does the APA refuse to acknowledge that social factors are often responsible for those same issues of depression and shame in gender non-conforming people?
Perhaps most perversely, these diagnostic criteria allow people who retreat deeply into the closet – which can be very damaging to one’s mental health – to escape a GID diagnosis and the social stigma of mental illness. At the same time, those who decide whether or not to transition, and by how much, are happy with who they are, yet they remain marked with that stigma for the rest of their lives.
Put yourself in the place of someone who’s trying to transition. Many people simply just don’t understand why you would do that. Then add to that the realization that the APA, a socially-recognized mental health authority, considers you to be diseased, simply out of who you are. Ask yourself if you would be willing to trade a bit of your dignity for medical treatment. If not, why should anyone else have to?
The best argument against removing or reclassifying GID is that a GID diagnosis can be necessary for some health insurance claims, which can be essential for one’s transition, especially given the expense and the proportion of trans people facing job discrimination and lack of family support.
However, one injustice does not legitimize another injustice. Such treatment is medically necessary – without it, a significant number of trans people would commit suicide. Some still do, not realizing there is another way. And the need to have a justification for insurance purposes does not force us to accept a need to define non-normative gender as a disease. There are plenty of medical conditions that are not diseases – take pregnancy, for instance. Yet, if anyone denied treatment to pregnant people, or called pregnancy an elective procedure, the public outcry would be immense.
The APA will not release its next revision to the DSM until 2012; however, a draft is due next year. If the APA continues this injustice, it will fall on us to act.
James Albaugh is a U2 Philosophy student. He can be reached at firstname.lastname@example.org.