Wednesday, March 31, 2010

Transcending Diagnoses

by Stacey Prince

One place where issues of politics, social justice and mental health come together in profound and impactful ways is in the Diagnostic and Statistical Manual (DSM), the diagnostic "bible" used by medical and mental health professionals to identify psychiatric disorders. Although its authors strive to be value-free and scientifically based, the DSM is unavoidably influenced by cultural norms, and conversely it influences how society determines what is normal, pathological, or deviant. On the flip side, the DSM can be a positive influence when it increases access to appropriate care (for example, insurance companies typically require a diagnosis in order to reimburse for treatment) and legitimizes previously unrecognized suffering (such as when PTSD was coined and identified as a common consequence of combat trauma for Vietnam veterans).

The next version of the DSM, the DSM-5, is currently being drafted and is scheduled for release in 2013. I have been watching closely the controversy surrounding one particular diagnosis and its proposed revisions in the DSM-5. Gender Identity Disorder (GID) is used to identify individuals whose internal experience of gender and/or desired gender expression is opposite that of their biological sex or gender assigned at birth--individuals who often identify as "transgender". From the beginning there has been a great deal of controversy around the GID diagnosis. At the most basic level, the very existence of the diagnosis implies that significant gender variance is pathological. This not only adds fuel to the fire for those who stigmatize, discriminate against and harass gender non-conforming individuals, but also lends credence to efforts to change or "convert" gender variant people, enforcing their conformity to their assigned birth sex. Further, the classification of gender variance as a mental disorder is used by some to deny transgender individuals basic civil rights and legal protections. These arguments against diagnostic criteria are similar to those around homosexuality, which was not removed from the DSM until 1973. (For those interested in this topic please see an excellent article by Jack Drescher offering a thorough review of the parallels and contrasts between GID and homosexuality with regard to diagnostic criteria and civil rights.)

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1 comment:

  1. In regards to the GID diagnosis, Stacey writes: " ... many people including some transgender rights activists feel that some form of the diagnosis is important to retain because it does increase access to reimbursable treatment that supports authentic gender expression, including ... "

    Even if that were true (let us assume for the sake of argument that it is so) then using that as a reason to guide how a diagnosis is to be written is criminally dishonest and morally bankrupt. It is fudging medical criteria for the express purpose of cheating insurance companies out of their profits.

    On March 15, 2010 the government of Spain (Congreso de los Diputados de España)committed to follow the lead of France and remove Transsexualism as a mental disorder by force of law. What is clear is that if psychiatry continues to refuse to put its house in order then the heavy hand of government will be used as a political tool to force psychiatry into the 21st century.