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Dec 8, 2012
Over the past week, there has been some major news concerning transgender citizens and the Diagnostic and Statistical Manual of Mental Disorders.
The Associated Press reported that the American Psychiatric Association’s Board of Trustees approved certain notable changes to that body’s Diagnostic and Statistical Manual of Mental Disorders on Saturday. The story began with the controversial announcement that Asperger’s syndrome will now be included in the autism spectrum disorder category, but another change buried at the bottom of the piece may prove to be even more divisive—and, if historical precedent is any indication, more influential on society at large.
Since the third edition of the DSM was published in 1980, some version of the diagnosis gender identity disorder has been included to describe patients whose subjective experience of gender does not match their biological sex. The common contemporary term for this group is transgender, the T in LGBT. Sources within the APA now confirm that in the DSM-5, which is due to be published in May 2013, GID will be replaced with the more neutral term gender dysphoria.
Approval of this revision has been years in the making and reflects a narrowing of psychiatrists’ focus to those who experience personal distress over their gender incongruity. Those patients who feel like they need psychological help dealing with their feelings can still seek it out, while those who feel fine need not be marked as ill.
Jack Drescher, a member of the APA group dedicated to considering this issue, explained to the Daily Beast back in 2010 that his subcommittee’s recommendation came from a desire to stop “pathologiz[ing] all expressions of gender variance just because they were not common or made someone uncomfortable.”* Moreover, in a recent interview in the Advocate, Drescher acknowledged that “all psychiatric diagnoses occur within a cultural context,” adding that “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”
I do believe that this change is progress. I have been very critical in the past of efforts to change the diagnosis, not because I believe that being transgender is a problem, but because being transgender leads to a range of other mental health issues, and if you are low income like me, it would be hard to remove diagnoses related to transgenderism without endangering access to crucial mental and physical health services, which sometimes don’t even exist for certain people.
The change from gender identity disorder to gender dysphoria strikes that delicate balance between not pathologizing the transgender community and provision of physical and mental health services. Currently, in Great Britain, the term gender dysphoria is used by the National Health Service, the public single payer health plan, yet said public health plan covers a range of transgender services, up to and including gender confirmation surgery.
However, I have found that transgender health coverage can be covered under certain disorders NOT relating to gender identity. When I was applying for a program, I had to have a medical form filled out by my doctor. He filled it out and gave my medical diagnoses as endocrinopathy and hirsutism; which, if you consider that I identify as female, isn\’t far from the truth. However, this may only be feasible if one can change the gender marker on your identification and on your healthcare plan (which Pennsylvania\’s medical assistance has allowed me to do), but it may be a tool in which one could get certain trans* health coverage.
All things considered, trans* health is a tricky issue and sometimes, the road to hell can be paved with good intentions.
-Jordan Gwendolyn Davis