Trans Diagnosis: Medical, Psychological or ... for medical paths (surgery, hormones, etc.)

[Linus]

So this is something I've been pondering. Like a few trans individuals I know, I don't like the DSM's take that being trans (I'm using trans as the short form for sake of ease and inclusiveness) means having a mental disorder. One of the things I recognize, however, is the medical industry's need to classify things for the sake of diagnosis and for the health insurance industry's need to classify things as urgent, elective, etc.

So the question is this: if GID/trans-sexuality/trans-sexed is removed from the DSM, how will the medical industry recognize it as something that needs medical attention? Classify it as a physical medical disorder?

[Hudson]

So this is something I've been pondering. Like a few trans individuals I know, I don't like the DSM's take that being trans (I'm using trans as the short form for sake of ease and inclusiveness) means having a mental disorder. One of the things I recognize, however, is the medical industry's need to classify things for the sake of diagnosis and for the health insurance industry's need to classify things as urgent, elective, etc.

So the question is this: if GID/trans-sexuality/trans-sexed is removed from the DSM, how will the medical industry recognize it as something that needs medical attention? Classify it as a physical medical disorder?



Hi Linus,

I don't particularly like the classification either. However, I view it like this: My brain is not aligned with my physical 'sex'. And because of this, it is my brain that has suffered *dysphoria* (this is what's being treated) - sadness, anxiety, fear, anxiety, intense discomfort and suicidality, and for some self-mutilation - and therefore, it is my brain where the root of those problems must be uncovered.

It is within my brain that the diagnosis is found because my gender resides there, not in my genitalia. My own recognition that I am male and mismatched with my body is the primary condition. (Just as with intersexed folks, the physical presence of both male and female gonads may or may not produce related secondary mental symptoms (secondary sex characteristics that don't align with the brain, hormonal imbalances that produce undesired effects, as well as any and all of the ones I listed previously).

Luckily, it's this same brain that tells me to get help for that physical incongruency which can be corrected chemically and surgically. The way I see it, and that I believe the medical community sees it, is that it is classified as such because this is where the problem originates and manifests itself in various other mental symptoms (some of which have physical components).

I see this classification as not a denial that it is a medical condition, just one requiring help from multiple disciplines for treatment of the total person with the brain being the most important organ, the one that houses my gender and my mental well-being and that determines to what extent help from each discipline is needed.

I wanted to throw in here too that the standards of care developed by WPATH are known as HBIGDA (Harry Benjamin International Gender Dysphoria Association's) Standards Of Care For Gender Identity Disorders, Sixth Version as seen here (http://www.wpath.org/Documents2/socv6.pdf).

From the SOC:

"III. Diagnostic Nomenclature
The Five Elements of Clinical Work. Professional involvement with patients with gender identity disorders involves any of the following: diagnostic assessment, psychotherapy, real-life experience, hormone therapy, and surgical therapy. This section provides a background on diagnostic assessment.

Are Gender Identity Disorders Mental Disorders? To qualify as a mental disorder, a
behavioral pattern must result in a significant adaptive disadvantage to the person or cause
personal mental suffering. The DSM-IV and ICD-10 have defined hundreds of mental disorders
which vary in onset, duration, pathogenesis, functional disability, and treatability. The
designation of gender identity disorders as mental disorders is not a license for stigmatization, or
for the deprivation of gender patients' civil rights. The use of a formal diagnosis is often
important in offering relief, providing health insurance coverage, and guiding research to provide
more effective future treatments.

So I ask, where else can the diagnosis be made and the psychotherapy be directed (to treat concurrent symptoms) and the evaluation of therapy (success or failure) take place if not in the brain? If a doctor or therapist could look at you and make the diagnosis of transsexualism or gender identity disorder, then we wouldn't have this classification. Likewise, if they could look at you (prior to transition) and determine you are male, you wouldn't be having this conversation right now.

Again, this is just my take on things and maybe it can help someone else feel better about the classification.

[weatherboi]

I don't really hold issue with being diagnosed with something that is classified as a mental disorder. What we have discussed in therapy pertains to the necessity of the classificaion/category of diagnosis. No diagnosis no place to start in order to provide health care or long/short/emergency term disability care where needed. My therapist made me do some homework for my own preparation and here are a couple of articles I came across. Unfortunately destigmatizing would/could mean hurting progress not helping. As far as trying to tie our situation with a physical diagnosis I have been told not possible from my doctor.

http://www.transadvocate.com/destigmatization-versus-coverage-and-access-the-medical-model-of-transsexuality.htm

http://birdofparadox.wordpress.com/2009/05/17/transsexuality-will-no-longer-be-classified-in-france-as-a-mental-illness/

http://lezgetreal.com/?p=8205

http://dentedbluemercedes.wordpress.com/2008/04/05/destigmatization-versus-coverage-and-access-the-medical-model-of-transsexuality/

[daisygrrl]

I feel like I need to “out myself” from the beginning: I do not idenitfy as "trans" but I’ve thought about these ideas for several years, as a humanitarian and as having partnered with self-identified trans persons in the past.

The crux of this argument for me is: does a diagnosis, which is imposed and used as the main indicator of “truth” (scientifically speaking), erase agency? I really like Hudson’s post because it helps me reframe my worries a bit into thinking that maybe the more important question is, “How can we create spaces of agency within the discourses of sex/sexuality/all diagnoses/and even trauma?”

As far as de-stigmatizing (meaning the removal of cultural belief of a “defect”), WeatherB, I think it’s an important project in regard to any clinical diagnosis. I just wish the individual’s personal identification was privileged over medical discourse.

[weatherboi]

Hiya daisygrrl-
Glad you joined in humanitarian!!!

I think in order to create what you are asking may involve creating an equal empathy playing field for all patients and all medical diagnosises. Medical discourse can almost be like an "ism". Doctors/medical providers/health insurance workers/people in general, and their personal ideologies/prejudices get in the way and create an oppressive structure stemming from unconscious behavior or not unconscious behavior coming from my own personal experince. I agree with you...I wish all peoples personal medical needs would be recognized and not structurally marginalized/minimized.

[atomiczombie]

Talking about it as a mental disorder implies, to me, that we are mentally ill. That is the basis upon which people have been institutionalized, treated with drugs such as anti-psychotics, and told that they are sick and need to be treated. That "treatment" has screwed up so many trans people and led to many suicides. A mental disorder is something to be treated by fixing the person's mind, not their body. So I hate that it is classified this way.