Diagnose this!

  • by Gwendolyn Ann Smith
  • Wednesday June 15, 2011
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(Illustration: Christine Smith)
(Illustration: Christine Smith)

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.