Mad as hell

by Helen G // 11 May 2008, 21:38

A_TransGender-Symbol_Plain2 from Wikimedia CommonsThe Diagnostic and Statistical Manual of Mental Disorders (DSM) is an American handbook that lists different categories of mental disorders and the criteria for diagnosing them, and is widely used by mental health professionals worldwide, including "clinicians and researchers as well as insurance companies, pharmaceutical companies and policy makers" (wikipedia). To say that it’s something of an influential document is a bit of an understatement.

After all, until 1974, homosexuality was classified as a mental disorder, according to the DSM-II. But after activists campaigned loud and long, protesting at APA offices and at annual meetings from 1970 to 1973, the Board of Trustees voted to remove homosexuality as a disorder. However, the DSM-III (1974) introduced a new category of "sexual disorder not otherwise specified" which can include a state of distress about one’s sexual orientation, as well as the diagnosis of "gender identity disorder".

The APA has been subject to controversy in other areas: in 2003, activists from MindFreedom International staged a 21-day hunger strike, challenging the APA to provide evidence of its claim that mental disorders are due to chemical imbalances in the brain.

More recently, when it emerged that US psychologists and psychiatrists were helping interrogators in Guantanamo, the APA stated that psychiatrists should not take a direct part in the interrogation of prisoners, but could "offer general advice on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise".

And in 2005, the APA president said that American psychiatry had accepted "kickbacks and bribes" from pharmaceutical companies, which had lead to the over-use of medication and neglect of other approaches.

So it seems that the APA is not exactly a paragon of propriety - and yet, the DSM which it produces still retains global credibility as a hugely authoratitive and influential work.

As I mentioned, the most recent (and current) revision - DSM-IV - was in 1994 but has been under review since 1999 with the aim of producing DSM-V, which "is expected in May 2012". There are 13 work groups involved in this process, and they began meeting in late 2007.

Lynn Conway has now reported that on 1st May, the APA named the members appointed to revise the Manual for Diagnosis of Mental Disorders in preparation for the DSM-V. Such a revision would include the entry for GID. To quote Lynn’s piece: "Ken Zucker, who heads a reparatist clinic for gender-variant youth in Toronto, was named as Chair of the Sexual and Gender Identity Disorders Work Group for DSM Revision. Ray Blanchard, widely known for pronouncing that transitioned women are "men without penises", was appointed as a member of that Work Group. Any bets on how this is going to turn out?"

According to TS Roadmap, Zucker is famous for - Actually, that whole page is a must-read. I really can’t find any single quote I’d want to abstract from it... *pauses briefly while mind boggles*

And Blanchard, head of the gender program at the Clarke Institute in Toronto, has established its reputation as "one of the most notorious facilities in the world in terms of controlling access to medical services". Their technique involves a reparative therapy apparently very similar to that used by other groups who claim to "cure" gays and lesbians. Blanchard himself is arguably equally notorious for inventing the mental illness he terms autogynephilia ("a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman")

According to Mercedes Allen, guest blogging in this post at The Bilerico Project, "Drs. Blanchard, Zucker [...] and a small cadre of others are proponents of dividing the transsexual population by sexual orientation (‘homosexual transsexuals’ vs. ‘autogynephilic’) and have repeatedly run afoul of the World Professional Association for Transgender Health (WPATH, formerly HBIGDA), and openly defied the Standards of Care that WPATH maintains (modeled after the original SoC developed by Dr. Harry Benjamin) in favor of conversion techniques".

Mercedes sees this as a "very serious danger to the transgender community" and I, for one, support hir fully in "calling on the various Transgender and GLBT organizations to band together to take action on this. I am also calling upon our allies and advocates in the medical community and affiliated with WPATH to band together with us and combat this move which could potentially see WPATH stripped of its authority on matters regarding treatment of transsexuals".

"Men without penises", my arse.

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Later edit: Zöe has an extensive and meticulously detailed analysis of this on her blog; I recommend it unreservedly: Transsexual Causation, the American Psychiatric Association, and Interpol. I want to quote two paragraphs of hers verbatim; she is so eloquent and succinct and I really couldn’t phrase it any better myself, no matter how hard I try:

"And that is why both Intersex and Transsexual groups are up in arms about this. The more scientifically literate, and that is a very high percentage, because of the "junk science" that will likely lead to greater persecution. The rest because of the insult such views offer us, to be mischaracterised and misrepresented in such a blatant way, our honest narratives dismissed as lies by lunatics."

"Should this state of affairs be allowed to continue, should the fringe views of a few paleolithic neo-Freudians be adopted as Gospel, then an avalanche of discriminatory regulation will likely ensue. The long-standing rights to correct birth certificates, to marry in the correct gender, even to work near children, will likely be withdrawn. After all, we’ll be officially "self-mutilating male perverts or gays" according to the APA, no matter what the specialists in the area might say."

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Even later edit (11 May):

  1. Mercedes Allen’s original post at The Bilerico Project - or, more accurately, the comments on her post - is (are?) worth revisiting. Link here.
  2. On 10 May, Transadvocate posted this Update on Zucker, Blanchard and the Revision of the DSM.
  3. Also on 10 May, Zucker himself compares ethnic identity conflict and gender identity conflict in this post.
  4. For those who are minded to voice their objections, Drakyn’s post Action Alert contains a useful selection of contact details, link here.
  5. There’s an online petition here for anyone who wishes to lodge an "Objection to DSM-V Committee Members on Gender Identity Disorders".

Finally, in case it needs to be said; this issue is likely to affect anyone who doesn’t conform to gender stereotypes because, given the probable influence and input into DSM-V of the two most senior panel members (Zucker and Blanchard) it seems almost inevitable that we will no longer have the right to self-define our gender variance.

(Cross-posted at bird of paradox)

Image licensed under Creative Commons Attribution ShareAlike 2.0 Germany License

Comments From You

Jess // Posted 11 May 2008 at 22:31

Thank you for calling attention to this, Helen. One thing that I wondered reading this, etc, was does this have much influence on the situation in the UK? Do UK psychiatrists have their own version of the DSM?

Helen G // Posted 12 May 2008 at 08:54

Jess: Although the DSM originates in the US, it is internationally recognised and the criteria it uses to categorise various medical conditions, such as GID (Gender Identity Disorder), are generally adhered to worldwide. And although it is far from perfect, it does at least formalise access to medical services, including GPs, therapists, medication (eg HRT) and surgery. The comparatively few rights and protections that exist for people diagnosed as having GID are there mainly because they are in the DSM.

The concerns of many trans* and other gender variant people is that, Drs Zucker, Blanchard and their colleagues in the APA’s Sexual & Gender Identity Disorders Work Group may well remove GID as a possible diagnosis, at which point it is likely that more people will be incorrectly diagnosed. The treatment of GID would become ‘cosmetic’ and, at its most extreme, it could also mean that things like HRT could be considered ‘harmful behaviours’.

But the argument for removing GID from medical classification is complex: when (in 1974) homosexuality was removed from the DSM, gay and lesbian rights began to gain prominence. It has been a suggested that if GID was removed, then trans* people’s rights could also benefit. My concern about this is that it ignores the fact that many trans* people have medical needs which did not, and do not, necessarily apply to GLB people, and provision needs to be made for this.

On the other hand, it is a concern that transsexual people are classified under the DSM as having a ‘mental disorder’ - an umbrella phrase which covers a wide range of conditions and which needlessly stigmatises many. From this there can follow the concept of being ‘mentally unfit’ which can, and does, lead to things like workplace discrimination or the loss of custody/visitation rights of children.

Maia // Posted 12 May 2008 at 13:58

What does this have to do with feminism?

Helen G // Posted 12 May 2008 at 14:12

It's an attack on gender equality.
I thought gender equality was an issue of concern to feminists.

Seph // Posted 12 May 2008 at 16:39

I think this has everything to do with feminism, especially the link to Dr whatshisface telling boys they have to play with trucks and girls they have to play with Barbies.
Assuming genders are genetically pre-programmed to play with one bit of plastic rather than another bit of plastic seems like the real mental disorder here.

Sian // Posted 12 May 2008 at 18:26

Dr Zucher sounds terrifying, frankly, and that his views are going to be taken seriously by DSM is even more so.

Obviously a feminist issue, btw.

Rachel // Posted 12 May 2008 at 19:34

The UK doesn't usually use the DSM critieria for mental health in clinical practise, as far as I know it usually uses the International Classification of Diseases criteria which is created by the WHO. (At least, this is what it uses officially, practise is often more variable.) This is certainly true for depression, I'm not sure about other mental illnesses, or what ICD has to say about gender identity..

Helen G // Posted 13 May 2008 at 08:26

Hello Rachel

According to the GID Reform Advocates website (link here), "The DSM is regarded as the medical and social definition of mental disorder throughout North America and strongly influences the The International Statistical Classification of Diseases and Related Health Problems published by the World Health Organization.".

Wikipedia says "The current edition of the International Statistical Classification of Diseases and Related Health Problems has five different diagnoses for gender identity disorder..."

This fact sheet (Links to PDF document) hosted at Gay & Lesbian Advocates & Defenders (GLAD) says this:
"Besides the DSM, what other medical authorities recognize GID?
Standard texts such as the American Medical Association Encyclopedia, the Merck Manual, the World Health Organization’s International Classification of Diseases all include Gender Identity Disorder. GID is discussed in standard psychiatric texts including Psychiatry, The Treatment of Psychiatric Disorders, Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, and the New Oxford Textbook of Psychiatry."

And this page at How Stuff Works also seems to agree... ;)

Hope this helps!
Helen

Steph Jones // Posted 13 May 2008 at 20:52

Thanks Helen, Jess for reporting on this. Whether you live in the States of not, the DSM still carries substantial weight in the medical and psychiatric world. In a number of cases, the WHO ICD has been directly influenced by the APA DSM.

For Maria who asks "what has this to with Feminism?", whilst this particular petition is focused towards the treatment of transsexual people, it has much wider implications. Zucker, Blanchard et al are infamous for their belief in 'reparative therapy' and trying to pathologise anyone who deviates from their heterosexist 'norm' - whether that be gay/lesbian or transsexual/transgender.

That these two people should now be considered to be involved in the next DSM manual is nothing short of astounding.

Rachel // Posted 14 May 2008 at 09:55

Lots of issues around how mental health is defined are feminist issues. The prevalence of diseases such as depression or anxiety are much higher in women than in men. Thinking about why this is is a feminist issue.

Dr Hyatt-Wallace // Posted 17 May 2008 at 14:26

If we hope to stop the APA we HAVE to keep the pressure on them.
Please sign the petition, we need your voice to be heard. The site is down this week end to upgrade the servers, but please sign it so when it is sent to them it has more than the 4400 plus names on it now
Thanks

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