Beyond Denial: GID Diagnostic Criteria and Gender-Conversion Therapies

 

Kelley Winters, Ph.D.

GID Reform Advocates

www.gidreform.org

 

 

On May 9th and 23rd, the American Psychiatric Association (APA) issued statements on “GID and the DSM,” repeating that,

 

“It is important to recognize that the DSM is a diagnostic manual and does not provide treatment recommendations or guidelines.”(1)

 

This was in response to concern from the transgender community and allies that the current “gender identity disorder” (GID) diagnosis is biased to facilitate gender-conversion therapies.  These are punitive psychotherapies attempting to change the gender identities of gender variant youth and adults, exemplified in a May 7 National Public Radio interview of Dr. Kenneth Zucker (chairman of the DSM-V Sexual and Gender Identity Disorders work group) which described his therapy regimen for a gender-nonconforming child he diagnosed with gender identity disorder: 

 

“Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder.” (2)

 

Such harsh shame and punishment, for behaviors which would be ordinary or exemplary for other children assigned female at birth, drew outrage from many transitioned individuals who themselves were forced to grow up in painfully incongruent gender roles.

 

A recent joint statement from the National Center for Trangender Equality and other leading advocacy organizations echoed broad concern about gender-conversion and sexual-orientation-conversion therapies:

 

“It is inconceivable that in the 21st century any credible scientist or medical professional would recommend any discredited treatment that would attempt to change a person’s core gender identity or sexual orientation. Such treatments have no empirical basis and are harmful”(3).

 

However, the APA’s denial of any treatment guidance in the Diagnostic and Statistical Manual of Mental Disorders, (DSM) has been repeated often in recent weeks (4) and is stated bluntly on the APA DSM FAQ page,

 

“No information about treatment is included.” (5)

 

But does repeating a thing often enough make it true?  In fact, diagnostic nomenclature and treatment are inseparably intertwined.  This is because the efficacy of all drug and psychotherapy treatments are judged according to specific diagnostic criteria listed in the DSM and ICD.  For example, it stands to reason that the efficacy and marketability of a psychopharmacological product could be expediently improved by tweaking DSM diagnostic criteria to favor it’s strengths.  In response to concerns of influence by drug manufacturers on diagnostic nomenclature(6), the APA requires disclosure of financial ties to pharmaceutical corporations by members of the DSM-V Task Force.

 

What does the the current DSM-IV-TR imply about gender-conversion treatment?  Kids and adults driven deep in the closet by gender-conversion therapies no longer meet the four diagnostic criteria for GID (7) and are emancipated from diagnosis of mental disorder. On the other hand, affirmed youth and adults who are happy and well adjusted after transition remain diagnosable with GID and suffer stigma of mental illness and sexual deviance for the rest of their lives (8,9). Children may be diagnosed with GID strictly on the basis of gender nonconformity, without evidence of gender dysphoria or distress with assigned birth sex (criteria A,B).  Adults and adolescents are implicated with “disordered” gender identity so long as they identify with or pass as other than their assigned birth sex or believe that they were “born the wrong sex” (criteria A,B).  Furthermore, current GID criteria fail to clarify that clinically significant distress or impairment, the basis for defining mental illness in the DSM, should exclude societal or family prejudice or intolerance (criterion D). Therefore, discrimination itself can be used as a basis to label transitioned or gender nonconforming victims as mentally ill.

 

The APA statement also mentioned the appointment of a new task force, separate from the DSM effort, to “review the scientific and clinical literature on GID treatment” (1). At this date it is not known who is on this treatment task force or what kinds of treatment it will favor. In any case, the problem of treatment bias within the GID diagnostic criteria remains unaffected by the efforts of a separate APA treatment task force.

 

While the current GID diagnostic criteria do not explicitly recommend gender-conversion therapy, they are certainly biased to favor that harmful treatment approach and to contradict the legitimacy of transition.  This is a major reason the DSM-V is of great importance to the transgender community and supportive mental health care providers. I hope that the DSM-V Task Force will move beyond denial and beyond archaic gender stereotypes in drafting new diagnostic nomenclature that does not harm those it is intended to help.

 

 

(1) American Psychiatric Association, “APA STATEMENT ON GID AND THE DSM-V, “

http://www.psych.org/MainMenu/Research/DSMIV/DSMV/APAStatements/APAStatementonGIDandTheDSMV.aspx , May 23, 2008,

 

(2) A. Speigel, “Two Families Grapple with Sons’ Gender Preferences,” National Public Radio, All Things Considered,” http://www.npr.org/templates/story/story.php?storyId=90247842 , May 7, 2008.

 

(3) National Center for Transgender Equality (NCTE), Transgender Law and Policy Institute (TLPI), Transgender Law Center (TLC), Transgender Youth Family Allies (TYFA), http://www.pamshouseblend.com/upload/Autumn/TransGroupsDSMStatement.pdf  , May 28, 2008.  (Disclosure, I was involved in the drafting of this statement)

 

(4) M. Forstein, “Update on the DSM-V Issue,”

http://quenchzine.blogspot.com/2008/05/update-on-dsm-v-issue.html , May 15, 2008.

 

(5) American Psychiatric Association, “Frequently Asked Question About DSM,” http://www.psych.org/MainMenu/Research/DSMIV/FAQs/WhatistheDSMandwhatisitusedfor.aspx

 

(6) L. Cosgrove, S. Krimsky, M. Vijayaraghavan, L. Schneider, “Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry,” Psychotherapy and Psychodynamics, Vol 75, No 3, http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=223864&Ausgabe=231734&ArtikelNr=91772 , 2006.

 

(7) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000, p. 537.

 

( 8 ) K. Winters, “Issues of GID Diagnosis for Transsexual Women and Men,” http://www.gidreform.org/gid30285.html , 2004/2008.

 

(9) K. Winters, “Issues of Psychiatric Diagnosis for Gender Nonconforming Youth,” http://www.gidreform.org/gid3026.html , 2004/2008.

 

Copyright © 2008 Kelley Winters, GID Reform Advocates

 

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About gidreform
Kelley Winters, Ph.D.is a writer on issues of transgender medical policy, founder of GID Reform Advocates and an Advisory Board Member for TransYouth Family Advocates. She has presented papers on the psychiatric classification of gender diversity at the annual conventions of the American Psychiatric Association, the American Counseling Association and the Association of Women in Psychology.

5 Responses to Beyond Denial: GID Diagnostic Criteria and Gender-Conversion Therapies

  1. I agree with Kelley. Most MTF TSs have way more problems due to bigotry than they have due to their gender identity. When the APA has the gall to define something as a disorder bigotry is encouraged. Imagine, for example, if the APA included in their DSM “religious identity disorder.” Since Christianity is the dominant religion in the USA anyone identifying as anything but Christian would be defined as having a disorder. Treatment for atheists might include not being allowed to read about evolution and mandatory bi-weekly attendance at a Christian church.

    The APA needs to get out of the role of defining what cultural stereotypes are appropriate and deal with real psychological issues.

  2. Julie Nemecek says:

    Does the AMA’s recent resolution (Resolution 122 passed earlier this week) have relevance to this discussion? At least the AMA’s advocacy for real treatment (as opposed to reparative therapy) might counter some of hype. They call GID a “serious medical condition”. On the other hand, their position might support the need to keep GID listed in DSM-IV.

  3. Gerri Cannon says:

    I agree with the thought that people and especially medical professionals cannot fully comprehend what a transgender person is going through unless they have lived it for themselves. I have given many talks over the past 8 years to groups in the greater Boston area, trying to get people to understand that I’m not a freak, but a normal functioning individual that was born with a gender conflict. When asked by members of my church if I know why I am this way I replied; I really don’t know why I am the way I am, I just am. God must have had a greater plan in mind when he put me on this earth.

    I’ve read many of the discussions about trying to convert transgender people back to the physical gender they were born as. I see that there is a great expense in doing this. Not only is it costly, but it can adversely affect the individual. I know of at least two people that contacted me to join a local transgender support group. They had been forced by their parents, while in their teens, to undergo psychiatric therapy and even electro shock therapy to change their behavior. Only to realize in their mid 40’s that this had taken place. Their drive to transition complete completely overwhelmed them. The result was complete isolation from family members, lost jobs and the need to completely start their lives anew. The good news is that both of these people were strong enough to develop their own network of friends and supporters and now lead wonderful lives in the gender they need to be.

    I’ve been a firm believer in educating the public about who we are. People fear us, when there is no need to. In the Greater Nashua, NH area we won the support of the local newspaper, the Nashua Telegraph. They have been running monthly articles about Transgender people. Some of the articles are well written, but others could be more complete. I think the other challenge is that many people being interviewed aren’t trained to talk with the press. So a couple of the articles don’t have clear messages to share about Transgender people. But the good thing is that some of our issues are being brought to public attention. I expect an article to be published on the front page of this Sunday’s paper about me and my family. Yes, I put my own story out there for general public to read. (www.nashuatelegraph.com/transgender)

    I applaud those transgender people that decide to use medical techniques to become the person they truly are inside, not the person others expect them to be. More often than not I have seen very conflicted people become good solid and stable citizens after transition. What I wish is that more people would come forward to share the stories of their journey. So that more and more people (including medical professionals) would realize that there are many more transgender people in our communities than they would believe. It would help to see that we are well adjusted and productive individuals with families, homes and jobs.

    Gerri Cannon

    PFLAG NH
    NH Freedom to Marry
    UCC NH Committee for GLBT Concerns
    Cannon’s Carpenter on Call

  4. Rev.Dr. Linda Miskimen says:

    My thoughts on this whole DSM issue are, we as a community have for too long allowed others to speak for us. We have allowed others outside the community to define us. We have given up the power to control our own life to those in the medical-industrial- complex who are using scientific sounding lies to gain from our misery and human suffering.
    Every time I hear someone that is not transsexual tell me they understand and know what I am or have gone through as TS are lying. They have absolutely nothing in their lives to compare it to, they have not had any life experience to compare it with.
    Even the term transsexualism has been variously described as a trait, disease, behavior, desire, mental illness, perversion, paraphilia and lifestyle by many that I have personally come into contact within the medical-industrial- complex. It is too many of those in the field of psychiatry and psychology that are the people of the lie. I would love to have one dollar for every time I have heard the term she/male or s/he used in a derogatory manner in bogus pseudo -scientific studies.
    They lumped transsexualism, transvestic fetishism together as transgendered. We stood by and allowed the medical-industrial- complex to stick it to us again and we did nothing. Well I do not as TS have anything to do with transvestic fetishism as they tend to dress and behave in a flamboyant manner which parodies their opposite gender only when it fits their needs.
    The Ray Blanchard’s, Kenneth Zucker, Joseph Nicolosi, Daniel Byrne, Julie Harren-Hamilton, HBIGDA/WPATH, Exodus International, American Psychological Association, American Psychiatric Association, AMA and so on with their junk pseudo -scientific studies, pseudo –therapies are going to win. We will, as a TS community, do what we always do hand over to them the power to define. They can keep their aversion therapy, psychotropic medications, hormone treatments, electroconvulsive therapy, reparative therapy and hypnosis cures, you see I am completely happy being just me. There is nothing to cure.

    Rev Linda Miskimen PhD in Religion

  5. LawSchoolAlumnus says:

    “No information about treatment is included.” (from the APA DSM FAQ page)

    And if that were true it would be a very strong reason why GID should be removed from the DSM since the only reason to keep a diagnosis that has no evidence supporting it is for therapeutic reasons.

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