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Friday, March 16, 2018

"Transgender" Does Not Mean "Mentally Ill"

Just about a month ago I posted this picture across social media, and it took off like a rocket. While I'm glad it was so well-received, more than a few replies were in the vein of "Well, isn't it? Transgenderism is listed in the  DSM-V."

... actually, those were the polite comments. More than a few were rather insistent in their declaration that "all trannies be crazy, yo."

So strap in, folks, this is going to be a long one and may take a few installments.

First, a note on terminology
This is another instance of "I hope you don't think I'm scolding you; that's not my intention. I just want to help some well-meaning but misinformed/uninformed people avoid an awkward situation."
  • "Transgenderism" is not the proper term. The clinical term for "being transgender" is gender dysphoria or gender incongruence. To quote Jae Alexis Lee on Quora
In referring to transgender issues as “transgenderism” it can be framed as an ideology, philosophy, political strategy… It places transgender issues in the realm of Environmentalism, Feminism, Libertarianism and any other -ism you’d care to think about. If a thing is a philosophy, ideology or political strategy then it can be diminished from the status of objective fact to controversial opinion. Once you move something from fact to opinion then it’s easier to build “everyone has an opinion” arguments and to place specious arguments on more equal footing.
  • "Tranny" is a word you need to be very, very careful with. Many people find it incredibly offensive, right up there with the sexual epithet beginning with C and the racial epithet beginning with N. Now I personally find the word hilarious, and I will often use the word to describe myself (and only myself) because if I laugh at it, it can't be used as a weapon against me. But I would never describe another trans person using that word unless I was specifically told to, and so as a courtesy you shouldn't either. 

If it's not an illness, why is it in the DSM-V?
The short answer is that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition deals with the brain and its problems. Some of those problems are psychological, like fears and traumas and neuroses. But some of those problems are biochemical or neurological, like schizophrenia or bipolar disorder. And some can be either: depression, for example, can be caused by a chemical imbalance within the brain, or it can be caused by something really traumatic happening to you.

In other words, if it's a "brain issue" instead of a "body issue" like a cold or the flu, it's listed in the DSM-V. If you're diagnosed with something from that book it doesn't mean you're crazy. It may mean you're mentally ill inasmuch as you aren't at optimum mental health, but that doesn't mean you're a threat to yourself or others, which is unfortunately what people think "mental illness" means. This is a topic I'd like to address in greater detail in a later post.

The much longer explanation is a quote taken directly from the American Psychiatric Association, the group which publishes the DSM-V. All underlined phrases are my emphasis.
Gender Dysphoria
In the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people whose gender at birth is contrary to the one they identify with will be diagnosed with gender dysphoria. This diagnosis is a revision of DSM-IV’s criteria for gender identity disorder and is intended to better characterize the experiences of affected children, adolescents, and adults.

Respecting the Patient, Ensuring Access to Care
DSM not only determines how mental disorders are defined and diagnosed, it also impacts how people see themselves and how we see each other. While diagnostic terms facilitate clinical care and access to insurance coverage that supports mental health, these terms can also have a stigmatizing effect. 

DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name “gender identity disorder” with “gender dysphoria,” as well as makes other important clarifications in the criteria. It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.

AUTHOR'S NOTE:  a mental disorder is "a behavioral or mental pattern that causes significant distress or impairment of personal functioning."  Dysphoria is "a state of feeling unwell or unhappy; a feeling of emotional and mental discomfort and suffering from restlessness, malaise, depression or anxiety."

As an analogy, then, dysphoria can be likened to having a cold -- which makes a person miserable but isn't life-threatening -- wheras a disorder is more serious, like being sick with influenza or pneumonia. END AUTHOR'S NOTE.


Need for Change
Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and won’t be used against them in social, occupational, or legal areas. When it comes to access to care, many of the treatment options for this condition include counseling, cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender. To get insurance coverage for the medical treatments, individuals need a diagnosis. The Sexual and Gender Identity Disorders Work Group was concerned that removing the condition as a psychiatric diagnosis — as some had suggested — would jeopardize access to care.

Part of removing stigma is about choosing the right words. Replacing “disorder” with “dysphoria” in the diagnostic label is not only more appropriate and consistent with familiar clinical sexology terminology, it also removes the connotation that the patient is “disordered.”

Ultimately, the changes regarding gender dysphoria in DSM-5 respect the individuals identified by offering a diagnostic name that is more appropriate to the symptoms and behaviors they experience without jeopardizing their access to effective treatment options.   
In other words, gender dysphoria is in the DSM-V so that transgender people can be diagnosed with it so their hormone therapy and surgery can be covered with insurance. Without this diagnosis, it would be considered cosmetic.

For example:
  • A woman who wants larger breasts has to pay for that out of pocket because insurance is not cosmetic surgery. 
  • However, a woman who had breast cancer and two radical mastectomies needs breast reconstruction surgery to help return her to the quality of life she had before. 
  • Similarly, because many gender dysphoric people are so at odds with their body that it's causing them real, measurable distress and degrading their quality of life, hormone therapy and surgery is not cosmetic but necessary to improve quality of life. 
  • I say "many" instead of "all" because some trans people get along just fine once they're accepted for who they are and can dress and act accordingly. 

But if you still need treatment, aren't you ill?
People think that being transgender is a sickness that needs to be cured, but that's not the case. Sick people want to return to their state of wellness before they were sick; but transgender people don't want to revert to an earlier state (which would be what, exactly? A time when we didn't know what was wrong with us, only that we were profoundly unhappy and didn't know why or how to fix it? Sounds hellish if you ask me).

Think of it like being born with a birth defect that handicaps you, like missing a leg. There's nothing to cure because you aren't sick. There's no pill which will grow you a new leg. But you see all those two-legged people, running around and playing sports and dancing and just walking up stairs like it's no big deal and that's something you want, too, with all of your heart and soul, and you can't have it.

But look! There's someone with a prosthetic leg! And she's walking and running and living a normal life. That's what you want, too! So you ask to be given a prosthetic leg so that you can feel normal and do all the things everyone else can do!*

That's what transitioning is for us. Wanting to transition isn't a sickness; transitioning is the cure. It's the procedure which allows us to lead happy, productive lives. It helps us overcome our birth defect.


A Mild Rant in the Footnotes
*To continue the analogy, when people say "Transgender folks are mentally ill" they are doing the equivalent of telling that one-legged person "Your desire to have two legs is a sickness. This is how you were born. You just need to learn how to accept it."

Not only is this incredibly cruel, it's amazingly discriminatory; they wouldn't tell a person with bad eyesight that she shouldn't get glasses but rather accept that she was born with bad eyes and just learn to live with being unable to see properly.

Yet so many people feel they are "speaking truth" and "refusing to pander to mental illness" by misgendering us and calling us by our birth names, when what they are really doing is yanking off that girl's prosthetic leg and saying "Hey everyone, look at the cripple!" and laughing as she tries to get it back.

My gender and sexuality neither breaks your leg nor picks your pocket. Stop acting like it does.


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