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to Section One | to Arts & Entertainment
posted Friday, December 7, 2012 - Volume 40 Issue 49
We're here, we're healthy
Section One
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We're here, we're healthy

Transgenderism no longer a 'disorder' in new APA manual

by Mike Andrew - SGN Staff Writer

Being Transgender will no longer be listed as a mental 'disorder' in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

In an announcement on December 4, the APA said it will replace the term 'gender identity disorder' with 'gender dysphoria' in the new edition of its manual, which will be published in May 2013.

The revisions are the first major rewrite in nearly 20 years of the diagnostic guide commonly referred to as the DSM - a standard text for psychiatrists in the U.S. and other countries.

The change comes after years of lobbying by Transgender activists to remove the suggestion that Trans people are 'disordered' or 'mentally ill.' The new term, 'gender dysphoria,' is defined as 'a marked incongruence between one's experienced/expressed gender and assigned gender.'

'All psychiatric diagnoses occur within a cultural context,' said Jack Drescher, a New York psychiatrist and member of the APA subcommittee charged with revising the manual. 'We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist's job isn't to pathologize.'

The new approach to Transgender people is reminiscent of the historic change in how the APA defined Gays and Lesbians. In 1973, the APA affirmed that 'homosexuality per se is not a mental disorder' and rejected the stigma of mental illness that the medical and mental health professions had previously placed on sexual minorities.

As a result of its new approach to Gays and Lesbians, the APA says, it 'then issued a position statement supporting civil rights protection for Gay people in employment, housing, public accommodation, and licensing, and the repeal of all sodomy laws.'

Activists hope that the APA will now speak out in support of the Transgender community's rights as they have in support of Gay and Lesbian rights.

DOUBLE-EDGED SWORD?
The legal implications of the change may be profound. On one hand, a diagnosis of mental disorder may be used against Trans people. On the other hand, it can also provide Trans people with legal protections under the Americans with Disabilities Act and other legislation.

In an ongoing child custody case in Utah, for example, a Trans woman is at risk of losing her parental rights because she was diagnosed with 'gender identity disorder.' Her former spouse's lawyer argued that she suffered from a 'severe, chronic mental illness that might be harmful to the child.' This is only one of several similar cases in which Trans parents have been, or are, at risk of being separated from their children.

However, a diagnosis of 'gender identity disorder' has sometimes helped Trans people combat discrimination because of their gender identity or expression.

'Having a diagnosis is extremely useful in legal advocacy,' National Center for Lesbian Rights Legal Director Shannon Minter said. 'We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice ... that this is a very deep-seated condition recognized by the medical community.'

In other situations, a formal diagnosis of 'gender identity disorder' can justify insurance coverage for gender reassignment surgery and other medical procedures.

LEGAL EFFECT UNCERTAIN
Since at least the 1980s, a growing number of insurance carriers authorize access to hormones or surgery for patients who decide to physically transition to a new gender, on the basis of the APA's 'gender identity disorder' diagnosis. Eliminating it from the diagnostic manual might make it more difficult for Trans people to qualify for treatment.

'Let's say someone born a woman walks into my surgical office and says, 'I would like my breasts removed.' What's the diagnosis?' Dr. Drescher said. 'The procedure is a mastectomy, but if there is no diagnosis, it is cosmetic surgery and your insurance won't pay for it.'

In other cases, however, insurance plans have excluded transition-related expanses, often under the excuse of 'pre-existing conditions.' President Obama's Affordable Care Act will prevent insurers from excluding pre-existing conditions beginning in 2014, but it is not clear what might happen if Trans people are no longer defined as having a 'condition.'

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