Policy/Biz

Transgender Advocates Lobby APA to Change or Remove Classification as Mental Illness

transgender
Qian Jinfan, an 84-year-old transsexual holds up a photo taken at the age of 59. She is believed to be the oldest openly transgender person in China. REUTERS/Siu Chiu

Advocates would like related definitions rewritten or altogether removed. Presently, transgender people are labeled by DSM-IV (or the fourth iteration of the Diagnostic and Statistical Manual of Mental Disorders) with Gender Identity Disorder, which classifies individuals as having "a marked incongruence between one's experienced/expressed gender and assigned gender." Instead, Gender Dysphoria would be in the book. Dysphoria has Greek routes and means "emotional distress."

While the difference may seem semantic, transgender advocates see the change as a huge leap forward. Dysphoria is temporary, after all, while a disorder is perhaps permanent. Advocates also see the new definition as a shield against politicians who perhaps see the condition as a mental illness.

This is not the first time the American Psychiatric Association has needed to reconfigure its definitions in order to reflect a changing world. In the 1970s, civil rights advocates succeeded in getting homosexuality removed from the book. It was previously classified as a mental disorder.

But, while there are parallels, the situation for transgender people is a bit more complicated. While sexual orientation is something that is either there or it is not, many people, in order to adhere to the gender to which they feel that they are, need surgery. And, as Jack Drescher, a member of the APA task force working on the issue, said, a person who is born biologically female might come into a doctor's office asking for the removal of that person's breasts. But, without a diagnosis, such a procedure would be classified as cosmetic surgery and would thus not be covered by insurance.

Indeed, some say that, while the definition has been inconvenient and damaging for some, it has benefited others. One psychiatrist, Dan Karasic, cited a Utah case where a woman's custody of her children was called into jeopardy because of her transition from a man. The opposing counsel cited her mental illness as a reason that the children, sired before her transition, should be taken out of her care. Lawyers, for example, have been placed in the uncomfortable position of having to embrace the definition in order to defend their transgender clients against employment discrimination.

The APA task force's findings can be found here.

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