Mind before body. Then why a disorder?

[SuzanneBender]

One of my professors in graduate school stated that when dealing with the Biology of the mind we should recognize that the body serves to provide a vessel for the mind. I was just reading a recent thread where a sister posted that she had "GDD" rather than "GID". Rather than hijack her thread I decided to start a new thread. The Psychologist in me has to ask why does having a body that does not match your gender identity constitute a disorder? The actual issue is with the persons body not matching the mind rather than the mind not matching the body. For Transsexuals it is more of a medical problem than a mental disorder. In my opinion labeling this problem a "Mental Disorder" focuses medical professionals on what can be done to fix the mind rather than what can be done to alleviate the stress caused by the body not matching the person. We are still stuck in the 1970's mentality of gender clinics. I understand that we still need a label to indicate that their is an issue to address. Otherwise, insurance companies, MD's and PhD's would have nothing to write on their charts about us. My hope for the new year is that the 2010 revision of the Diagnostic and Statistical Manual of Mental Disorders focuses more on the confirming a person's desired gender role and less on suggesting that a person is confused, illegitimate, perverted, dysphoric, dis-associative, neurotic, or bipolar simply because they lost the biological lottery at birth.

I have only dipped my toe in the water of the transgendered plunge. Currently I am in therapy and moving forward, but thus far my experience is that the Standards of Care are focused 180 degrees wrong way.

I am interested in the opinion of my sisters that are going through this now or have been through the process. Is this a case of me being naive and overly frustrated or am I onto something?

[melimelo]

Hi Suzanne,

I'm a fan of any movie that relates to altering the way we perceive the world (as long it's not too much on the horror side of things). Recently, I rented "Eternal sunshine of the spotless mind" and I loved it. Consider the situation of Gender Identity Dysphoria with brutal honesty: a tiny part of the brain is "screaming" to the rest of the body that it has a different gender. And how do we treat this condition? By taking hormones, undergoing surgery and learning skills appropriate to our inner gender. Basically, we changed our whole body to accommodate a tiny brain area.

Take the Matrix's "blue pill" or "red pill" choice. And now trans-pose it (pun intended) to our own situation. Suppose the blue pill could simply "adjust" the inner gender to match the body gender. Now, the interesting question is: "would I still be the same person?"

This is more of a gedankenexperiment. Even if the science was available to do it, would I? Would you?

[Schatten Lupus]

I can see it being a mental disorder, physical disorder, or even a genetic disorder. With it being mental or physical depends on if you view as the mind not matching the body, or the body not matching the mind. My opinion as a psychology student is it is more on the physical side. While their is probably away to "turn off" any transgenderedness, this can likely lead to even deeper depression and thoughts of suicide, as is common in homosexuals who go through the so called "gay therapy" clinics that have patients repressing a very important part of themselves. My reasonings for it being physical are simple. I tore a ligament in my left knee at the end of my junior year in high school. It caused a tremendous amount of pain, and make walking, standing up, sitting down, kneeling, and many other movements difficult, and very painful if my knee slipped. I was prescribed Lortabs for the pain, but to fix the issue was a surgery.
The mind of a transexual isn't causing the pain. It's the body that is. You can help treat the after effects with anti-depressants, but that does not fix the actual problem itself. While I am not saying every case needs surgery to be fixed, IMO, it becomes more a physical issue when you look at the body as a whole, rather than just the mind.
As for it being a genetic disorder. I say this because it is argued that the causes are likely genetic; there was some misfire, crosswire, power-surge or something that causes the brain and body to develop as two different genders; and as I previously stated, it probably is possible to "turn off" being transsexual. It likely wouldn't be a successful treatment when considering long term mental health and stability, but it is likely possible.

[SuzanneBender]

While their is probably away to "turn off" any transgenderedness, this can likely lead to even deeper depression and thoughts of suicide, as is common in homosexuals who go through the so called "gay therapy" clinics that have patients repressing a very important part of themselves.

Thank you for illustrating the point so well. Homosexuality was removed when the DSM IIIR was published in 1996 just for this reason, but we still treat transgenderism with the same lets see if we can turn it off mentality. It is the body that is causing the pain, not the mind.

I am in agreement with you concening genetics. We can't completly discount environement, but I feel it is only a matter of time until it is conclussive proven that genetics are the prime driver when it comes to gender and sexuality.

[sempervirens]

The actual issue is with the persons body not matching the mind rather than the mind not matching the body. For Transsexuals it is more of a medical problem than a mental disorder. In my opinion labeling this problem a "Mental Disorder" focuses medical professionals on what can be done to fix the mind rather than what can be done to alleviate the stress caused by the body not matching the person.

...or am I onto something?
Yep, that's pretty much the view of most trans activists, and to be fair the DSM calls for treatment of the body rather than the mind when that incongruity exists. I agree with you. Some folks are trying to take GID out of the DSM entirely, wishing not to be pathologized, but like you said, that might make it harder to get treatment, who knows.

The etiology is probably partly biological, but finding some definitive source will solve some problems and exacerbate others. Like, we know why people are black, but that hasn't stopped racism, and we know why people are men or women, but that hasn't stopped sexism. I'm a little nervous about the search for a source, since it'll probably spur a search for a cure or validate this-or-that eugenics viewpoint. Or if you want to get paranoid Orwellian style, you can worry that parents in the future will be able to screen for "gay" or "trans" factors in the same way we can now screen for birth defects.

[Sally24]

Homosexuality was removed when the DSM IIIR was published in 1996.


Some folks are trying to take GID out of the DSM entirely, wishing not to be pathologized, but like you said, that might make it harder to get treatment.
Homosexuality was removed when they decided it didn't need "treatment". Whether you call it a disorder, a syndrome, or something else, it has to be a documented condition that needs treatment otherwise you won't get insurance companies to pay for it. I don't have a problem with it being called a disorder.

"Disorder - An ailment that affects the function of mind or body"

[Melissa A.]

Ah, but there's a major difference between calling it a physical disorder or a mental disorder. I do have a problem with the assumption, if not by most providers and therapists, just by the public at large, that transsexualism makes me mentally and/or emotionally less than stable, in any way, simply in and of itself. Unfortunately, no matter what I believe, it will take real evidence to back up what I instinctively know to be true, in order to change the DSM. That evidence just isn't there yet. Sucks. I do think in the long run, it would benefit most of us in terms of getting treatment covered. All treatment. And just maybe, help remove some of the stigma and bust many myths, over time.

Hugs,

Melissa:)

[CharleneT]

.... we should recognize that the body serves to provide a vessel for the mind.


How very Buddhist of him/her ! I agree completely.



.....The Psychologist in me has to ask why does having a body that does not match your gender identity constitute a disorder?


It doesn't, but society and the med profession believe otherwise. For purposes of getting treatment, we put up with that.



.....In my opinion labeling this problem a "Mental Disorder" focuses medical professionals on what can be done to fix the mind rather than what can be done to alleviate the stress caused by the body not matching the person. We are still stuck in the 1970's mentality of gender clinics.


YES !! But at least they do treat us with reasonable respect these days... and you do not have to re-tell the "myth" in order to get their attention or treatments. It is still very expensive because "it" is so marginal. While I agree that we are still stuck back a few years, there are signs of progress. It will be slow, as it is for all such things.



.... My hope for the new year is that the 2010 revision of the Diagnostic and Statistical Manual of Mental Disorders focuses more on the confirming a person's desired gender role and less on suggesting that a person is confused, illegitimate, perverted, dysphoric, dis-associative, neurotic, or bipolar simply because they lost the biological lottery at birth.


I have heard some very worrying things about the committee for the update (DSM V). What do you think of them ?? Have you seen a draft of the new sections ?



I have only dipped my toe in the water of the transgendered plunge. Currently I am in therapy and moving forward, but thus far my experience is that the Standards of Care are focused 180 degrees wrong way.


Go ahead hun, jump in the waters, they feel just fine :) :)



I am interested in the opinion of my sisters that are going through this now or have been through the process. Is this a case of me being naive and overly frustrated or am I onto something?

I think you are onto something. Now, what to do with that ? Harder question than it seems. I'm not an admin type, nor trained in a way that any of them will listen to my opinion. I can try and educate my local docs (and have). So, that little bit is good ... but the bigger picture ? I've no idea what I *could* do ? !

Charlene

[Kaitlyn Michele]

ahhhh what a thread..

when we settle on the answer let me know..

this question has caused me so much suffering and confusion...

melimo...a couple years ago i saw a movie called "The Tenant"...its a pretty strange and abstract movie, but as I thought about it, I felt it was about identity and how our perception of the world impacts our identity...its a very dark themed movie and based on an incredibly harrowing ending i think it has a very hopeless view of the world..

IN it, the main character moves into an apartment and he starts to assume the identity of the woman that lived there before, and had attempted suicide.

it seems like a transgender themed movie because the main character starts to "become" a woman..but i think the trans part is incidental and is used to illustrate the much deeper theme of identity as a whole...its interesting that Polanski chose a change in gender as his way of dramatizing the vast impact of the changes that end up driving every tenant insane...

it also has one of my absolute favorite conversations where the main character is talking to his girlfriend and says,,,

"If I cut off my arms, I say, "This is me, and these are my arms." If I cut off my legs, I say, "This is me, and these are my legs." But if I cut off my head, do I say, "This is me, and this is my body," or "This is me, and this is my head."? What right does my head have to say it's me?"

Her reaction is basically WTF are you talking about? she was totally carefree...she had no qualms about her identity..her response sounds very similar to the reaction i get from telling any cisgendered person about what goes in my head......



btw...i know what Roman Polanski did and he's rotting in jail finally....its too bad someone with all the talent was so evil

[luvSophia]

My hope for the new year is that the 2010 revision of the Diagnostic and Statistical Manual of Mental Disorders focuses more on the confirming a person's desired gender role and less on suggesting that a person is confused, illegitimate, perverted, dysphoric, dis-associative, neurotic, or bipolar simply because they lost the biological lottery at birth.

The release of the DSM version V has been pushed back to 2013. From what I have been told, at least a part of the reason was due to a lack of consensus about what to do about GID.

[LisaM]

Suzanne,

You have started a terrific post. I would like to see transexualism removed from the DSM just like homosexuality was. I consider TSlty a naturally occurring issue.

At the same time I understand that I have needed to see therapists and medical doctors to be treated for this condition. These doctor visits have helped me understand my condition and feel better. Not being a medical doctor I don't know how one would define TSlty as a medical condition.

But in the end I feel it is a naturally-occurring condition where we need to treat our bodies as well as our minds.

[SuzanneBender]

The release of the DSM version V has been pushed back to 2013. From what I have been told, at least a part of the reason was due to a lack of consensus about what to do about GID.

So much for the 2010 target date. Who knows when the next update will be now that we have multiple and divergent organizations working on the next version.

[Schatten Lupus]

Ah, but there's a major difference between calling it a physical disorder or a mental disorder. I do have a problem with the assumption, if not by most providers and therapists, just by the public at large, that transsexualism makes me mentally and/or emotionally less than stable, in any way, simply in and of itself.
I got to thinking about this today. A mental disorder, such as depression, anxiety, bi-polar disorder, borderline personality, scizophrenia, and so on, are conditions in which can make it difficult to function in society. These conditions are treated by treating the mind, and the result is that the patient is left able to function in society, and is often left feeling better.
Now, when you look at the mind and body of someone who is transsexual, we have two options, treat the mind, or treat the body. Treating the mind has been tried before, and was shown to be an utter failure. To me, this indicates that more than likely the mind has nothing wrong with it. It's really no different than giving somone who is in chronic pain anti-depressants to deal with it. The anti-depressants treat the depression that is often associated with chronic pain, but it fails to take care of the real issue.
When it comes to treating the body, the results are quite the opposite. The body is treated, and the condition improves. A man breaks his leg, and it would be foolish, and even unethical, to only look at the mental aspects of a broken leg. The leg is worked on, and the mental aspects aren't as much of an issue.
While being transgender deals with things on a much deeper level than chronic pain and a broken leg, on a basic, at-face-value level, it becomes easier to see it as a physical disorder. There is nothing wrong with the mind. It's perfectly fine. The only issue is the body that the mind was placed in.

[Schatten Lupus]

But in the end I feel it is a naturally-occurring condition
Indeed it is. There are many vairous animals that do actually change genders. While those species are biologically capable of, and programmed to do so under certain conditions, which is radically different from a human sex-change, it still does occur in nature, outside of the human race.