The new DSM

[AmberTG]

Apparently, according to my therapist, the new version of the DSM, the DSM-5 will be coming out this fall. I wonder how it will affect the treatment of GID, if at all. Will they change any of the classifications for Transgender issues? I guess we just have to wait and see.

[loriannetucson]

Hmmm, your therapist needs to do more homework. The DSM-V (or 5), won't reach publication until on or around 2011. Follow the link below to read about the timeline placed into effect by the APA for the next version of the DSM.

http://dsm5.org/timeline.cfm

I am hearing that a lot of professional opinions are recommending they declassify gender identity disorder as an actual disorder and reclassify it as a medical issue. This, most believe, will lead to better treatment by health insurances to pay for necessary medically related expenses associated with gender identity issues and will help to reduce the stigma of having a behavioral disorder.

Years ago homosexuality was declassified as a disorder. The stigma of being told you have a DISORDER versus a medical condition (which can be corrected partially or completely through medical intervention) also continues to burden TG people like myself. I for one hope to see a complete reworking of that section of the DSM.

[Kimberley]

I cant see any development on this issue unless HB takes the bull by the horns and so far all they have done is adhere to their already established standards of care.

This was supposed to have been changed with the DSM-IV and it wasnt. Any bets on why? My guess is that the psych. community would lose some coin and the medical community dont want to deal with it, havent the training to deal with it etc etc.

It will be interesting to see what happens though.

:hugs:
Kimberley

[Marcie Sexton]

Wouldn't it be so nice to have this classified as a medical problem...it would in deed simplify things...

[AmberTG]

I think that at least part of it will stay classified the way it is now simply because a therapist is usually better at treating the dysphoria associated with trans issues. The dysphoria is a side effect of the trans issue, the chronic depression, the self rejection and shame, the unwillingness to accept it for what it is, the inability to come to terms with our issues. Most of us have been there and gone through that. A medical doctor is the proper person to treat the medical issues associated with this "birth defect", but doctors aren't so good at treating the hidden issues of the dysphoria that usually goes along with trans issues.

[melissaK]

Lorianne, I'd love to see us declassified from being labelled as having a 'disorder.' The only time 'disorder' was funny was when the Three Stooges did the short clip "Disorder in the Court." :heehee:

There's always another side to the coin. Such determinations about which field of study TS's belong to should be made upon science and rational thought, i.e., what's genetic vs learned/unlearnable behavior. I think researchers find more and more all psychology has a genetic base. No one simply has a mental disorder - we have behavioral manifestations from life experiences laid upon a substrate of genetic differences.

It is hard to figure out where the line between psychology and medicine ought to be drawn for us. In that, I side with Kimberley that such things are more influenced by the politics of the situation, and that generally means 'follow the money.'

I always thought the HB guidelines worked politically because they stuck us in both the world of psychology and medicine and they shared us - TS's must have some therapy, then they can/must have some medicine.

And, if we have no 'disorder' at all, we risk being called 'normal' and our transistions being called 'elective.' That could mean no protections. Zip, nada. No contstitutional protections, no insurance for transition meds or SRS. So we have to at least have a 'condition.' Something that warrants medical care, something that warrants a Dr. saying this was 'medically necessary.'

And since the 'necessity' for care is to offset bad side effects of the condition, and those side effects are disabling depression or other anxiety attacks, we end up back in the land of psychologists or psychiatrists.

Dr. Anne Vitale has written some good papers that explain these DSM classification issues. http://www.avitale.com/TherapeuticErrors.htm http://www.avitale.com/hbigdatalkplus2005.htm And Arlene Lev's "Transgender Emergence" has a lot of this discussion collected from other writers as well.

So, I would not look for a classification change anytime soon.

Hug's
'lissa

[Calliope]

TS's must have some therapy, then they can/must have some medicine. [...] And, if we have no 'disorder' at all, we risk being called 'normal' and our transistions being called 'elective.' That could mean no protections. Zip, nada. No contstitutional protections, no insurance for transition meds or SRS. So we have to at least have a 'condition.' Something that warrants medical care, something that warrants a Dr. saying this was 'medically necessary.'

It's the dialectical double-whammy - support psychiatric control in the hopes of getting a little cuddle from the medicine men. And the insurance companies are the most recalitrant. It's sickening how TSs are victimized by the last remaining guild (racket) in the land of the "free market." Do "bimbos" have to see a shrink to get silicon implants? Not even teenboppers! In my opinion, the head doctors should be terminated as the middlemen they are; regarding DSM, they are parasites upon the TG community. (Funny, the political opposition to SRS has its genesis in "Mayhem," which has an anti-war element; now fast-foward to the Sixties and long hair. Hmmm.)

[loriannetucson]

Ahhh... good dialogue. I simply love this!

I think we all understand that as far as both the medical and psychiatric communities are concerned, it's "all about the Benjamins." I wouldn't go so far as to categorize psychologists as parasites, although it does seem that both the med and head doctors do appear to have a symbiotic relationship concerning trans people.

I for one believe that the emphasis should be on reducing the punishing costs of transition for those who are challenged by society to earn a decent living. Richard Juang, a respected scholar and activist, recently cited studies on transgender employment showing a 35% unemployment rate and 60% earning less than $15,300. You can read the rest of these findings at:

http://transworkplace.blogspot.com/2007/07/national-statistics-on-transgender.html

I want to avoid crossing topics, but the fact of the matter is that the new DSM will undoubtedly either make it more or less costly for TG people to transition based on new standards of care. Yes, homosexuality is no longer in the DSM as an illness, nor is it treated as such, but at least the core element of homosexuality doesn't typically involve a costly change of gender and surgery (for many at least!).

[Calliope]

I for one believe that the emphasis should be on reducing the punishing costs of transition for those who are challenged by society to earn a decent living. Richard Juang, a respected scholar and activist, recently cited studies on transgender employment showing a 35% unemployment rate and 60% earning less than $15,300. [...] [T]new DSM will undoubtedly either make it more or less costly for TG people to transition based on new standards of care. Yes, homosexuality is no longer in the DSM as an illness, nor is it treated as such, but at least the core element of homosexuality doesn't typically involve a costly change of gender and surgery (for many at least!).

We abolish "Biology = Destiny" only to end up with "$ = Destiny." Is there such a being as a workingclasstranny? Streets, I suppose. It seems to me unless the shrinks can push HRT and SRS through insurance (like good ol fashioned depression, etc.), then they've not, institutionally speaking, sold a very tenable service. There is no "free market," it retains guild elements.

[AmberTG]

Come on Calliope, you don't really think money has anything to do with transgender treatment procedures, do you??

(heavy sarcasm added)

[Maggie Kay]

I am wrestling with the disorder part of the diagnosis. Now that I am diagnosed a Transexual by a gender therapist, I have to deal with the family and the reaction that I now have a diagnosed mental illness. The problem is where does the illness stop and the normal begin? I am being now looked at like a person that can't take care of herself. Is this the way I am supposed to think of myself now? Just what areas am I to be trusted to function? What things should I be shielded from? Should I be excluded from important family decisions? Is my judgment clouded and no longer trustworthy? Gosh, I didn't see that one coming. This is obviously something that can be very emotional. Now, when I trot out my finest femme clothes or buy something new i.e. jewelry, I am exhibiting a symptom.... Something just isn't right here.

[AmberTG]

You have to remember that Gender Identity Disorder is not a mental illness, it is a condition. An illness has the implied component of being treated and cured. GID is not cureable, it's a birth defect that is correctable. There is a very large difference between the two. GID is not classified in the current DSM as an illness. The only difference between you and a "normal" person is the discrepancy between your perceived gender and your physical development. In all other respects, you are probably about as "normal" as anyone else. There's no reason that you can't function as well as anyone else, except maybe dealing with the crushing depression that comes with Gender Dysphoria. The term dysphoria means that you have problems, such as depression and self isolation, that come from your not coming to terms with the GID within yourself. Believe me, I was there for many years, it took a therapist and an anti-depressant to pull me out of the hole I was in.
Even though some of the people around you might not understand what's going on inside your head, that doesn't make you less of a person, you are still a human being with as much value as anyone else around you. You may be different from them, but they are different from each other also, and you have the same right to be that they have. Never forget that!

[loriannetucson]

I think that most women I know who were identified as male gender at birth are smart and happy people. It's the circumstances and the discriminatory practices that keep the unemployment high, the stigma and fear that keep crime towards TGs high, and the world will have to get used to us. We really are on the gender frontier. I know we didn't ask for it, but those TG people yet to be born should have an easier road to transition if we keep our heads high and hold onto one another for strength.

Most transgendered/TS/or HBS people I know are tender, loving, compassionate, and wonderful people!

[Maggie Kay]

I agree with everything that is said here. However, how do I get my family to understand that? They resist the idea that TS exists as we say it does. Instead all they see is me going to a mental health professional and coming back with a diagnosis. In the broad brush of things, that makes me in the category of mentally ill. While, I found a group of like minded people similar to the wonderful folks here, what is talked about there and here stays here. My SO will not participate and will not read anything here. Instead, it is preferable that I be viewed as being somehow not all there....

[Calliope]

I agree with everything that is said here. However, how do I get my family to understand that? They resist the idea that TS exists as we say it does. Instead all they see is me going to a mental health professional and coming back with a diagnosis. In the broad brush of things, that makes me in the category of mentally ill. While, I found a group of like minded people similar to the wonderful folks here, what is talked about there and here stays here. My SO will not participate and will not read anything here. Instead, it is preferable that I be viewed as being somehow not all there....

Sympathies for your very difficult, isolated situation.

Now I'm going to rant.
:Party:

"[G]o[]to a mental health professional and com[e] back with a diagnosis."

That's what they're paid to do - tag and stamp. Too bad they have no such clout with insurance providers.

I believe the whole crap contradiction begins with Harry Benjamin saying psychoanalysis won't "cure" TS but, what the hell, let's add the shrinks anyway before SRS is permitted. A real racket these guys got. Fancy cars, trophy wives, golf on the weekends.

As I see it, the TS and TG community has got to become the professional service providers for themselves, otherwise it's a ripoff. And we KNOW, don't we, it is a ripoff everytime we have to hear these people tell us what color is the sky.

Myself, I'm seeing life as bigendered instead of transgendered - meaning take from both, abolish both, dialectical disobedience. No idiot in an office gets to usurp my "definition" because I'm not ASKING or paying or begging for anything.

[AmberTG]

Calliope, that sounds like a good way to be. I don't fit the standard model of a transsexual, although "transgendered person" is adequate for now. I do like the term "bigendered", it comes a lot closer to my situation.
I will say that the "gatekeepers" have some very stiff rules for getting into their "club". Like everything else, if you don't fit in their narrow definition,they won't do much for your physical needs.

Kay, I think maybe that is their way of not facing the reality of your situation, if they're not willing to take the time to learn anything about your situation, they'll never understand anything about you. So many people are narrow-minded and unwilling to let go of their own version of reality, these people will never even try to understand where people like us are coming from. They prefer to just dismiss us as mentally unstable or perverts, depending on their mindset. As unfortunate as it is, there's not much you can do about their attitude if they won't even try to understand. I expect all my siblings to be that way when I come out to them, but I continue to hope for better. My mother didn't teach us to be narrow-minded but people change as life goes on.