The DSM (Diagnostic and Statistical Manual of Mental Disorders) is published by the American Psychiatric Association, and is a primary tool in diagnosing mental health conditions, such as depression, schizophrenia, etc.
Basically, it establishes the "criteria" people need to meet in order to obtain a specific diagnosis. These DSM diagnoses can be used for workplace and academic accommodations, medical leave, disability benefits, as well as treatment options.
Similar to psychiatry in general, the DSM has a controversial history. In 1973, it removed "homosexuality" as a mental "disorder"; and in the 1994 edition, Post traumatic Stress Disorder was changed to more accurately reflect the prevalence of interpersonal violence (including domestic violence and sexual abuse) by removing from the definition of trauma "an event that is outside the range of usual human experience."
Unfortunately, given the statistics we have on sexualized and domestic violence, trauma is very much inside the range of usual human experience.
The section on "Personality Disorders" has been highly criticized. For instance, Borderline Personality Disorder (BPD) is thought by some (including myself) to be a modern version of "Hysteria". Indeed, they both are highly diagnosed in women, are often the result of an abusive childhood, and tend to pathologize people versus seeking and treating the source of their symptoms.
There is a new DSM coming out (DSM-V) and I hope that BPD will be replaced by some sort of PTSD-like addition, which recognizes that people are impacted differently by interpersonal violence (versus a car accident or natural disaster), as well as ongoing trauma (such as domestic violence) particularly in early developmental years (e.g. childhood abuse).
Various communities disagree in their criticism or support of various diagnosis. For instance, Gender Identity Disorder is the "diagnosis" of transpeople and is viewed by some to be problematic in the same way that homosexuality in previous DSMs pathologized and "othered" something that is perfectly normal and healthy. However, it has also been pointed out that without some sort of "official" diagnosis legitimizing that one is transgender and that living in the wrong gender can be emotionally distressing, treatments such as hormone therapy and gender reassignment surgery may not be covered by health care benefits.
The DSM-V continues to bring additional controversies. Trans groups have been criticizing some of the members of the DSM-V Sexual and Gender Identity Disorders Work Group, including its chair, Dr. Kenneth Zucker, and Dr. Ray Blanchard.
Dr. Kenneth Zucker's work with children and adolescents has been highly controversial. He works with youth with the intention of aligning them with the gender others view them as, versus their own identity. His work has included taking away toys he views as inconsistent with the child's gender, even to the point of the child's distress. Rather than work with families and youth to deal with potential challenges that may arise due to society's fear and hatred of people who are non-gender conforming, Dr. Zucker simply reinforces binary gender roles.
Dr. Zucker's "reparative" therapies are strikingly similar to ex-gay or conversion therapies that seek to change a person's sexual orientation. The American Psychiatric Association, American Psychological Association, American Medical Association, American Counseling Association, American Academy of Pediatrics, and (US) National Association of Social Workers all condemn ex-gay therapies, with various groups noting that not only are they ineffective, but that they can cause emotional distress, including depression, guilt, anxiety, and self-destructive behaviours. (For more information on ex-gay therapies, visit Truth Wins Out).
How someone who has a clear bias towards gender conforming behaviour, it is frightening that Dr. Zucker is not only a member of the DSM-V Sexual and Gender Identity Disorders Work Group, but he is the chair.
Dr. Ray Blanchard also sits on this working committee, assigned to the Paraphilias portion. This too is problematic because Dr. Blanchard doesn't view transgenderism as a gender identity issue but rather, that it is based on sexuality - specifically, a man's being turned on by the thought of being a woman. He created a word for this (autogynephilia) and needless to say, this is really insulting to transpeople.
I am not sure if there are any transpeople on the working group, and if any consultation was done with trans communities. My guess is that this is a group of either mostly or exclusively privileged cisgender men who are making decisions that could drastically impact trans communities. What a surprise.
5 comments:
>> without some sort of "official" diagnosis legitimizing that one is transgender ... treatments such as hormone therapy and gender reassignment surgery may not be covered by health care benefits.
The DSM is concerned with diagnosis and not with treatment. And even if it were concerned with treatment then shaping a diagnosis to maximize money payout would be (literally) a crime punishable by the legal system.
Please sign the petition to tell the APA (American Psychiatric Association) that transsexualism is NOT a mental illness at http://snipurl.com/telltheapa
Henry,
Thanks for commenting.
It is having a diagnosis that allows for province/state or private insurance to pay for things like hormone therapy and GRS (although GRS was recently delisted in the province I live in).I don't see this as a crime because being denied hormones (etc) because one cannot afford it can cause psychological distress.
I agree,however, that transgenderism is not a mental illness, any more than being lesbian, gay or bi is. (Which of course, they aren't)
Monika
The crime I pointed to was creating or retaining a DSM diagnosis responsive to money considerations.
However, using a psychiatric diagnosis in bad faith, that is to say using it even though despite a belief that it is not a mental illness, is doublethink at best.
It is argued that transsexualism causes depression and traumatic stress disorder. Fair enough, so diagnose depression and PTSD, do not diagnose the bogus GID.
If you are suggesting that the dx of depression or PTSD as a result of being in the "wrong gender" and thus, part of treatment could involve hormones and/or GRS, then I am comfortable with that.
You may be interested to know that a number of the codes in the DSM aren't specific psychological disorders, e.g. sexual abuse of a child (two different codes, depending if the focus is on the victim or not). I am not sure why this is; perhaps it is a billing issue, who knows.
But I agree with you that pathologizing trans people is absolutely not the way to go, but there needs to be some clause to legitimize trangenderism and allow health care to pay for the treatment that could prevent, in many people, psychological distress.
Oops! I also wanted to add that the DSM is actually concerned with treatment, usually providing an overview of the efficacy of peer-reviewed studies of treatments.
I don't have my DSM here so I can't check to see what it says about treatment for GID.
But I digress. This post was originally about my various criticisms of the DSM, not to defend it :)
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