{"id":3296,"date":"2012-02-17T11:25:27","date_gmt":"2012-02-17T16:25:27","guid":{"rendered":"http:\/\/girlwpen.com\/?p=3296"},"modified":"2012-02-17T11:25:27","modified_gmt":"2012-02-17T16:25:27","slug":"body-politic-dsm-and-gid-were-talking-about-it-wrong","status":"publish","type":"post","link":"https:\/\/thesocietypages.org\/girlwpen\/2012\/02\/17\/body-politic-dsm-and-gid-were-talking-about-it-wrong\/","title":{"rendered":"BODY POLITIC: DSM and GID \u2013 We\u2019re Talking About It Wrong"},"content":{"rendered":"

\"\"KYLA: We are having the wrong conversation(s). This is the conclusion I came to after attending an amazing community dialogue on Gender Identity Disorder (GID) in the Diagnostic and Statistical Manual (DSM).\u00a0 Part of the NYC Quorum Forum<\/a>,\u00a0the dialogue explored how language is used in ongoing debates around GID to \u201cdistance gender expression\/experiences from other experiences currently described in the DSM.\u201d<\/p>\n

This was far from the first time I\u2019ve thought about the DSM within my work on transgender legal protections.\u00a0 Indeed, when discussing various legal strategies for employment discrimination recourse, I often bring up the article written by Levi and Klein in Transgender Rights <\/em>on using disability law to protect transgender workers<\/a>. \u00a0I have also done a lot of reading on the pathologization and stigmatization caused by a diagnosis of GID<\/a> and engaged in conversations on the removal of this diagnosis or its transference to a medical rather than psychiatric diagnosis.\u00a0 And I\u2019ve chewed on Andrew Sharpe\u2019s point about how the GID excludes members of the transgender and gender non-conforming population<\/a> whose identities do not fit into the narrow narrative the DSM has established as the \u201cright\u201d narrative for accessing treatment and care.<\/p>\n

Despite all of this, my brain never quite connected these two conversations \u2013 the pathologization of DSM diagnoses and the connections between transgender and disability rights.\u00a0 But thanks to the folks who gathered in Bluestockings for this dialogue and demanded more from our community\/movement\/whatever you want to call it, my brain is working in new directions now.\u00a0 And these directions feel darn exciting.<\/p>\n

As much as I appreciate the advocacy people are conducting around the upcoming revision of the DSM<\/a>, I don\u2019t believe talking about a removal of GID is the right conversation at this time.\u00a0 The fact is access to health care and coverage often hinges on a diagnosis.\u00a0 DSM diagnoses are also used in courts to prove the legitimacy of a transgender plaintiff who is bringing forward a discrimination claim.\u00a0 Now, do I think either of these things are right?\u00a0 NO!\u00a0 But these are currently the structures we are operating under.<\/p>\n

Now, let\u2019s definitely talk about changing the way our legal system works and expanding its overly narrow definitions of who fits into protected categories and who isn\u2019t deserving of protection.\u00a0 And let\u2019s definitely continue the fight for universal affordable quality healthcare that includes the specific healthcare needs of trans communities.\u00a0 But it is my belief that we need to work towards these goals first before considering the removal of GID from the DSM.<\/p>\n

In the meantime, we can learn a lot from the disability rights movement.\u00a0 Like how a diagnosis or a disability is not necessarily the sum total of your being.\u00a0 Rather, it is part of who you are – and for some, it can be an empowering part.\u00a0 Let\u2019s challenge the rampant stigmatization around psychiatric and medical diagnosis. I believe that in engaging in this work and these conversations our movement for collective liberation* will only be made stronger.<\/p>\n

* Thanks to Dickerson for introducing me to this term!<\/p>\n

AVORY: Thanks so much for bringing this topic up, Kyla!\u00a0 As our readers are about to learn, I have a lot to say on the subject…<\/p>\n

There are two basic strains to the diagnosis question, as I see it.\u00a0 One is the narrow definition of what \u201ctransition\u201d means.\u00a0 The other is the connection you\u2019ve identified between transgender identity and (dis)ability.<\/p>\n

First, what is transition?<\/p>\n

There is one fairly well recognized, if not well understood medical model that involves a cognitive distance between gender identity and \u201cphysical sex,\u201d followed by therapy, GID diagnosis, and physical transition from one binary gender to the other through some combination of hormones and surgery.\u00a0 In this process, some might argue that there is a clear end point to transition, that once a person has completed surgery\/ies and is living as the \u201copposite\u201d gender, he or she \u201chas transitioned.\u201d\u00a0 Of course, there are attendant social and legal elements to this–friends and family recognizing the transition, gender marker being changed on ID documents, etc.<\/p>\n

Of course, this isn\u2019t exactly what everyone who is MTF or FTM and chooses to medically transition goes through.\u00a0 Some do all these steps but don\u2019t identify with their gender exactly the way their therapist wants.\u00a0 Not everyone who completes these steps considers transition \u201ccomplete\u201d or wants to pass as cisgender.\u00a0 Moving out from this narrow definition, there then those who choose limited or no surgical intervention, but do take hormones.\u00a0 There are those who do not take hormones.\u00a0 There are those who are perfectly happy with what others perceive as a \u201cmale\u201d body while using a female name, pronouns, and identity (and vice versa).\u00a0 And there are non-binary folks like me, or binary trans folks who aren\u2019t quite comfortable with the straight-line transition narrative from one gender to the \u201copposite.\u201d<\/p>\n

The point of all this is that the GID diagnosis, and the recognized standards of care around that diagnosis, narrow the cultural and legal understanding of \u201ctransition.\u201d\u00a0 Most trans people know that there are many ways to transition, but those outside the community may continue to see transition very narrowly, and reject those who do not fit the model.\u00a0 Lawmakers also tend to make law based on what medicine says about trans people, so in some cases the GID definition limits ability to legally transition.<\/p>\n

GID also privileges certain forms of gender expression, and certain transition paths, over others.\u00a0 In order to get a GID diagnosis, some trans people have to drastically alter their authentic gender presentation to \u201cconvince\u201d a therapist or be eligible for medical intervention.\u00a0 Some non-binary people, for example, would be more comfortable having chest surgery, but in order to convince a doctor that this surgery is needed, have to fit into an FTM or MTF mold.<\/p>\n

The second issue, as Kyla points out, is the connection between transgender and (dis)ability.<\/p>\n

What is disability?\u00a0 Often, it is an inability to do things in the \u201cnormal\u201d way.\u00a0 Most people perceive things through sight and sound, so those who cannot see or hear are seen as \u201cdisabled.\u201d\u00a0 Most people move through the world by walking on their feet, so those who use prosthetic limbs or roll down the street in a chair are seen as \u201cdisabled.\u201d\u00a0 There wouldn\u2019t be a concept of disability without a concept of ability, or the \u201cnormal\u201d way of doing things.<\/p>\n

This frame doesn\u2019t only apply to things we think of as disability-related.\u00a0 Some examples:<\/p>\n

– It\u2019s \u201cweird\u201d to talk with your hands instead of your mouth<\/p>\n

– It\u2019s \u201cweird\u201d to express yourself very emotionally, or to express yourself very infrequently<\/p>\n

– It\u2019s \u201cweird\u201d not to think and feel within a certain realm of acceptable thoughts and feelings<\/p>\n

– It\u2019s \u201cweird\u201d to prefer the same sex<\/p>\n

– It\u2019s \u201cweird\u201d to have multiple partners<\/p>\n

– It\u2019s \u201cweird\u201d to have a gender that doesn\u2019t culturally \u201cmatch\u201d chromosomal or physical \u201csex\u201d<\/p>\n

Those who are perceived as \u201cweird\u201d often form distinct communities based on different ways of doing things.\u00a0 Because of privilege, the majority doesn\u2019t generally question its view of what\u2019s \u201cnormal\u201d and what\u2019s \u201cweird,\u201d but those in a particular community may consider their version perfectly normal.\u00a0 For example, in the Deaf community, communicating through sign language is not considered a \u201cdisability.\u201d\u00a0 Many transgender people, similarly, don\u2019t see themselves or their friends as having a \u201cdisorder.\u201d<\/p>\n

These differing perceptions, unsurprisingly, tend to create rifts between communities.\u00a0 The idea of \u201cability\u201d or \u201cnormality\u201d is used by the majority as a protective mechanism.\u00a0 If you\u2019re weird, I\u2019m okay.\u00a0 There\u2019s a discomfort with different ways of doing things, because if those ways are normal, the majority has to question its own ways.\u00a0 Both the disability model and the gender binary are a kind of line-drawing that makes the majority comfortable.\u00a0 I am on one side of the line, you are on the other.<\/p>\n

From the perspective of someone on the \u201cother\u201d side of the line, these categories may seem quite arbitrary.\u00a0 For example, I recently read a post on Sociological Images about two runners who use prostheses.\u00a0 There is a resistance to allowing disabled runners to compete alongside those running on their natural legs, explained by the possibility of some advantage being conferred by the prosthesis.\u00a0 A prosthesis is seen as an \u201cunnatural\u201d advantage, but we don\u2019t say the same about very tall basketball players or very short gymnasts.\u00a0 Similarly, we have no problem with people being beautiful, happy, or comfortable in their gender without surgery or hormones, but those who need medical intervention to reach this state are seen as \u201cwrong.\u201d<\/p>\n

The fact is, there\u2019s nothing inherently wrong or unnatural about having a gender that doesn\u2019t \u201ccorrespond\u201d in our cultural understanding to chromosome makeup or birth genitalia.\u00a0 It\u2019s difficult to be transgender because of stigma, social harm, lack of access to care, and other reasons.\u00a0 Many of the justifications for putting transgender in the DSM are based on the social response<\/em> to trans identities and the harm it causes to trans people, rather than on the simple state of being transgender.\u00a0 It\u2019s a disorder because society defines order.<\/p>\n

This is not to minimize what it\u2019s like to live in a body that feels wrong.\u00a0 Even if these societal harms didn\u2019t exist, if we were correctly gendered no matter what our bodies looked like, there would likely still be dysphoria and some people would still need surgery to feel right in their bodies.\u00a0 But it is unclear why we should treat this need for surgical correction as indicating a disorder.\u00a0 Is having wisdom teeth a disorder?\u00a0 Are the cultural and ritual changes that take place in many other areas indicative of a disorder?\u00a0 When we look at it this way, the norm of having the same sex characteristics throughout life seems rather arbitrary, kind of like talking with our mouths rather than our hands.<\/p>\n

Like people with disabilities, transgender people are harmed by others not understanding the way we perceive the world, by lack of education, and by difficulty finding affirming community.<\/p>\n

This brings us back to the question of the GID diagnosis, and the benefits Kyla points out–access to healthcare and the use of GID in discrimination claims.\u00a0 Those benefits are real, and I agree that there are big changes we need to make before taking transgender out of the medical sphere entirely will benefit trans people.\u00a0 However, I would argue that there should be a change in the DSM to less stigmatizing vocabulary.\u00a0 The DSM-V criteria under consideration offer<\/a> <\/a>a<\/a> <\/a>mostly<\/a> <\/a>workable<\/a> <\/a>concept<\/a> <\/a>of<\/a> <\/a>gender<\/a> <\/a>dysphoria<\/a>.<\/p>\n

I\u2019m not an expert in diagnostic criteria, and so I can\u2019t guess what the implications of the revision being considered would be.\u00a0 However, I do think it makes sense to frame gender transition as something (covered by insurance) that some need and some don\u2019t.\u00a0 A condition doesn\u2019t have to be a stigmatized disorder to ensure access and insurance coverage.\u00a0 For example, near-sightedness isn\u2019t a stigmatized problem–you just get glasses.\u00a0 Birth control for contraceptive purposes is covered as a legitimate form of preventive care.\u00a0 I can even imagine framing transition as preventive care–not a sign of a disorder, but something that is necessary to prevent later health problems.<\/p>\n

The bottom line for me is that we have to have a serious paradigm shift as a society, and I think the DSM-V provides at least one opportunity to start making that change.<\/p>\n

KYLA: I love the idea of using conversations around DSM revisions as an\u00a0opportunity\u00a0for paradigm shifts!\u00a0 That is such an exciting re-framing of what has typically been a very painful conversation.<\/p>\n

I also want to use this opportunity to contextualize coverage for birth control.\u00a0 Yes, it\u2019s fantastic that about 9 in 10 employer-sponsored insurance plans now cover a full range of prescription contraceptions<\/a>. \u00a0But this is only thanks to over two decades of hard core activism, a history which may be too easily forgotten.\u00a0 Gloria Feldt lays out this strategy in her final chapter of The War on Choice<\/a> <\/em>and the National Women\u2019s Law Center has a handy-dandy timeline<\/a> of this push for coverage of contraceptives.\u00a0\u00a0You can also read about the first big victory in 1998<\/a> where activists successfully used insurance coverage of Viagra to point out the absurdity of not<\/em> covering birth control.\u00a0 It\u2019s important to remember this history,\u00a0especially\u00a0in light of the backlash to President Obama\u2019s recent mandate for birth control coverage<\/a> and this week\u2019s no-girls-allowed Congressional hearing<\/a> on birth control.<\/p>\n

When it comes to insurance, there are many battle fronts to fight on. \u00a0Perhaps this is another opportunity to use the collective liberation strategy to push for real change that leaves no one behind.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

KYLA: We are having the wrong conversation(s). This is the conclusion I came to after attending an amazing community dialogue on Gender Identity Disorder (GID) in the Diagnostic and Statistical Manual (DSM).\u00a0 Part of the NYC Quorum Forum,\u00a0the dialogue explored how language is used in ongoing debates around GID to \u201cdistance gender expression\/experiences from other […]<\/p>\n","protected":false},"author":1923,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21098],"tags":[345,21311,21385,21392,779,306],"class_list":["post-3296","post","type-post","status-publish","format-standard","hentry","category-body-politic","tag-disability","tag-dsm-v","tag-gender-identity-disorder","tag-gid","tag-queer","tag-transgender"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/3296","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/users\/1923"}],"replies":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/comments?post=3296"}],"version-history":[{"count":0,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/3296\/revisions"}],"wp:attachment":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/media?parent=3296"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/categories?post=3296"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/tags?post=3296"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}