Tuesday, June 26, 2012

Gender Dysphoria - the latest in the DSM-V development

It's been a while since I reviewed the latest draft of the Diagnostic and Statistics Manual, Version 5 - the encyclopedia of recognized psychiatric conditions by the American Psychiatric Association.

It comes with plesant surprise to take note that transsexualism has been completely separated from transvestic fetishism.  It's great to see that this committee is finally listening to global experts on this matter.  Traditionally, transsexualism was considered a mental illness in which it was assumed that the patient was undergoing an uncontrolable impulsive sexual fetish of percieving oneself as the opposite sex.  This theory was coined by Ray Blanchard of CAMH fame, and even given specific terms - Autogynephilia (for lesbian and bisexual identified transwomen), and Homosexual Transsexual (for straight identified transwomen).

While many trans patients and experienced trans medical professionals may not have doubted the existence of said 'diseases', it has been proposed that this is not the only reason why one might identify as trans or gender-dysphoric.

The latest draft now indicates that Gender Dysphoria and Transvestic Disorders are two completely separate categories.  the draft also goes on to specify that Gender Dysphoria will be declassified as a mental illness and will now sit as an unclassified condition - neither psychiatric or medical, which is commonly accepted as a condition that requires physical intervention via hormones and/or surgery, to resolve.

The document also makes reference to the term 'specifier' which indicates that post-transitioned patients can be considered in partial or full remission, due to the lack of symptoms for Gender Dysphoria.

In short, transsexuals will no longer be recognized as mentally ill, nor will they be directly linked to fetishism.  These proposed changes to the DSM-V were tabled back in May 2011, and can be expected to become official in May 2013 - the date of the next APA annual conference.

A complete listing of the latest drafts can be viewed here on the APA's page for Gender and Sexual Identity Disorders.

As an aside, I find it disturbing to see such a huge list of newly-created mental illnesses - many of which would appear to be biological conditions. Nonetheless, from the scope of reviewing this as someone who retroactively would have been labeled with Gender Dysphoria and without Transvestic Disorder, and who would retroactively be classified as in remission, I can't help but feel estatic and elated to have the APA doctors apply labels that are congruent with what I have been saying all along.

Bottom line, I am not, nor have I ever, been 'mentally ill' nor a 'fetishist' for being trans. As a post transitioned patient, while I may be labed with an unclassified medical condition for life, I can also lay claim to permanent remission - hence the medical condition has absolutely no negative factor as far as my mental health is concerned.

So, what does this mean? I'd like to hope that this can validate the claims of trans health professionals that transition is medically necessary, and diagnosis of transsexualism can be made by any psychiatrist. I can only hope that this will bring an end to the CAMH monopoly in Newfoundland, as far as gatekeepers for sex reassignment surgery funding, and bring an end to province's refusal to recognize sex reassignment surgery as a medically-necessary procedure for all patients diagnosed with Gender Dysphoria.

Finally, what this also validates, is the concept that rather than 'being trans', I may simply refer to myself as a 'woman with a history' (to steal a line from Jenna Talackova's now infamous Thailand youtube interview).

So where do I go from here? Having just recently lost my battle with the Newfoundland health care and human rights system over funding for said-mentioned surgery, notwithstanding a future civil law suit against these offices, it would appear that I have run out of things to fight for, at least from the perspective of me as an individual.  I could fight for others, then again, those others who may or may not exist, showed absolutely no interest in alligning with me, while I undertook these battles. It would seem that the time has come for me to distant and severe myself from the trans label and the trans community, and focus on the rest of my life as simply, a woman.  But I will save any formal announcement for my next blog post.


BillyHW said...

And I'm Napoleon.

Jack Molay said...

"It comes with plesant surprise to take note that transsexualism has been completely separated from transvestic fetishism. "

I wish I could be as optimistic as you are, but I am afraid the fact that autogynephilia (and autoandrophilia) remain in the DMS, those that want to hurt transwomen can continue to do so.

The autogynephilia theory stipulates that ALL gynephilic transwomen (and by implication ALL androphilic transmen) are paraphiliacs (classified under the heading of "transvestic disorder" in the DMS-5).

Moreover, the theory presupposes that any transwoman or transman who has felt arousal from imagining him or her self as having a body in harmony with his or her inner self is an autogynephiliac or autoandrophiliac.

As far as I can see, the only way a pre-op transman or transwoman can be aroused is by imagining him- or herself as having such a body. This arousal is classified as autogynephilia. The logical conclusion must therefore be that ALL transsexual men and women are perverts.

I am sure Mr. Ray Blanchard will make an exception for the transwomen he calls "effeminate gay men", while others will make exceptions for transwomen and transmen who report no sexual desire whatsoever, but that gives me little comfort.

As long as the "transvestic disorder" category remains in the DMS-5 the battle is not over.

Miranda Gjedde said...

But those terms are there for the crossdressers and transvestites. And from my interactions with a lot of the former and not so much the latter. They do belong in the DSM.

I mean I know how improper wording, to discibe a person who may have either of those two paraphilias, could lead the mis diagnoses of a persn with GD could happen.

But don't remove autogynophilia and androphilia from the DSM. Improve the distinctions from those and GD.

On another note. I do wish they would come up witha better term than either transgender or transsexual to describe a person such as myself. A self identified "non-op" trans woman.

So transsexual doesn't quite fit, cause I have no dysphoria when it comes to my sex, just my gender.
And transgender doesn't fit for it's to broud a term.
Because in the trans community, it's used to describe any gender non-conformist.
Maybe there just needs to be a new umbrella term.

Yes, even though I have been on HRT and transitioned from m to f. I still have dysphoria, because all the "medical" terms to discrbe a person like myself are inaccurate.

All I'm trying to say is, that we don't need two quite accurate paraphilias removed. What ee need is better understanding of all trand identities.

Btw... Just because you are now a female, doesn't mean you stop being trans. So I hope you don't abandon your trans brothers and sisters just because you've become whole.

Trans rights are going to be contested for a long time to come. And we need get AND keep as many activists we can.

Miranda Gjedde said...

Well hello Napoleon, nice to meet you.

And does someone have a height complex? Or is it just an inteligence complex?