Stop Trans Pathologicalization 2012

Every where I look I see signs that the movement to end GID and the pathologizing of transsexualism/transgenderism is reaching the point of Critical Mass.  Like the parable regarding the hundredth monkey, once enough people start thinking that the whole idea that transsexualism or transgenderism as mental illness is a lie, a fiction created to oppress us then that idea becomes the new paradigm.

I saw this very interesting manifesto over on Stop Trans Pathologicalization 2012


International Network for Trans Despathologization

The advocates and groups who sign this document, and are part of the International Network for Trans’ Identities’ Despathologization, publicly denounce once again the psychiatrization of our identities and the serious consequences of the so called “Gender or Sex Identity Disorder” (GID). In the same way, we want to make visible the violence done to intersex people throughout the current medical procedures.

With “psychiatrization” we name the practice of defining and treating transexuality under a mentally disordered label. We are also speaking about the mistaking of non normative bodies and identities (those out of the cultural dominant order) for pathological bodies and identities. Psychiatrization gives the medical-psychiatric institutions the control over gender identities. The official practice of these institutions, motivated through state, religious, economical and political interests, reflects and reproduces the male/female binomial on people’s bodies. Making believe this exclusive position is a “true” and natural one. This binomial, supposes the solely existence of two bodies (male or female), and associates a determined behavior to each one of them (male or female). At the same time it has traditionally taken into consideration heterosexuality as the only possible relationship between them. Today, as we denounce this paradigm, which has justified the current social order with nature and biological arguments, we evidence its social effects so as to put and end to its political pretentions.

Those bodies which do not anatomically correspond to the current western medical classifications are classified under the label of intersexuality, a condition that by itself is considered pathological, whereas the medical classification is nowadays not yet questioned about it. Transexuality is also conceived as a problematical reality by itself. However, the gender ideology which psychiatry develops, is still not questioned

The legitimization of social norms that are part of our life experience and our feelings, implies the invisibilization and pathologization of all the other existing options, setting one single path that doesn’t question the political dogma around which our society is built: the solely and exclusive existence of only two ways of being and feeling. If invisiblizing means performing violent and normalizating surgeries on intersex newborns (those with ambiguous functional genitalia) it will be done. Especially when its’ goal is to eliminate the possibility of these bodies and to veto the existence of those differences.

The paradigm, in which the actual treatment procedures for transexuality and intersexuality are inspired, makes them become medical procedures of binary normalization. It is “normalization” because these procedures reduce the diversity to only two ways of living and inhabiting the world: those considered statistically and politically as “normal.” With our critique to these procedures we also resist to having to adapt ourselves to the psychiatric definitions of man and woman for being able to live our identities, so that our life’s value is recognized without giving up the diversity in which we constitute ourselves. We obey no kind of label or definition imposed on us by the medical institution. We demand our right to name us by ourselves.

Nowadays transexuality is considered a “Sexual Identity Disorder” mental pathology classified in the ICD-10 (International Classification of Diseases from the World Health Organization) and the DSM-IV-R (Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatrist Association). These classifications are the ones that guide psychiatrist all around the world when establishing diagnosis. In them, we find a less tan casual error: the mistaking of the transphobia effects for those of transexuality. Social violence against those that don’t follow the gender standards is invisiblized. This way, it is actively ignored that the problem isn’t gender identity but transphobia.

The DSM-IV-R revision is a process that started two years ago, which aims to determine the changes in the list of disorders. Few months ago the names of the psychiatrist who will determine the future of de Gender Identity Disorder (GID) were published.

In charge of the GID work-group are Dr.Zucker (the group’s director) and Dr.Blanchard , within others. These psychiatrists are well known for using reparative therapies on homosexuals and transexuals, and are linked also to clinics where operations on intersexual people are done. What they propose, is not only not withdrawing the disorder, but expanding its treatment to children who present gender-variant behaviors, and applying them reparative therapies for them to accept their original role. Because of this, the North-American trans movement has started to demand their expulsion from the group in charge of revising the DSM. The International Network for Trans’ Identities’ Despathologization supports wholeheartedly this demand.

Transexuality’s pathologization under the “Gender Identity Disorder” is an extreme exercise of control and normalization. This disorder’s treatment is carried away in different centers around the world. In some cases, like the Spanish State, it is compulsory to go through a psychiatric monitoring in the Gender Identity Centers. In some cases it is linked to a weekly control of our gender identity through group therapies, family, and all sorts of derogative procedures which infringe our rights. While referring to the Spanish State’s case, it is important to highlight that anyone who wishes to change their name in their official documents, or who wishes to modify their body with hormonal treatment or with some operations, has to go through a psychiatric monitoring.

Finally, we are directly speaking to all politicians. Our demands are clear:

  • We demand the retirement of transexuality from the mental disorders’ manuals (DSM-IV-R and ICD-10). To bring the treatments on intersex babies to an end.
  • We demand our right to change our name and sex in the official documents without having to go through any medical or psychological monitoring. We also think that the State should have no jurisdiction over our names, bodies and our identities.
  • We take here the words from the feminist movement in their fight for the right to abortion, and the right to your own body: we demand our right to freely decide whether if we want or not to modify our bodies. Our rights to be able to carry on with our decision, with no bureaucratic, political or economical impediments, nor any other type of medical coercion. We want the sanitary systems to take positions regarding the Gender Identity Disorder, for them to recognise the transphobia that this classification implies, and for them to rethink their healthcare programs regarding transexuality, making the psychiatric monitoring an unnecessary step, and the psychotherapeutic monitoring a voluntary option. We demand too that the surgeries on intersex newborns stop.
  • We denounce the extreme vulnerability and the difficulties, when accessing the labor market, of the trans community. We demand granted access to the labor market and that specific politics are engaged to end marginalization and discrimination of our community. We also demand health and security conditions for sex workers and the end of the police’s besieging to these persons, as well as sexual traffic.
  • Vulnerability situations are stressed in cases of immigrant trans persons, who reach our country fleeing from extreme violence situations. We demand the immediate concession of political asylum in these cases, and at the same time we claim that the rights of migrant people are brought to the same level. We denounce the effects of the actual politics on foreign nationals over the most vulnerable social sectors
  • While we shout that we are no victims but active beings and with the capacity of deciding over our own identities, we want to remember too all the aggressions, murders, and suicides of trans people due to transphobia. We signal the system guilty of this violence. Silence is complicity.

We finish showing the extreme rigidity with which the male/female binomial is imposed as the solely and exclusive option. Binomial that is built and therefore can be questioned. Our solely existence proves its falseness and points to a plural and diverse reality. Diversity that we dignify today.

When medicine and State define us as disordered, they are proving that our identities, our lifes, deeply disturb their system. That’s why we say that the illness is not in us but within gender binarism.

We make public that the International Network for Trans’ Identities’ Despathologization is born to consolidate a worldwide coordination of our first goal: the retirement of transexuality from the DSM-TR the year 2012. A first step for diversity, a first knock to transphobia.

For the diversity of our bodies and identities!

Transphobia makes us ill!





12 Responses to “Stop Trans Pathologicalization 2012”

  1. Véronique Says:

    Now that I’m on this side of transition and surgery, looking back it seems ludicrous that the need or even the desire to change sex would be considered a mental condition. After all, the need or desire is alleviated by physiological changes for the most part. Certainly psychotherapy does nothing to alleviate it.

  2. HenryHall Says:

    There are really two active movements: (1) Depathologization and (2) De-psychopathologization. STP2012 favors (1) but sees (2) as a valuable intermediate step, an important piece of progress along the way.

    Presently WPATH has come out in favor of (2) but is silent as to (1). Of course the Zucker/Blanchard DSM5 activity is very strongly opposed to both.

    To illustrate the difference:-

    Under DSM a transman can have mastectomy because she is terminally deluded; under De-psychopathologization he can have mastectomy because normal men do not have big boobs; under Depathologization the transman can have mastectomy because zhe has control over hir own body.

    Then, quite separate from the health protocols is the issue of procedures for change of LEGAL sex. In many jurisdictions (eg California and most other places), change of legal sex is pathologized (surgery is required) but it is not psychopathologized (following the SOC is not required).

    But in some jurisdictions (e.g. Germany, UK, New York) change of legal sex is psychopathologized. In a few places (e.g. Spain) you get to pick between pathology or psychopathology; that is to say in Spain today you need EITHER psychiatry with RLT or you need surgery. As contrasted with Germany where you need both; or with UK where you must have psychiatry but surgery is not required.

    Importantly, however, in several places there are laws pending to completely depathologize change of LEGAL sex. All that will be required is an oath promising to embrace the new gender and give up the old sex. And when that happens everything changes, because people will change legal sex BEFORE seeking medicine. The DSM and SOC are completely unable to cope with that.

  3. Bobby Love Says:

    Well we are living in a modern world with modern technologies. Everyone has its own right to what he or she should believe and do for his or her own body.

  4. Jessica Says:

    In Canada,. I was quite shocked to learn transsexual men can have hysterectomies after a certain amount of time on testosterone: this leads to premature menopause which is an indicator for hysterectomy–without the need of going through the DSM or the Standards of Care, AT ALL.

    The pathologization of transsexual men in Canada, at least for ‘bottom’ surgery has never been; ‘top’ surgery, depending on the doctor, can be similarly finessed.

    I had to obtain a diagnosis for GID AND follow the Standards of Care. I would argue there is a fundamental sexism involved here–one that I have never heard discussed.

    As I read one of the depathologization manifestos, though it seems not the one above, there was a call for surgery to be covered by national health insurance plans. Without some medical diagnosis, coverage, such as the San Francisco municipal plan would lose its medical base and would probably not cover it any more.

    I recognize the extreme libertarian culture in America is often profoundly against single-payer, such as we have in Canada, that provides coverage for SRS, without which many, many transsexual women–the men in many cases covered under OTHER categories already–will, as they are now, be excluded.

    There must be a way to square this circle–depathologize but retain medical coverage to the extent that it will be paid for.

    Unless libertarian ideology replaces transgender ideology governing the lives of transsexual women without regard to their lives and needs–what’s new!

  5. HenryHall Says:

    @Jessica writes: Without some medical diagnosis, coverage, such as the San Francisco municipal plan would lose its medical base and would probably not cover it any more.

    That is what the de-psychopathologize intermediate position is all about. For example – to treat transwomen under diagnosis and hormone protocols for anovarian women and surgical protocols for MRKH girls. ICD-10 diagnoses E28.9, E34.9, Q50.0, Q52.0 and so on. In some places this needs a prior change of legal sex, in other places medical sex is allowed to be opposite to legal sex.

    • Suzan Says:


      Transsexualism was only made a pathology so the multitude of psych grads wouldn’t be forced to find fulfilling careers as baristas. If you were to cut through all the bullshit and create a free society transsexual is just something a reasonably substantial number of people would be.

      Get rid of the pathology and make surgery and the rest free and more people would get it.

      Now it is very class structured and requires either the economic means or the ability to convince some “expert” that you meet their qualifications for them to sign off on tab for those who cover it.

      Like a religion it requires you to accept the lie of their pathological theology and bare the stigma in order to get what you need.

      In someways that sort of thing resembles something out of Solzhenitsyn’s “Gulag Archipelago”. Like Bailey and Blanchard’s “Sophie’s Choice” set of questions that require one to answer one way or the other when both sets of questions lead to a pathologized category.

  6. Jessica Says:

    Henry, I appreciate your mention of “the de-psychopathologize intermediate position” but, as I’ve pointed out in Canada, we are just talking about transsexual women, transsexual men have long escaped the psychopathologization the women have always been subject to.

    And in libertarian countries such as the United States the entire idea of single-payer, or ANY health care system run by the government smacks of the “repellent socialism.”

    I also appreciate, Suzan, that this is a very class-structured thing, which is why I advocate for a single-payer health care system.

    For some reason of sexism/gender the men simply go through the system without any psychology stigma; the women must.

    I begin to believe that until the Despathologization movement actually, formally, explicitly recognizes this sexism at the heart of the treatment of transsexuality it will be little more than an interesting side issue.

  7. Véronique Says:

    Just to clarify what Jessica wrote (and I don’t mean to pick on her, but those outside Canada often have misconceptions about our system)… We don’t actually have a national health system in Canada. We have 13 provincial and territorial systems under the Canada Health Act. SRS is covered in British Columbia and Ontario, sort of covered in Quebec (they haven’t been very clear), and (I think) partially covered in Manitoba. Alberta delisted SRS last year. So unfortunately there is still plenty of room for discrimination based on income.

  8. HenryHall Says:

    @Suzan wrote: Now it is very class structured and requires
    > either the economic means or the ability to convince
    > some “expert” that you meet their qualifications for
    > them to sign off on tab for those who cover it.

    That is exactly how it is today for flat-chested women (trans or non-trans alike) who seek breast augmentation.

    So it is understandable (not fair but understandable) that vaginoplasty is treated the same as breast augmentation.

    And that society and medical insurers wish it to be so.

  9. Jessica Says:

    “We don’t actually have a national health system in Canada. We have 13 provincial and territorial systems under the Canada Health Act. SRS is covered in British Columbia and Ontario, sort of covered in Quebec (they haven’t been very clear), and (I think) partially covered in Manitoba. Alberta delisted SRS last year.”

    Its actually more complicated even that what Veronique writes above.

    The Canada Health Act does require certain minimum standards to be met, and the federal government does fund the system, not to the 50% that was once the ideal, but still significantly, as it does for other “shared cost” programs, what most would understand as social programs.

    There is much discussion, and it is the policy of the party whose member introduced C-389, the bill to add gender identity/expression to the Canadian Human Rights Act and the Criminal Code, to add to the Canada Health Act a specific requirement for SRS.

    I would actually argue what we have in Canada is unique, a national health system that has the provinces as full partners–something our American readers would find incomprehensible; many Canadians find this incomprehensible, too–this is why it is under siege.

    Much about Canada, I believe, is incomprehensible to Americans, most of which are the very good parts.

  10. Andrea B Says:

    Firstly, Transsexualism needs to be de-pathologised, immediately.

    Secondly, every psychiatrist, psychologist, sociologist, church, politician and lawyer involved in any form of pathologisation of transsexual people, should be made to publicly apologise for the pathologisation.

    Thirdly, every journal that has printed any transphobic bigotry should be immediately shut down, as they are hate joournals, nothing else.

    Fourthly, every psychiatrist, psychologist, sociologist and lawyer who has made money of our backs, should be forced by law, to pay it back, immediately.

    Fifthly, all transsexual people should be compensated for the abuse they have had to suffer due to the pathologisation. The money should be raised primarily from sales of assets belonging to psychiatrists, psychologists, sociologists, lawyers, politicans and churches who took part in campaigning against transsexual rights and those who pathologised transsexual people.

    That would be a good start.

  11. Jessica Says:

    In America, governed by the Obama dictum, **Look Forward, Not Backward** this is unlikely.

    Given his government’s protections of torture, pardon me, “enhanced interrogation techniques,” what you’re calling for isn’t likely even to be discussed, let alone acted upon–regardless of its merits.

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