The term ‘gender identity disorder’ is being replaced with ‘gender dysphoria’ in the new Diagnostic and Statistical Manual used by psychiatrists. But the move has split the trans community
Posted by Paris Lees
Sunday 9 December 2012
The American Psychiatric Association (APA) no longer sees transgender people as disordered. Well, sort of.
Gender identity disorder (GID) – the psychiatric term given to people who wish to undergo gender reassignment – is being dropped from its new Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Say hello instead to gender dysphoria, “a marked incongruence between one’s experienced/expressed gender and assigned gender”. Hurrah! Gender identity disorder is dead, long live gender dysphoria! Or something like that.
The move has split the trans community. Many claim gender dysphoria describes the mental pain they feel about their birth sex, and the model does provide grounds for treatment through the NHS and progressive medical insurance. Still, others ask, must we categorise trans people’s discomfort?
As a student I developed social phobia and stayed indoors for weeks. Back then I didn’t “pass” so well and would sometimes get street insults such as “tranny!” or “Are you a bloke?” (It’s always “bloke” in these situations, never “man”.) When friends asked me why I didn’t visit, I told them I had problems leaving the house. Did I have a problem, though? Or was it just a rational response to abuse?
Labelling, most trans people agree, is tricky. Previous DSMs classed a range of behaviours as “disordered” – including homosexuality until the 1970s. And today you can be diagnosed with a plethora of psychological conditions that apparently didn’t exist 40 years ago. Psychiatrists had yet to dream them up.
In a petition denouncing the APA’s desire to medicalise natural human variation, academic Y Gavriel Ansara argues that “pathologising human expressions, identities and experiences harms civil rights and violates international human rights standards”. The manual, he says, ignores evidence from various cultures that celebrate trans identities, rather than see them as problem.
Then there’s US sexologist Ray Blanchard, best known for his … well, problematic concept of autogynyphelia: the idea that trans women are actually men who feel attracted to their female-selves. Yes, really. Blanchard has expanded the DSM’s “paraphilia” section (where crimes such as paedophilia and exhibitionism go) to include transvestic disorder. That’s cross-dressing to you and me and, according to Blanchard and the APA, there are two types – fetishism and autogynephilia. That’s not all: “transvestic disorder can be applied to any person who is sexually active while wearing clothing incongruent with their birth-assigned sex.” So female-born humans who wear “men’s” clothes while aroused will have “autoandrophilia”. Annie Lennox, in a suit, feeling raunchy? Androphile! Just what is “incongruent” clothing is not specified by the DSM – but watch out for unisex hoodies, just in case.