Latest version of Diagnostic and Statistical Manual still includes gender variance as a disorder,recommends ‘reparative’ therapy
Mental illness can carry a heavy stigma. It can destroy families, end careers, cause health care to be turned down and even the most basic of human rights to be denied.
Just look at homosexuality as an example: It was once labeled a mental disorder, and the liberation of LGB people today continues to depend upon them having a clean bill of mental health.
But that same clean bill is routinely denied to freely expressing gender-variant people — from toddlers to adults — regardless of transgender identity. And though the liberating road ahead is anything but clear, many voices are speaking out amidst a firestorm of controversy, and they’re speaking to the American Psychiatric Association.
The 38,000-member APA, formed in 1892, has the mission to "ensure humane care and effective treatment for all persons with mental disorders." The organization defines and publishes criteria for mental disorders in its Diagnostic and Statistical Manual, originally published in 1952 and now in its fourth edition.
The upcoming DSM-V, with draft revisions released just last month, and its appointed revising committee for disorders related to sexuality and gender are at the center of the controversy, enough so that the National Gay and Lesbian Task Force issued a statement on the subject in May of last year.
Those revisions show the DSM continues to include the GID entry, a fact that has transgender advocates up in arms.
The Task Force declared the appointments of Drs. Kenneth Zucker and Ray Blanchard to be "clearly out of step with the occurring shift in how doctors and other health professionals think about transgender people and gender variance. It is extremely disappointing and disturbing that the APA appears to be failing in keeping up with the times when it comes to serving the needs of transgender adults and gender-variant children."
Zucker is the psychologist-in-chief at the Centre for Addiction and Mental Health in Toronto and is the head of the Gender Identity Service in the Child, Youth, and Family Program at CAMH. He is a proponent of treating gender-variant children to adjust to their birth sex, which some have criticized as a form of "reparative therapy."
Zucker chairs the DSM-V Sexuality and Gender Identity Disorders Work Group (Work Group).
Blanchard is also with CAMH as senior scientist in the Clinical Research Department and head of Clinical Sexology Services. He is known for his research in gender dysphoria and for coining the term autogynephilia meaning "[an erotic] love of oneself as a woman."
His belief that all male-to-female transsexuals desire gender reassignment either for autoerotic reasons or as an attraction to men has not been well received by the transgender community.
Indeed, the International Foundation for Gender Education has issued a resolution last year calling on the APA to ameliorate harm against transgender individuals by issuing a statement stating that "gender variance, and gender non-conforming behavior, do not constitute a psychological disorder."
The APA issued a statement declaring the organization stands by Zucker and Blanchard, and has not issued any statements at this time in regard to gender variance as not being pathological in and of itself. Zucker and Blanchard declined comment to the Dallas Voice.
Transgender woman Deidre McCloskey, an economics professor at the University of Illinois and well-known transgender activist, was committed twice to mental hospitals for her gender-variant behavior in the mid-1990s. She feels strongly that the appointment of the CAMH researchers is unjust.
"I regard the new DSM’s committee and its recommendations as a coup by a radical wing of the sexology community against reason. It is a throwback to the era before 1973 in which homosexuality … was considered a sickness by the APA," McCloskey said.
She said she is "astonished that in the face of a more than a 1,000-person petition against the new [Work Group] and its slanted composition, the APA chose to go along with the reactionaries."
Dr. Jack Drescher, a distinguished member of the APA and member of the Work Group, said he believes he is the only gay man on the Gender Identify Disorder (GID) subcommittee and that there is no transgender representation in the group.
But Beth Casteel, spokeswoman for the APA, said that Jamison Green, "a respected transgender person," is advising the Work Group.
Drescher said he feels that Zucker and Blanchard don’t always get a fair shake. "I don’t think demonization of individuals has been helpful toward arriving at a more trans-positive DSM," he said.
But Dr. Kelley Winters, founder of Gender Identity Disorder Reform Advocates, said the bottom line is that the current DSM contains diagnoses for GID and Transvestic Fetishism, and that anyone that exhibits significant cross-gender behavior is classified as mentally ill in one of these categories — though women are excluded from TF.
Winters said there should be a "call to arms" from the transgender commnity for DSM reform because "anyone who is caught as a crossdresser can lose their rights."
Following in the footsteps of one of her heroes, Frank Kameny, Winters staged the "Reform GID Now" protest on Howard Street outside the Annual APA Meeting last May in San Francisco.
Winters, who is transgender, stood with bullhorn in hand, declaring, "My identity is not disordered."
Winters spoke with about a dozen other speakers at the meeting, including Masen Davis, executive director of the Transgender Law Center; Mara Keisling, executive director of the National Center for Transgender Equality; and Andrea James, director of Trans Youth Family Allies.
Madeline Deutsch, M.D., won applause from the transgender activist for exposing the presumptuousness of the APA in requiring that transgender people should have to prove they are psychologically sound.
"It is time to change society and change the system, rather than placing the social, financial and psychological burden on transgender people," Deutsch said.
One symposium at the Annual APA Meeting was held to discuss whether or not Gender Identity Diagnoses should be "In or Out" of the DSM. Members of both the DSM-V community and leaders from the transgender community, including Kiesling and Winters, were present.
According to Casteel, Dr. Peggy Cohen-Kettenis, the chair of the GID subcommittee, attended the symposium and has been described by some as a "trans ally."
It is not entirely clear why gender reform of the system is coming at a slower pace than for homosexuality, but Dr. Susan Stryker, an associate professor at the Gender Studies Department of Indiana University suggested that while it may not be useful to rank oppressions, she does "think that gender is a more fundamental category than sexual orientation."
"The gut reaction some people have against same-sex attractions can be understood as a reaction against gender-norm transgression … so I see trans, gay and lesbian issues as all being related to one another, in that they all need to contest limiting notions of conventional personhood," Stryker said.
Homosexuality was removed from the DSM in 1973, but it t
ook until 1987 to have its consecutive replacements, Sexual Orientation Disturbance and Ego Dystonic Homosexuality, removed. With the appointments of Zucker and Blanchard to the Work Group, rumors that homosexuality would be re-added to DSM have surfaced.
Drescher, in a report he has preliminarily released to the Dallas Voice, stated that "there is no factual basis to the rumors that the APA … might reinstate homosexuality to the DSM."
In regard to change forthcoming in the DSM-V, he said, "The needs and desires of the trans community decades ago are much different than those today. Thus the DSM evolves, perhaps not as quickly as some would like, with changing times."
Arlene Istar Lev, a social worker and transgender advocate who writes on GID reform, does not believe that the GID entry will be removed from the next DSM issue, and she does "firmly believe there will be slow reform on this."
The APA DSM-V draft released last month does indeed maintain the GID entry.
Lev, who said she "cares deeply" about the transgender community, says her hope is to help the Work Group develop "the least noxious diagnosis" and she is "pushing for the language that is least pathological."
Lev said she believes change is slow in the APA due to research. She said the APA is a group of researchers and academicians of the highest educational levels and their world is a "clinical research perspective."
"The only truth that matters to them are the numbers … what the research says," Lev said. "However, the nature of research is if you ask certain questions though, you will be assured of certain answers."
And when the APA asks who has the gender disorder numbers, she said Blanchard and Zucker are the only ones able to say "I do."
Lev said she believes Blanchard and Zucker have been unfairly maligned, but she said she strongly disagrees "with their gender research methods and their values and goals" and believes new research will show that transgender individuals transition to self-actualize.
Lev compares the research needed today on transgenderism to the 1950s research done by Evelyn Hooker, a psychologist who was convinced gay men were as socially adjusted as their non-gay counterparts. Her scientific "numerical" research was instrumental in convincing the APA to remove homosexuality from the DSM in 1973.Â
The difficulty in proving the analogous social adjustment for transgender people, Lev said, is that "in today’s economy, there is not $100,000 to do the work."
According to Dr. William Narrow, DSM-V research director, "The fate of gender identity disorders in the DSM-V has been one of the most emotionally charged issues we have faced in the DSM revision."
He said, "The listing of this disorder in the DSM, the content of the diagnostic criteria and the accompanying text all are being closely examined. Each member of the work group recognizes that there are not just clinical ramifications to their decisions, but also unique personal and social issues that affect each person who receives a diagnosis of GID."
Both Winters and James said that GID reform may be made harder due to a conflict of interest. Winters said that CAMH has a "lucrative business model that is based upon gender identity conversion."
James, who was cast in the Oscar-nominated film "Transamerica," added, "Dr. Zucker’s job depends on maintaining the status quo. He’s the main hindrance to ending ‘gender identity disorder’ and reparative therapy of gender-variant youth, because he helped create both. He’s just delaying the historically inevitable paradigm shift that’s underway."
Two mental health organizations outside the APA, the American Psychological Association and the National Association for Social Workers, released statements in 2008 supporting the civil rights of gender variant individuals and encouraging an end discriminatory practices.
The American Medical Association also released a statement in 2008 stating that its members "oppose discrimination on the basis of gender identity."
The APA recognizes that DSM GID reform is needed, but without transgender representation on the GID reform committee, the urgency of reform and the discrimination against gender variant individuals can hardly be felt, according to Winters.
Another concern, Winters said, is that focusing on GID reform, while necessary, may overshadow the need for having Transvestic Fetish as a mental disorder removed. She said this may be hard because, "my personal view is that [the classification of] Transvestic Fetishism is not based upon science, but based upon religious prohibitions of feminine expression by birth assigned males."
Winters also said that Blanchard proposed last April to retain TF, but rename it Transvestic Disorder, and proposed to add Autogynephilia as new third entry.
"The transgender community should be jumping up and down over this," Winters said.
The APA DSM-V draft revision currently does not add a third entry, but adds autogynephilia as part of the TF diagnosis.
Drescher believes that the APA committee will make some advances forward.
"Hopefully the DSM-V will be more reflective (although probably not entirely) of today’s trans community’s wishes, desires and sensibilities than previous volumes have been,"Drescher said.
The DSV-V is now expected out in May of 2013 and the public is encouraged to review the draft (until April 20, 2010) online at DSMfive.org.
For more information on GID reform, go online to GIDReform.com.
Renee Baker is a transgender diversity consultant and can be found online at GenderPower.com.
This article appeared in the Dallas Voice print edition March 12, 2010.
Your article states: ” … a more than a 1,000-person petition against the new [Work Group] and its slanted composition, the APA chose to go along with the reactionaries.â€
In fact the petition calling for the removal of Drs. Zucker and Blanchard had over 11,000 signatures, not 1,000. That is more than one fourth of the entire membership of the APA.
Mental illness can carry a heavy stigma.
Or so you are trained to say. Who trained you?
Compare to these:
Rape can carry a heavy stigma.
Jews can carry a heavy stigma.
Would you place those in print? Who untrained you? How do I untrain you to the first?
Harold A. Maio, retired mental health editor
Just to clarify, I did not organize the Howard Street protest of the APA Annual Meeting last May but was honored to be invited to participate by community organizer, Ms. Danielle Askini. That I spoke to the outdoor rally only minutes after presenting a scholarly paper on the same topic inside the APA conference made the experience seem uniquely San Franciscan.
Also, only birth-assigned women are excluded from the Transvestic Fetishism (TF) diagnosis. Both transsexual and non-transsexual transwomen are subject to diagnosis of TF in the DSM-IV-TR (depending on sexual orientation) and also in the proposed Transvestic Disorder category for the DSM-5 (regardless of sexual orientation).
I advocate reform of the GID diagnosis and removal of the Transvestic Fetishism/Disorder diagnosis in the DSM-5.
The fact Mr. Zucker and Mr. Blanchard(they do not deserve to be called doctor) are heading this goes to show the APA has no grounding in what current reality is. No other respected, notice I say respected, gender psychologist agrees with Zucker at all, his methods are considered counter productive at best, offensive and based on pseudo-science at worst. How does this man even keep his day job?
The concept of ‘gender’ appears to be highly problematic.
What is gender, really? Are we born with it? Is it fixed biologically and to deviate from the accepted moral, social and cultural norms implies deviance, abnormality and pathological illness?
Does ‘gender’ vary at all geographically and historically? How do we become ‘gendered’? Is ‘gender’ something we learn from birth onwards; something that varies across time (our era and culture) and space (the place we live in at this time)?
In this ‘modern’ era, or post-modern, some believe; we have individuality and choice in ways that our predecessors never had. Modernity seems to be a negotiation where our new freedom is weighed down by responsibility and duty. We can be ‘free’ and choose to do what we want, be who we want to an extent. We must also comply with laws, rules, morals, values and norms that are not optional. We learn these early in life in various ways.
Unlike our biological ‘sex’, which we are born with, i.e. male and female genitals and physiology, gender is a different ball-game, pardon the expression!
WHO decides what gender is, and WHO decides how it is interpreted, its meanings and consequences? If such a group of people as the APA (who I have nothing against as fellow human beings), or whoever, decided that decided I was ill because I was born a man, still am a man, but enjoy cross-dressing, love my ‘feminine’ side; on what basis would that be?
It’s not ‘normal’; right? It’s not what normal people do. Boys are boys; girls are girls. Boys do ‘boy’ things; girls do girl things. We learn how to be boys and girls, and from infancy onwards, any deviation results in corrective action by parents, teachers etc. Maybe even punishment. Does anyone believe that gender is unproblematic?
Traditionally ‘Western’ scientific ‘knowledge’ seems to have been largely generated from and by white, male, ‘heterosexual’, ‘normal’ people.
That is now changing, with the times we live in. Women, thanks to feminism have a louder voice now in the natural and social sciences, as do more ‘black’ and ‘Asian’ people.
My concern is that at the heart of the whole ‘gender’ debate lies: A lack of genuine understanding of modern human identity in all it’s amazing complexity; and consequently, too many opinions that would seem to be based upon outdated ‘conservative’ (I stress with a small ‘c’) prejudices rather than any ‘scientific’ evidence.
Science has a major problem when studying human beings, especially anything concerning the mind or our mental life. How can one human objectively study another without their values and beliefs getting in the way and affecting their work? Sexuality and gender are classic examples of this dilemma. I am not ‘sick’. I don’t need any medical or psychiatric help. I am normal.
With the help and support of others like me, and through higher education, I understand who I am, like who I am, am who I am. I am now more ‘functional’ and happy than ever before. My gender and identity issues are not as one psychoanalyst suggested due to unresolved issues with my mother. Really, I have resolved them now, without psychiatry or medication; though it was offered to me.
Even though I’m a guy, and enjoy being a guy most of the time, I sometimes like to wear a frock, slap on some lippie and get those gorgeous high heels on. Mandy is a cool girl, and a part of ‘me’.
Normality as we once knew it, is being re-negotiated, and new history as always, is being made; every day.
I am ‘OK’ and so are you!
Who’s demonizing who? I am sick and tired of being exploited and harmed by the influence of a group of academics who are so driven by their own economic interest and careers that they are willing to cause so much heartache and suffering and destruction in my life. As far as I’m concerned, the blood of countless transpeople is on their hands. If being harassed and persecuted is a disorder, than so is being in debt to the IRS.
I see nothing wrong with boys acting like girls or girls acting like boys. The sick part is when people surgically and chemically alter their body to look like the opposite sex. People should embrace their bodies as they are but not be confined to gender or sexual roles.
I strongly favour the concept outlined by Ray Blanchard in his 25 papers on transexuality. As a post-op; transsexual woman, I am not ashamed of “what” I am nor am I fearful of any alleged “stygma” (but I live in Canada where things are a bit less tense). Many transsexual women have now stepped forward to say that they too favour the approach taken by Dr. Blanchard, no longer quite as fearful of attacks by the likes of Andrea James, who has attacked and maligned many transsexual women on her web page if they differed from her opinion. James most recent attack was on Kay Brown, who’s “sin” in James’ view, was to write a blog favouring the Blanchard concept.
Most transexual woman are far more fearful of an attack by Andrea James than by any theory of Ray Blanchard.
James has harmed many in her attacks and “outed” transsexual women against their will.
Your article states that “: “Zucker and Blanchard declined comment to the Dallas Voice.”
I do not know if you tried to contact Dr. Zucker, but I did contact Ray Blanchard regarding this matter. As I anticipated, Dr. Blanchard replied that “I have no recollection of being contacted by the Dallas Voice, and if I had been, I would have said, “I am not on the Gender Identity Disorders Subworkgroup; you need to contact Ken Zucker.”
Now, your article purports to be neutral. As to Blanchard, it appears you did not try all that hard to contact. Yet you did manage to contact the opponents of the psychiatric model.
Of course, they want to be quoted – it adds to their “image” as “activists” and such.
What your article totally ignores is that most European countries and Canada have state medicare. Even Iran has this! All costs of treatment, including surgery, are covered. With costs easily rising to over $50,000, even $100,000, this is a great benefit. In the USA, you do not have state medicare. To non-Americans, the DSM designation carries a substantial advantage; to those in the USA, there is no such benefit. Thus Americans may be more conscious of the supposed negative “stigma” while non-Americans are able to bear the stigma as they do not have to pay the expense.
To put that in a nutshell, we do not wish you to throw out our baby with your bathwater…. And yes, I do know of France and Cuba but that does not alter the risk many of us see from delisting.
Rika wrote:
“I am sick and tired of being exploited and harmed by the influence of a group of academics who are so driven by their own economic interest and careers that they are willing to cause so much heartache and suffering and destruction in my life.”
And what, pray of the economic interest of those professionals, therapists and doctors who facilitate transition and surgery. Do they not gain substantially? Is it not in their financial interest to encourage free access to their very expensive services? “You betcha”, to quote one governor…
Willow, thank you for your comments.
As stated, I did contact Dr. Blanchard and he did reply exactly as you said he replied that he would.
Also, I contacted Dr. Zucker who referred me to Best Casteel, spokesperson from the APA, who reviewed two preprints of the article.
Two others besides Casteel are quoted in the article and had chance to review the preprint. So, the APA had a preprint and was given full opportunity to comment.
Five individuals from the APA were given an opportunity to comment, only 3 chose to.
I have also contacted them to let them know the article has been printed so they may further voice comments on the BLOG or a further letter to the editor.
You may write to Beth Casteel to verify that we did work with her as she is the primary media contact.
I was very thorough with this article in giving everyone a full chance to voice their thoughts.
It is not an easy topic and even harder to give a perfect balance too.
Best regards,
Renee Baker
What’s missing from this story- what’s unfortunately almost always missing from any discussion of GID revisions in the DSM, including discussion from the committee members- is any mention of the actual science. People can argue about whether the revisions are helpful or politically disadvantageous, and those are legitimate concerns, but at the end of the day the DSM is supposed to be science based. When the furor over Blanchard’s taxonomy first blew up publically, the science was beginning to point in the direction of cross gendered brain wiring as the cause of transsexuality. In the seven years since, it’s become conclusive. A small partial list of the studies confirming this are toward the bottom of this post:
https://aebrain.blogspot.com/2010/03/we-do-things-differently-here-in.html
TThe owner of this site has got many, many more from multiple research groups referenced in various posts I don’t have the time to dig out. They all support the same conclusion- transsexuality is caused by cross-sexed brain wiring, and sexual orientation, contra Blanchard, has nothing to do with it.
And that’s not even mentioning the fact that “autogynephilia” was never actually differentiated from “normal” female sexuality in Blanchard’s studies. It has since been found that if you apply his criteria to cisgendered women, over 90% would be classed as “autogynephilic”
https://home.netcom.com/~docx2/AGF.htm
(Note that Blanchard’s original AGP and transsexual typology study used what Moser characterized as the “common” definition rather than his “rigorous” one)
Unfortunately, Blanchard and Zucker have managed to insulate themselves from reality with their political influence within the field of psychiatry, so all this will be completely ignored for this round of DSM revisions.
I don’t usually post to articles, but read this one with great interest. Several great quotes, by several hard working people on these issues of gender.
To the regards of Blanchard and Zucker, they are part of a very old group “psychologists†hence I struggle with the continued recognition of “doctors†insinuated when discussing their engagement regarding the DSM. They are doctoral doctors of psychology, not medical professionals, which is problematic that this has been perpetuated over the years. They are not trained physicians.
In Canada, as I am a high performance athlete working with the Government of Canada and working with international groups, government, legal and scientists in anti-doping to bring fundamental change to world sport which is transpiring right now, of which is very exciting – What is most important and why I mention this, is that neither Blanchard, Zucker or for that matter APA engaged in this process with actual world experts.
What needs to be understood, this is very much a (silo) trajectory – In Canada, CAMH is not seen as a Canadian resource for Government at the federal level, as a “goto†resource on GENDER. Many resources are now available and are more modern and have that expertise. Unfortunately, as many of the person(s) though fantastic people and whom many I have great regard, is in the United States. So there is a bit of a disconnect of the facts, and how Canada and government, educational institution feel about this for that matter CAMH as it pertains to gender. Canada has strong policies of discrimination and protections through our charter of rights and freedoms, which blankets every Canadian. As an example, our RCMP have this in place and in practice at the federal level.
In closing what I am trying to explain, there is a disconnect – Moreover we have a situation of the “old guard†guarding the hen house. The stakeholder’s are Blanchard. Zucker and the APA as they know there time is coming due, and they are protecting their “turfâ€, not in the best interest unfortunately of the people they were suppose to serve and protect, but of their own. It is the failing of the governance of the APA, in past years to allow this slip by them, now “caught in a rock in a hard placeâ€, where they have little control of the matter hence how Blanchard/Zucker ever got seated in the Task Force as they have. It is certain, and knowing them as I do, they are “bullies†to protect their place as it pertains to gender this is about their legacy of their work, continued research revenues and control.
The irony is, when asked to defend their research often enough they are unable. They decline to speak and make themselves unavailable, especially when they are made aware of who else would be commenting. Hence in my own experience, and working as were doing here in Canada and work going on internationally which is ground breaking in world sport which has gotten tremendous traction – Neither Blanchard, Zucker and the APA are in any of the language in these international scientific circles.
The bigger question then should be asked why and what are the real experts feeling and seeing? I assure you, no one is knocking on their doors for their “gender expertiseâ€.
This is a (silo) problem specific in nature to that of the APA in the United States. An institutional problem of psychology even being part of how we understand gender at a science/research and healthcare level. Opening the door to greater expertise from many circles to ensure well rounded practices, not in the hands of just a few, effecting 10’s of thousands of lives and their healthy positive futures. At large this is the problem.
I congratulate all those doing great work around this issue. Your efforts are bringing change. It is around the corner!
Great article!
Harold Maio: Honey, when people talk about “stigma” they are already on the bus. You don’t have to untrain them; they already think the stigma shouldn’t exist.
Did you actually read this article? Do you even know what it is about?