Exciting trans news that came out yesterday. France has set a precedent by becoming the first country to depathologize transsexualism. An article came popping out about it that was all slathered in, well, French - but an English translation came popping out soon after:
Interesting that most countries - the United States in particular - classify transsexualism as "Gender Identity Disorder" or "Gender Dysphoria", where it's described as a mental and not physical disorder. Yet, this mental disorder is treated physically - via hormones and surgery.
Funny, that.
And thanks to this wonked out, nonsensical classification, insurance hardly covers a thing for trans people and makes transitioning to live a happy, functional life an uphill battle. Mine wouldn't even cover my hormones.
Anyway, the above news is exciting and sets a precedent for other countries to follow. It also highlights the reality that transphobia is getting cranked down a notch, bit by bit.
Thank you French. All that stuff they say about you being rude, stinky, frequently topless at beaches, and smokers with dirty toilets - I never believed a word of it! Not a word!
Transsexualism will no longer be classified as a mental illness in FranceYay for translations!
Transsexualism will no longer be classified in France as a mental illness, a government decision hailed Saturday as "historic" by the associations concerned, on the eve of the International Day Against Homophobia and transphobia. Read more >
Interesting that most countries - the United States in particular - classify transsexualism as "Gender Identity Disorder" or "Gender Dysphoria", where it's described as a mental and not physical disorder. Yet, this mental disorder is treated physically - via hormones and surgery.
Funny, that.
And thanks to this wonked out, nonsensical classification, insurance hardly covers a thing for trans people and makes transitioning to live a happy, functional life an uphill battle. Mine wouldn't even cover my hormones.
Anyway, the above news is exciting and sets a precedent for other countries to follow. It also highlights the reality that transphobia is getting cranked down a notch, bit by bit.
Thank you French. All that stuff they say about you being rude, stinky, frequently topless at beaches, and smokers with dirty toilets - I never believed a word of it! Not a word!
I'm a couple weeks behind on this, but I'm surprised that there are no other comments! I guess it's just me who gets all meta about this kind of stuff. :)
ReplyDeleteI'm actually not certain that this change is quite as good as it initially seems, especially this part: "Until now, transsexuals benefited from a fee waiver for their medical care," which seems to suggest that transsexuals will no longer be able to qualify for the fee waiver.
The problem here is that medicine deals with pathologies. The model functions in a very linear fashion - identify the problem, find the solution. The difference between labelling homosexuality as a disorder and labelling transsexualism as a disorder is that many transsexuals DO desire medical intervention, although it is, as you said, treated physically not psychiatrically.
I think the knee-jerk reaction in the LGBTQ community is that the DSM is some horrible tome of woe that brings stigma upon all that it touches. I don't think that's the case, though. The problem with including homosexuality in the DSM was that it implied that it was something you could and should "treat." As a completely opposite example, clinical depression is also in the DSM, a fact which I am grateful for - if it weren't classified as a treatable disorder, I'd probably still be curled up in a little ball under my desk. Therein lies the problem - in order for transsexuals to get the medical treatment that will enable them to feel connected to their bodies, there has to be some sort of diagnosis. Something has to be "wrong" in order for medicine to make it "right."
I think the bigger problem here is the way we think about "Mental Illness" as a category. I think that "Gender Dysphoria" is actually a pretty accurate term (dysphoria - a state of unease or generalized dissatisfaction). It might not be perfect, but it could be a hell of a lot worse. As to whether we call it a "mental" or a "physical" disorder, that's really just a reflection of how stigmatized "mental" disorders are. I would contend that it is simultaniously both of these things, and neither of them, since the mismatch is somewhere between the body and the mind.
The problem with trying to talk about transsexualism in medical terms is that the diagnosis is psychiatric and the treatment is physiological. You had a perfectly healthy, fully functional female body, but it didn't agree with who you are, which is a measure of your mental health and satisfaction. I understand the fear that if transsexualism is listed in the DSM that doctors will try to treat it psychiatrically (i.e. - "convince" people that they should change their minds to fit their bodies, and not vice-versa), but I fear that if it isn't listed at all, that it will be even harder to get any sort of physical treatment.
(Barely related PS - Someone in my sociology of human sexuality class said that Vermont is very trans-friendly, and that insurance there DOES cover hormones and stuff! If you're sick of Utah. . .)
raedances: This topic is definitely up your alley! Thank you, always, bundles, for your thoughtful responses. I'm all about em'!
ReplyDeleteI agree, by the way, about how mental disorders are stigmatized, but I'm not one of those people! No siree bob!
I also like "Gender Dysphoria" and it is pretty accurate... 'ish. The Dysphoria part, anyway. Since gender is a social construct, I think it misconstrues what's going on, especially since it may only be intertwined with gender directly due to those social constructs that force us all into binary gender options. Which is changing, bit by bit, and could potentially make the "Gender" portion of the term outdated!
Or so I hope. ;]
Anyhoo, for me, it's not the name of it that bothers me. Whether it's called Gender Dysphoria, Gender Identity Disorder, a disease, what have you - it's in the classification of it as a psychiatric disorder instead of a medical illness. I realize that the etiology of transsexualism is super uber poorly understood. There's a lot of incomplete evidence saying that it's caused by a poorly understood interaction between one's genes and early environmental factors (including prenatal hormonal influences). But it's becoming more and more understood every day, which is exactly why France depathologized it. Not because it's stigmatized, but because it isn't a psychiatric disorder.
And just to clarify, I'm honestly not upset about transsexualism being classified as a psychiatric illness because of unfair, bullshit stigma associated with mental illness. It's just inaccurate and nonsensical to me and it makes seeking treatment for it in the medical industry incredibly difficult. From my own experience, it's more like a physical disease - one that's ultimately caused by physical differences in the body. That's NOT to say that a lot of psychiatric illnesses aren't causes by biologically differences. Depression, for example, is a chemical thing, not a problem with someone's character. And a lot of mental disorders ARE treated physically, directly due to being chemical.
However, irrelevant to what causes someone to be a frickin' tranny, the basis in 'physical' (neurological and endocrine) abnormalities indicate that it's a medical rather than psychiatric illness. We're treated with physical modalities (drugs and surgery) which demonstrate the medical rather than mental nature of it. The problem also isn't in our minds, but with our bodies. And it's cured (in that no symptoms of dysphoria remain, aside from fear or social stigmas which are separate, socialized problems that vary in individual-to-individual) once someone transitions. I think this also differentiates it from psychiatric illness when, once someone transitions, we're no longer diseased. How does that happen? How does a biological mental disorder go *poof!* once one feels genuinely connected with their anatomy?
And I also agree that having it listed in the first place, and the fact that someone like me can actually go see someone and gain access to hormones or surgery IS a really big deal and entirely awesome and wonderful. I think it's leap and bounds better than my trans predecessors got to experience, but... I'd like for it to get better, more fair, and more accurate in terms of listing it for what it really is so that individuals can get the best treatment without all of the barriers and misconceptions in the medical industry that my generation has to experience. If that makes sense?
I definitely understand why transsexualism is experientially a 'physical' disorder, but in terms of the medical diagnostic model, I think that it needs to be conceptualized as something that is both physical and mental.
ReplyDeleteIf someone is transsexual, then they understand the problem to be with their body, but from the perspective of a doctor, that body is objectively healthy. Having breasts doesn't hurt you because they're somehow diseased, it hurts you because you feel that they aren't supposed to be there. Unfortunately, there isn't any sort of scan or biopsy that a doctor can use to diagnose the sort of pain these wrong parts cause trans individuals. It's something that has to be self-disclosed and diagnosed by sorting through things like experience, emotion, and feelings of unease. That's why one foot is always going to be in the psychiatric camp, from the perspective of the medical community.
In some ways, I think that it's not entirely a negative thing. For example, you're much better off having a psychologist/psychiatrist be the one in charge of giving you a "diagnosis" (i.e. - your ticket to treatment), rather than having some random general practicioner be the gatekeeper. Also, I think it helps keep the lines clear between issues of gender dysphoria and other issues that might seem superficially similar to people unfamiliar with them. For example, someone who wants to remove their male genitalia because they know that they are female is vastly different from a man who suffers from body dysmorphic disorder and wants to remove his genitalia for that reason. People like you and I know that those are absolutely not the same thing, but how do you diagnose that difference? Maybe someday there will be a blood-test that can physically tease out the hormonal or genetic differences, but until then, it's a psychiatric call to make.
It's not a perfect system, but I don't think that the diagnostic model will ever be able to fully match the experiential model (at least not until some medical breakthrough can identify a trans individual by blood chemistry or brain scan). In that way, it's fairly similar to the diagnosis of depression - the problem is physiological/neuro-chemical, but we still diagnose it psychiatrically. (As an interesting aside, a general practicioner can prescribe meds for depression, but in my personal experience, they tend to be assholes about it and really poor at regulating the dosage and following up, which is a big part of the reason I think that putting the responsibility of 'trans diagnosis' in the hands of uninterested GPs could be a massive problem.) The way you're explaining the experience of 'disorder' makes perfect sense to me (and obviously you would know far better than I), but the bottom line, in terms of medical intervention, is that someone has to make a 'diagnosis' before any sort of physiological medical treatment can start, and right now, psychiatry is the closest thing that the medical community has to a diagnostic tool. That doesn't mean it's a great diagnostic tool, but there aren't really any alternatives yet.
I was getting all ready to go to bed and check back in the morning, but I thought of a more succinct and articulate way to say what I'm trying say. :)
ReplyDeleteMy fear is that if the trans community is too successful at "depathologizing" transsexualism, that it will be seen by insurance companies as something that one 'elects to act upon,' rather than a 'problem that needs fixing.' In other words, that it will be placed in the same category as voluntary plastic surgery for insurance purposes.