Transverse: Disordered or Not? Unpacking the DSM's New Trans Language

By Thomas Page McBee Fri., Dec. 7 2012 at 7:30 AM

When the story broke on Monday that the American Psychology Association had officially approved changes to the new edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) that included removing "Gender Identity Disorder," my Facebook feed lit up with enthusiastic reposts of the news. Makes sense. On its face, the announcement seems like a step in the right direction: It seems to suggest that transgender folks will no longer be considered, at least semantically, fundamentally disordered at the level of our identities. That's a win, for sure. Who wants to be pathologized? Not me!

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But what about the concerns of activists who are afraid that totally removing transgender individuals from the DSM will further screw up our already-strained relationship with insurance companies and, sometimes, hospitals, and other healthcare providers by somehow suggesting that we're not in need of the medical care we seek?

Enter the new diagnosis of "gender dysphoria." Gender dysphoria, which appears to focus more on the emotional effects of feeling dissonant or "at odds" with one's body, ideally allows for a more elastic definition of what it means to be transgender, and hopefully will continue to bring less barriers to medical transition for those who want it. This change could also allow a more client-centered treatment, while keeping the medical aspect of being trans "on the books," thus hopefully helping maintain access to care where it exists, and paving the way for more comprehensive coverage of our hormones, mental health care, surgeries, etc. as necessary.

According to a statement by Mara Keisling, director of the National Center for Transgender Equality, the new criteria is a boon. "When the DSM-V is published in the spring, it will mark a significant lowering of the stigmatization that many trans people have faced. The changes help make clear that there is nothing pathological about having a transgender identity."

I contacted Masen Davis, executive director of the Transgender Law Center, about the nitty-gritty of what this new diagnosis might look like for trans people in the day-to-day. He told me over e-mail that gender dysphoria as a diagnosis "appears to be a good step in this direction." But he emphasizes that they won't know exactly what this all means until they see the final version of the manual.

"From what we understand, the diagnosis has been changed in a way that preserves a transgender person's ability to obtain medically necessary transition-related care while removing language that seemed to many community members to be outdated and stigmatizing," he writes.

"Generally, having a gender dysphoria diagnosis in the DSM can be a powerful legal tool for challenging discrimination in health insurance plans and services."

He also says that if you're a California resident worried about how this will interact with your insurance: don't be. California law prohibits insurers from discriminating against transgender people, including transition-related care or the same care available to people who aren't trans. So an exclusion for gender dysphoria should be illegal, he says, just like an exclusion for gender identity disorder.

They also don't expect the new diagnosis to have an impact on the implementation of the Affordable Care Act, which is good news for uninsured trans Americans. Overall, he's optimistic."It is our expectation that the gender dysphoria diagnosis will normalize gender diversity while providing new pathways to ensure access to the care and rights transgender people need."

Sounds good. But if you're familiar with any critiques of this process already, it's probably this: One prominent member of the revisions committee was none other than Kenneth Zucker, head of a notorious Toronto Gender Identity Disorder clinic for children and adolescents, a controversial clinic that has been accused of practicing reparative therapy. Zucker encourages children presenting gender variance to not engage in cross-sex play, though he also does endorse transition as a path for some adolescents. Many transgender activists find his gender-conforming therapies troubling, to say the least. It's hard to trust a guy who takes toys away from children.