The LGBT community has had a long, often painful relationship with the psychiatric profession. Until 1974, when the American Psychiatric Association (APA) voted to remove the diagnosis from the second edition of its "Diagnostic and Statistical Manual of Mental Disorders" (DSM), the organization maintained that homosexuality was a mental illness. The change came slowly, after years of protest and debate.
At this year's APA meeting, in San Francisco, it is transgender activists who are demanding that the organization depathologize their identity. Their anger centers around the controversial diagnosis of "Gender Identity Disorder," which Psychology Today defines as "strong, persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex. People with GID desire to live as members of the opposite sex and often dress and use mannerisms associated with the other gender."
On Monday night, protesters gathered outside the APA meeting at a "Reform GID Now!" demonstration. As the association's membership works to revise the DSM for a fifth edition, activists want the APA to select a more representative working group on gender identity. Many in the transgender community are upset that Kenneth Zucker, psychologist-in-chief at Toronto's Center for Addiction and Mental Health, has been chosen to lead the DSM-V Task Force on Sexual and Gender Identity Disorders. Zucker, according to the Psychiatric Times,
has been on the record as saying that parents and clinicians should work to socialize very young children who behave in ways discordant with their physical gender so that they come to identify with it -- but that teens who have not done so should be helped to adjust to their discordant gender identity.
Activists also want the APA to release a statement affirming
that diagnosing normal variants of human gender identity and expression as psychiatric disorders encourages an adversarial relationship between psychiatry and sex and gender minorities. We also urge the APA to state that these diagnoses are misused by some people outside of psychiatry who wish to deny civil rights to trans and gender-variant people.
Of course, not all APA members agree with Zucker, and the transgender community has found a number of advocates among the psychiatrists convening in San Francisco. Kelley Winters, Ph.D. and founder of GID Reform Advocates, spoke at the conference, making the case to her colleagues that "in the absence of dysphoria, gender identity and expression that vary from assigned birth sex are not, in themselves, grounds for diagnosing a mental disorder." The precedent for this criterion is clear: Since the publication of the DSM-IV, in 1994, the APA has largely sought to avoid pathologizing symptoms unless they cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning."
Dr. Diane Ehrensaft of the Wright Institute echoed the activists' accusations. "The mental health profession has been consistently doing harm to children who are not 'gender normal,' and they need to retrain," she said in an interview with Psychiatric Times. And Edgardo Menvielle, M.D., M.S.H.S., recently completed a comparative study of Zucker's program and his own. The results showed that children in Menvielle's program, which provides peer support for gender variant youth, exhibited "less pathological tendencies" than those in Zucker's.
Although it's still unclear what effect the protests will have on the DSM-V, Ehrensaft is optimistic. "We got homosexuality out of the DSM because of protests at the APA," she told Psychiatric Times. "Now it’s time to do the same with GID." She also noted that a movement within the association is moving toward a "more balanced" Task Force. With psychiatrists and activists working together to reform the APA's position on gender identity, it may be only a matter of time before we stop labeling perfectly sane transpeople mentally ill. Imagine that!