Gender Identity Disorder - Controversy

Controversy

People diagnosed with gender identity disorder (GID) may not regard their own cross-gender feelings and behaviors as a disorder, and may question what constitutes a normal gender identity or gender role. One argument is that gender characteristics are socially constructed and therefore naturally unrelated to biological sex. This perspective often notes that other cultures, particularly historical ones, valued gender roles that would presently suggest homosexuality or transgenderism as normal behavior. Individuals diagnosed with GID may also view "transgendering" as a means for deconstructing gender; however, not all transgender people wish to deconstruct gender or feel that they are doing so.

Those in the community who disagree with the diagnosis of GID also state that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity, rather than vice versa.

Some critics of the classification of GID as a mental disorder argue that transsexualism instead should be listed as a "birth defect" or "rare disease," citing in evidence research suggesting a physiological cause. This argument is supported by evidence that includes overall more feminine white matter and neuron patterns observed in male-to-female transsexual participants and overall longer instances of the androgen receptor gene. (Also see Causes of transsexualism.) One rebuttal to this view is that these markers do not identify every individual who undergoes transition, and that using them to define transsexualism could falsely exclude some people from treatment.

The question of continued inclusion of gender identity disorder with mental illnesses has expanded in recent years. One opponent, Dr. Darryl Hill, insists that GID is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents have trouble relating to their child's gender variance. Hill insists “There is little evidence of pathology” in GID and compares the treatment prescribed to "reparative therapies" for changing sexual orientation. Others, including Dr. Robert Spitzer and Dr. Paul J. Fink, disagree with Hill's assertions, contending that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction. A middle ground also exists: Dr. Katherine Wilson suggests that the diagnosis be made of gender dysphoria without emphasis on gender nonconformity.

Members of WPATH are split on the issue, but are concerned that those who experience distress have proper access to medical treatment, including psychological, endocrinological, and surgical services, and insurance coverage for those services.

The DSM-V Task Force proposes that the classification of the disorder be maintained with emphasis on gender variant behavior and thoughts as well as distress, evaluated separately, but the classification will be under a different name due to "criticisms that the term was stigmatizing." The revisions include expanding criteria, separating child and adult dysphoria, removing a specifier for sexual orientation, and allowing the inclusion of other disorders such as somatic disorder of sex development. In response to criticism that the new criteria would include all gender-variant people, the distinction would not include all gender-variant people, as the disorder must be "associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability."

In December 2002, the British Lord Chancellor's office published a Government Policy Concerning Transsexual People document that categorically states "What transsexualism is not...It is not a mental illness." In May 2009, the government of France has also declared that a transsexual gender identity will no longer be classified as a psychiatric condition in France.

The Principle 3 of The Yogyakarta Principles on The Application of International Human Rights Law In Relation to Sexual Orientation and Gender Identity states that "Person of diverse sexual orientation and gender identities shall enjoy legal capacity in all aspects of life. Each person's self-defined sexual orientation and gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom" and the Principle 18 of this states that "Notwithstanding any classifications to the contrary, a person's sexual orientation and gender identity are not, in and of themselves, medical condition and are not to be treated, cured or suppressed." According to these Principles, any gender identity of a transsexual or transgendered person is neither "disorder" nor mental illness, thus the diagnosis "gender identity disorder" can be contradictory and irreverent. As well, The Activist's Guide of the Yogyakarta Principles in Action states that "It is important to note that while "sexual orientation" has been declassified as a mental illness in many countries, "gender identity" or gender identity disorder" often remains under consideration."

Some people feel that the deletion of homosexuality as a mental disorder from the DSM-III and the ensuing creation of the GID diagnosis was merely sleight of hand by psychiatrists, who changed the focus of the diagnosis from the deviant desire (of the same sex) to the subversive identity (or the belief/desire for membership of the opposite sex/gender). People who believe this tend to point out that the same idea is found in both diagnoses, that the patient is not a "normal" male or female. As Kelley Winters (pen-name Katharine Wilson), an advocate for GID reform put it, "Behaviors that would be ordinary or even exemplary for gender-conforming boys and girls are presented as symptomatic of mental disorder for gender nonconforming children." However, Kenneth Zucker and Robert Spitzer argue that GID was included in the DSM-III (7 years after homosexuality was removed from the DSM-II) because it "met the generally accepted criteria used by the framers of DSM-III for inclusion".

The GID controversy figured prominently at the 2009 meeting of the American Psychiatric Association in San Francisco, both in presentations in the meeting and in protests outside the meeting; protesters focused on the attitude of the psychiatric community and tried to make the point that GID is not a mental disorder, as well focusing on the role of Kenneth Zucker in leading the DSM-V Task Force on Sexual and Gender Identity Disorders.

In August 31, 2010, Thomas Hammarberg, Commissioner for Human Rights within the Strasbourg-based Council of Europe, an independent institution, opposed the mental disorder classification and the sterilisation of transgender persons as a requirement for legal sex change.