The Associated Press reported that the American Psychiatric Association’s Board of Trustees approved certain notable changes to that body’s Diagnostic and Statistical Manual of Mental Disorders on Saturday. The story began with the controversial announcement that Asperger’s syndrome will now be included in the autism spectrum disorder category, but another change buried at the bottom of the piece may prove to be even more divisive—and, if historical precedent is any indication, more influential on society at large.
Since the third edition of the DSM was published in 1980, some version of the diagnosis gender identity disorder has been included to describe patients whose subjective experience of gender does not match their biological sex. The common contemporary term for this group is transgender, the T in LGBT. Sources within the APA now confirm that in the DSM-5, which is due to be published in May 2013, GID will be replaced with the more neutral term gender dysphoria.
Approval of this revision has been years in the making and reflects a narrowing of psychiatrists’ focus to those who experience personal distress over their gender incongruity. Those patients who feel like they need psychological help dealing with their feelings can still seek it out, while those who feel fine need not be marked as ill.
Jack Drescher, a member of the APA group dedicated to considering this issue, explained to the Daily Beast back in 2010 that his subcommittee’s recommendation came from a desire to stop “pathologiz[ing] all expressions of gender variance just because they were not common or made someone uncomfortable.”* Moreover, in a recent interview in the Advocate, Drescher acknowledged that “all psychiatric diagnoses occur within a cultural context,” adding that “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”
As any student of the history of LGBT civil rights can attest, being deemed pathological by the medical establishment is considered to be one of the biggest obstacles to social and legal progress. Indeed, the removal of homosexuality from the DSM in 1973 was a watershed moment for the early gay-rights movement, as it neutralized the argument that gay men and women did not deserve equal treatment because they were somehow sick. Unsurprisingly, many in the transgender community see the label “disorder” as having a similarly restrictive effect on their fight against discrimination. But leaving the fraught term behind may bring some harm along with the good.
As Drescher points out in his thorough analysis (PDF) of the parallels and contrasts between the gay and trans campaigns to escape the bonds of medical judgment, one important difference is the desire of many (but not all) transgender people for hormonal or surgical intervention to better align their bodies with their internal identity. Currently, insurance coverage for these procedures can be justified on the grounds that GID is a medical problem—a disorder—needing treatment. Without that argument, some transgender people—a group that already suffers from a great deal of social and economic marginalization—may now find it more difficult to finance their transitions.
For those gender-variant individuals who do choose to seek treatment, the APA practitioners may soon be prepared to offer more organized care. While Drescher and his subcommittee were debating the differences between disorder and dysphoria, another APA group, called the APA Task Force on Treatment of GID, was busy deciding if enough empirical and clinical data existed to justify the creation of a standard set of “APA Practice Guidelines” for treatment. According to a report published over the summer, the answer was a strong yes. If the APA agrees with the recommendations, guidelines could soon be established for adults, adolescents, and even children. The task force additionally recommended that the APA begin making position statements supporting the “rights of persons of any age who are gender variant, transgender, or transsexual.”
*Correction, Dec. 4, 2012: This article originally misspelled Jack Drescher's last name.
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