It’s a bit embarrassing to remember that it was less than half a century ago that being gay was listed as a mental illness by the American Psychiatric Association. The organization declassified homosexuality as a mental illness in 1973, thanks in large part to the efforts of Alfred Kinsey, famed researcher of human sexuality. Kinsey argued that sexuality was a spectrum, not a binary, and managed to convince his colleagues that men attracted to other men were not victims of a disease that needed treatment. The declassification marked an acknowledgment by the psychiatric profession that many of the problems seen in gay patients—depression, anxiety, suicide attempts—were the result of societal judgment and hostility, rather than the sexual orientation itself. In essence, that it was finally OK to be gay—or at least, it was no longer listed as a mental disorder.
Today, being transgender is facing the possibility of a similar paradigm shift as the medical establishment seeks to better understand the condition. In 2013, the APA made a promising move when it released a new edition of the Diagnostic and Statistical Manual of Mental Disorders—the DSM-5, the manual that categorizes all mental illness. The new version renamed gender identity disorder as gender dysphoria and moved it into its own chapter. (It had previously been part of the chapter on “Sexual Dysfunctions and Paraphilic Disorders.”) Separating gender dysphoria (the medical term for the distress a person experiences when sex and gender don’t match) from other disorders was lauded as an effort to reduce stigma and to acknowledge that many of the issues related to transgender identities are not psychological ramifications of the condition, but more likely the result of a society that has been slow to accept those identities.
The global psychiatric community has not yet followed the APA’s lead, though. The World Health Organization’s medical classification manual—the International Statistical Classification of Diseases and Related Health Problems (or, ICD for short)—still lists gender identity disorder as just that—a disorder. So researchers are stuck with proving that the anxiety and distress that often comes with this disorder does not result from being trans but from living as trans in an unaccepting society.
Research out of Mexico this week underscores the APA’s findings that a hostile environment is to blame for the pain that transgender people experience and may help move the needle. The researchers, who interviewed 250 transgender people about their experiences, concluded:
Distress and dysfunction were very common, but not universal, and were more strongly predicted by experiences of social rejection and violence than by gender incongruence, consistent with the perspective that these reflect the result of stigmatisation and maltreatment rather than integral aspects of transgender identity.
The sample size skewed heavily toward transgender women (80 percent), but the conclusion still resonates—this is a societal problem, not an individual problem.
The ICD-11, due out in 2018, is considering a reclassification of certain conditions related to sexual orientation, including gender identity disorder. Let’s hope the WHO takes research like this into account, and makes the change.