Naming and Claiming

Hans Weiditz: Doctor and servantI read that psychiatrists have renamed the diagnosis, from “gender identity disorder” to “gender dysphoria”.

This is not an improvement, even if some trans folk think it is, or asked for it. Before transition, my gender identity did not fit my chromosomes or gonads. I think this is a “disorder”- it makes life and procreation significantly more difficult.

Now, the word “dysphoria” is in the diagnosis, as if the discomfort were the thing which was sick. Generally, a diagnosis names an illness, kidney disease is a problem with the kidneys, the new name “disruptive mood dysregulation disorder” states that a person’s inability to control his temper is the Problem. We M-Fs experience ourselves as female, and our experience is not deluded, or psychotic, or sick: the problem is being thought to be male, and what follows from that.

The problem is not the word “disorder”, but the inclusion in the Diagnostic Statistical Manual of Mental Disorders. Being trans is not a mental illness. I recognise, however, that a surgeon will need confirmation from a psychiatrist that she should do a vaginaplasty and orchiectomy.

So there should be two possible diagnoses: “Gender identity incongruence”, which is a physical health problem, requiring physical intervention, and “Psychotic delusion of gender identity incongruence”, a mental health problem, where the belief that one is really of the opposite sex arises from mental illness. I don’t know whether anyone actually suffers from the latter, but the concept allows the psychiatrist, physician and surgeon to work together: the psychiatrist says No, I am certain your patient does not suffer from psychotic delusion, so the appropriate treatment is hormones and surgery.

Gender identity incongruence would continue to be self-diagnosed, as now. “Yes, I know I have testicles, but I also know that I am a woman, and want hormones. Therefore I have GII.”

Self-diagnosis is important. Someone else, who an outsider might think to be very similar to a person with GII, might say, “I am a man. I have testicles, and I want to retain them. However sexually I am a femme lesbian, and I want to express myself in ways which my culture considers feminine.” Or whatever. Only those of us who want surgery or hormones need come into contact with scientists or doctors at all.

And each individual is the one to classify themself. If anyone else does it, that is oppression.

While on classification, there is no word I hate more than “non-homosexual”. The scientists refer to the “homosexual transsexual”, a M-F attracted to men. That is, they call her a man. So what do they call us gynephiles? Heterosexual would be the obvious word, we are attracted to women- though, under the pressure of being forced to jump through hoops, some of us claim to be Bi or asexual. But “Heterosexual” would make us appear almost normal, and that would never do. “Non-homosexual” it is, not even homosexual, not even as normal as that. Rational scientists, with their Objective terms! Using the word “gynephile” would have just a tincture of kindness, and that would never do.

More detail on DSM5 than even some trans women will want, here.

9 thoughts on “Naming and Claiming

  1. You have given me much to think about, and I will have to reread your post a few times as I struggle to gain a better understanding of the issues you bring to the fore. I know that I would find it beneficial if you could elaborate on your dissatisfaction with the term, dysphoria. Personally, I always interpreted the use of the term, ‘disoorder,’ in reference to gender, to imply that it was the actual *feeling* of being a gender not “supported” by one’s physical “appearance” that was being called “disordered,” and thus, “sick” and indicative of mental illness. It seems to me that calling that feeling “dysphoric,” i.e., a feeling, essentially the opposite of ‘euphoric,’ thus indicating being less than thrilled with one’s penis (or lack of one) would be a step in the right direction… Wouldn’t the term ‘dysphoria’ be a move towards being less judgmental? Less damning? Isn’t DSM saying that rather than calling you “sick” for wanting to be your “shell,” we’re admiiting, instead, that you are profoundly unhappy with your assigned “gender role,” — and it’s AOK to feel that way? I’m no fan of the “mental health profession” but this truly struck me as ‘progressive’…

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  2. Additionally, while I realize that you actually say you have no problem with the word ‘disorder,’ itself, I do find that, in itself, problematic, which is why I provided my previous comments, first.

    As for its inclusion in the DSM-5, one advantage in “naming” it thusly could be so that for the time being, it is “less-negatively” named, if you will, until the blessEd day when we won’t have to name it at all…

    Mind you, these are just my thoughts about a topic about which I have no expertise. My only “experience” is that I once again, for the second time in in 25 years, find myself acting as one of the major support systems for a m-f trans person. And much to my surprise, things don’t seem to have improved much…

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    • What a coincidence! Remembering how much I depended on my support people, and still do, I am vicariously grateful.

      You see I think the dysphoria is a sign of health, not illness. I was shoved into this male box, and I did try to make a man of myself, and the discomfort was a sign that was not OK, it brought my true nature to my attention. It could be the only diagnosis of mental health in DSM: this person is completely sane, so sane that s/he can disregard the messages of society about her/his gender and assert it. But this is the Diagnostic and Statistical Manual of Mental Disorders.

      I am not certain that the names matter that much, what matters is the attitude: yes, transition is the appropriate course of action, yes it is difficult but not as difficult as the alternative. We need to name it, because what I suffered from needed medical intervention, but psychiatric diagnosis, not psychiatric intervention.

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      • Thank you for this thoughtful clarification. Your point is much clearer to me now. And yes, I agree that the dysphoria is a sign of health. I have so much respect for my young friend going through this process in the midst of so much ignorance (jokes, snide remarks, unrelenting gossip, and isolation being just a few of the byproducts of her decision to make this journey to becoming the woman she knows she truly is).

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  3. Have a very merry Christmas, Clare! Hard to imagine. God pulling his heart out (his Son) and sending him to earth as a defenseless little baby in a very poor little village, in a barn. May the impact of Christmas give you joy!♡

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  4. Thanks for the pingback to my blog, Clare. I think I understand where you’re coming from– that the distress of gender dysphoria is a rational response to the underlying condition of physical characteristics that are incongruent to our gender identities, much as throbbing pain is a rational response to hitting our thumbs with a hammer. You point out that the underlying incongruence should be the focus of diagnosis, rather than it’s resulting distress. I took a similar path, supporting “dissonance” and “incongruence” as diagnostic titles in a paper to the 2003 APA Annual Meeting and a 2005 paper in the Journal of Psychology and Human Sexuality. However, I received feedback from folks in the trans community that “incongruence” was too ambiguous in a population as diverse as ours. Lots of trans people are perfectly OK with bodies that differ (according to social convention) from their inner gender identities and have no need of medical transition care. A label of incongruence could be inferred to wrongly pathologize their bodies and “diagnose difference.” We need diagnostic nomenclature that focuses, not on difference from social convention, but specifically on incongruence that is painful/distressing to the individual.

    I now favor Gender Dysphoria, from a Greek root for distress, as a more descriptive title, but with a much more precise definition than proposed by the APA (see http://tinyurl.com/atk2png). It’s not a perfect term, but both “dysphoria” and “incongruence” are immensely better than Gender Identity Disorder, which was specifically intended by its key Clarke Institute authors to imply “disordered” gender identity– suggesting that our identities are in themselves pathological and represent confusion. The current GID title and diagnostic criteria were crafted to serve a business model of gender conversion/reparative psychotherapy.

    I also share your concern about mental disorder diagnosis for a medical problem with a medical solution. In the long term, I would like to see a new coding in a non-psychiatric section of the ICD that would obsolete the need for a DSM coding in North America (and the current psychiatric coding in the ICD).

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    • Thank you for all the time and effort you put into this, and for your patient thinking these things through from inside the group- we need to balance the outsiders.

      Why should trans people who do not want medical intervention need to be classified at all? Possibly to go to trans groups. Members can then argue over the definitions themselves.

      I do not like the scientific investigation because of that word “Non-homosexual”. I think it shows active hostility, and therefore an inability to understand us: empathy is necessary for understanding. I am happy with any amount of woolly thinking as long as the surgeons keep operating, and I would rather be happy than anyone else’s conception of “mentally healthy”.

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