Many transgender people, me included, bristle at the notion that we are mentally ill. This was especially the case when Andrea Lafferty of the Traditional Values Coalition spoke out in April against allowing teachers who transition genders to retain their jobs:
Why are we giving our schoolchildren over to people with a serious mental disorder?" ... "We have no problem with people with a serious mental disorder receiving help, but to give them an elevated status within civil rights, within law is very different.
The "elevated status" we seek is merely to not be fired from a job because of being transgender, a protection currently available in only 40 percent of the country.
The "serious mental disorder" she refers to is the diagnosis of Gender Identity Disorder in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, the catalog of mental disorders.
I decided to look in the DSM to see who else is in there besides me. I don't know why I've never done that. Did you know that people diagnosed with depression, anxiety, ADHD, or phobias are considered to have mental disorders, too?
I wondered, then, how many people might be mentally ill. According to the National Institute of Mental Health, "about one in four adults suffer from a diagnosable mental disorder in a given year." That's a lot. And it means that Lafferty likely has someone in her immediate family who has a mental disorder. Does she look down on her relative, too?
I thought back to the April Associated Press story that mildly or moderately depressed airline pilots are now allowed to take anti-depressants. That means some pilots are mentally ill, too. Pardon the pun, but given the fact that we regularly entrust them with our lives, I think they constitute a group that already has "elevated status."
It turns out that the prior concern about depressed pilots was not depression itself, but rather that the older anti-depressant medications could cause drowsiness, never a good thing when one is at the wheel. Depressed pilots taking new medications that don't cause drowsiness can now fly.
In fact, many people with mental disorders are able to control their illness and adequately perform their job duties. Their ability to retain their job is based upon their job performance. Transgender people should have the same chance.
Why are transgender people unfairly singled out for job discrimination? In part it is because the current DSM has its own bias against transgender people. As opposed to the other diagnoses, individuals who successfully resolve their gender incongruence, through a gender transition or otherwise, are still considered mentally ill. This bias is removed in the draft of the next version of the DSM due in 2012.
But transgender people argue that gender variations are normal occurrences in nature, not a mental disorder. A recently published paper in the International Journal of Transgenderism stated that, of the international organizations surveyed whose concern is the welfare of transgender people, 56 percent felt that the diagnosis should be excluded from the next version of the DSM.
So why not remove it? In the survey, the primary reason cited was that, without the diagnosis, transgender health care would not be covered by insurance reimbursement in most countries. Most except the United States, of course, where transgender care is generally not covered by health insurance, diagnosis or not.
Scott Leibowitz, MD, of Children's Hospital Boston has found another group opposed to removal of the diagnosis: parents who accept their children as transgender, and who want to show that acceptance is based on professional diagnosis when they are accused of parental whim.
Sadly, the next version of the DSM does not consider whether or not the transgender person is experiencing distress. Some of us are well-adjusted in spite of our gender incongruence. For others, the problem is usually not their gender identity but rather society's reaction to it.
Dr. Leibowitz, who is coordinating a pilot gender and sexuality psychosocial program at Children's, believes that measuring the degree of invalidation a person feels can provide the metric to assess the level of intervention needed. Invalidating factors include external forces ranging from rejection to abuse and internal factors such as the person's own internalized transphobia. Perhaps Leibowitz's pioneering work will be able to inform subsequent versions of the DSM.
But the next version of the DSM is already far along, going into "field trials" soon. The World Professional Association for Transgender Health has pronounced the new DSM name for the diagnosis - Gender Incongruence - "a commendable attempt to depathologize," while at the same time noting several new concerns.
This is clearly a puzzle that's not going to be solved anytime soon.
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The notion that transgender people are mentally ill,
whereas gay, bi and lesbians are now accepted in mainstream life
is very hypocritical to me.
Can we do this? Indeed yes, as our society has lost many prejudices over the past decades, this too can and should change. But to ignore the problems confronted by transgender and transsexual people (most of which is due to the reaction of our societies) and the help afforded by mental health professionals (to say nothing of the matter of coverage by state or private insurance) is to throw the baby out with the bathwater.
As a counselor, I never saw the "pathology" of being transgender, and during my training I railed against the pathologizing paradigm of the DSM. We are who we are.
I've read your article and while you start out complaining about being (admittedly wrongly) defined as having a mental disorder, you spend a lot of time pointing the finger at other people who might also be considered to have a disorder. If, as you correctly assert, it's wrong to target transgender people, then surely it's wrong to target anyone on the basis of a mental disorder.
My main confusion lies in the question of why anyone where you work needs to know about your transgender status. Surely your psychosexual orientation is not appropriate subject matter for your work situation. I would think any professional would pride him- or herself on going through their entire career without that kind of intimately personal information being made available to coworkers or bosses - let alone students - and would realize how inappropriate any consideration of a person's sexuality is in a job situation.
The conflict arises - as it always has and always will - when a person chooses to exist outside societal norms and then expects to not be singled out for that choice. You cannot have one without the other. That's just how society works.
In the end, all you need is love:
http://www.nemrits.com/gallery/pic/20090507145702
It is tough one. On the one hand, I think Gender Identity Disorder has no business being DSM included at all in that it is mentally pathologizing what is fact a biological condition. The reason Transgender individuals can become mentally ill for being Transgender is because we live in a society that only accepts two genders not because Transgender is a mental illness.
On the other hand, I want Transgender individuals to be able to receive whatever medical treatment they need to transition IF that is what they want to do, but that should be biologically identified w/r/t insurance coverage IMO anyway, not mental illness identified. However, that does not solve the issue of needing psychological evaluations before transitioning or is that irrelevant…I don’t know.
PS. I am not transgendered so I hope was appropriately respectful.
I'm MtF too, and I'd like nothing more than to be able to work for a wage I can live on, and have a health insurance plan which covered the costs of transitioning.
But sadly, I've been suffering from severe depression for a number of years, and if it wasn't for my medication, I'd be lying in my bed sleeping, not bathing or taking care of myself for weeks/months at a time like I had been. I've been trying for *years* to get disability for my depression, but the system thinks just because I can breathe and walk and talk, I'm able to work...
I am glad to hear I was respectful. Thank you for letting me know.
I do not know if this is too personal. If I KNEW it was, then I wouldn't ask, but since you provided details about your life I thought it was maybe okay to ask. Do you feel your depression is caused by (beyond any biological reasons) from having been unable to transition to a female gender?
"Mental illness" is already a nebulous term. It's not like physical medical conditions, such as cancer, where you outright have a tumor, or you don't. Mental illness diagnoses are based on patterns of behavior and combinations of symptoms, and the degree to which they interfere with an individual's ability to function. A better understanding of the human mind has led to more acceptance of personalities which, while they are non-standard, should not be considered abnormal.
We're making progress. Wait for Andrea Lafferty's generation -- with its old, tired prejudices -- to pass on. The future will be a happier, more accepting place.
Thanks for the article, Joanne.