The American Psychiatric Association has released a draft of proposed diagnostic criteria for its Diagnostic & Statistical Manual-V (DSM-V). A 90-day review period is now underway with feedback solicited prior to creation of a final draft which will be published in 2013.
My initial reaction to the draft after a cursory review is generally positive. It's progress. The new code would replace the punitive descriptor "disorder" with the palliative term "incongruence." But does it cure what really ails us?
Here's an excerpt from the APA:
It is proposed that the name gender identity disorder (GID) be replaced by "Gender Incongruence" (GI) because the latter is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one's assigned gender (usually at birth) (Meyer-Bahlburg, 2009a; Winters, 2005).
The revised language acknowledges use of the term "disorder" perpetuates the marginalization of gender variant transitioners. Respondents to an APA questionnaire indicated Gender Identity Disorder is stigmatizing.
Gender Incongruence frames a more palatable treatment definition and an "exit strategy" that humanizes instead of chronically pathologizes those who have successfully transitioned to their target gender.
I applaud the proposal to banish the "perceived cultural advantages" proviso. It had reflected cisgender ignorance and arrogance. Good riddance.
The draft proposes a separate diagnostic category for children and another for adolescents/adults.
The battle over word choice has been a flashpoint between transgender activists and the medical community for years. Now the APA is on the cusp of excising that discriminatory verbiage.
So will transgender America be one happy family if the proposed changes are enacted?
A loaded question since the transgender community is a volatile conflagration.
Ever since the APA designated gender identity disorder in the DSM, divergent camps and personality types have been forced together in a largely unwelcome union.
The transgender "community" is a philosophically divergent, politically unstable, culturally uncooperative lot, loosely held together under the catch-all of gender variance.
It's a thread bare hold.
At times it appears the self-ascribed true transsexuals' moral imperative is to secede from this uncivil union of psychiatric convenience; to break free of the "fetishistic transvestite" and the garden variety crossdresser.
How about this old joke as a counterpoint: What's the difference between a crossdresser and a transsexual? Answer: About 2 years. (Fill in the blank with whatever time period you've personally experienced).
I'll buy the term Gender Incongruence. Amazing the APA committee agreed on such a diagnostically neutral designator given Ray Blanchard's guiding hand and his inflammatory dissertation on autogynephilia.
But this tit for tat exercise gets tedious, really. There are far more substantial trans-issues at stake.
Like transgender unemployment, under compensation and inequity in the workplace.
Like the inability to pee in peace.
Like youth homelessness and an unwelcoming or threatening environment in public shelters built on sex stereotypes.
Like incarceration, transphobia and violence.
Like the discriminatory practice of landlords and building managers who reject or overcharge qualified transgender applicants to discourage renting.
And my pet peeve: The continued discriminatory practices of the health insurance industry.
Unwarranted, across-the-board exclusions perpetuate mental and physical health issues, and prevent transgender individuals from physical transition due to cost prohibitive treatment protocols and reassignment surgeries.
It's all well and good to advocate DSM reform. Transgender activists who have worked tirelessly on it deserve credit for their herculean efforts. But it's crucial to take a stand for universal civil rights equality, by actively supporting ENDA, LGBTQ health care reform and--in the interim--statewide anti-discrimination legislation.
Unless equality initiatives receive the vocal support of the entire "transgender nation" our voice will never truly be heard much less accepted.
Federal law is where "enforced" credibility counts, mandating America to experience gender variant individuals for who we really are---people just like them. Civil rights reform on a state level--and ultimately Federal reform is where long-term change is effected on the social culture status quo, not in a diagnostic manual.
Do that and GID and Gender Incongruence both go away.