Kelley Winters

Gender Diversity, Scapegoating & Erasure in Medicine & Media

Filed By Kelley Winters | April 23, 2012 4:00 PM | comments

Filed in: Media, The Movement, Transgender & Intersex
Tags: conversion therapy, DSM V, gender identity disorder, GID, Rachel Maddow, reparative therapy, Robert Spitzer

On the April 18th broadcast of the Rachel Maddow Show, she reported an "explosive revelation" that psychiatrist Robert Spitzer had rescinded his controversial 2001 claim that sexual conversion, or sexual reparative, psychotherapies can change sexual orientation in gay and lesbian people. Quoting an interview of Dr. Spitzer in The American Prospect, Maddow celebrated the historical significance of Spitzer's reversal for the gay rights movement, calling it,

step one in what we're now going to see as a real change, a real reckoning, in antigay politics

Sadly, Maddow only told half of the story. For four decades, Robert Spitzer has played pivotal roles in mental health policies - not only on sexual orientation, but on gender diversity as well. Rachel Maddow and other journalists turned a blind eye to Dr. Spitzer's failure to retract a lifetime of trans psychopathologization, stereotyping gender identities and expression that differ from assigned birth roles as mental disease. This omission speaks to the marginal status of trans people within the GLbt rights movement and progressive media, as much as Spitzer's omission speaks to trans marginalization by mental health policymakers.

Shifting stigma from one oppressed class to a more oppressed class is not real change.

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Robert Spitzer played a central role in the declassification of same-sex orientation as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) between 1973 and 1987. The DSM is published by the American Psychiatric Association and remains the medical and cultural definition of mental disorder in North America. As Chairman of the DSM-III and DSM-III-R Task Forces and chief editor of the diagnostic manual, Spitzer oversaw removal of the last major vestige of gay diagnosis, "Ego-dystonic Homosexuality," from version III-R.

However, while depathologizing same-sex orientation, Dr. Spitzer simultaneously directed a massive expansion of trans-pathology diagnoses in the DSM. In 1980, a new category of Gender Identity Disorders (GID), including a Transsexualism (TS) diagnosis, was added to the class of Psychosexual Disorders in the DSM-III. The TS coding was paradoxical and controversial for many trans people.

Many community advocates and medical providers agreed (and do today) that some kind of diagnostic coding was necessary to facilitate access to medical and/or surgical transition care for those trans and transsexual people who needed it. On the other hand, defining a medical transition coding as a mental illness, rather than a treatable medical condition, contradicted access to hormonal and/or surgical transition care and encouraged gender conversion, or gender-reparative, psychotherapies- unsubstantiated treatments attempting to change gender identity and shame trans and TS people into the closets of their assigned birth roles. Vulnerable trans and gender nonconforming youth were targeted and institutionalized as a consequence of diagnostic criteria based on nonconformity to birth-assigned stereotypes.

In the DSM III-R, Dr. Spitzer's Task Force expanded the diagnostic criteria for children to emphasize gender role nonconformity for birth-assigned girls, including "persistent marked aversion to normative feminine clothing" (whatever that means). Even more damaging, a new category was added, Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type (GIDAANT), to psychopathologize for the first time the gender identities of trans people who did not need access to medical transition care.

The punitive category of Transvestism in the DSM-III was renamed "Transvestic Fetishism" in the DSM-III-R, to further stigmatize crossdressing or gender nonconformity by birth-assigned males as sexual obsession. This change served to sexualize a diagnosis that did not clearly require a sexual context in its diagnostic criteria. The DSM-IV Casebook, edited by Dr. Spitzer in 1994, went even further in pathologizing gender nonconformity, recommending a Transvestic Fetishism diagnosis for a self-accepting bigender male, whose crossdressing was not necessarily erotically motivated and whose primary distress was his spouse's intolerance.

HPIM0170a_vga.jpg

Sexual and Gender Identity Disorders symposium from the 2003 APA Annual Meeting. From the left, Drs. Karasic (speaking), Hill, Winters, Moser, Drescher, Spitzer (front), and Fink.

In May, 2003, Dr. Spitzer and I presented papers to a symposium entitled, "Sexual and Gender Identity Disorders: Questions for the DSM-V" at the Annual Meeting of the American Psychiatric Association. The only trans person and non-clinical scholar in the session, I sat on the left side of the stage table with presenters advocating reform of the Gender Identity Disorder (GID) and paraphilia diagnoses in the DSM-5. At the far right end of the table, Spitzer joined former APA President Dr. Paul Fink in defending the status quo. Spitzer wasted no time in invoking the worn stereotype of disordered gender identity:

Children normally develop a sense of gender identity. It is not taught - it just happens. I would argue that by itself, the failure to develop a gender identity that is congruent with biological gender is a dysfunction.

In the May, 2006, issue of Congressional Quarterly Researcher, Robert Spitzer debated UC San Francisco psychiatrist Dan Karasic on the question of GID as a mental illness. Spitzer used his most defamatory language to date to argue that well adjusted post-transition adults should continue to be regarded as mentally ill, so long as they deviate from their birth-assigned sex roles:

Granted that hormone therapy or surgery may now be the only treatment that we can now offer the adult with GID... But surely something remains profoundly wrong psychologically with individuals who are uncomfortable with their biological sex and insist that their biological sex is of the opposite sex. The only diagnosis that is appropriate for such cases is GID.

In issues of social discrimination, historic context matters. Cisgender GLB people had every right to their outrage at Spitzer's 2001 attack on their dignity. This week, they had cause to celebrate his retraction. Wayne Besen noted that,

Spitzer just kicked out the final leg from the stool on which the proponents of 'ex-gay' therapy based their already shaky claims of success.

Perhaps, but trans and especially transsexual people are not celebrating. Dr. Spitzer and like-minded policymakers in American psychiatry have long kicked the the legs from under our human legitimacy, and the rush to his redemption in progressive media has cast our issues aside once again.

We too have been injured by Robert Spitzer's role in perpetuating defamatory stereotypes of mental "dysfunction" and deviance. Trans people continue to lose our jobs, homes, children, families, dignity and civil justice because of these stereotypes and continue to face predatory gender conversion psychotherapies.

These stereotypes lie behind every extremist political campaign that demeans our most basic civil rights as "bathroom bills." These stereotypes lie behind military discrimination and government policies that still malign us as "mentally unfit." These stereotypes convince parents and school officials to dismiss trans youth as "confused" or going through "a phase."

Trans communities have waited more than two decades for a retraction or an apology from Dr. Spitzer. and we are still waiting.

An expanded version of this post can be found on the GID Reform Advocates Blog


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