Handcuffed A.P.A.: Pulling With
or Pushing Against

A Response To The Call For Removal
Of GID From The DSM

By Stacy M. Clement, M.A.


At the outset let me say that I am not an in-your-face activist, screaming and shouting protagonist. I am more the persuasive, convince-you-that-this-was-the-way-you-felt-in-the-first- place-but-didn't-recognize-it kind of advocate.

Perhaps it is because I am a psychologist, a current student of psychology, or a member (in good standing) of the trans-community that I have a unique perspective about the current push to remove Gender Identity Disorder (GID) from the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). I would like to share that perspective with you and present an alternative to what I see as a slow-paced effort that may well cause more resistance than movement.

Why its in there: It is clear that the DSM is a compilation of mental disorders, both organic and otherwise, and is presupposed to be an aid in the diagnosis and treatment of said maladies. That fact notwithstanding, the presence of Gender Identity Disorder (Code numbers 302.6 and 302.85) allows the identification of behavior that may otherwise be diagnosed as paranoia, bipolar, depressive, obsessive/compulsive, or any one of several other psychological anomalies. The presence of the Codes allows the clinician to steer away from the presenting behavior (e.g., suicide) and direct concern to the root cause (e.g., being a trans-person in today's narrow-minded society). There is also the availability and usage of up to four axes that differentiate presenting issues from historical issues, chronic ones from incidental. These Codes allow the insurance agencies, along with referral doctors and others, to assign treatment based on collective years of experience in the field.

Unfortunately, the presence of the two codes also allows the insurance company to refuse payment for treatment. (Most insurance companies state clearly that they do not cover costs related to transgender treatment.) More than one trans-person has lost insurance coverage in general, or specifically for related services when a well-meaning but uninformed practitioner notes the patient's condition as gender related.

The key, therefore, is to educate the medical and psychological professionals about the affects of transsexualism and transgenderism so they will stop negating our insurance coverage and, also, to provide the transgendered client/patient with the wherewithal to be able to tell the therapist or doctor; "don't make a notation of this as a gender disorder as my insurance will cancel me." I assure you, if your doctor or therapist is caring, they will be more concerned about your welfare than about the insurance adjusters and will abide. If not, get a new doctor or therapist.

The alternative, I believe, is in education. I wonder if there is a group of people, diagnosed with obsessive compulsive disorder who are lobbying the APA to remove OCD from the DSM? I do not know how much education effort was brought to bear in the removal of homosexuality from the DSM-III. I assume there was some. I do know that the training of clinicians and medical doctors regarding gender identity disorders, their formation or treatment, is scant at best. A new doctor friend of mine has turned to me three times for information and referrals for patients who present to her with transgender issues ranging from suicidal depression from the dysphoria to a rather benign request to be placed on estrogen.

When asked what the other doctors, young and old, do with such a case, her answers truly frighten me. They range from administration of medication for depression, to denial of the patient's self-evaluation of the cause of the affect, to referrals to psychiatrists who know nothing more about transgendered issues than the referring doctor to dismissal until something "real" comes along. Further, my own experience in promoting my doctoral dissertation has come against three professors who knew only of the terms, not anything of the epistemology, treatment or prognoses for transgendered people. I am thrilled to report that each of those three has now enthusiastically agreed to sit on my dissertation committee. My point here is that doctors, psychiatrists, psychologists, family therapists, and counselors are woefully ignorant about the entire package (behavior, diagnosis, treatment, and prognosis) that is transgenderism.

What to do It seems to me that if you want to change something, the best way to do it is to have as many people pulling for you as possible; not having as many people pushing against something as necessary to move it. The education, research, and treatment of, by, and for transgendered people will surely win the necessary allies in the fields that deal directly with both the DSM and the insurance underwriters. Education is required at many levels

  • Academic level: all therapists require education of some sort and most require re-education or ongoing training to maintain their licenses.
  • Treatment level: when you seek out that endocrinologist, surgeon, therapist, or counselor, be sure s/he knows about you and your specific needs, about your coverage, and about how best to meet your needs.
  • Public level: when confronted by stares and snickers in public, seek to inform the people that we too have feelings, are not weirdoes, and demand the same degree of respect as everyone else.
  • Self level: know what you are talking about and talk about it with confidence, honesty, and sincerity when dealing with a therapist, a doctor, or the public.

While I support the eventual removal of gender identity disorders from future DSMs, I recognize their necessary place for now. Right now I see it as necessary until the education process has moved further along. This does not mean education of the APA, but of its members. And PLEASE remember that there are a TON of psychologists, therapists, counselors, and doctors who are not now nor never will become an APA member who will not be educated or even informed of actions taken against the APA (myself included).

If the transgender movement is truly twenty years behind the homosexual movement (and most say it is), learning from the methods, mistakes and successes of that movement can only serve to improve our elapsed time from zero to acceptance. I encourage continued pursuit of change, but there is more and more a frantic voice of demand heard from the activists and in the experience of most other rebels, you either need patience or you need guns.

Communication Is the Key to Understanding ...as always, I welcome your comments, tedclem@ix.netcom.com


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