To Diagnose Or Not
While the gender community has never been known for its passive, conciliatory stance when threatened, it has more than lived up to its reputation in the face of the most recent controversy, whether a diagnosis of Gender Identity Disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition is in the best interest of transgender consumers.
This manual, otherwise known as the DSM-IV, is the definitive book of diagnoses by which the behaviors/symptoms of all individuals seeking mental health services are classified. Insurance companies require that any patient seeking reimbursement for mental health treatment be diagnosed with a classifiable disorder. Those transgender individuals who seek counseling but who do not wish to be so classified, either because of their resentment of being considered mentally disordered or because of concerns about lack of confidentiality and its impact on their career, have the right to pay for their treatment out-of-pocket.
In addition to the commonly thought of mental disorders such as depression and schizophrenia, you will find listed and defined others, such as learning disorders, substance abuse, panic attacks, bereavement, and many other problems not usually associated with mental illness. The categories that might be of most interest to readers of TG Forum are the following two, but the current controversy seems to surround the second.
Transvestic Fetishism is described as the activity of cross-dressing accompanied by erotic arousal. Individuals with this behavior are usually heterosexual men whose interest in dressing ranges from occasional solitary activity to active involvement in the TV subculture. Some are focussed on specific pieces of female attire while others dress and makeup entirely. In some individuals the reason for crossdressing changes over time with erotic arousal becoming less important and feelings of comfort and contentment taking its place. For a few people, feelings of gender dysphoria may emerge, with individuals feeling increasingly dissatisfied and seeking to dress and live permanently as the opposite sex. They might, in time, be rediagnosed with Gender Identity Disorder.
Gender Identity Disorder occurs when individuals express strong cross-gender identification, feel inappropriate in the role of their assigned gender, and are significantly distressed or impaired in social, occupational and other areas of living. There is a preoccupation with the wish to live as a member of the opposite sex. This may be satisfied by crossdressing, by making cosmetic modifications to the body, by taking hormones which increase desired physical and emotional characteristics and/or by sex reassignment surgery.
Individuals in either of the above diagnostic categories may seek psychotherapy if they feel the need to deal with the emotional concerns aroused by their transgender feelings or behaviors or those concerns of their significant others, parents, children and friends. Please note, the treatment deals with negative attitudes, behaviors and emotions, not with the existence of transgenderism itself. Transgenderism is not amenable to change, although its expression may be modified in more appropriate and respectful directions.
However, some individuals with Gender Identity Disorder, who are seeking referral for hormonal therapy or sex reassignment surgery, will be required to have a certain period of psychotherapy, whether or not they experience such need. If they seek reimbursement from their health insurance company, they will have to be diagnosed. Therein lies the rub.
Some members of the TG community are seeking ways to have insurance companies cover the cost of medical and psychiatric treatment while avoiding being stigmatized with a psychiatric diagnosis. The best solution I have heard promoted is the reclassification of Gender Identity Disorder as a physical condition. Since the most appropriate treatment is modification of one's physiology, it makes sense to think of transsexualism as a birth defect, similar to an intersex condition. This would not eliminate the requirement that a transsexual seeking psychological treatment be diagnosed, however, some would find a label of "depression" more comfortable than one alluding to a gender disorder. It would resolve both the issue of stigmatization as well as remove the justification of mental health practitioners to pursue the futile search for a cure of transsexualism.
Dr. Anderson is located at 1537 Franklin St, Suite 104, San Francisco, CA 94109, 415-776-0139.
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