03 December 2012

How Much Of A Victory Will The DSM-V Be For Transgenders?

If you're not LGBT, or not a medical or psychiatric professional, or an actuary, you've probably never looked at the Diagnostic And Statistical Manual (DSM).

However, even if you haven't, it probably has a greater impact on your life than you realize.  Doctors, psychiatrists and researchers in those fields depend on it because it provides a common nomenclature and has, by and large, standardized the categories used to classify various psychiatric issues.  Perhaps even more important to most people, health policy makers as well as pharmaceutical and insurance companies use it in a variety of ways.  

That last fact is one reason why removing "transgender" from the list of mental disorders--one of the many revisions in the upcoming DSM-V, due to be released in May--may not be as much a cause for celebration as some would believe.

To be sure, it would remove much of the stigma of being a transgendered person, just as the subtraction of homosexuality from the list of disorders in the seventh edition of DSM-II did much to help gay men and lesbians.  One result was that serious medical and psychiatric practitioners would no longer sanction the use of electroshock, lobotomies and other horrific "therapies" that were employed in the hope of "curing" a person's attraction to other people of his or her own gender. (In its place, we got "reparative" "therapies" and ministries.)  In turn, that would lead to the greater availability of appropriate medical and psychological care for members of the LGBT community.

However, there is one major difference between the situation of gays before and after changes to the DSM-II and that of trans people.  Most of the care we now receive has been made available to us based on the assumption that we do indeed have a "disorder" that needs treatment.  The few insurance plans that paid for psychotherapy, surgery, hormones and other treatments did so because transgenderism was seen as a disease, as it were.  

So I wonder:  Could the change in DSM-V actually make it more difficult for many trans people to get the care we need?  And would it give insurance companies a rationale for continuing to see gender reassignment surgery as "cosmetic" and refusing to cover the costs of it?

On one hand, I am glad that we will no longer be classified as mentally ill.  But, as we all know, you don't have to be ill to need treatment.

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