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.

The Rabbi Says We're Not Ill

A British rabbinical student is on a crusade.

All right.  You might think I'm getting my medieval history mixed up here.  But I assure you that, in fact, a young Londoner studying for the rabbiniate is indeed a man on a mission.

I'm not talking about his efforts toward ordination.  He is asking the contributors to, and editors of, the Diagnostic Statistical Manual to change something they've done since the third edition of said manual came out in 1980.

In DSM-III, transsexualism was included for the first time.  It was classified as "Gender Identity Disorder," the first known use of that phrase.  In DSM-IV TR, a revision of the fourth edition, GID was placed in a category of sexual disorders.  

DSM V is in the works.  Maxwell Zachs, the rabbinical student in question, wants to see the de-classification of transsexualism as a mental disorder in the new edition of the manual.  "Gender is not an illness," he explains.  "It's just a part of who I am, like being Jewish or a vegetarian or sometimes talking too much!"

While re-classifying people like me and him might remove some of the stigma and alleviate some of the prejudice we can experience, it is not as simple a choice as one might expect.

You see, medical practitioners and administrators, public health officials and even pharmaceutical companies rely on the DSM to help them set priorities and policies.  So do insurance companies.  

So, if we are re-classified as "normal," that might actually make it difficult for many of us to get treatments and therapy.  While very few trans people have insurance policies that pay for surgery, many (myself included) were able to get our hormones and visits with doctors paid for, and psychotherapy partially covered.  And I have been able to get mammograms and, since my surgery, gynecological care.

If transgenderism is no longer considered an illness or disorder, insurance providers might decide not to pay for those things.  And some practitioners might not provide their services.  

Plus, I have to wonder whether it would make it more difficult for someone to file a complaint of discrimination, much less a lawsuit.  Could some judge or lawmaker decide that because a transgender is not ill, he or she doesn't need legal protections and is simply pursuing a "lifestyle choice"?

This is very interesting and controversial, to say the least!