Gender Identity is Not a Disorder

Transgender-SymbolOn December 3 2012, the American Psychiatric Association announced that it is replacing “Gender Identity Disorder” with the more neutral and less-stigmatizing title, “gender dysphoria” in its Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the DSM.

The DSM is the mental health professional’s diagnostic book.  Psychiatrists, psychologists, social workers and counselors all use this book to assign a diagnostic code to mental health disorders.  These codes are then used to bill insurance for proper medical treatment and are often required to justify covering the cost of office visits, prescriptions, and needed medical procedures.  It is paramount in the healthcare of someone who is transgender.  Perhaps at no other time in one’s life is it more important to have quality healthcare than during a gender transition.

The title change comes after decades of advocacy to remove the more stigmatizing diagnosis, “Gender Identity Disorder,” which equates gender identity with a mental health disorder.  Being transgender is not a mental health condition and it’s not abnormal.  Uncommon, yes; but abnormal, no.  There is no normal – normalcy is only what one perceives as common in his/her own existence.

If I grow up a white woman in a middle-class catholic suburban neighborhood, that’s my normal.  If a lot of women grow up the same way around me, it’s common.  But we’re not normal for everyone, just for us.  If I grow up Arab American in Dearborn, Michigan and all my friends speak Arabic as easily as English, and go to the same Eastern Orthodox church and celebrate the same holidays, that’s my normal.

Being transgender is not abnormal.  It’s just not as common and it’s doesn’t appear en masse within families and communities.  It can be a very isolated and isolating experience.  And it’s not a mental health disorder.  It’s like being born red-haired in a blonde, black and brown-haired world.  Or at least it should be… but it’s not – red-haired people don’t lose their homes, their jobs, their families; they aren’t denied basic human dignities based on the fact that they have red hair.

Having to cope with the societal stigma of gender transition drives many mental health concerns for transgender individuals.  Layer hormone therapy and other medical issues on top of that and it’s a difficult and uncommon territory to navigate.  Seeing a professional to sort through all that can help, but it comes with a cost – the cost of having that mental health diagnosis attached to your name, the cost of being “outed” to every other person who comes into contact with your medical record.

And how do you find a therapist who understands these same truths – that there’s nothing abnormal about being transgender, that it’s a personal characteristic.  How do you find someone who understands that the anxiety you are dealing with is caused by societal stigma and not caused by your gender identity?  It’s not easy.

Last week the Detroit region’s LGBT community center, Affirmations, brought together leading Michigan experts on LGBT mental health in what’s been called a queer mental health “think tank.”   After months of work, The LGBT Mental Health Task Force led the first ever two-day training on Clinical Issues & Sexual Orientation for therapists.  It was sold out with a waiting list for the next training.  This March, they are forging even newer territory – putting together the first two-day training on Clinical Issues & Gender Identity for therapists and counselors.  It will be the first such training offered in Michigan.  On the heels of the APA’s new announcement, there is no better time to be preparing mental health professionals to competently and knowledgeably provide services to people who fall outside of the two most common gender boxes.

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