Contemporary Sexuality - March 2009 - (Page 4)

Creating the DSM-V continued from page 1 “If you look at the criteria, you may be surprised to learn that boys who don’t engage in ‘rough and tumble play’ may have GID. That’s an absurd criteria to include at this point in the world.” — Arlene Istar Lev point to the DSM as evidence that transgendered people are mentally ill. After Montgomery County, Maryland passed an ordinance preventing discrimination based on gender identity, a group attempting to overturn the statute wrote that “those who wish to assume a ‘gender identity’ contrary to their biological sex are in need of mental health treatment to overcome such disturbed thinking, not legislation to affirm it.” Striking GID from the DSM would be a major step in destigmatizing the lives of transgendered people. Advocates of such a move compare it to removing homosexuality from the manual in 1973. “I find that the mental illness label imposed on transsexuality is just as disquieting as the label that used to be imposed on homosexuality,” wrote psychologist Madeline Wyndzen, PhD, in a 2004 article published in the American Psychological Association Division 44 Newsletter. The article was titled “A Personal and Scientific Look at a Mental Illness Model of Transgenderism.” Many others — activists and academics included — agree. But complete removal of transsexuality seems unlikely in this revision. “It’s probably not going to happen in the DSM-V,” says Arlene Istar Lev, LCSW. “Ultimately, it may happen in the DSM-VI.” Lev, author of the book Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families, says GID sub-work group members aren’t as open to the idea of removal as others in the profession. In addition, there are practical considerations to keeping a re-written diagnosis in the new version of the manual. Mental health counseling, prescription medication and surgery (for those seeking it) may not be paid for by insurance companies and governments without a DSM entry. “In the real world, one needs to think about that,” says Jack Drescher, MD, a member of the GID sub-work group. “In countries with a national health care system — Canada, Holland, Germany — it’s a rationale for treatment. That’s not a small thing. For people who transition, they sometimes need a lifetime of medical care.” Sandra Cole, PhD, a University of Michigan professor (retired) and an AASECT member, agrees. “If we remove it, we remove the surgical option for scores and scores of people who can’t afford it,” she says. Leaving it in also poses problems because it continues to stigmatize transgendered people. That’s why Cole wants to see GID “redefined in a way that does not carry the pathology but allows people access to health care.” So, how should the GID entry be altered? Moser, a San Francisco-based physician and AASECT-certified sex therapist who is also a professor at the Institute for Advanced Study of Human Sexuality in San Francisco, believes GID is a misnomer. In a 2008 article published in the Society for Sex Research and Therapy newsletter, he argues that transgenders have “no doubt about their gender identity; it just does not match their genitalia or social expectations.” The real issue is one of “discomfort with one’s assigned gender or the profound feeling that one is in the wrong gender.” Moser proposes the name Gender Dysphoria Disorder (GDD), which would only apply to those experiencing “persistent and profound discomfort.” That may remove some of the stigma because transgenders not experiencing discomfort wouldn’t be diagnosed with a mental disorder. While not commenting specifically on Moser’s GDD proposal, Lev spoke of changing the disorder’s name to one that includes the phrase “gender dysphoria” or “gender dissonance” and altering the definition. “We need to help this committee that’s a pretty conservative committee to shift language so it’s less pathologizing and less sexist,” Lev says. “If you look at the criteria, you may be surprised to learn that boys who don’t engage in ‘rough and tumble play’ may have GID. That’s an absurd criteria to include at this point in the world.” Lev and five other practitioners and researchers are urging the APA to add new members or advisors to the GID sub-work group. Lev’s ad-hoc organization, “Professionals Concerned with Gender Diagnoses in the DSM,” has launched a website (www.professionals. gidreform.org) outlining their concerns with the present GID sub-work group and offering names of possible new members or advisors. “Many professionals are concerned that [the GID sub-work group], as it is currently convened, does not represent their clinical perspectives and treatment methods,” Lev writes. “Evidence-based practice depends not only on extant scientific research, but also the ‘best practices’ of clinicians.” The ad-hoc organization suggests adding Edgardo Menvielle, MD, Michele Angello, PhD, Dan Karasic, MD, Herbert Schreier, MD, Diane Ehrensaft, PhD and Gail Knudson, MD, PME, FRCPC to the GID sub-work group as members or advisors. In addition to Lev, the “Professionals Concerned with Gender Diagnoses in the DSM” ad-hoc organization includes Angello, Virginia Erhardt, PhD, lore m. dickey, MA, Jamison Green, MFA, Francoise Susset, MA, and Reid Vanderburgh, MA, LMFT. www.aasect.org | March 2009 Vol. 43, No. 3 4 Contemporary Sexuality http://www.professionals.gidreform.org http://www.professionals.gidreform.org http://www.aasect.org

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Contemporary Sexuality - March 2009 Contents Member Profile AASECT Conference Registration Form and Information Quick Hits: Sex in the News Book and Media Reviews Educational Opportunities

Contemporary Sexuality - March 2009

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