On December 3, a lot of the internet, including this site, got very excited that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is used by mental health professional and folks in related fields, no longer labeled trans people as “disordered.” This would be a great win to celebrate. The problem is, it’s not actually true.
It is true that Gender Identity Disorder, the main diagnosis put on trans folks, was changed to Gender Dysphoria. This is a big deal, and hopefully matches the goal of a lot of trans organizers in this struggle: to make sure trans folks can access the medical care we need without being labeled as disordered. That would be in the hands of competent health professionals, of course – the diagnostic criteria are still coming from a pathologizing place, and are still very much a problem. Kelley Winters, who’s played a central role in the trans community’s response to the DSM, explains:
On the negative side, the proposed diagnostic criteria for Gender Dysphoria still contradict social and medical transition and describe transition itself as symptomatic of mental illness. The criteria for children are particularly troubling, retaining much of the archaic sexist language of the DSM-IV that pathologizes gender nonconformity rather than distress of gender dsyphoria. Moreover, children who have socially transitioned continue to be disrespected by misgendering language in the diagnostic criteria and dimensional assessment questions. There is very plainly no exit from the diagnosis for those who have completed transition and are happy with their bodies and lives. In other words, the only way to exit the GD label, once diagnosed, is to follow the course of gender conversion/reparative therapies, designed to shame trans people into the closets of assigned birth roles. While supportive care providers will continue to make the diagnosis work for their clients, intolerant clinicians will exploit contradictory language in the diagnostic criteria to deny transition care access and promote unethical gender conversion treatments.
However, GID wasn’t the only possible diagnosis for trans folks in the DSM. Transvestic Fetishism has always been the most dangerous diagnosis, and it only became stronger in the new DSM. And now it’s been renamed as a disorder. Again, from Kelley Winters:
Like its predecessor, Transvestic Fetishism, in the [former] DSM, Transvestic Disorder is authored by Dr. Ray Blanchard, of the Toronto Centre for Addiction and Mental Health (CAMH, formerly known as the Clarke Institute). Blanchard has drawn outrage from the transcommunity for his defamatory theory of autogynephilia, asserting that all transsexual women who are not exclusively attracted to males are motivated to transition by self-obsessed sexual fetishism (Winters 2008A). He is canonizing this harmful stereotype of transsexual women in the DSM-5 by adding an autogynephilia specifier to the Transvestic Fetishism diagnosis (APA 2011) . Worse yet, Blanchard has broadly expanded the diagnosis to implicate gender nonconforming people of all sexes and all sexual orientations, even inventing an autoandrophilia specifier to smear transsexual men. Most recently, he has added an “In Remission” specifier to preclude the possibility of exit from diagnosis. Like a roach motel, there may be no way out of the Transvestic Disorder diagnosis, once ensnared.
Transvestic Disorder probably won’t be an issue for folks like me, living in a city like San Francisco where I have access to knowledgeable medical and mental health professionals. Hopefully it won’t cause problems for folks who crossdress but already have access to a kink or crossdressing-friendly therapist. Just looking at the diagnosis at face value, it’s a real problem that folks who do get off on crossdressing are being labeled as disordered. And Transvestic Disorder could prove disastrous for, say, a rural trans girl who only has access to one or two medical professionals. If those doctors happen to be ignorant and/or bigots, this diagnosis will be there for them to slap on her.
I see this as a super feminist issue. Being sexualized and labeled as disordered because of the medical care I need as a woman resonates strongly for me with the idea of hysteria, a diagnosis that sexualized women and saw them as disordered because of their gendered bodies. Yeah, the trans community is still stuck fighting hundred year old feminist battles.
For more on this issue, Julia Serano has a great overview of the struggle around Tranvestic Disorder, chock full of useful links. And of course Kelley Winters has a ton of useful material on the subject. DSM reform, and the larger project of ensuring trans folks can access the medical care we need without barriers, is a huge project. And unfortunately, the work is still far from over.