A Rubicon crossed?

**Celia Eriksson** Thu May 30, 2019 6:18 pm

Hi Everyone!

So, the World Health Organisation has decreed that being transgender is no longer deemed to be a disorder. This is a Rubicon that had to be crossed! However, it has repercussions, when implemented by nations across the globe..... (it will be interested to see whether the Americans take a blind bit of notice though).

I cannot comment upon how this might affect transgender people in other countries and the treatment they receive free at the moment, because it is not only a little early to know how it will be interpreted by health authorities. But, it could benefit some, whilst be a disadvantage to others. It is however, in my view necessary and advances our status in society. Finally, we are not viewed as having a mental disorder, we are recognised as being born the wrong gender.

The danger is, that it may well, be for some on a personal level, one step forward and many steps back, whilst for others it is a welcome advancement, that will not affect them r may prove positive. However, it is a line that had to be crossed, one of many we have yet to do so, it is advised that nations adhere to the new WHO guideline by 2020. We shall see.

I do not advise reading the comments upon the link, it might well prove distressing, but the newspaper is a known to be a right wing organ, albeit not far right. Some of the commentators views are awful..

Celia xx

**MichaelaSJ** Thu May 30, 2019 7:27 pm

A very interesting quandary, Celia.

In the US, and maybe elsewhere, we have the 'The Diagnostic and Statistical. Manual of Mental Disorders, Fifth Edition (DSM-5)' which is sort of the bible for mental health professionals to tag a specific disorder.

In version 4 of the DSM transgenderism was classified as 'Gender Identity Disorder' whereas in version 5 is has been tagged as 'Gender Dysphoria'. Either tag allows a health care professional to enter a diagnosis in the patient record and be reimbursed for services rendered and also to provide a reason to prescribe a certain medication.

I think it entirely appropriate to delete homosexuality from the DSM-II going forward. Being gay is not a 'disorder' needing treatment. (There is also a political argument against treating gayness differently, but that is for another thread.) Being transgender can and should be listed as a disorder and something needing treatment.

Having the World Health Organization (WHO) take away a definition of transgender simply because they may want to lump us in with gay individuals will tend to take away from us the ability to receive medical help, whatever help that may be.

A gay individual can seek help with depression, but not to be un-gay. A transperson can seek help to realize who they are and receive appropriate assistance. It is so easy to see into the conservatives thinking that they will jump on this WHO directive as something to take away from us. Let's not have this taken away from us.

**MichaelaSJ** Thu May 30, 2019 7:46 pm

I wanted to add the following excerpt from a website regarding the DSM-5 classification of transgenderism as a disorder:

The fifth version of DSM is important for several reasons. The DSM-5 contains two diagnoses relevant to transgender and gender-variant individuals. First, the previous and disliked “Gender Identity Disorder” (GID) will be replaced with the diagnosis “Gender Dysphoria”. The second change will replace “Transvestic Fetishism” with “Transvestic Disorder,” which is a disturbing development because the phrase “Transvestic Disorder” is stigmatizing and problematic for a number of reasons.
The Task Force hails the APA’s revision and renaming of GID to “Gender Dysphoria” as a step in the right direction, and applauds the APA continuing to take a positive stance on transgender civil rights. However, it is our firm stance that both “Gender Dysphoria” and “Transvestic Disorder” should be removed from the DSM entirely. While we support retaining “Gender Dysphoria” for the time being, the “Transvestic Disorder” diagnosis should be removed immediately. (Note: The renaming GID has been confusingly called “removal” by some community members yet our analysis is that it is better understood as renaming and/or revision.)
Gender variance is not a psychiatric disease; it is a human variation that in some cases requires medical attention. For this edition of the DSM, because there is no other medical diagnosis available for transgender people to seek reimbursement of medical expenses under, we recommended that some version of gender dysphoria appear in DSM-5 as a stop-gap measure. There is a continuing need for the medical and insurance industries to update their procedures for reimbursement so that gender dysphoria can be removed entirely in the future.
Yet, we must understand that as long as transgender identities are understood through a “disease” framework, transgender people will suffer from unnecessary abuse and discrimination from both inside and outside the medical profession. As long as gender variance is characterized by the medical field as a mental condition, transgender people will find their identities invalidated by claims that they are “mentally ill,” and therefore not able to speak objectively about their own identities and lived experiences. This has even been used to justify discrimination against transgender people, such as in child custody cases, discrimination in hiring/workplace practices, or justifying them to be mentally unfit to serve in the military.
Even more alarming is the high rate of children—and adults—who will continue to be forcibly subjected to abusive“reparative” therapies designed to “cure” them of gender variance. While the “Gender Identity Disorder” framework of the DSM-IV did have some usefulness for accessing care, there is significant evidence that it has been gravely abused since its creation as a way to subject gender-variant children and adults to damaging “reparative” treatments against their will.
https://www.thetaskforce.org/invalidating-transgender-identities-progress-and-trouble-in-the-dsm-5/

I do take issue with the article's idea that we should not have a diagnosis of 'gender dysphoria'. Without a diagnosis how can we receive medical and/or mental health assistance? I do not understand the concept of on the one hand saying there is nothing wrong with me because I believe I am a different gender and at the same time demanding assistance in alleviating any issue, medical and/or mental that I may have. Why would any insurer even think twice about reimbursing an individual's claim for reimbursement for medical and/or mental health costs for something that doesn't exist?

**Celia Eriksson** Thu May 30, 2019 8:27 pm

Hi Miki,

I believe the WHO presumption is that an individual born as the wrong gender can have 'treatment' that corrects the natural occurrence. But that is not necessarily going to be how it will be interpreted. There is no other word apart from 'treatment' for the overall process, but it does not presume that a mental disorder is the base for that. So, I agree with all that you write about being regarded as having a mental disorder, but I believe individuals born wrong gendered is without doubt natural and should be viewed and qualify for treatment as such. The negative connotations of being considered having a mental disorder is bigoted. It is though, one over the other, a catch 22. I have to say I welcome it, for it is very important that we are not locked in, ad infinitum, as mental health cases, just to qualify for treatment.

So yes, as I intimated, it is a fact that the declaration is a double-edged sword and will have many negative effects. But, it needs to be clear to all that we do not possess a mental disorder. It is an advancement and hopefully 'treatment' will not be affected by level headed governments and authorities that actually heed the WHO.

Celia xx

Elizabeth Lynn Thu May 30, 2019 9:13 pm

WHO publishes the International Classification of Diseases. They are working on version 11 to make this change. The US has still not completely implemented ICD-10 and is typically years behind the rest of the world in version implementation.

In the US, it is ICD codes that are used as the source for most reimbursement billing and pre-authorization codes. This change removes the diagnosis from the Mental Health section and places Gender Non-conformity in the chapter on Sexual Health. This is very similar to what happened for DSM V.

Ostensibly this de-pathologizes the state of identifying as a gender other than the one assigned at birth. It's a step, but it ain't going to change the world. Every nation chooses if and when they implement a new version of the ICD code set. Here in the US, the implementation is driven by the Centers for Medicare and Medicaid Services, a part of the Health and Human Services Administration. Remember is is HHS who is driving the attempt to remove section 1557 (non-descrimination section) from the Accountable Care Act (ObamaCare) and allow provider organizations and individual practitioners to discriminate at will against trans people.

Here's a short informational vid from the WHO's website about what they did and why.

WHO ICD-11 Transgender Changes

~ Liz

**MichaelaSJ** Thu May 30, 2019 9:42 pm

Here is a link to the detailed, and mostly confusing ICD code regarding transfolk:

https://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.1

Lesley Niyori Thu May 30, 2019 10:22 pm

All that glitters isn't gold.

I got my new OHIP card the other day. The previous one had F for female, this one doesn't even have gender as an option.

Some might see this as a good thing, some might not. Having FEMALE boldly stated on a transgender female's ID can be very affirming. Of course, gender fluid persons and non-binary persons might like the ambiguity. I do not though. It took me a lot of discomfort to get recognized as female.

Some times we actually NEED something that appears like a nuisance at first glance.
I don't like being referred to as a 'disorder', but, hey, if it gets a person covered for expensive medical attention, I say "shut up and be happy for the coverage."

**Celia Eriksson** Thu May 30, 2019 10:41 pm

Hi Liz and Miki...

So Liz, the yt video is a set proposal that was met last Saturday. It outlines it perfectly. Thanks Liz!!!, Dr. Say also explained it well, in advance, last year. xx

Miki, the ICD-10 code is contrary and needs revision, maybe it is not actually up yet. The new ICD-11 code has eliminated us from the viewpoint as being mentally ill, to our natural status in humanity, as being born the wrong gender. I have edited this because I find no revision yet to ICD-10, but I am sure the ICD-10 page will be revised. It may be a defunct page, but I will mail them if they don't change it!!!

Lesley, when faced with the choice of only male or female I choose female, now I have to admit, if transgender is an option, which in the UK is increasingly available, I will choose that. I do not opt for 'neutral' or 'rather not say', which I have encountered. I understand the point of immediate referral, but that should not change just because our condition is natural rather than a mental disorder. It needs addressing!

I began the thread to discuss whether we really want to be classed as having a mental disorder.... if that means ditching the term dysphoria in being recognised as not having a mental disorder. I doubt some can. I believe our condition is natural, as I have said many times, yet still needs treatment. It is a worthwhile trade off. If we can become more like the gay community, recognised as being what we actually are, natural human beings living natural lives that deserve respect, then I am all for it. That we suffer depression because of the lack of support, or receiving both swift diagnosis as being born in the wrong gender and having 'treatment' for that is key for all to embrace it, I realise that. But do we want truly, to be auto-placed into the mental disorder bracket???!!!!

This is what I wanted the emphasis upon, to gauge how you girls feel about that.

Celia xx

Guest Thu May 30, 2019 11:02 pm

I can only agree with Celia. In fact her last post is exactly how I see it. Look in an ideal world we'd just be accepted. I've seen how being gay is now actually mainstream at one level but not really in the real world where bigotry is not gone.

But we're not. We're also a political football. The last minority who can be painted as a danger to women and children in the typical bigoted patriarchal religious bollox.......

I despair.

I wish I wasn't transgender. Every fucking day. I feel guilty about it even though I'm really a nice person. My wife says so. My female friends say so. My kids say so, my sister says so but in reality I'm mentally ill and a threat to society according to those people.

**MichaelaSJ** Fri May 31, 2019 6:19 am

What if any of us show up at a health professional's office and say 'I am not listed as the correct gender. I am male or female yet I appear as female and male and I want help to make my physical gender congruent with my desired gender.'

The health care professional says 'You fall within the normal human condition and there is nothing I can offer you.'

Is this what we are really after? Do we really want our acceptance so total that we have been precluded from any medical and/or mental health help? Do we want any medical help to be on the same par as cosmetic surgery? Do we want hormone therapy treated as an elective therapy and not subject to insurance reimbursement?

We are not sick! But we do have a treatable condition that for lack of a better term is called 'Gender Dysphoria'. Do you realize this all goes away if we do not have a medical and/or mental health treatable condition?

**Celia Eriksson** Fri May 31, 2019 8:17 am

Hi Miki!!!

And there is the rub. It is difficult not to go round in circles here, or repeat oneself.

Suffice to say that in an ideal world one would still expect treatment without the stigma of being labelled with a mental health problem. I certainly do not wished to be labelled so.

So, as far as receiving treatment is concerned, if an individual has any naturally occurring problem that is causing depression, and otherwise they are a mentally healthy person, does that person receive treatemt, or are they left without treatment to suffer? I would say that was not going to happen, they would receive treatment.

The problem lies in individual nations, or in the USA's case, states and their attitude towards transgender people. That for me, is the bridge that needs to be crossed... being labelled mentally disordered does not help build that bridge.

I'd like to write more, but I have to go, but quickly, look at some of the states today, Alabama and Georgia and their attitude towards abortion, they are going backwards..... this is where the problem lies, right wing governance. Back later,

Celia xx

**MichaelaSJ** Fri May 31, 2019 9:16 am

Celia Eriksson wrote:Suffice to say that in an ideal world one would still expect treatment without the stigma of being labelled with a mental health problem. I certainly do not wished to be labelled so.

A lot of people receive treatment for depression and we don't label them as mentally unfit. Simply receiving treatment for a diagnosed condition, in our case, also does not label us as mentally unfit.

Celia Eriksson wrote:..... this is where the problem lies, right-wing governance.

And we can ALL agree with that!!!!

Supreme_Pizza Sun Feb 23, 2020 12:32 am

It is nice to be recognized as statistically significant.

Even if we are only recognized for our deviance from the "norm" at least we are recognized as people.

It's that statistical significance that requires classification, not so much the people, but the condition.

So we've come far.
We were recognized as culturally deviant.
We were counted.
We were deemed significant enough to protect.
We gained the right to be treated medically. (sometimes)

But not far enough.
That was followed with right wing propaganda and public outrage.

Being used as a political distraction in order to divide people really ticks me off.

**Celia Eriksson** Sun Feb 23, 2020 12:43 am

Hi SP,

Thank you, I particularly like the last line, on that we must all agree! I have said many times, we are the last free hit for the bigot. It is time we had the same protection as any minority and I plain refuse to be thought of as suffering from a mental disorder!

Celia xx

Supreme_Pizza Sun Feb 23, 2020 1:16 am

Celia Eriksson wrote:Hi SP,

Thank you, I particularly like the last line, on that we must all agree! I have said many times, we are the last free hit for the bigot. It is time we had the same protection as any minority and I plain refuse to be thought of as suffering from a mental disorder!

Celia xx

Any in-congruence is disorderly and that's how it's going to be classified. No sense in arguing with science. We have provided, through our own volition, irrefutable empirical evidence that we are different. That's wonderful, and eventually medical science will explain to us why.

The horrible part is the cultural reaction to the classification. That will not change completely in our lifetime. Quite frankly we don't have to like it, but we do have to live with it. Which is why I go to work in drag. (Men's business casual.) And I rock it fiercely.

Maybe for not much longer, I'm leaning toward FFS. I stopped transition cause I didn't want to get cut on but now I'm concerned about continuing the drugs as i get older.

Anyway, the classification is just that, it has no feelings that we don't ascribe to it.

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