Kelley Winters

Call to Action to Urge Trans-Affirming Position Statements by the APA

Filed By Kelley Winters | May 25, 2009 1:00 PM | comments

Filed in: Action Alerts, Living, Transgender & Intersex
Tags: American Psychiatric Association, APA, gender identity disorder, GID, Psychiatry, Psychology, transgender, transsexual

On May 18, I presented a paper to the Annual Meeting of the American Psychiatric Association on the diagnostic categories of Gender Identity Disorder (GID) and Transvestic Fetishism (TF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Coauthored by San Francisco psychologist and community advocate Dr. Randall Ehrbar, our presentation stressed the need to address two issues in the upcoming Fifth Edition of the DSM. First, the GID and TF diagnoses inflict harmful stigma of mental illness and sexual deviance on all trans, gender variant and queer identified individuals who do not conform to their assigned birth-sex, either by inner identity or outer social expression. Second, the GID diagnosis fails to support the medical necessity of hormonal or surgical transition care for those transsexual individuals who need them. In fact, the current GID diagnostic criteria and supporting text contradict both medical and social transition.

In addition to the case for reforming GID and removing the defamatory TF diagnosis in the DSM-V, we also urged the elected leadership of the APA to issue three public position statements in support of human dignity and medical care for trans and gender variant people.

We would like to ask the trans-community, our LGB and straight allies and especially our supportive medical and mental health providers to join us in calling for position statements that gender difference is not disorder, affirming the medical necessity of transition care, and recognizing social gender transition. The American Psychiatric Association has an opportunity today to reclaim its compassion for human dignity and its mandate to do no harm.

In 1973, the American Psychiatric Association made a historic step toward the ultimate declassification of same-sex orientation as mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although the actual removal of the homosexuality diagnosis from the DSM occurred in incremental revisions over the following fourteen years, the elected leadership of the APA issued a Position Statement on "Homosexuality and Civil Rights" that had a profound impact on public opinion and defamatory stereotypes. Tragically, the APA has never issued a similar position statement in support of trans and gender variant people.

How can you help?

Please send letters to the President and Board of Trustees of the APA and the President of the Association of Gay and Lesbian Psychiatrists with the following requests:

  1. We ask the elected leadership and Board of Trustees of the American Psychiatric Association to affirm in a position statement that gender identity and expression which differ from assigned birth sex do not, in themselves, constitute mental disorder and imply no impairment in judgment or competence.
  2. We also ask the APA to follow the example of the American Medical Association and the American Psychological Association with a statement clarifying the medical necessity of hormonal and surgical transition treatments for those who suffer painful distress with their physical sex characteristics that are incongruent with their persistent gender identity.
  3. Finally, we ask the American Psychiatric Association to follow the example of the American Psychological Association in encouraging legal and social recognition of all people that is consistent with their gender identity and expression. We ask the APA to affirm in a position statement the dignity and legitimacy of individuals who have transitioned their social gender roles, regardless of their physical anatomy or assigned birth sex.

Contact Information:

Alan F. Schatzberg, President, American Psychiatric Association Carol A. Bernstein, M.D., President-elect, American Psychiatric Association American Psychiatric Association 1000 Wilson Boulevard Suite 1825 Arlington, VA 22209 email in care of: [email protected]

Board of Trustees, American Psychiatric Association

in care of: Thomas Graham Senior Governance Specialist - Board of Trustees email: [email protected]

Copy to Ubaldo Leli, M.D., President, Association of Gay and Lesbian Psychiatrists

email: [email protected]

Also, please send copies of your letters to me at [email protected] to be posted in an online archive. Include the phrase "APA Gender Position Statements" in your email header.

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Nice post, Dr. Winters! I strongly agree with you and have followed your suggestion to send e-mails to the parties mentioned.

On a related note and in the spirit of the Dallas Principles ( ) it is getting old patiently waiting for the US Constitution to be followed in encouraging fair treatment of everyone. Why is it that every group has to fight for what was established in the US Declaration of Independence? For what the men and women of our armed forces who we honor today fought for many times:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

That's great news, Dr. Winters! What was the reaction to your presentation?

I will certainly send in my letters.

I empathize with the arguments of those trans people who feel that the diagnosis is helpful to our cause and I agree that it is helpful in countries where trans identity is otherwise unanimously viewed as sinful. The move from "bad" to "mad" was, as historians of medicine note, a major step forward in destigmatization. For that reason, I am not sure whether it should now be removed from the ICD IV.

In the US, however, we are past the need for medicalization that once existed. We will be strengthened much more by working on social acceptance, and I believe it is more likley to achieve that acceptance without medicalization.

Do you have a position on ICD, Dr. Winters?

There is a lot of confusion about gender disorders in the International Statistical Classification of Diseases and Related Health Problems, or ICD, because the manual contains both physical medical disorders and mental disorders. The current ICD diagnoses of Transsexualism, Dual-Role Transsexualism, and Gender Identity Disorder of Children are classified as Mental and Behavioral Disorders, under the section of Adult Disorders of Personality and Behavior. These diagnoses are modeled after GID in the DSM and pose many of the same horrible false stereotypes of mental illness and sexual deviance, as well as barriers to medical transition care. In the near term, I would like to see forward progress on the issues of unfair social stigma and access to transition medical care in the ICD as well as the DSM-V. Ultimately, I hope that physical medical diagnostic nomenclature in the ICD will replace all psychiatric gender diagnoses in the DSM and ICD. Dr. Becky Allison presented a compelling case to the APA Annual Meeting in San Francisco for a medical approach to diagnosis and treatment of gender dysphoria.

You're a natural with a bullhorn, Kelley!

I am one who favors a separation in the DSM in regard to those who might be listed under the transgender construct from those who are actually transsexual. Transsex should never be a sub-set under the transgender umbrella.
I had surgery 37 years ago and since that time have run into many whom I firmly believe are psychologically 'misguided' and should be listed under some clearly defined mental aberration in the DSM. Rarely would I apply that comment to those who have had surgery, at least those I met, who seem to live rather fruitful lives after corrective surgery.
I also believe the medical establishment has been led to confuse the issue of 'trans whatever' and to include all who actually are in need to correct their genitalia to conform with their brain gender with some misconception that all trans folk somehow are linked by some transparent sticker glue. Not so!
To act out a fantasy is not the same as being in drastic need to bring the part to the whole: genitalia into conformity with the actual brain gender.
Fantasy is just that and in some arenas might well be a psychological problem affecting the normal range of behavior which may reflect in harm to ones self either physically or socially. For too long that avenue of thought has been linked to even those who might well be true transsexuals which should never be thought to be but an extension of sexual orientation, fetishism, or 'in your face' behavior.
The true transsexual is in need of medical care and not to be equated with someone who may well suffer a delusion fostered by a progressively unsatisfying and growing fantasy.
I firmly believe that many transgender societal inclusions are aspects of nurture whereas I also believe that a true transsexual is a matter of inborn anomaly. The confusion is when the two are joined as if but the same with a slight difference.

great video, Dr. Winters. I'm glad people are inspired to fight this one out!