Keri Renault

Is "Gender Incongruence" the Cure for What Ails?

Filed By Keri Renault | February 11, 2010 9:30 AM | comments

Filed in: Living, Transgender & Intersex
Tags: American Psychiatric Association, APA, DSM V, ENDA, gender identity disorder, Gender Incongruence, GID, LGBT Health Care Reform, transgender, transsexual

The American Psychiatric Association has released a draft of proposed diagnostic criteria for its Diagnostic & Statistical Manual-V (DSM-V). A 90-day review period is now underway with feedback solicited prior to creation of a final draft which will be published in 2013.

My initial reaction to the draft after a cursory review is generally positive. It's progress. The new code would replace the punitive descriptor "disorder" with the palliative term "incongruence." But does it cure what really ails us?

Here's an excerpt from the APA:

It is proposed that the name gender identity disorder (GID) be replaced by "Gender Incongruence" (GI) because the latter is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one's assigned gender (usually at birth) (Meyer-Bahlburg, 2009a; Winters, 2005).

The revised language acknowledges use of the term "disorder" perpetuates the marginalization of gender variant transitioners. Respondents to an APA questionnaire indicated Gender Identity Disorder is stigmatizing.

Gender Incongruence frames a more palatable treatment definition and an "exit strategy" that humanizes instead of chronically pathologizes those who have successfully transitioned to their target gender.

I applaud the proposal to banish the "perceived cultural advantages" proviso. It had reflected cisgender ignorance and arrogance. Good riddance.

The draft proposes a separate diagnostic category for children and another for adolescents/adults.

The battle over word choice has been a flashpoint between transgender activists and the medical community for years. Now the APA is on the cusp of excising that discriminatory verbiage.

So will transgender America be one happy family if the proposed changes are enacted?
A loaded question since the transgender community is a volatile conflagration.

Ever since the APA designated gender identity disorder in the DSM, divergent camps and personality types have been forced together in a largely unwelcome union.

The transgender "community" is a philosophically divergent, politically unstable, culturally uncooperative lot, loosely held together under the catch-all of gender variance.

It's a thread bare hold.

At times it appears the self-ascribed true transsexuals' moral imperative is to secede from this uncivil union of psychiatric convenience; to break free of the "fetishistic transvestite" and the garden variety crossdresser.

How about this old joke as a counterpoint: What's the difference between a crossdresser and a transsexual? Answer: About 2 years. (Fill in the blank with whatever time period you've personally experienced).

I'll buy the term Gender Incongruence. Amazing the APA committee agreed on such a diagnostically neutral designator given Ray Blanchard's guiding hand and his inflammatory dissertation on autogynephilia.

But this tit for tat exercise gets tedious, really. There are far more substantial trans-issues at stake.

Like transgender unemployment, under compensation and inequity in the workplace.

Like the inability to pee in peace.

Like youth homelessness and an unwelcoming or threatening environment in public shelters built on sex stereotypes.

Like incarceration, transphobia and violence.

Like the discriminatory practice of landlords and building managers who reject or overcharge qualified transgender applicants to discourage renting.

And my pet peeve: The continued discriminatory practices of the health insurance industry.

Unwarranted, across-the-board exclusions perpetuate mental and physical health issues, and prevent transgender individuals from physical transition due to cost prohibitive treatment protocols and reassignment surgeries.

It's all well and good to advocate DSM reform. Transgender activists who have worked tirelessly on it deserve credit for their herculean efforts. But it's crucial to take a stand for universal civil rights equality, by actively supporting ENDA, LGBTQ health care reform and--in the interim--statewide anti-discrimination legislation.

Unless equality initiatives receive the vocal support of the entire "transgender nation" our voice will never truly be heard much less accepted.

Federal law is where "enforced" credibility counts, mandating America to experience gender variant individuals for who we really are---people just like them. Civil rights reform on a state level--and ultimately Federal reform is where long-term change is effected on the social culture status quo, not in a diagnostic manual.

Do that and GID and Gender Incongruence both go away.

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Given the steady erosion of civil rights of post corrected women I have personally experienced and witnessed over the past 13-14 years....I am celebrating because:

It acknowledges that classic transsexuality is vastly different, that it has a cure and once cured, you are free of all taint of mental illness.

Post corrected women are acknowledged as not "trans" anything, not disordered because they were born with a correctable birth condition once that condition is treated. This is the long and short of it. Having been told for over a decade that I am crazy due to inclusion of transsexuality in the DSM and transgenders are not by "trans activists", the irony of seeing this reversed is downright delicious.

Combined with the recent tax decision, the acknowlegement of the AMA that SRS cures transsexuality in the last year this ends any claims of post corrected women being included in transgender political identity unless they willingly embrace it and I know most of us won't.

The great trans war is over, the trannys lost, the women won. Let them spin this to their hearts content, it changes this not one iota.

Don't use the word "tranny". It's not a difficult concept to comprehend. How many times does this have to be said?

"Tranny"? I don't comprehend what you're saying since I didn't use the slang. Lecture to your heart's delight. It's your right. But please understand where & when your social critique may be applicable.

Dear Megan who are you to tell people what to say? Are you the WORD POLICE? My self definition is beyond your need for political correctness.

What arrogance. How many times do I have to repeat it?

I am Granny Tranny. If you don't like it, don't use it. But don't tell others how to talk. It's rude.

Keri, Sissy,

I was imagining Megan could further explain this, but without a response yet let me step in.

I can see pretty clearly from Megan's comment that she wasn't speaking to either of you. Keri, take a look at the nestled comment. It's a direct response to Radical Bitch, who did use the word "tranny."

Sissy, notice that she's not telling someone who self-identifies with the term not to use it. RB's use of the word is pretty clearly derogatory. She uses it to speak of a sub-population of trans women which she despises.

I can't say exactly what Megan's intentions are, but usually you don't assume someone is against reclamation through self-identification when they are telling someone not to use a derogatory slur as a derogatory slur. If someone was ranting about "stupid faggots" I might tell them not to use that word, but I wouldn't dream of telling someone not to share their pride in their faggotry.


I appreciate your enthusiasm, as I was happy to see the very same changes. As much as I want the "trans war" to be over regardless of who is declared a winner, I'm a bit confused by what you are presenting. I don't understand how you see this as a blow to the people you refer to as "trans activists" and "the trannys." Unless, perhaps, you are referring specifically to people who maligned you and called you crazy.

Most of the folks I know who identify as trans activists or might be included within the derogatory slur "tranny" would be appreciative of this change as well. The possibility of an "exit clause" is cause for celebration for anyone who does not feel or believes they will reach a point they no longer feel an "incongruence" between their gender and their physical and/or legal sex and do not want a DSM diagnosis.

The incongruence being measured is both between sense of gender and physical sexual characteristics and between sense of gender and legal sex. A non-op trans person who has their legal sex recognized will be "cured" of the diagnosis just the same as a post-op trans person who has their legal sex recognized.

Wow, I read the proposed changes, and I didn't get this from the new text (that ppl with surgery are then excluded). Could you explain this a bit?

Thanks! :)

At the top you'll notice four tabs. Along with the proposed revision is the rationale and the end notes. End note #2 includes the following:

The term “sex” has been replaced by assigned “gender” in order to make the criteria applicable to individuals with a DSD (Meyer-Bahlburg, 2009b). During the course of physical sex differentiation, some aspects of biological sex (e.g., 46,XY genes) may be incongruent with other aspects (e.g., the external genitalia); thus, using the term “sex” would be confusing. The change also makes it possible for individuals who have successfully transitioned to “lose” the diagnosis after satisfactory treatment. This resolves the problem that, in the DSM-IV-TR, there was a lack of an “exit clause,” meaning that individuals once diagnosed with GID will always be considered to have the diagnosis, regardless of whether they have transitioned and are psychosocially adjusted in the identified gender role (Winters, 2008) Emphasis added

"Successfully transitioned" in this case, refers to reaching a point where the diagnostic criteria -- which focuses on incongruity between one's sense of gender and their physical and/or legal sex -- no longer apply. The idea being that if one's physical and/or legal sex are sufficiently altered to reduce or eliminate the sense of incongruity, then the diagnosis no longer applies.

Thanks, Tobi!

I didnt see the other info, just looked at the new text. Seemed pretty terse to me, not a lot of context. I'll have to go back and take another look.

Carol :)

Radical Bitch,
I appreciate your comment, but please remember that women are not the only transsexuals. So if you want to refer to 'post corrected' people, please remember to include men and third gender folks. Someone who identifies as neither gender and reaches the point where their physical body and social life is incongruent with their non-gendered identity and are therefore no longer suffering body dysphoria or incongruence, is also considered 'corrected.' Leaving out these people perpetuates the stereotype that all transsexuals are some take on MTF.

AMEN...and I'm an atheist!

I'm not at all an expert here since I am neither psychiatrist, sociologist or trans, but my education is philosophy and religious phenomenology so I do wonder a bit from a logical perspective.
My most basic problem is considering something and illness like this be it a disorder or a incongruence. The use of the term problem bothers me in as much as the assumption is that something is wrong.
I just don't see considering this to be a healthy problem when in some societies third genders and gender expression have a role. It means that in those societies it is considered within social norms.
I wonder if Psychiatrists c should be taking about it as a problem that individuals have or if it should be talked about by sociologists as a problem that some societies have.
I just don't see it. It doesn't make sense that something that has been historically present in human kind for so long and which is accepted in some societies should be treated as an illness when it does not endanger the person in any medical way. The dander to the person seems to be in societal response and treatment of the person.

Agreed. Whether in Somoa, or as part of Native American culture and in all other societies, throughout history "transgenderism" has existed, under many different names. It has found respect in the Somoan culture as a 3rd sex. As Berdache and Two-Spirited in Native culture to name a few. American society deems it a "disorder" by virtue of the fact that gender variant people violate the gender binary. Until society finds the ability morally or legislatively to accept the diversity of human expression, fear will continue to legislate oppression, mandating gender outliers to conform. The struggle for equality will continue, sadly, and at what cost.

In 302.85, the term "Assigned Gender" is newly concocted and not explained. The implication is that a person has just one assigned gender and it is a simple concept.
That is actually true - but ONLY for non-transsexual non-intersex people.

It is not even clear whether the ambiguity is unintentional, uninformed, callously uncaring, due to lack of awareness of other cultures, intended to give practitioners unlimited discretionary power or simply invidious.

I find nothing to be offended by in the post by Keri, and agree with nearly all of it. I do feel however it is slow going and keep in mind what they put into this DSM volume will be the "law" many therapists will subscribe to for the next decade. In that I feel it has moved too little in the direction I would wish to see if I view it in that light. Ten years is a long time to be not fully be recognized as worthy of the respect. Something I feel is long overdue already. It is unfair in a country that is supposed to champion fairness. Yet because our voice is not loud enough to overcome the bigots that wish to lump us in with the likes of peepers, and predators we remain mired in what I feel is nothing short of injustice.