Due out May 22, 2013, the newest version of the Diagnostic and Statistical Manual (DSM-5.1) will no longer treat gender variance as a disorder. Among other revisions (hoarding will now have its own diagnostic code rather than remaining under the OCD umbrella), the stigmatizing term of “disorder” will not be used to describe Transgender men and women. Instead, the term “Gender Dysphoria” will replace it. Now remember, the good-hearted folks of the American Psychiatric Association do not take anything away without leaving something in its place. Their decision may be just what we’ve needed all along.
Just like most of the changes made to the DSM over the years, this one does have an upside. Furthermore, as the Chairperson of the DSM5 Taskforce, David Kupfer, M.D. states in the “For the first time in the history of DSM, the total number of diagnoses will not grow.” (DSM-5.org, June 01, 2012) Along with more than 700 of his fellow mental health clinicians, Dr. Kupfer has worked tirelessly over the past fourteen years to create a kinder, gentler version of the manual, which is totally revised and published every ten years. Between totally revised editions there are minor revisions made which have previously had the letter ‘R” added to their titles. For example, the DSM-IV-R, which I have been using for the past decade, is a revised edition of DSM-IV. The new 5.1 allows for revisions with the technological reference ascribed to updated versions of web browsers and operating systems. We can look forward to the DSM-5.2, etc. Also note that the use of Roman numerals has been replaced by the more commonly used (in the U.S and Europe) Arabic numeric system.
Health insurance companies require a diagnostic code if they are going to cover the cost of treatment, and I do mean: if they are going to cover the cost. But that, however, is a topic I will save for another day. Our Transgender sisters and brothers frequently rely on the insurance companies to pay for or reimburse them for the high cost of ‘transitioning.’ A term I use with some trepidation because one does not transition to a gender one was born to. Nevertheless, if you want to call helping the body conform to the spirit, then transition is, I guess, as good a term as any. So, without a diagnosis that the insurance companies can hang on to, there would be no reason for them to shell out a cent of the money they have taken in through premiums and investments. A trade off is perhaps the price we pay in negotiations. So let us at least revel in the most positive aspect of this small, or maybe not so small, victory.
Please don’t let my snide comments dismay you. I practically had to memorize the DSM when I was in graduate school. There are entire courses centered on navigating the manual, learning how to decipher it and use it to our best advantage. It goes beyond coding and reimbursement. It is one way that mental health professionals learn to communicate effectively with one another. If we all had different names for various conditions it would be like harkening back to Babel. So, maybe the DSM is a necessary but not so evil guide to better communication. And maybe it gets better with each revision.
How the Trans Community sees this change, I’m sure, is as diverse as the many members of the community at large. At the NCMR (National Conference for Media Reform) held in Denver, Colorado this month I spoke to several Transgender and Gender Variant individuals who had differing opinions on this issue. One TransWoman told me that “people with little or no financial resources depend on a diagnosis-any diagnosis” to obtain support for prescription hormones, mandatory mental health treatment and surgeries (if that is a desired option). Another told me that during a brief incarceration for a misdemeanor shoplifting charge she was only permitted to get her medication because of the psychiatric diagnosis. Another conference attendee who refused to be identified as either male or female stated that “it’s all just another way to keep us labeled and deny our humanity.” I do not mean to use these examples as a testament for or against the DSM and/or for any of its policies. What I am saying here is that there is a change, and for better or worse it is like all change… inevitable.