Views on GID
Not everyone agrees
with the pathological approach to diagnosis and treatment of Gender
Identity Disorders. While this site focuses on the scientific, medical
approach to GID it has no agenda or makes claim that approach is the
only viable option. This section will attempt to present, briefly, the
main differing opinions on the subject.
for Inclusion of GID in the DSM & ICD
First of all, the
reasoning behind inclusion of Gender Identity Disorders in a catalog
of "mental illnesses" should be explored.
Benjamin International Gender Dyphoria Association, widely regarded
as the "authority" on diagnosis and treatment of gender disorders,
is a professional organization of mostly doctors who support the pathological
approach to diagnosis and treatment.
One argument they
have put forth is that inclusion in the DSM-IV and ICD-10 are necessary
for gaining access to the medical services involved in treating gender
problems. They argue that, without such inclusion, there would be no
legitimate basis for GID patients to receive proper psychological, endocrinological,
or surgical services from the medical community.
An additional, somewhat
dubious argument, is that inclusion is necessary to ensure coverage
of those medical services by insurances. The statement is dubious because
most private insurance companies use the medical definition of GID as
a means to exclude it from coverage. Even in those nations with National
Healthcare systems, many are excluding coverage of therapy, and especially
surgery, for those diagnosed with GID.
The final argument
in favor of the pathological approach from the HBIGDA folks is that
the "Standards of Care" (HBSOC) needs a medically accepted
definition to ensure consistency in diagnosis and treatment.
Against Medicalization of Gender
There is also a
group of people who oppose the inclusion of gender behaviors and presentations
as "diseases" or "disorders" altogether.
Part of the basis
of this argument is that gender behaviors are naturally variable from
person to person. And that "acceptable behaviors" are a dictate
of social beliefs, not mental or physical illness. Proponents of this
view say that behaviors currently diagnosed as "transsexualism"
or "transvesticism" are actually just forms of "social
The DSM manual defines
"mental illness" at the beginning of the book in this way:
deviant behavior, nor conflicts that are primarily between the individual
and society are mental disorders unless the deviance or conflict is
a symptom of a dysfunction in the individual."
Which does beg the
question as to why, in the section on Gender Identity Disorders, it
makes an exception to that definition with:
Identity Disorder can be distinguished from simple nonconformity to
stereo-typical sex role behavior by the extent and pervasiveness of
the cross-gender wishes, interests, and activities."
The argument is
that most of the psychological turmoil faced by people of variable gender
behavior or presentation is due to social non-acceptance of them. Which
would be a conflict "primarily between the individual and society."
And the exception, as stated, implies that you can be a "non-conformist"
but only within some undefined social boundaries. Which is somewhat
nonsensical because the definition of "social non-conformity"
is a person whose behavior is outside normal social boundaries.
Most backers of
this viewpoint state they simply have an inalienable civil right to
live their lives as they wish, free of the stigmatization of "mental
illness" or "perversion" they believe is perpetrated
by the medical community against gender-variant people. They
believe it is irrelevant whether or not their behavior is a "choice"
or "innate," because they have a basic human right to live
in whatever way makes them happy and comfortable with themselves.
Much of the foundation
for this argument is based in the success by Gay Rights activists in
having homosexuality removed from the DSM as a "mental illness"
in 1973. Given the many similarities in definition and social attitude
toward gender-variant people, they believe it makes no sense that homosexuality
was removed, yet GID was not.
Some people behind
this viewpoint actually endorse the current version of the Harry Benjamin
Standards of Care, because of it's focus on the relief of the individual's
distress, rather than on the imposition of socially dictated (often
sterotypical) gender roles.
feel that ANY medicalization of what they see as a simple matter of
"personal identity" as being - at the very least - highly
insulting if not a denial of their basic civil liberties. They hold
a view that the DSM/ICD criteria and the Triadic Therapy advocated by
the HBSOC serve to render them "infantile," without ability
to make decisions concerning their own lives, and render their personal
identities "illigitimate," "delusional," or "perverted"
in favor of a medically defined, socially acceptable identification
in alignment with their genitals.
For more detail
on the points of contention in this argument you may wish to visit the
GID REFORM web site
or a detailed summary available on this site.
for Medical, but not Mental, Definition
There is also a
contingent of people who strongly believe that GID should be removed
from the catalogs of mental illnesses in favor of inclusion in the catalogs
of "rare diseases and disorders" alongside other "birth
People behind this
argument claim that gender disorders stem from a as-yet-undiscovered
physical cause. They believe that physical difference is a "birth
defect" that exclusively affects the part of the brain responsible
for gender role behaviors. The term they have used is "neurologically
intersexed." They would also like to see the name changed from
"Gender Identity Disorder" to "Benjamin's
Syndrome." (apparently not to be confused with the existing
"Benjamin Syndrome," which is a form of anemia).
The main hurdle
for those who favor this view is that a physical, medical re-definition
will not be forthcoming until that underlying physical cause is identified.
Given the great strides being made in neurology and genetics they are
confident that, one day soon, researchers will announce they've found
the "gene" or "brain structure" responsible. And
once that happens there will no longer be any justification for including
gender disorders in a catalog of mental illnesses.
Critics of this
view of GID point out that, even if such a "cause" is scientifically
identified, it would only take discovery of ONE person with the "marker"
who wasn't Gender Dysphoric to disprove the theory. Proponents point
out that most of the genes that have been tied to behaviors do not "dictate"
the behavior but "predispose" the individual to it, given
an environment that triggers the predisposition to the behavior. Regardless
of whether or not the individual acted in a gender-variant fashion,
opponents argue that such "proof" could be used to stigmatize
anyone who presented with Gender Dysphoria who DIDN'T have the marker
as "insane" or "delusional" (potentially leading
to misguided efforts to "cure" the person).
Unlike the argument
presented above, most people who favor this idea believe that the gender
role behaviors are "innate" and that the individual does not
"choose" to act in a gender-variable manner. They generally
reject the idea of gender-variable behavior as a "lifestyle choice."
that end is an ongoing, international effort covered in greater detail
under the medical research section of this
Those that do not
like the medicalization of GID often actively avoid interaction with
the portion of the medical community that follows the Harry
Benjamin Standards of Care, and choose instead to self-medicate
with hormones and seek surgical services from doctors outside the "established
channels." The fact that they can do this at all proves that not
everyone in the medical profession agrees with the "official position."
No matter which
position you may choose to stand behind, you are bound to run into people
who do not share that opinion - and may even be vehemently opposed to
it. There are obviously pros and cons to each position, but there is
also no "right" answer.