Conflicting 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.

The Argument 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.

The Harry 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.

The Argument 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 non-conformity."

The DSM manual defines "mental illness" at the beginning of the book in this way:

"Neither 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:

"Gender 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.

Others, however, 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.

The Argument 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 defects."

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."

Research toward that end is an ongoing, international effort covered in greater detail under the medical research section of this site.

CONCLUSION

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.