Western psychiatry's struggle to characterize those who do not identify with prescribed gender roles looks to be analogous to the history of homosexuality, which was a diagnosis (in at least some form) until 1987.
When asked, "What are you?" Cocoa Chandelier confidently replies, "I am māhu. Not ma-hu or mahU, but māhu."
In Native Hawaiian culture, māhu represents a third gender -- someone who embodies both male and female qualities. In old Hawai'i, māhus entertained the chiefs and people held them in high regard. Māhus distinctively had higher powers because they embodied the best of male and female qualities, making them confidants, kumu hulas (dance teachers) and spiritual leaders.
Native American epistemology has a similar concept of the two-spirit or third gendered individual. Native Activist and scholar Will Roscoe found documentation of third and even fourth genders in more than 150 North American tribes. In Samoa, the term fa'afafine refers to a biological man who lives as a woman. Samoans appreciate fa'afafine for their hard work and dedication to family, and for the large part offer them social acceptance.
Western psychiatry, on the other hand, is still trying to figure out how to conceptualize people like Chandelier. In May 2013, the American Psychiatric Association (APA) will unveil the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). It has been thirteen years since the last update and eighteen years since the last edition. The field considers this the most anticipated advancement in the science of mental health.
Controversy surrounds DSM updates, especially in the area of sexual disorders. Most famously, homosexuality did not get fully removed as a diagnosis until 1987, and only after a long battle. In 1970, when the APA held its annual convention in San Francisco, gay rights activists disrupted the conference. In 1971, the protestors again appeared en force. Based on the research of Alfred Kinsey and Evelyn Hooker, the seventh printing of the DSM-II in 1974 de-listed homosexuality as a disorder, replacing it with the term sexual orientation disturbance. In 1980, the disorder changed to ego-dystonic homosexuality (EDH). The argument went that those who felt uncomfortable about their homosexuality should still be able to receive treatment. But the larger question was, why did so many people feel uncomfortable about their homosexuality? In 1987, ego-dystonic homosexuality went into the garbage heap of diagnoses. Neurosis, hysteria, combat exhaustion disorder and premenstural dysphoria have also died there.
It is hard not to see the parallels between the diagnosis of homosexuality and the latest heat around gender identity disorder (GID). At the annual APA meeting in San Francisco in 2009, protesters once again gathered to lobby against continued inclusion of this diagnosis in the DSM-5. During the comment period, GID received more comments than any other diagnosis up for discussion. It's worth reading the entire diagnosis, but the last version of the manual, the DSM-IV (TR), identifies the disorder as "a strong persistent cross-gender identification ... [and] a repeatedly stated desire to be, or insistence that he or she is, the other sex." Basically, the diagnosis is "transgendered."