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."
To address the controversy surrounding GID, the DSM-5 plans to redefine the disorder as gender dysphoria (GD), moving it to a temporary condition. The APA
states the change arose "in response to criticisms that the term was stigmatizing." Part of the APA's argument for keeping a version of GID has to do with
providing medical attention and insurance reimbursement for transgendered individuals seeking counseling or gender reassignment surgery. This echoes the
move from homosexuality to sexual orientation disturbance to ego-dystonic homosexuality.
An argument against there being any diagnosis for transsexual individuals, especially children and adolescents, is that therapists can use the GID or GD
diagnosis to encourage them to adhere to prescribed gender roles based on biological sex. I have had parents come into my office asking me to work with
their son who keeps wearing girl's clothes. The boy doesn't mind at all, the parents do.
Proposals have been put forward to use the term "social role dysphoria" to identify the distress that enforced social gender roles cause. The "problem"
becomes the fault of rigid gender roles rather than of the individual, and the diagnosis would still offer reimbursement for gender reassignment surgery.
The term sends a much different message: There's something wrong with rigid gender role categories versus there's something wrong with you.