Come down the rabbit hole with me…
Have you ever read the DSM-5 or seen it?
The DSM is, according to Wikipedia, “a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is the main book for the diagnosis and treatment of mental disorders in the United States and Australia,[2] while in other countries it may be used in conjunction with other documents. The DSM-5 is considered one of the principal guides of psychiatry, along with the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual.”
New documents and videos from WPATH (the leading organization for transgender health) have been released and it doesn’t look good. As it turns out, they’ve been misleading healthcare organizations, doctors, and patients. They know the science behind hormones and puberty blockers is weak. They know the risks of cross-sex hormones are worse than what they’ve let on. They know children lack the mental and developmental capacity to understand their fertility but will sentence them to a life of infertility and sexual dysfunction anyway. Precocious puberty and some forms of dwarfism aside, there is no medically necessary reason to halt a child’s development and damage their reproductive system. I’m reading parts of the “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8” because I’m trying to understand the diagnostic process. Listening to the stories of trans and detrans people the one plot point they all have in common is a hasty diagnosis or lack thereof.
It’s a little hard to understand, so bear with me as I try to make sense of it.
WPATH seems to be at odds with the DSM-5 classification of Gender Dysphoria as a mental health diagnosis and instead prefers the ICD-11 definition of “gender incongruence.”
Why? I have a theory. Being listed in the DSM-5 makes Gender Dysphoria a mental health problem, something that psychologists and psychiatrists must first address. The DSM-5 doesn’t address gender identity, so it doesn’t factor in one’s lived experience. Basically, the DSM-5 says Gender Dysphoria is in the brain and can be dealt with by psychological means as a first line of defense. There is some political language in there, but that’s what it’s saying.
The DSM-5 says the problem is in the brain. By leaning away from the DSM-5 and a gender dysphoria diagnosis WPATH can say the problem is in the body. Also, the DSM-5 only makes mention of being “transgender” once:
Transgender refers to the broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender. Transsexual denotes an individual who seeks, or has undergone, a social transition from male to female or female to male, which in many, but not all, cases also involves a somatic transition by cross-sex hormone treatment and genital surgery (sex reassignment surgery).
If psychologists, therapists, and psychiatrists were to go by the DSM-5 instead of WPATH guidelines, the diagnostic process would be annoyingly long, probably about as long as most mental health conditions. Because the DSM-5 says (without saying) the issue is in the brain and the individual’s perception of oneself, treatment would begin with helping the patient come to terms with their natal sex, but WPATH views that course of action as conversion therapy. Changing one’s gender identity, or attempting to change one’s perception of oneself, is wrong even if it leads to psychological relief, but that’s where I have more questions: What would the consequences be if psychologists and doctors agreed people could make peace and be comfortable with their natal sex?
Another theory…money. Right now, insurance companies are required (thank you Obamacare) to cover gender-affirming care and if you know anything about insurance companies they always want to go with the least expensive option. Long-term therapy is expensive, but medication is cheaper. Insurance companies would rather pay for hormones than psychotherapy, and big pharma can’t make money off of therapy and they’re certainly not willing to lose patients. Gender dysphoric people making peace with their natal sex means less money for them.
It’s weird. WPATH wants to treat gender dysphoria as irrelevant and transgenderism as normal, like homosexuality. They want to take people’s word for it (the same way we accept a man is gay because he says so) and use that as a basis for prescribing blockers and hormones, but if they were to follow the DSM-5 half the people wouldn’t qualify for medical or surgical treatment. AGPs wouldn’t be prescribed hormones, autistic children wouldn’t be put on hormone blockers, and people with other mental health co-morbidities wouldn’t be treated for gender dysphoria at all…not directly anyway. Their depression, anxiety, OCD, body dysmorphia, or schizophrenia would get all the attention, and gender dysphoria would be seen as a symptom.
But WPATH wants to have their cake and eat it, too. They want to avoid associating being trans with a mental health problem while claiming a lack of treatment and social affirmation can lead to suicidal ideation.
What!?
Before everything became political, this was my understanding: gender dysphoria is persistent distress regarding the incongruence between one’s natal sex and the sex they believe themselves to be, and being trans refers to someone who takes steps to transition, whether that’s social, medical, or surgical. Not every person with gender dysphoria is trans, but every trans person has gender dysphoria…at least that’s what it used to be. We live in a time where people can access with either an inadequate diagnosis or no diagnosis at all.
What’s missing for me, and what I need WPATH to clarify, is the science behind “gender identity” and why I should take it seriously.
Who’s diagnosing the people that write this garbage??
I wish I could make everyone read this