OPINION

The following article was originally published in the Philippine Online Chronicles.

The Gender Disease

(Decoding the pathologization of identities)

All known psychological conditions examined by health professionals are categorized according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The manual is published by the American Psychiatric Association (APA), the U.S.-based and internationally recognized association of professional psychiatrists and psychiatrist trainees. Risking oversimplification, picture this: if all people are appliances and everyone comes with operation instructions, the DSM is the manual that technicians consult when an apparatus goes berserk or breaks down (pun intended). People, of course, are not appliances, and the manual was created for purposes presumably much nobler than merely stamping a “for repair” label on someone’s forehead.

The DSM is intended as a guide for psychiatrists to determine conditions that are otherwise “not normal”. It’s unlikely that many fellow LGBTs are still reading this, having seen the words “label”, “not normal” and “disorder” but for those who are still reading this, hang in there and blame it all on Freud later.

The current version is DSM-4 but in May 2013, the fifth edition or the DSM-5 is slated for publication. “The preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses (meaning the DSM-4) are now available for public review,” according to the APA. The website http://www.dsm5.org, hence, was created “as part of the development process…(and as an) opportunity not only to learn more about the proposed changes in DSM-5.”

One of APA’s proposed revisions to the DSM is on the category “Sexual and Gender Identity Disorders” and under this umbrella nomenclature are the subcategories “Gender Identity Disorder” and “Paraphilia”. The latter is defined by Webster as “a pattern of recurring sexually arousing mental imagery or behavior that involves unusual and especially socially unacceptable sexual practices”.

Word War

As with most crusades for equality, this is a fight against labels because indiscriminate labeling, one way or another, creates stigma. 2010 AD and people are still branding people with a scarlet letter and burning them at the stakes. Jesus!

Ironically, however, battling the stigma brought about by labeling entails introducing the “proper terms” as words, after all, are integral in communicating. It is important to know what a land mine is in order not to step on it.

“Trans” for instance, are females that identify as males and their female counterparts, including transsexuals and transgenders—the latter being persons preparing for a medical change that will transform them into that of the preferred sex.

“Intersex” are individuals who have “genetic, hormonal and physical features that may be thought to be typical of both male and female at once,” according to the Organization of Intersex International. They are females with male biological characteristics, males with female features and people with “no clearly defined sexual features at all.”

“Genderqueer”, meanwhile, is “the term people use to describe themselves if they do not fit into society’s standardized expectations for alignments of sex, gender expression and sexuality,” as per the Columbia University Students Active for Ending Rape (SAFER).

Whether with complex political underpinnings or basic biological classification, trans, intersex and genderqueer (TIG) encompasses the LGBT community, asexuals and “any person who does not fit into society’s rigid alignment of sex and gender,” said SAFER.

Curiously, the bulk of reports, term papers, theses and dissertations are written according to the rules of the APA. Although most people are unfamiliar with the Association itself, very few who have done some sort of formal writing are not familiar with the rules and syntax as per the APA Style Guide.

Depathologization

Classifying gender identity as a disorder effectively defeats the age-old struggle for equal rights and as such, organized LGBT groups worldwide are lobbying for the exclusion of said category from the diagnosis manuals. How many times does it have to be said before we drive home the point: WE ARE NOT SICK. It’s almost fantastical to realize that at this day and age of supposed enlightenment there are those who just don’t get it.

The International Net for Trans Depathologization, for one, has launched a campaign coordinating the cessation of the pathologization of “trans identities” or TIG. Almost a year to the date, the organization mobilized about 40 cities worldwide. The event will be repeated in October 23, 2010 still calling for:

– the removal of TIG from the DSM and other diagnostic manuals
– eliminating the mention of sex from official documents;
– abolition of treatments of binary normalization for intersex people;
– free access to hormonal treatments and surgeries without the psychiatric trusteeship; and the fight for educational efforts and inclusion of trans persons in society and the labor process.

To its credit, the DSM is designed to be a means to communicate a patient’s diagnosis for evaluation, research and treatment. It is also used by drug regulation agencies and health insurance and pharmaceutical, and policy makers. Perhaps as its take on political correctness, the APA, overcome with magnanimity, is recommending the term “Transvestic Fetishism” with “Transvestic Disorder”.

The APA concedes that a paraphilia is not in itself a psychiatric disorder and does not “automatically justify or require psychiatric intervention”. Having a paraphilia could cause “distress or impairment to the individual or harm to others” but is not necessarily “a sufficient condition for having a paraphilic disorder.” Incidentally, Webster used sadism and pedophilia as examples of paraphilia.

Choice

In as much as most people abhor being labeled as “pathologically ill”, some with nonheterosexual preferences or leanings may not identify as LGBT or TIG. Others could simply care less and the rest are, well, straight.

To write this article I consulted with doctor and psychiatrist friends and one of them, shaking her head and sheepishly grinning said, “I can’t even say the word ‘tomboy’, merely hearing it makes me flinch. Hindi ko talaga gusto ang bagsak ng salitang yan.

Admittedly, most Filipino LGBT and TIG cannot as yet grapple with the significance of the call for trans depathologization because many of us are still coming to terms with being regarded as “not straight”. For now, however, knowing is more important than coming to terms with the terms used, inadvertently or deliberately, to identify us. We may not like the words that define who we are, or having known them refuse to acknowledge that we are that and nothing more, but knowing is enough. For now, at least.

The safe word, the one that would not cause the proverbial land mine to explode in our faces, is “choice”. And as most things, choice can be interpreted more than one way. The best word is “dignity” and the word in between, the key to connecting everything and everyone into one seamless and radiant spectrum is “respect”.

The beauty of the rainbow, after all, is not in the distinction from red to orange, yellow to green, blue to indigo or even violet. It is how the colors go together as they stand out individually or when they blend into hues of unknowable shades and gradations and intensity.

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Other articles in POC:

The Big Move

The case of the gender-benders

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