As we write of things like the sectioning of trans people, it’s easy to see that as past, finished, something which could never happen again. Lest we forget, it’s important to remember that as recently as 2007 the British Government reaffirmed that in and of itself gender identity disorder(GID) can be grounds to section and individual. This was set out in appendix 1a of the fifteenth report from the Joint Committee on Human Rights in a letter dated 1 April 2007 from Rt Hon. Rosie Winterton MP (Labour), Minister of State, Department of Health. It includes sections like these:
The Government’s understanding, therefore, is that gender dysphoria and transvestic fetishism potentially constitute “a disability or disorder of the mind” in the terms of the Mental Health Act 1983 (“the 1983 Act”) and a “true mental disorder” for the purposes of Article 5(1)(e) of the Convention, where they reach a sufficient level of clinical significance. The issue has not arisen as far as the Government is aware, and the Government does not think it is possible, in the absence of case-law, to take a definitive view.
On the other hand, if a person did meet the criteria for detention as a result of gender identity or transvestic fetishism (or any other equally unlikely disorder) and needed to be detained for their own sake or to protect others then it is right that mental health legislation should enable appropriate action to be taken. But for that to happen there would have to be wholly exceptional – and very hard to envisage – circumstances.
What is doubly concerning is that when passing the Mental Health Act 2007 the Government specifically excluded learning difficulties as a mental disorder but, despite being urged to do so, retained the classification of GID as a “true mental disorder” which means transsexual people can be sectioned or forced to undergo treatment – for instance a transgendered adolescent could be forced by a pysch to undergo gender-reparative therapy.
There are less critical implications, which are nevertheless potentially serious to transsexual people such as the ability of Family Courts and adoption agencies to take a mental disorder into account when considering cases involving trans people.
It is also worth remembering that the Gender Recognition Act 2004(GRA) forces those who have undergone gender reassignment to secure a diagnosis of GID (ie of a mental disorder which could see them forcibly detained) even though it is, in practice, possible to receive hormonal treatment and surgeries to alter sexual characteristics without needing a GID diagnosis. This is surely wrong.
More positively, the suggestion that transvestism may also be regarded in law as a mental disorder means that transvestites (who have received no protection under the Sex Discrimination Act 1975) may have rights under the Disability and Discrimination Act 1995.
In the recent post about DSM V, I alluded to concerns within the trans community about the composition of the APA workgroups. The opposition has many facets but a core objection is that the APA has not spoken against reparative therapy and that some workgroup members still seem to advocate reparative therapy.
Reparative therapy is a an emotive subject for trans people. Those transitioning in middle age are very much aware of the treatment they could have expected had they transitioned (as most would have wished) in adolescence. I’ve now found an article at the GID Reform sitewhich describes some of the horrors of raparative therapy that transsexual people have been subjected to. This is not something which has been made up: I have trans friends who have suffered exactly this sort of treatment.
On the same site there is also a good page on some of the problems with the DSM.
Many transsexual people find the classification of gender identity disorder(GID) as a mental disorder inaccurate and offensive. It harks back to the time when homosexuality was also classified as a mental disorder: fortunately that has now changed.
To blame is DSM-IV-TR, version 4 ( updated by a text revision) of the Diagnostic and Statistical Manual of Mental Disorders (DSM) produced by the American Psychiatric Association (APA). A review is underway to produce version 5, DSM-V. The APA has recently announced their intention to publish a draft in 2010 and the final version in 2012.
By way of background, it is of great interest to the international trans community whether GID will be reclassified as either a physical or intersex condition. There is concern in the trans community that this won’t happen. Although most specialists, particularly in Europe, do not see GID as a mental disorder, the composition of the working group Sexual and Gender Identity Disorders Group includes controversial individuals like Kenneth Zucker who are expected to fight to retain the existing classification.
Despite the APA’s recent publication of a timeline for the release of DSM-V, little information is coming out of the workgroups. It is understood that members have been asked to sign confidentiality agreements, in sharp contrast to the more open approach being adopted by the World Health Organisation (WHO) in their update of the International Classification of Diseases and Related Health Problems (ISM), which contains the other key internationally recognised definition of GID. This accusation has been stated very forcefully by Robert L Spitzer MD, Professor of Psychiatry at Columbia University a Former Chair of Work Group to Develop DSM-III and DSM-III-R.
The most recent report of the Report of the DSM-V Sexual and Gender Identity Disorders Work Group, released in November 2008, is very brief and in terms of gender issues includes only the following paragraph:
Apart from the literature reviews, the Gender Identity Disorders sub-work group has addressed feedback from interested advocacy groups and other stakeholders. It has developed a formal survey seeking input from various organizations that advocate for and represent transgender adults. Surveys were sent to more than 60 organizations, with a closing date for response in October, 2008.