Gid, The Stinkin' Dsm, And Trans Health Care

[Guest StrandedOutThere]

There has been a LOT of talk about GID being removed from the DSM and no longer being classified as a mental illness, as homosexuality was a while back. I think this is definitely a step in the right direction. There is a lot of stigma that comes with having a diagnosis like GID. As well, my firsthand experience with GID suggests that it is VERY different from what people generally think of as a "mental disorder". However, GID is definitely a departure from "the norm". When I say "the norm", I mean what is statistically common and am not trying to make any statements about whether or not something is or should be considered acceptable.

Okay, here's what I'm reaaaaaally wondering about. If GID is removed from the DSM and is no longer considered a mental disorder, how would we get access to treatments like hormones and surgery? Let's face it ladies and gentlemen, we are exceptional people with exceptional needs!

The first, most obvious option is that we could do with people with any other medical condition do: go to our doctors. That would certainly be preferable. However, I think we are in a difficult position because, although transition is often a life and death matter for us, I can see it being difficult to convince a medical professional of that fact. Furthermore, the problem is also complicated by the fact that HRT and surgery also involve some level of risk. Doctors take an oath to "do no harm". I think that some doctors may worry that giving people hormones and access to surgery might harm them, since their bodies are technically healthy...they just don't match with the person's true gender.

Another, potentially less preferable option would be to reclassify GID. Right now, or at least last time I looked, it was listed in the same section as paraphilias and other kinds of sexual dysfunctions. NOT OKAY! I think this classification, among other things, fosters confusion about the separability of gender identity and sexual orientation. GID is currently considered an Axis I disorder.

* Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders

* Axis II: underlying pervasive or personality conditions, as well as mental retardation

* Axis III: acute medical conditions and physical disorders

* Axis IV: psychosocial and environmental factors contributing to the disorder

* Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale for children and teens under the age of 18

Source: http://en.wikipedia.org/wiki/DSM-IV-TR

I think some people would be okay with having GID renamed and added to Axis III, but the problem with that is that Axis III is reserved for acute problems. In other words, it's not for chronic, lifelong issues. I think another option would be to consider transsexualism something that should be mentioned under Axis IV. In reality, what people call GID and a lot of the problems that stem from living with GID (depression, anxiety, substance abuse problems) are caused by social issues. Gender nonconforming people are often treated poorly and made to feel that they should force themselves into the mold of their birth sex. This isn't something native to ourselves. This is something the external world and its social expectations causes. Without the social issues, the majority of us would be better off.

Of course, reclassifying GID in this way doesn't necessarily help us get access to treatment. For some of us, being free to express ourselves in the way we see fit would reduce our distress enough for us to live a happy life without hormones or surgery. For others, the mismatch between body and mind makes hormones and surgery essential to our happiness. I'm afraid. What if GID is dropped from the DSM and no alternative plan is in place for us to get access to medical treatments? My gut feeling is that doctor's are more willing to give us prescriptions and surgery when we have letters because that distributes the risk to them. Now they aren't the only one to get sued if someone is unhappy, the psychologist who wrote the letter is also liable. When people are unfamiliar with something, they do not like to step out alone. As far as transgender individuals go, we are largely uncharted territory for medical science. Without a diagnosis or therapist's letter, would doctors still prescribe hormones and allow us to get surgery? Is dropping GID a path to legitimizing our need for medical treatments?

Another concern I have is whether being a transsexual could ever become "just another body mod" to people. If you look around, you'll notice that people are doing some pretty extreme body modifications. I won't list specific examples, but there's plenty out there that illustrates my point nicely. Rather than being a medical condition, I wonder if altering one's body to become more androgynous or more like the other sex might end up becoming an acceptable type of body modification. While I realize that this sounds crazy, keep in mind that people that don't identify strongly as one gender or the other (and are distressed by aspects of their body that gender them) are largely left out in the cold in our current way of doing things. I've found stuff on the internet that suggests that at least some of those individuals DO end up going the body mod route. This means that they end up going not to medical professionals, but to paraprofessionals...or worse, someone without any medical training. I won't say more on this because I think it goes beyond the bounds of what's appropriate for this forum.

I'd be interested to hear some of your thoughts on these issues. Just to be clear, I am very much in favor of reclassifying or dropping GID. I think it is silly to treat it like just another mental disorder. What I'm truly concerned about is whether dropping GID from the DSM would then open the door to get us services on demand. Remember: there are lots of cases with other medical issues where doctors decide the treatment and don't necessarily do what the patient would like them to. I think we should all consider the possibility that dropping GID might end up making it more difficult to get treatment. I'm not saying that this would definitely happen, just that we should consider it as a possibility.

As always, I'm curious....

[Guest Nikki A]

I agree with having it dropped, the way I am is a physical condition. Because in a way I am what my mind is soooo it isn't my mind that is off it is my body! I wish I could see into the future and tell if treatment would get easier or harder after this, but alas... I have no such ability! Lol

hugz, Nikki

[Paula ult]

* Axis III: acute medical conditions and physical disorders

For me it is a physical disorder, my body does not match what my brain thinks it is, so Axis III if we have to be reclassified would be preferable to being classified in with paraphilias and other kinds of sexual dysfunctions.

Paula

[Guest Edu]

IMO, that's a quite complex issue. Sure, it's just a birth issue (potentially a genetic defect: a Y where there should be a X or vice-versa); however...

While I don't consider transsexuality a mental illness (it's a missmatch between body's sex and mind's gender, and I think mind is more important than body, so what has to be fixed is the body); it almost never goes alone: how many transsexuals out there have not been through anxiety, depression, and/or many similar problems? These are well known mental issues that need specialized treatment and therapy.

From my point of view, the most reasonable approach would be:

• Do not consider GID a mental illness. Remove it from the DSM and similar documents. However, keep it on psychology and psychiatry studies: therapists have to know how to handle affected people, just like they learn how to treat victims of accidents, sex crimes, and so on: these aren't "mental illnesses" themselves, but have to be treated to prevent mental issues raising from them.
  
• Do not consider HRT and surgeries as treatments for GID itself, but to the mental issues it raises. This way, it's still on the therapists' hands to recommend such treatment. In practice, it's not very different to what is being done now: therapists will normally help you with transitioning when they consider that not transitioning would be (or has already been) a cause for mental issues.
  

Anyway, I'm neither a medic nor a therapist, and I'm transgendered myself, so this isn't likely to be scientifically accurate, and I'm most probably biased. Take this just as what it is: an opinion.

Regards,

Ethain

[Guest Charlene_Leona]

While I don't like being considered a deviant pervert as we are seen at the moment, I am afraid that removing this will make it hard if not impossible to get treatment. Within the last 2 years Medicare has started paying for SRS for cases that are deemed a medical necessity. Now that medicare is paying for it that will basically make the other insurance companies have to pay for it as well since medicare is the bell weather for insurance acceptance. With all of this in or out talk it will just give the insurance companies the grounds to deny our care from HRT to SRS. I don't care about being labeled with GID because I was pinned with a personality disorder upon discharge from the military. Once my SRS is done the GID will be cured and so should the P.D. I look at the GID as just being the foundation for a treatment regime to correct our dysphoria.

[Guest Robin Winter]

IMO, that's a quite complex issue. Sure, it's just a birth issue (potentially a genetic defect: a Y where there should be a X or vice-versa); however...

While I don't consider transsexuality a mental illness (it's a missmatch between body's sex and mind's gender, and I think mind is more important than body, so what has to be fixed is the body); it almost never goes alone: how many transsexuals out there have not been through anxiety, depression, and/or many similar problems? These are well known mental issues that need specialized treatment and therapy.

From my point of view, the most reasonable approach would be:

• Do not consider GID a mental illness. Remove it from the DSM and similar documents. However, keep it on psychology and psychiatry studies: therapists have to know how to handle affected people, just like they learn how to treat victims of accidents, sex crimes, and so on: these aren't "mental illnesses" themselves, but have to be treated to prevent mental issues raising from them.
  
• Do not consider HRT and surgeries as treatments for GID itself, but to the mental issues it raises. This way, it's still on the therapists' hands to recommend such treatment. In practice, it's not very different to what is being done now: therapists will normally help you with transitioning when they consider that not transitioning would be (or has already been) a cause for mental issues.
  

Anyway, I'm neither a medic nor a therapist, and I'm transgendered myself, so this isn't likely to be scientifically accurate, and I'm most probably biased. Take this just as what it is: an opinion.

Regards,

Ethain

What she said...

[Guest Joanna Phipps]

* Axis III: acute medical conditions and physical disorders

For me it is a physical disorder, my body does not match what my brain thinks it is, so Axis III if we have to be reclassified would be preferable to being classified in with paraphilias and other kinds of sexual dysfunctions.

Paula

Im with you Paula, our mental issues are (in general) a product of our physical condition. If it has to remain in the DSM as of DSM-V then axis III is where to put it. That way we still loose the stigma of mental illness and the problem of having it associated with paraphilias, just due to the section it's in but keep the clinical diagnostics that are so critical to us attaining other things further along the process.

I wonder if those who control the book have thought of that, however having Blanchard as chair of the committee examining the section I fear that we are going to come off worse than what we have now. Getting this done is like mating elephants, its done at very high levels and takes a long time to get results. In the end the results are going to be what the psychiatric community wants because we dont seem to want to come far enough out to give them the fight that the Gay crew did in 73 to get removed from the DSM in 74.

Dont get me wrong, I do understand why but if we want changes like that we are going to, as a community, have to examine options to make our voices heard the way we want them heard. We cannot always count on the LGBt organizations to be our voice since they have their own agendas covering their main constituencies. At around 1% of the general population we are the smallest branch of the LGBt community and given our own internal divisions the one that is the hardest to give a voice to. We only need to ask ourseves and the members of the other branches of the Transgendered community who needs what in the line of support from the medical community; it is likely to range from none(in some cases) to therapy, hormones and surgery in others.

We are not a straight forward homogenous community like the Gays, Lesbians or Bisexuals are; our community is a diverse and complex one which in the end MAY have to split along needs lines in order for everyone to get what their group requires to be happy and fulfilled.

Just my 0.15 worth (inflation you know)

[Sally]

I tend to agree with Ethian but I have another request.

While we are reclassifying our condition could we possibly rename it to get 'sex' out of it completely to most of the totally unenlightened members of society that single syllable conjurers up images of a physical activity not just a specific body type and therefor hinders our acceptance because we become to them - sexual deviants!

I am not sure what would be better but I do believe that while "a rose by any other name would smell as sweet" if you call it a stinking pile of garbage who want to smell it.

Sorry, my own personal issue.

Love ya,

Sally

[Guest viv]

Hi hun,

I remember reading somewhere lately we Trans folk are generally

intelligent , well balanced members of society who , by and large ,work

and contribute positively all our lives *before AND after SRS . That tells

me our heads are cool ,yes some of us have fallen to the pressures of

our lives and this has manifested itself in mental illness and the like .

(later improving with sympathetic treatment) So, yes, take away that

opinion we suffer mentally , our mental health is ok, its below the head

needs ""refurnishing"" , viv

[Guest Justme360]

I recently read, stumbled across an article http://nickgorton.org/misc/work/private_re...tal_illness.pdf

From what I understand and don't go by me because I'm delusional. So that the reason we shouldn't reform DSM is that we lose health care here's a quote from above article.

"Loss of the DSM diagnostic category for GID will endanger the access to care,

psychological well being, and in some cases, the very life of countless disenfranchised

transgender people who are dependent on the medical and psychiatric justification for

access to care."

Anyway to me a John to Jane come lately I really don't see a system worth preserving. I don't see how removing GID from DSM some how invalidates need for care. To me who is just starting her journey I see a mountain of bills ahead and frankly I don't see health insurance or the medical community helping unless I have a bra full of cash.

[Guest nova]

Whenever I'm wondering how the struggle for GID reform is going I check out Kelly Winter's site at www.gidreform.org. She has been advocating for reform for a long time. In her book, "Gender Madness in American Psychiatry", she has a chapter where she discusses the choice between access to corrective hormonal and surgical procedures to support transition and the stigma of mental illness imposed by the current diagnosis of gender identity disorder and how this dilemma has divided the trans-community and allowed no progress on GID reform in nearly three decades. She discusses the AMA's resolution 122 which reinterprets GID to emphasize distress and not disorder. Her book has helped me to have a more informed opinion. I am tired of psychiatrists and psychologists who are not one of us, always trying to tell us about us, and who we are are aren't--never listening to what we have to say, but that is changing. Born with a girl brain and boy body: or a boy brain and girl body--how can that not be a medical, physical condition? The last sentence --I'm just referring to my identity as a transsexual woman.

[Guest Leah1026]

Okay, here's what I'm reaaaaaally wondering about. If GID is removed from the DSM and is no longer considered a mental disorder, how would we get access to treatments like hormones and surgery? Let's face it ladies and gentlemen, we are exceptional people with exceptional needs!

In case you haven't heard there's so much fighting going on about the new edition of the DSM, the publishing date has been pushed back a couple years. Instead of 2011, it'll be 2013 or later. So we have time to work on getting GID out. But I also need to stress GID is not transsexualism, it is merely a symptom of it.

Next, how will we be covered? That's already been taken care of:

Exhibit A: http://www.tgender.net/taw/ama_resolutions.pdf The AMA has already recognized transsexualism as a MEDICAL condition that should be treated with TRANSITION. Further they called on the insurance industry to eliminate exclusions against us.

Exhibit B: http://www.wpath.org/documents2/socv6.pdf The AMA also noted the internationally recognized Standards of Care as the framework for how our care should be handled.

Exhibit C: Don't have a link for this one, you'll have to take my word for it. The movement for removal is not restricted to the USA. This movement is international, people everywhere are screaming for an end to stigma that being associated with the DSM has traditionally meant for us.

The biggest obstacle in our way is the callous and greedy insurance industry. To realize how greedy read this article:

http://www.frontierspublishing.com/IN_arch...orts/sprt2.html

That story was written by somebody that works in the insurance industry. She says that if all exclusion were eliminated nation-wide the impact on the premiums for the average Joe would be 2¢/month. Did you get that? The insurance industry sold us down the river for 2¢! The insurance industry studies costs to death, so you know this was a conscious decision on their part to exclude us because they didn't think we were worth 2¢.

We must remain active as a community, constantly pushing the insurance industry to do the right thing. We have powerful allies on our side (science, WPATH, AMA) and as soon as the O'Donnabhain vs the IRS is resolved we will probably have the IRS on our side as well:

http://www.glad.org/work/cases/in-re-rhiannon-odonnabhain/

Things are coming together for us. Too late for me and possibly for many other people here, but change IS coming.

Hope this helps.

[Guest doodle]

I asked my therapist this question a few months ago. Everyone in my support was talking about this question. Whe said weveryone eas asking her the same question. she said that it was not going to happen because to many people would lose their benefits such HRT, welfare ect.

kelly

[Guest Leah1026]

I asked my therapist this question a few months ago. Everyone in my support was talking about this question. Whe said weveryone eas asking her the same question. she said that it was not going to happen because to many people would lose their benefits such HRT, welfare ect.

That's just not true. Considering almost nobody enjoys said benefits now, anything would be an improvement. Sounds more like a therapist trying to protect their mental health turf if you ask me. We are moving towards transsexualism coming under a MEDICAL model and away from a PSYCHOLOGY model. Just yesterday there was further proof of this:

http://www.pinknews.co.uk/2009/12/29/hiv-e...mental-illness/

Mental health providers, like your therapist, may feel they are losing control and thus are poo poo-ing developments. What they don't realize is that in addition to everything else I've mentioned, this is an issue of Civil Rights. For too long our transitions and our futures were controlled by the psychological establishment. The result is the stigma we are all aware of from being in the DSM and being attacked as being mentally ill. Because of the DSM we have not been considered worthy of full civil rights. With the move to a medical model we will have more control over our own care and lives. And in time the public will become educated that, just like homosexuality before us, being classified as a mental illness was a mistake. In the medical model mental health providers still have a role, but not the dominating role they've become accustomed to. Just like for any other medical conditions WE will have control. The move to the medical model will also be the nail in the coffin for many pseudo (junk) scientists (J Michael Bailey, Blanchard, Zucker) who have enjoyed cushy jobs by using us a lab animals.

You can read more about this movement here:

http://www.GIDReform.org

[Guest Anna_Banana]

That's just not true. Considering almost nobody enjoys said benefits now, anything would be an improvement. Sounds more like a therapist trying to protect their mental health turf if you ask me. We are moving towards transsexualism coming under a MEDICAL model and away from a PSYCHOLOGY model. Just yesterday there was further proof of this:

http://www.pinknews.co.uk/2009/12/29/hiv-e...mental-illness/

Mental health providers, like your therapist, may feel they are losing control and thus are poo poo-ing developments. What they don't realize is that in addition to everything else I've mentioned, this is an issue of Civil Rights. For too long our transitions and our futures were controlled by the psychological establishment. The result is the stigma we are all aware of from being in the DSM and being attacked as being mentally ill. Because of the DSM we have not been considered worthy of full civil rights. With the move to a medical model we will have more control over our own care and lives. And in time the public will become educated that, just like homosexuality before us, being classified as a mental illness was a mistake. In the medical model mental health providers still have a role, but not the dominating role they've become accustomed to. Just like for any other medical conditions WE will have control. The move to the medical model will also be the nail in the coffin for many pseudo (junk) scientists (J Michael Bailey, Blanchard, Zucker) who have enjoyed cushy jobs by using us a lab animals.

You can read more about this movement here:

http://www.GIDReform.org

I wholeheartedly agree that this is the best option for the trans community. Making this medical rather than psychological would really put us on the map going in the positive direction. We're going to need this before we can ever hope to get recognized by our so called "normal" peers.

.Anna

[Guest Jeannine Bean]

I know I am not comfortable with the classification system in America and all the obsessive records keeping. I've been living in Taiwan and happily getting seen by endocrinologists and doctors and what have you without a heck of a lot of records being kept. I pay cash and I have learned that hospitals and clinics have little communication between them.

Contrast with the U.S.A., where I once tried to get insurance and was denied it because I had been seen for a "pre-existing" psychiatric condition, and the company wouldn't put a rider on there for me. I couldn't afford other insurance. Thus my "getting help" for being transgendered meant I didn't get any medical help for anything at all for the three years after.

I am coming back to America soon, and the doctor's sending me with enough meds for six months or so. After that, I have to consider what I want to do, and how much I trust the system... which frankly my experiences tell me not to do!

I think these are very real problems a lot of us face and I would like to see things change!

--Jeannine

[Guest Kieri]

From my point of view, the most reasonable approach would be:

• Do not consider GID a mental illness. Remove it from the DSM and similar documents. However, keep it on psychology and psychiatry studies: therapists have to know how to handle affected people, just like they learn how to treat victims of accidents, sex crimes, and so on: these aren't "mental illnesses" themselves, but have to be treated to prevent mental issues raising from them.
  
• Do not consider HRT and surgeries as treatments for GID itself, but to the mental issues it raises. This way, it's still on the therapists' hands to recommend such treatment. In practice, it's not very different to what is being done now: therapists will normally help you with transitioning when they consider that not transitioning would be (or has already been) a cause for mental issues.
  

It's a good thought, and I have no problem with the first suggestion, but I think the second could just lead to a whole new bunch of problems for some people - at least as worded. In the past I was seriously depressed, but I have come to terms with my life since then and am now a pretty balanced individual (but still pushing very hard to transition this year). If therapists were to take things too literally (and I'm sure many do, sadly) could they not deny HRT to people like me, or even deny surgeries to those who have become much more balanced because of HRT? Keep in mind I'm just playing devil's advocate here, but it is something to think about.

Without a doubt, GID/TS needs to come off the DSM... who the new gatekeepers will be is the tough question. There should still be some kind of process to weed out those who should not transition. The last thing we need is people transitioning when they shouldn't, then going to the media and slandering the community for "ruining their lives" when in actuality it was themselves. Sticky subject

[Guest Jeannine Bean]

Without a doubt, GID/TS needs to come off the DSM... who the new gatekeepers will be is the tough question. There should still be some kind of process to weed out those who should not transition. The last thing we need is people transitioning when they shouldn't, then going to the media and slandering the community for "ruining their lives" when in actuality it was themselves. Sticky subject unsure.gif

I know, the media. Even if the person sought, bought, and paid for something themselves, they could still paint a picture of being taken advantage of. And since gender variant people are among the most reviled humans in most places I know of on earth, the media would eat that up... The muppets.

I'd love to live in a world where people had good boundaries and took responsibility for themselves. I'd pay to move to that world even if it cost me my SRS money.

[Guest Janessa]

I do not know much about this subject, but I agree it should not be considered a mental disorder. Calling it a mental disorder makes it sound like we need pills and can not make good decisions for ourselves, which is not true. However, if calling it a mental disorder is truly the only way for us to get treatment, I guess that is better than just being denied our rights to medical treatment.

I do think no longer classifying it as a mental disorder would help people understand us a bit better.

[Guest Pól]

* Do not consider GID a mental illness. Remove it from the DSM and similar documents. However, keep it on psychology and psychiatry studies: therapists have to know how to handle affected people, just like they learn how to treat victims of accidents, sex crimes, and so on: these aren't "mental illnesses" themselves, but have to be treated to prevent mental issues raising from them.

* Do not consider HRT and surgeries as treatments for GID itself, but to the mental issues it raises. This way, it's still on the therapists' hands to recommend such treatment. In practice, it's not very different to what is being done now: therapists will normally help you with transitioning when they consider that not transitioning would be (or has already been) a cause for mental issues.

This is the best suggestion I've heard thus far, but it's got it's own problems, as Kieri noted. The point that is most on my mind is that I do not think any of this should be changed until there is a solid, detailed replacement that gets people what they need -- whether that be full transition or simple counseling. While there is a certain stigma to having transsexuality listed as a mental disorder, it's not worth getting rid of that classification if that means that trans people can no longer get any treatment at all.

It would be ideal if all this were completely covered by insurance and seen as medically necessary and not unusual by the medical community and the general public, but realistically that's not going to be our next step.

Another thing to keep in mind is that people's classifications of us as 'abnormal' at best isn't coming from the fact that in the DSM-IV, transsexuality is listed as a mental disorder. Changing that classification will not solve that problem. I think the only 'solution' to the problem of the public image of transsexuals is long-term, consistent, good press, both in the media and in television and film. The idiot who is looking to hurt you because you are trans is not going to suddenly change his or her mind about it because transsexuality is no longer listed as a mental disorder.

I think that keeping therapists involved in the process is probably a good idea, at least in the short-term. Your average GP is probably less prepared to make the mental assessment necessary to determine gender identity to begin treatment (both physical and psychological) for a trans person than your average therapist. While our treatment is primarily physical, your average trans person probably has acquired a reasonable amount of psychological baggage, at the very least, just from dealing with dysphoria for x number of years. Even if it's not necessarily directly important to a person's transition that they deal with all this baggage, it is generally good to address any issues rather than letting them fester, trans-ness entirely aside. Judging from my own experiences, the help that your therapist gives you in dealing with issues caused by your trans-ness may be far more useful than the help they give you in dealing with your trans-ness to begin with. That said, however, Leah's point about this being in some ways a Civil Rights issue is important -- as we all know, it's tricky.

A more immediate problem is now that transsexuality has been recognised by the AMA as a medical condition requiring proper treatment (transition), it is unacceptable that an insurance company may deny you any medical treatment pertaining to transition simply because you are transsexual. Before we go changing the DSM-IV, we need to get the insurance companies in line with current medical treatment for transsexuality, providing appropriate coverage. I think this has to be the first order of business. The current DSM-IV, despite it's faults, does provide us with a justifiable rationale for treatment. We should be able to use that to more freely obtain medical care for transition.

[Guest Jeannine Bean]

The next step?

My problem with the way things are classified now is, as I posted above. Being on records as transgendered counted as a "pre-existing pyschological condition" aka a pre-existing ILLNESS and my insurer would not add a rider for it. It was that simple. My having been in counseling for being transgendered, in America, in 2005, meant that for three years after I could not get insurance (because I could not afford to buy it from another provider, outside my company).

Who needs to make a mental assessment? I'm all for someone giving a "fitness of mind" assessment akin to what you'd need to do to get into the military or to contract on a house or whatever. I think a psychologist or a lawyer ought to be able to give the okay, for whatever treatment someone wants.

At that point, someone is also taking full responsibility for their decisions, and we're not saying "you have an illness and we're treating it with this extreme therapy called HRT and SRS" which I think is the current medical approach... we're saying, "you want this service, you know what it entails, you're sane and you agree to accept the risks."

This is funny because we're talking about something similar to first wave feminism, we all just want to be treated equally. I think the bleeding edge of our discussion is that we transgendered people are different and actually might be special in some really cool ways.

--Jeannine Pre-Second Wave transandrogyfeminist thinker

[Guest nova]

Process for weeding out those not suited to transition.

I don't believe this will be a problem when GID is reclassified as distress rather than disorder. For example, people who have hepatitis have to get medical clearance showing a clean bill of mental health before they undergo the treatment because it can trigger significant depression. This is what two different people told me who have gone through it.

When Johns Hopkins accepted their first patients for SRS, they had been first carefully screened and found to be "remarkably normal". Even though many people were prejudiced against transsexuals at the time, this was before they invented GID; we were not yet thoroughly stigmatized in the DSM. It wasn't until Paul McHugh came to Hopkins in 1975, screeching about transsexuals being "yicky" and mentally ill and SRS was just cooperating with madness (which resulted in killing the SRS program by 1978) . . . . and which resulted in the mental illness stigma becoming DSM doctrine a couple more years later.

The screening process has been in place before GID and I see no reason why it would be thrown out with GID or with a reclassified GID: with the D meaning distress instead of disorder.