LGBT or Gender Dysphoria; the DSM Controversy

I have noticed a pattern in my own blogging; I don’t tend to jump on issues that are currently major controversies. Striking while the iron is hot is hard for me to do when everyone else is trying to hammer away at the same lump. I don’t like the chaos of a lot of other voices, and I’m wary of the way my own prejudices towards or against the people arguing might obscure my ability to make up my own mind. One of my greatest fears is falling into the trap of believing what I believe because it conforms to the beliefs of people I like. I would rather wait until the iron has cooled, after the other smiths have wandered away, and examine what remains. If I think there’s some work left to be done, then I’ll reheat the iron myself and see if I can hammer out something in peace. It might not be the right thing, but at least I feel like I have space to think while I’m working.

Now that I have entirely exhausted that metaphor, let me resurrect a controversy from a year ago; the DSM’s continuing classification of transsexuality as a medical disorder in the DSM-5, albeit with the new name Gender Dysphoria and a new description of the diagnosis. This article by the Huffington Post covers it well, but in brief, the new diagnosis is almost universally regarded as an improvement, but the mere presence of transsexuality in a medical text is resented. At this time nobody is fighting too hard to entirely remove it, because without it trans people could not get insurance coverage, leaving transition out of the reach of the majority of trans people. Still, it is tolerated with a good deal of grumbling.

The association of being trans and being disordered goes back to the days when homosexuality was also considered a mental illness. Being transgender was considered an extension of homosexuality; the misconception that there is no difference between an extremely effeminate gay man or extremely butch lesbian still exists. It naturally follows, then that once the L, G, and B were no longer considered medical issues, the T should also cease to be a diagnosable condition.

Or does it? For one thing, as I just argued, the whole association between being gay and being trans was flawed to begin with. I identify as a man, but I am also attracted to men. My place in that acronym as a G is independent of my place as a T. Therefore, just because homosexuality is no longer a medical condition, that does not necessarily mean gender dysphoria needs to be removed from the DSM. Furthermore, there is a reason that homosexuality has been removed from the DSM while transsexuality hasn’t. Gay and bisexual people don’t need any therapy to live a productive, fulfilling life. They just need social acceptance. If society fully accepted trans people, if I no longer felt that I needed medical assistance to pass as male to protect myself in bathrooms and on the streets, would I still want hormones and surgery? Yes. Even concealed by binders, my chest bothers me. Surgery will heal me of that. Having taken testosterone makes me feel good when I look in a mirror. I used to feel dissociated from the person I saw. Now I actually see myself. Quite apart from any social issues, having a body that misaligned with my feelings about my identity caused me daily stress. Having a body that feels more like mine gives me daily relief. Medicine objectively helped me.

Now, I can think of three different problems with considering trans people disabled. First, many trans people love their bodies, love their place in the queer community, and don’t want to be pathologized. Second, having a disability is highly stigmatized, and trans people have enough irrational prejudices to deal with without adding ableism to the mix. Third, there’s a fear that consenting to be labelled with a diagnosis will ultimately take power away from trans people to determine their own medication. Not every surgery or hormone is the best choice for every trans person, and worse, there’s the fear that someday, someone might invent a drug to stop trans people from being trans, a pill that would make every trans person’s mental gender align with the gender they were assigned based on their biology. These are all legitimate issues, but I have come to believe they are not sufficient to justify a crusade to remove transsexuality from the DSM.

The first is a case of personal identification. Many trans people don’t feel remotely disabled. Some don’t even desire any medical alteration, either because they identify outside of the gender binary entirely, or because, for whatever reason, they feel male or female enough without the intervention of hormones or surgeries. That is completely fine. If I have learned anything from the social justice community, it’s that there is no battle more doomed to failure than the fight to make people identify as something that that doesn’t feel right to them, just because the identity they currently have is inconvenient for your particular social mission. It’s also a cruel battle. I want a world where everybody respects everybody’s identity, provided that identity is not motivating them to violate somebody else’s safety or consent (I only bring this up in anticipation of an asshole who says, “what if somebody identifies as a serial killer or a rapist?” Go fuck yourself, hypothetical troll).

My argument against the first issue is not that trans people as individuals can’t have legitimate reasons for feeling they don’t belong into the category “disabled.” My argument is that in the world of disability activism, there is precedent for that. Much of my experience with disability comes from studying ASL for four years to work as an interpreter. This education focused on the culture as well as the language, and I had many d/Deaf friends, and even dated a deaf guy for a little while. The whole reason for that funny lowercase/uppercase split I did is that some people consider themselves disabled (like the guy I dated, who was lowercase deaf), and some people consider themselves part of a linguistic minority (and capitalize Deaf to show their pride in their identification). For those who live in predominately signing communities, the objective reality is that their experience is more like that of a linguistic minority than that of a disabled person. I don’t see why the trans community can’t accommodate the same sort of variable identification. For some individuals, “has gender dysphoria” describes how they feel about their bodies and their place in society; they are men or women who had to overcome a physical problem to live the lives they needed to. For others, an identification as queer works best, and many combine both.

The second one has a pragmatic logic, but on a moral level it bothers me. The argument is ultimately is at best accommodating ableism, and at worst actively ableist. Look at this quote I found on Yahoo answers, by someone who was delivering a Trans 101 that was otherwise very balanced and well informed;

“However, many (most?) folks who qualify for this diagnosis [Gender Identity Disorder] dislike the term. That is because being born transsexual or being transgender is NOT a disorder, they are natural variants. However, because of the stigma applied in the past it was labelled as such. Modern research over the last 25 years has more or less proven that people are in fact born this way.”

She is saying that trans people are unlike disabled people because they are natural and born that way. Well, many if not most disabled people are born that way, and in what objective sense are they unnatural? Disabilities often arise from genetic inheritance or mutations, which are entirely natural processes. And, once again, we are not different in the sense that we don’t sometimes need medical intervention to live our lives. She isn’t using natural in any objective sense, but in the same sense that a cultivated rose is “natural” but a two-headed snake is “unnatural.” She’s really just saying that being transgender is good and nice and fine but being disabled is bad and yucky. I’m not okay with that.

The third issue is actually one where disabled and transgendered people are actually natural allies. Whether it’s cochlear implants for d/Deafness or Ritalin for ADHD or SSRIs or prosthetics vs wheelchairs, disabled people are constantly faced with the issue of people believing that a particular cure is either something every person with condition X must have, or that it’s something unnatural and if you take it you are betraying the great movement of condition X positivity. The reality, for practically every cure that does not actually prevent premature death, is that there are pros and cons, side effects and new opportunities, and what is a good choice for one person may be a poor choice for another with the same condition. In nearly every disability 101 I have encountered, a key issue has been the right to self-determine treatment based on your individual needs. The sentiment that certain cures would take something away from who you are as a person is not uncommon. Deaf people, people with autism, some artists with manageable mood disorders are just a few examples, and again for every example there is someone else who would give anything to have been born without their disability. Similarly, some trans people would jump at the chance to be cis, while others, like myself, feel like being trans is part of who they are, and that losing it wouldn’t be an improvement, just changing who they are to make other people comfortable.

This is a massive article because I am trying to condense so many complex issues into one piece. As it is I feel I will need follow-ups and clarifications, and on that note if you have some objection to what I have said please leave a comment, so I can clarify or educate myself as needed. Ultimately, my point is this; the aim of trans activism is to convince people to accept our rights to self-determine our identities and our bodies, without scorn or alienation from people who find us distasteful for bigoted reasons that have nothing to do with our own well-being. This is a primary goal of many disabled activists as well; for non-life threatening conditions that have treatment options, this is often the primary goal. So rather than alienate ourselves from them, why not ally ourselves with them?

Hi, I’m Lane William Brown. I have been diagnosed with gender dysphoria. I  am really okay with that.


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