Do you think the Buggery Law should be?

The Safe House Homeless LGBTQ Project 2009 a detailed look & more


In response to numerous requests for more information on the defunct Safe House Pilot Project that was to address the growing numbers of displaced and homeless LGBTQ youth in Kingston in 2007/8/9, a review of the relevance of the project as a solution, the possible avoidance of present issues with some of its previous residents if it were kept open.
Recorded June 12, 2013; also see from the former Executive Director named in the podcast more background on the project: HERE also see the beginning of the issues from the closure of the project: The Quietus ……… The Safe House Project Closes and The Ultimatum on December 30, 2009

Sunday, December 26, 2010

Ten Reasons Why the Transvestic Disorder Diagnosis in the DSM-5 Has Got to Go

Kelley Winters, Ph.D.
GID Reform Advocates
www.gidreform.org
kelley@gidreform.org

The classification of gender diversity and nonconformity to birth-assigned gender roles as mental illness by the American Psychiatric Association (APA) has drawn growing protest and outrage from transpeople and and allies worldwide. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA, is regarded as the medical and social definition of mental disorder throughout North America and strongly influences international diagnostic nomenclature. The fifth edition of the manual, the DSM-5, is in development and scheduled for publication in 2013. While the diagnostic category of Gender Identity Disorder (GID) has garnered most of the controversy, a second category of so-called Transvestic Fetishism (TF) has harmed transwomen, including transsexual women, as well as male-to-female crossdressers, dual gender and gender nonconforming people since the earliest days of the DSM. Trans and LGB advocates have been inexplicably quiet about the TF category, even after the APA proposed to expand the category in the DSM-5, renamed Transvestic Disorder, to implicate gender nonconforming people of all sexes and all sexual orientations.

The proposed DSM-5 diagnosis of Transvestic Disorder, even worse than its predecessor Transvestic Fetishism, labels gender expression not stereotypically associated with assigned birth sex as inherently pathological and sexually deviant. The diagnosis is punitive and scientifically capricious, serving to punish social and sexual gender nonconformity and enforce binary stereotypes of assigned birth sex. Here are ten reasons why the Transvestic Disorder diagnosis should be eliminated entirely from the DSM-5.

1. Diagnosis of Diversity

The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association, (HBIGDA), publishes recognized standards of medical transition care for those who need it. In May, 2010, WPATH issued the following pivotal statement on de-psychopathologisation of gender variance,

The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide. The expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative. The [psychopathologisation] of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being. WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people.

Gender expression that differs from social expectations of assigned birth sex does not meet any medical or scientific definition of mental pathology. Difference is not disease.

2. Stigma of Sexual Deviance

Transvestic Disorder is classified as a “paraphilic” sexual disorder, grouped with diagnoses of such harmful behaviors as pedophilia and exhibitionism. The resulting stereotypes of sexual deviance deny human dignity and civil justice to transgender and gender variant people, including transsexual individuals, who consequently lose their jobs, homes, families, children, freedoms and access to public accommodation.

In the United States, these false stereotypes were exemplified in a full-page newspaper ad campaign in 2008 by Focus on the Family, a political extremist group opposed to civil rights for transpeople in the state of Colorado. A transwoman was depicted in a photo as a disheveled suspicious male in dirty work boots, lurking in a women’s restroom as a little girl stepped out of a stall. The ad contained the headline, “Colorado Just Opened Its Bathrooms to Either Sex!” with the phrase, “sexual predator.” The association of transwomen with sexual predation and threat to children was in reference to the association of transwomen with “paraphilia” in the DSM.

3. Denial of Civil Justice

In the DSM-III, the APA stated, “The crucial issue in determining whether or not homosexuality per se should be regarded as a mental disorder is not the etiology of the condition, but its consequences and the definition of mental disorder.” Tragically, the APA has neglected to apply this same logic to the consequences of psychopathologization of gender variance and nonconformity.

For example, Andrea Lafferty, of the extremist Traditional Values Coalition, exploited the TF and GID diagnostic categories to oppose national employment nondiscrimination legislation for GLBTQ Americans in a CBS News interview this year. Lafferty cited the APA while repeating that transpeople have “a serious mental disorder” and represent a threat to children. In fact, the current TF and GID nomenclature have played a pivotal role in the ongoing defeat of the Employment Nondiscrimination Act (ENDA) in the U.S. Congress, as opponents have focused on sensational false stereotypes of mental illness and sexual deviance rather than direct attack against gay and lesbian people.

4. Pathologization of Ordinary Behaviors.

The supporting text of the Transvestic Fetishism diagnosis describes behaviors that would be ordinary or even exemplary for cisgender women as symptomatic of mental disorder for transgender women and gender nonconforming males. These include wearing female clothing, dressing entirely as females, wearing makeup, expressing feminine mannerisms and appearing publicly in a feminine role. The text goes so far as to list “involvement in a transvestic subculture” among pathological “transvestic phenomena.” It is not clear how the very same behaviors and social/political affiliations can be pathological for one group of people and not for others.

5. Harm to Transsexual Women

The proposed Transvestic Disorder category is not limited to crossdressers or male-identified people. It also targets transsexual women with a specifier of “autogynephilia,” a deeply offensive label that sexualizes ordinary and customary social gender expression and promotes a poorly supported and socially defamatory theory that transsexual women transition to satisfy a sexual fetish rather than attain harmony with their experienced gender identity. The label of Transvestic Fetishism has also been used to deny medical transition treatment for transsexual indivicuals who need it. For example, the diagnosis was cited by Federal attorneys against Ms. Rhiannon O’Donnabhainn in her recent landmark case in U.S. Tax Court. They used the TF category to promote a false stereotype of fetishism to argue that corrective transition surgeries for transsexual women are not medically necessary.

6. Harm to Transmen

In June of this year, the phrase “in a male,” in reference to birth-assigned sex, was removed from criterion A for the proposed Transvestic Disorder without explanation. As a result, transmen and masculine or butch women may now be implicated with Transvestic Disorder because of the clothes they wear. A new specifier of “with autoandrophilia” was added to the diagnostic criteria to target transsexual men, much as the specifier of “autogynephilia” would target and defame transsexual women.

7. Harm to Non-erotically Motivated Crossdressers

Ambiguous language in Criterion A of the APA Transvestic Disorder proposal implicates sexual expression “involving” crossdressing, without evidence of causation. Thus, virtually any gender expression among bigender, dual-gender or genderqueer people that is coincident with any kind of a sex life may be inferred as diagnosable, whether erotically motivated or not.

It is apparent that DSM authors have long intended for the TF diagnosis to implicate non-erotic or ambiguously erotic crossdressing as a fetishistic psychopathology. For example, the DSM-IV Casebook recommended a Transvestic Fetishism diagnosis for a male-identified subject whose crossdressing was not necessarily sexually motivated.

8. Harm to Erotically Motivated Crossdressers

Crossdressing that is erotically motivated is a benign consensual sexual expression that does not rise to the definition of mental illness. There is no scientific justification for labeling this behavior as mentally or sexually pathological. The DSM-IV-TR states, “Neither deviant behavior … nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of dysfunction…”

9. Harm to Ego-Dystonic (self-unaccepting) Crossdressers

The APA proposal for Transvestic Disorder, pathologizes ego-dystonic crossdressers, who are distressed by internalized shame and societal transphobia, very much as the previous diagnosis of Ego-Dystonic Homosexuality in the DSM-III pathologized victims of social homophobia. Ego-Dystonic Homosexuality was removed entirely from the DSM-III-R in 1987, because it inexorably associated all same sex orientation with pathology and because “almost all people who are homosexual first go through a phase in which their homosexuality is ego-dystonic.” The very same logic should apply to the Transvestic Disorder diagnosis in the DSM-5. It would be tragic for the APA to perpetuate a diagnosis so analogous to Ego-Dystonic Homosexuality of the last century.

10. Implicit Endorsement of Gender-Reparative Therapies

In 2008, the American Psychiatric Association (APA) released public statements that, “…the DSM is a diagnostic manual and does not provide treatment recommendations or guidelines.” In fact, however, diagnostic nomenclature and treatment are inseparably related. The efficacy of all drug and psychotherapy treatments are judged according to specific diagnostic criteria listed in the DSM and ICD. The diagnostic criteria for the proposed Transvestic Disorder in the DSM-5 favor gender-reparative therapies that serve to repress gender nonconforming fantasies, urges and behaviors, described in criterion A. Bigender, dual gender or gender variant individuals who are not shamed into repression but are distressed by external societal intolerance, would perpetually meet the criteria regardless of how happy and functional they might otherwise be.
It is time to call upon the APA leadership to reject the proposed diagnostic category of Transvestic Disorder and remove nomenclature from the DSM that casts crossdressing and gender role nonconformity in themselves as mental disorder.

Appendix A: DSM-IV-TR Diagnostic Criteria for Transvestic Fetishism
(APA 2000)

A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Specify if: With Gender Dysphoria: if the person has persistent discomfort with gender role or identity

Appendix B: Proposed DSM-5 Diagnostic Criteria for Transvestic Disorder
(APA 2010)

A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving cross-dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.:

Specify if:

With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)

With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)

With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)

Specify if:

In Remission (During the Past Six Months, No Signs or Symptoms of the Disorder Were Present)

In a Controlled Environment

References

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Washington, D.C., p. 426.

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, D.C., p. xxii.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, D.C., pp. xxxi, 574-5.

American Psychiatric Association (2008), “APA STATEMENT ON GID AND THE DSM-V,”http://www.psych.org/MainMenu/Research/DSMIV/DSMV/APAStatements/APAStatementonGIDandTheDSMV.aspx , May 23

American Psychiatric Association (2010) “DSM-5 Development; Proposed Revisions, 302.3
Transvestic Fetishism,”
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=189

Blanchard, R. (1989). “The Classification and Labeling of Nonhomosexual Gender Dysphoria,” Archives of Sexual Behavior, v. 18 n. 4, p. 322-323.

Cordes, N., CBS News (2010). “Washington Unplugged,” April 20 http://www.cbsnews.com/video/watch/?id=6414895n (audio excerpts of Andrea Lafferty, of the Traditional Values Coalition, repeating slurs of mental disorder are available at http://www.gidreform.org/cbslafferty1.mp3 )

DeCuypere, G., Knudson G., & Bockting, W. (2010). “Response of the World Professional Association for Transgender Health to the Proposed DSM 5 Criteria for Gender Incongruence,” http://www.wpath.org/documents/WPATH%20Reaction%20to%20the%20proposed%20DSM%20-%20Final.pdf

Focus on the Family Action (2008). Colorado Springs, CO, http://www.citizenlink.com. Photo available online athttp://www.gidreform.org/2008FOFsb2006.jpg

Lev, A., Alie, L., Ansara, Y., Deutsch, M., Dickey, L., Ehrbar, R., Ehrensaft, D., Green, J., Meier, S., Richmond, K., Susset, F., Winters, K. (2010). Professionals Concerned With Gender Diagnoses in the DSM Statement on Transvestic Disorder in the DSM-5,http://gidconcern.wordpress.com/statement-on-transvestic-disorder-in-the-dsm-5/

Serano, J. (2009). “Autogynephilia’ and the psychological sexualization of MtF transgenderism,” International Foundation for Gender Education 2009 Conference, Alexandria VA, March, http://ai.eecs.umich.edu/people/conway/TS/IFGE2009/Disordered_No_More.html#Julia

Spitzer, R., editor (1994), DSM-IV Casebook, A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition), American Psychiatric Press, pp. 257-259.

Winters, K. (2008). Gender Madness in American Psychiatry: Essays from the Struggle for Dignity. CO: GID Reform Advocates, pp. 33-43.

Winters, K., (2010). “A Taxing Question of Medical Necessity,” GID Reform Advocates Essay Series on Gender Diagnoses in the DSM-V, Feb 6,http://www.gidreform.org/blog2010Feb06.html

Winters, K. (2010). “Comments on the Proposed Revision to 302.3 Transvestic Fetishism,” http://www.gidreform.org/201004APATFkwB.pdf

World Professional Association for Transgender Health (2010). “Statement Urging the De-psychopathologisation of Gender Variance,”http://wpath.org/

Petition site:
http://www.change.org/petitions/view/remove_transgender_from_the_dsm-5

Register HERE with The APA to comment:
http://www.dsm5.org/Pages/Registration.aspx

# # # # # # # # #

Back Ground Information

APA's DSM-5 Development Page
http://www.dsm5.org/Pages/Default.aspx

GID Reform.org
http://www.gidreform.org/index.html

3 comments:

planet trans said...

Great article! This post will serve us well as we struggle to break the chains of pathologization the APA has wrapped around us, dragging us down and away from full social integration.

Our unique expressions are a blessing not a mental illness.

Kelley, I'm delighted and humbled that such a articulate and educated person as yourself choose the Care2petition site we started.

I pray for our success. It is our first step.

Unknown said...

Thanks or the comment Kelli but the piece was taken from the GID blog and the website was linked below her name, I thought I'd share it with my readers although I am a gay male but do observe the other issues surrounding gender identity and transgenderism.

Howie
lgbtevent@gmail.com

Anonymous said...

Then Howie, you are our most valued of allies. Thank you!

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Thanks for your Donations

Hello readers,

Thank you for your donations via Paypal in helping to keep this blog going, my limited frontline community work, temporary shelter assistance at my home and related costs. Please continue to support me and my allies in this venture that has now become a full time activity. When I first started blogging in late 2007 it was just as a pass time to highlight GLBTQ issues in Jamaica under then JFLAG's blogspot page but now clearly there is a need for more forumatic activity which I want to continue to play my part while raising more real life issues pertinent to us.

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2 SGL Women lost, corrective rape and virtual silence from the male dominated advocacy structure


Al Miller on UK Aid & The Abnormality of Homosexuality 19.11.11


Homosexuality is Not Illegal in Jamaica .... Buggery is despite the persons gender 12.11.11 MORE HERE 


MSM Homelessness 2011 ...my two cents


Black Friday for Gays in Jamaica More HERE


Bi-phobia by default from supposed LGBT advocate structures?


Homeless MSMs Saga Timeline 28.08.11 (HOT!!!) see more HERE


A Response to Al Miller's Abnormality of Homosexuality statement 19.11.11


UK/commonwealth Aid Matter & The New Developments, no aid cuts but redirecting, ethical problems on our part - 22.11.11


Homophobic Killings versus Non Homophobic Killings 12.07.12


Big Lies, Crisis Archiving & More MSM Homlessness Issues 12.07.12


More MSM Challenges July 2012 more sounds HERE


GLBTQ Jamaica 2011 Summary 02.01.12 more HERE


Homosexuality Destroying the Family? .............. I Think Not!


Lesbian issues left out of the Jamaican advocacy thrust until now?


Club Heavens The Rebirth 12.02.12 and more HERE


Should gov't provide shelter for homeless msm?


National attitudes to gays survey shows 78% of J'cans say NO to buggery repeal


1st Anniversary of Homeless MSM civil disobedience (Aug 23/4) 2012 more HERE


JFLAG's rejection of rowdy homeless msms & the Sept 21st standoff .........


Atheism & Secularism may cloud the struggle for lgbt rights in Jamaica more HERE


Urgent Need to discuss sex & sexuality II and more HERE


MSM Community Displacement Concerns October 2012


The UTECH abuse & related issues


Beenieman's hypocrisy & his fake apology in his own words and more HERE


Guarded about JFLAG's Homeless shelter


Homophobia & homelessness matters for November 2012 ................


Cabinet delays buggery review, says it's not a priority & more ...........................(November 2012) prior to the announcement of the review in parliament in June 2013 More sounds HERE


"Dutty Mind" used in Patois Bible to describe homosexuals


Homeless impatient with agencies over slow progress for promised shelter 2012 More HERE


George Davis Live - Dr Wayne West & Carole Narcisse on JCHS' illogical fear


Homeless MSM Issues in New Kgn Jan 2013 .......


Homeless MSM challenges in Jamaica February 2013 more HERE


JFLAG Excludes Homeless MSM from IDAHOT Symposium on Homelessness 2013


Poor leadership & dithering are reasons for JFLAG & Jamaica AIDS Support’s temporary homelessness May 2013 more HERE


Response To Flagging a Dead Horse Free Speech & Gay Rights 10.06.13