The New Normal

By Schwartzapfel, Beth | Mother Jones, January/February 2013 | Go to article overview
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The New Normal

Schwartzapfel, Beth, Mother Jones


Until 1974, being gay was officially a mental illness. Now transgender people want shrinks to stop calling them crazy

By just about every standard, Dr. Nick Gorton is like any regular, well-adjusted guy. A 42-year-old veteran emergency-room doctor in the San Francisco Bay Area, he is happily married to his partner of 16 years. He is a self-professed science geek who enjoys hanging out with his Chihuahua-Jack Russell mix and spending too much time online.

But according to the American Psychiatric Association, Gorton has a major mental illness: gender identity disorder. Gorton was raised female, though as early as nursery school he knew he did not feel like a girl. Or, in the phrasing of Diagnosis 302.85 in the fourth edition of the apa's Diagnostic and Statistical Manual of Mental Disorders (dsm), he had "a strong persistent cross-gender identification" and "persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex."

Transgender activists have long called for this diagnosis to be revised or removed altogether from the dsm, arguing that being transgender is not a disease but a human variation-more like being lefthanded than schizophrenic. The manual listed homosexuality as a form of "sexual deviation" until 1974, and some advocates say that in a generation most people will see the diagnosis of gender identity disorder as equally absurd.

Many trans people do describe being intensely unhappy before they came out-feeling betrayed by their bodies and unable to live as their true selves. This disconnect between one's body and sense of self, known as gender dysphoria, can be crippling. "I literally spent the first three decades of my life, pretty much every day, unhappy," Gorton says. He recalls seeing homeless men on the streets of New York City and wishing he could trade places with them just to have their bodies. In his early 30s, he decided to undergo a course of treatments that included a mastectomy, male hormones, and talk therapy. Now that he's transitioned to living fully as a man, he says, his "tremendous amount of mentalhealth issues" are "virtually gone."

Yet according to the dsm, he still has a mental-health problem. The manual is the scientific bible by which psychiatrists and other mental-health professionals standardize, identify, and, importantly, bill insurance companies for their patients' afflictions. Because the gender identity disorder diagnosis includes "a lot of stuff that basically just describes trans people," explains Dr. Dan Karasic, a psychiatrist at the Bay Area-based Transgender Life Care Program, there is no way to be transgender, according to the dsm, without being mentally ill.

That can have devastating consequences. "We lose our homes, we lose our families, we lose our jobs," says Kelley Winters, a transgender activist and the founder of GiD Reform Advocates. Family law is littered with cases of transgender parents whose parental rights were threatened or terminated because their ex-spouses or former partners argued that their mental state put their children at risk. Until the Federal Aviation Administration changed its policy last August, transgender people aspiring to be pilots were required to undergo expensive psychological testin g-which they often had to pay for themselves-before they could get a license.

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The New Normal


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