Academic journal article Ethical Human Psychology and Psychiatry

Ethics of Gender Identity Disorder

Academic journal article Ethical Human Psychology and Psychiatry

Ethics of Gender Identity Disorder

Article excerpt

Gender identity disorder is unique among all DSM-IV-TR diagnoses. It is the only disorder in which treatment is designed to confirm, reinforce, and validate the belief that is the basis of the mental disorder. In all other diagnoses, the symptoms in the diagnostic criteria are viewed as pathological and the goal of treatment is to remove the symptoms. In gender identity disorder, however, the body is altered to match the belief that is said to be a symptom of mental disorder. This is self-contradictory. Either gender identity disorder should be dropped from DSM-V, just as homosexuality was dropped from the diagnostic system, or gender reassignment should be discontinued. The core contradiction in the current approach to gender identity is an ethical problem in the mental health field.

Keywords: gender identity disorder; DSM-IV-TR; ethics

Homosexuality was classified as a mental disorder in DSM-I (American Psychiatric Association [APA], 1952) but this was changed in DSM-II because of political pressure by gay and lesbian lobbyists. DSM-III states that, "Since homosexuality itself is not considered a mental disorder, the factors that predispose to homosexuality are not included in this section" (APA, 1980, p. 282). This statement is made in the text for 302.00 ego-dystonic homosexuality. There is no DSM-III category of ego-dystonic heterosexuality.

In DSM-III-R the category of ego-dystonic homosexuality was removed, but a subtype of 302.90 "sexual disorder not otherwise specified" was, "persistent and marked distress about one's sexual orientation" (APA, 1987, p. 296). The same language appears in DSM-IV-TR (APA, 2000, p. 582). The DSM system has attained political neutrality and correctness concerning homosexuality. All these changes were based on politics and lobbying.

DSM-IV-TR still retains the diagnosis of 302.85 gender identity disorder: the code is 302.6 for gender identity disorder in children. In the text for DSM-IV-TR gender identity disorder, it is stated that the genitals are normal and that there are no laboratory tests for the disorder. This is so because the genome and hormones are normal in such cases.

Why, though, is gender identity disorder retained in DSM-IV-TR when homosexuality has been purged from the system because of political pressure? The genome and hormones are normal in homosexuality, and the gay/lesbian political lobby is actually the gay/lesbian/ transgender political lobby. The key difference, it seems to me, is the existence of gender reassignment programs. There is no biomedical intervention available for homosexuality, so there is no turf to protect from a financial and power perspective.

Psychiatry, it seems to me, retains gender identity disorder in the DSM system in order to retain its gatekeeper function in gender reassignment programs. The American Medical Association (www.ama-assn.org) states in Resolution 122 passed in 2008, that:

Whereas, The AMA opposes limitations placed on patient care by third-party payers when such care is based upon sound scientific evidence and sound medical opinion, and

Whereas, Many health insurance plans categorically exclude coverage of mental health, medical, and surgical treatments for GID (gender identity disorder), even though many of these same treatments, such as psychotherapy, hormone therapy, breast augmentation and removal, hysterectomy, oopherectomy, orchiectomy, and salpingectomy, are often covered for other medical conditions; and

Whereas, The denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient's gender identity; and

Whereas, delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, which further endanger patients' health and strain the health care system; therefore be it

RESOLVED, That the AMA support public and private health insurance coverage for treatment of gender identity disorder (Directive to Take Action); and be it further

RESOLVED, That the AMA oppose categorical exclusions for treatment of gender identity disorder when prescribed by a physician (Directive to Take Action). …

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