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View Diary: When homosexuality was mental illness (134 comments)

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  •  Is the problem of stigmatization due to (1+ / 0-)
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    the fact that transgendered people are stigmatized, mental illnesses are stigmatized, or both? I was under the impression that something isn't normally considered a mental disorder or illness unless it causes significant distress to the individual or interferes with socialization. It seems to me that there are two issues. A person who is born presenting as a gender they are not comfortable with has an issue that needs addressing. But a person who addresses that issue faces social stigma. It appears to me that the social stigmas are the real problems. If it weren't for that, then treating gender dysphoria as a medical/psychiatric issue wouldn't be so problematic.

    Please correct/educate me if I'm wrong.

    •  Both (3+ / 0-)
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      musing85, bluesheep, Transactivist

      Mental illnesses are stigmatized and variations of in gender or sexuality are stigmatized.

      But a diagnosis of GID in DSM is admissible in US courts in cases involving child custody, for example, because it is in the same general category as child molestation. In court, we can be made to appear essentially as sex offenders, or people who are crazy in a similar way. That is the effect the DSM psychologists have on us.

      Just look back at the world as it was for gays prior to 1973. Trans people are still living in that world.

      •  what about depression, bipolar disorder, etc.? (1+ / 0-)
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        Should those be removed on the same basis? Or is there something that delineates these diagnoses from GID?

        •  I think that there is probably natural human (2+ / 0-)
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          musing85, Transactivist

          variation going on in these things too, but with harm heaped onto variant people by a society that wants us all to be interchangeable machine parts in a Koch factory.

          •  does the idea of natural human variation (0+ / 0-)

            preclude the possibility that some of this variation can legitimately be considered a disorder or illness? I recognize that part of the distress caused by these conditions has to do with the societal context in which they occur. But given that this is the world we live in, and there is some biological basis for some of these conditions, doesn't treating them as medical conditions make some sense, if it improves the life of the individual?

            It's true that there is a great deal of variation in human brains and physiology generally. But it isn't a completely random, flat distribution of variation across all parameters. The majority of people seem to be content with the gender they are assigned to at birth. I don't think that the fact that we categorize subsets of these variations is an entirely artificial construct. Some ways of categorizing human behavior are a better fit than others. There will always be people who don't fit neatly into these categories, and we have to accept that and deal with it. But that doesn't mean the categorization is without merit. At least, that's how I see things.

            Personally, I'm grateful for this medical model. It's far from perfect, but I think it has improved my life. Of course it can be misused, as any tool can.

            •  If a gene variant is always harmful (0+ / 0-)

              natural selection removes it from a population very quickly. It is then found only at a level at which the gene variant is reintroduced by mutation. That is a very low level, around 1 per million or less. There are some diseases such as Huntington's which occur at this low level, and are a product of random mutations.

              But transsexualism occurs at a rate of at least 1 per 500. That is three orders of magnitude greater than the low selection-mutation equilibrium rate. To have an incidence level this high implies that there been environments in our recent evolutionary past in which it was beneficial to have transsexuals in a group.

              And you don't have to look any further than two-spirit traditions to find examples of those environments.

              •  Are the people in those traditions (0+ / 0-)

                generally able to be content without making any change to their bodies? If so, does that mean that difficulties encountered by transgendered people in our society are entirely cultural?

                I'll have to think about what you say regarding genetic disorders. It seems to me there is evidence that many common problems may have a genetic component. I would think that unless a problem has a deleterious affect on reproduction or survival, natural selection wouldn't necessarily eliminate it.

                •  In some cultures body modifications are used (0+ / 0-)

                  in others not. I see no reason why Ts our culture should not use available body modifications. Is that proof of mental illness in your mind?

                  If a "problem" does not have a deleterious effect on reproduction or survival, in what medical sense can it be an "illness"?

                  •  What if something causes someone (0+ / 0-)

                    pain or discomfort, but doesn't lead to premature death or impact the ability of the population to propagate itself? Arthritis and depression, both of which I have had treatment for, are things I regard as illnesses. Yet they are not things which directly or inevitably would lead to my premature death or the survival of my species or population group. They may indirectly impact my personal ability to reproduce, and they may shorten my lifespan. But they are also prevalent and have been for a long time, suggesting that natural selection hasn't affected them.

                    As for body modification, I don't think it is proof of mental illness. But if it is done to alleviate some sort of suffering, it is evidence of either a physical or mental issue that requires addressing. I would say that issue could be characterized as an illness. Apart from social ramifications attached to such a characterization, I don't see why that is a problem.

                    •  Depression may well be or once have been adaptive (0+ / 0-)

                      it is not unique to humans but occurs in other primates.

                      Arthritis is actually a ragbag of different diseases. But they could certainly affect survival under ancestral conditions.

                      I think that many of the diagnoses in DSM such as schizophrenia represent mental variations that in past societies would have been sought-after traits in shamans.
                      Our culture has turned these once-beneficial characteristics into diseases.

                      •  I suppose we have a different point of (0+ / 0-)

                        view about these things. It seems that you don't agree with the idea of mental illness and the DSM altogether. But your effort focuses on having a particular diagnosis removed from the DSM because of your focus on transgender rights. My concern is that if this effort is being done because of the stigmas, stereotypes, and legal problems associated with mental illness, that this effort perpetuates those problems while striving to help transgendered people.

                        •  I think a lot of "mental illnesses" were once (0+ / 0-)

                          adaptive variations that our culture has turned maladaptive -- in effect, the "disease" is a cultural construct based on a trait that is not inherently disease. Trans and homosexuality are examples.

                          •  Well, I don't think trans and homosexuality (0+ / 0-)

                            are diseases, but maybe I don't understand what is encompassed by the term "trans". I didn't think that GID was the same thing. I was under the impression that it referred to the dissatisfaction with the gender one is assigned from birth, not the gender identity itself.

                            I'll grant that there are illnesses which may have been adaptive at one point in our long evolutionary history. But for one thing, we're dealing with the present day, so in some sense that may be irrelevant. And I don't know if there's enough evidence to conclude that all modern diseases were once adaptive, thus explaining their survival. It could be that many diseases are neither adaptive nor maladaptive.

                          •  GID is a synonym for transsexual (0+ / 0-)

                            I'm not saying that all modern diseases were once adaptive, I am saying that if something that was once adaptive is now maladaptive in our culture the cause of distress is our culture.

                            It is not science-based medicine to blame the victim of social prejudice for the harm done to her by social prejudice, which is exactly what the disease theory of human variation does.

                          •  but isn't adaptation always in the context of (0+ / 0-)

                            a culture? Our culture has changed, so what once may have been adapted no longer is. In general, I don't see why the onus is necessarily on the culture to change so that these can be adaptive again. But there are other issues involved, and we have other cultural values that we don't consistently apply. I think we should change our society to be more accepting and tolerant of these gender variations, and I don't think these gender variations should themselves be considered disorders or diseases. But if a person desires or requires surgery or other treatment, does that mean that we should allow any surgery or treatment without some sort of medical diagnosis?

                            I also note that, per Wikipedia, among the criteria for GID in the DSM-IV-TR are:

                            Long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex
                            Significant clinical discomfort or impairment at work, social situations, or other important life areas.

                            So it seems to me that absent these issues there is no diagnosis of GID according to the DSM. Of course, the second criterion can be construed as a societal problem rather than a medical problem. But in any case it is a problem that needs to be addressed, and how it is addressed may be important. I also am questioning whether the first criterion is purely a result of cultural influence.

                            I also think that calling something a mental illness does not imply blame. That does a disservice to those who do have mental illnesses, and perpetuates the stigmas against the mentally ill. But I start from a different premise than you do, I think.

                          •  That is a general argument for preserving (0+ / 0-)

                            an unjust status quo.

                            It exemplifies what transsexuals mean when we say that
                            "psychologists are politicians in lab coats"

                            If your goal is the political one of protecting a status quo that does harm to groups of people, medicalizing your political purpose is just pseudoscience.

                            Of course we only have to look at psychologists who do research on torture ("learned helplessness") for DOD to see examples of these white-robed priests of power.

                          •  I don't think this is an either/or situation (0+ / 0-)

                            I think psychologists and psychiatrists in general do a lot of good, and at times they have not. The idea of learned helplessness has been misconstrued and misused, but that does not mean it has not helped people, myself included. Psychologists are no more political than anyone else. I am for preserving the status quo in some cases and not in others.

                          •  "I am for preserving the status quo (0+ / 0-)

                            when it benefits me."

                            Spoken from a perspective of true cisgender privilege.

                            This is a political fight for us -- a battle for human rights.
                            We know perfectly well where psychology as a profession has always stood on human rights issues.

                            Psychology is the most ethically challenged field in the academy. When it is not advocating eugenics, it is looking for ways to control people's behavior in economics and politics.

                          •  Not just me. (0+ / 0-)

                            Most of my political views are not based on what would advantage me personally. That is in part because I am, as you say, privileged. Mental health issues are among the few issues that do affect me personally. I believe in human rights, but I disagree with you about psychology. I support your rights, and if getting rid of GID as a diagnosis is what is best for trans people, then it is the right thing to do. I have questions and concerns that come from my personal perspective. I'm not trying to impede anyone's rights.

                          •  Possible Darinian value for gender variation (0+ / 0-)

                            I am saying that any variation which appears at well above selection-mutation equilibrium cannot be deleterious in all environments.

                            At many times it must have been adaptive or at least selectively neutral.

                            For example, it may be that MTF transsexuality represents not "incomplete masculinization" of the brain, but decreasing sexual dimorphism of human brain structures, that provides the benefit of greater neural plasticity.

                            This is still a natural variation -- variation in the degree of dimorphism. If the result is people with heightened creativity or insight, it would be a Darwinian benefit to have such a person in your group. The distress of transgender, as Darwinian negative selection, might be more than offset by the advantages to the group.

                            This is speculation, of course.

                          •  You may be right about all of that (0+ / 0-)

                            but evolution has no moral or prescriptive implications, in my view.

                          •  Where did I attribute morality or prescription (0+ / 0-)

                            to evolution?

                            I'm making a fairly elementary point about population genetics. Harmful alleles are rapidly removed from a population. If a trait occurs at a level that is orders of magnitude higher than the back-mutation rate, it is not reasonable to call it harmful in an evolutionary sense.

                            It may be disliked in a certain culture, but please don't confuse that cultural attitude with an objectively biological deleterious condition.

                            To do so is to abuse science for political purposes.

                          •  Whether something is harmful in an evolutionary (0+ / 0-)

                            sense doesn't determine whether it is harmful to an individual. The decision to treat something medically shouldn't be based on how it will affect the survival of the species, but what is in the best interests of the individual. If a person requires surgery, then it seems to me that a medical issue is involved.

                          •  Medical technology is being used (1+ / 0-)
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                            Medical technology is also used during childbirth. That doesn't make childbirth a disease.

                          •  And women do not need to get the approval (0+ / 0-)

                            of psychologists to have a baby.

                            But we have to get the approval of psychologists to have SRS.

                            That is unjust power, and we will work politically to remove that unjust power from those quacks who exercise it over us.

                            And that process starts with delisting GID (and TF) from DSM.

                          •  What do you think should be required of (0+ / 0-)

                            someone who wishes to undergo SRS? Should it simply be a that if someone wants it and is either able and willing to pay for it or have insurance pay for it, that should be sufficient? I'm just asking. As you have said, I have no standing on this issue.

                          •  You can write your own ticket now (1+ / 0-)
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                            if you have the money and want to do so. It's not hard to find surgeons outside the US who will overlook letters of reference for a few extra thousand dollars. This has been going on for years.

                            As I wrote previously, the transition process would not be affected in any way by delisting GID. The transition process in the US is run by WPATH, not by the DSM people, who are not even members of WPATH. WPATH sets the Standard of Care that the US surgeons adhere to.

                            WPATH has requested the APA to remove GID and TF from GID.

                            This is not about the transition process for adults. It is about a cadre of homophobic, reparatist right wing psychologists maintaining their control over trans children.

                            It's a battle for the future, another chapter of the right wing's culture war. They do not want transsexuality and homosexuality to be normalized in our culture. They have some power right now, and they do not want to give it up. They want to expand it.

                            WPATH and the professional psychologists and surgeons who work with adult transpeople are not supporting retention of GID or TF in DSM. They are on record against it.

                          •  Here is an example of distress without disease (1+ / 0-)
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                            Birth can certainly cause distress, but it is hardly maladaptive and it is not a "disease", even if it causes dis/ease.

                            Birth is natural, but there is certainly no reason why humans should not take steps to relieve or reduce the distress it causes. No one today -- outside the most extreme religious groups -- thinks that Nature or God requires women to experience the maximum pain during childbirth if it can be lessened.

                            Transition is similar. We may have distress, but it is not a "disease".  Using technology to relieve our stress is not somehow prohibited by Nature. And it is not a symptom of mental illness.

                            I know that cisgender men are really, really spooked by SRS. "You want to cut off what? You must be crazy." From there they go on to invent all sorts of pseudoscientific rationalization for why such people need to be controlled.

                            But the decision isn't up to them. It's not their body, and by their own admission they cannot begin to understand our motivations.

                            Fine. We are not asking you to understand. We are asking -- or perhaps now telling -- to get the f*ck out of our faces. We will make these decisions for ourselves. We don't need your approval or understanding. It's our right to make these decisions and not to discriminated against for doing so, because they do you no harm. You have no "standing" in the matter.

                          •  OK, thanks for that good example. (0+ / 0-)

                            So the question for me is, where and on what basis do we draw the lines around diseases, illnesses, or disorders (which are not necessarily all the same thing.) I can see your analogy between pregnancy and transition. I think many people are concerned with the idea of transition because it doesn't seem to be a process which is easily reversible. So if a person is suffering from some mental disorder they may seek out transition and regret it later. But the likelihood of this may be very small, and the same thing could be said about many other medical procedures.

                            I am not spooked by SRS, and I realize that it isn't up to me. I have no desire to control anyone. I know that you are not asking me to understand. I am seeking to understand more anyway, even though I know that there is a limit to that understanding. I'm not trying to cause any aggravation, or get in the way of anything. I think it is natural that I am concerned about issues which are closer to home for me, such as the stigmatization of mental illness. What I want is for the concept of mental illness to be looked at objectively without moral judgment.

                          •  Many people are concerned with transition (0+ / 0-)

                            Oh, tell me about it. I only lost a human lifetime because of that tender "concern".

                            Suicide is also irreversible. How many more of us have to kill ourselves before cisgender males stop trying to "save" from us from doing something that gives them the creeps?

                            I predict that no number of suicides of trans people would ever make you comfortable with SRS.

                            Therefore this is a purely political issue, exactly like abortion rights. We will simply work to take our rights regardless of whether cisgender males like it (and it is usually the cisgender males who are ultra-creeped-out)

                          •  Abortion rights is a political issue, but (0+ / 0-)

                            abortion itself is a medical issue. That point aside, are the high rates of suicide caused by the inability to have SRS, or as a result of being abused and tormented by others, or both? Dealing with suicide and trauma should be of primary concern, of course.

                            Anyway, I personally have no more discomfort with the idea of SRS than any other procedure which alters the body. I am currently recovering from a total hip replacement, and even though that is a pretty straightforward procedure which has a high potential of greatly improving my life, it's not something I easily jumped into. I would think the same would be true for most people undergoing any kind of surgery, including SRS. These aren't things a person jumps into willy-nilly. However, I did need a diagnosis to proceed with my surgery. Whether that should be the case for SRS, I don't know. Should I care, given that it has no impact on me? No, not really. My initial concern with this diary had more to do with the attitude about psychology, although I am interested in the general subject matter.

                          •  The high rates of suicide among trans (0+ / 0-)

                            are caused by not being able to live as who we are.

                            I can't help it if you can't understand that. It is the only possible truthful explanation.

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