Tuesday, 13 April 2010

Natacha's submission to the APA about GID in children and the DSM-V

This is thoroughly unacceptable as a diagnosis category. As a researcher who is specialising in transgender children, and who has many years experience of teaching transgender children, I am totally opposed to this. Pathologizing transgender children and young adults will only make their conditions worse. Transgender children are simply presenting themselves in a natural way, which happens not to fit with the gender norms of society as a whole. Retaining GID for children, as for adults, risks perpetuating the traumas which these children face from social exclusion and bullying at school and home. The arguments for retaining GID in children include references to the fact that they suffer mentally as a result of social exclusion. However the APA risks perpetuating this exclusion and mental trauma by retaining this diagnosis. Withdrawing it will send a powerful signal to society that these children should be accepted for who they are.

There is no evidence (Minter 1999, Gottschalk 2005)that any psychiatric treatments work in changing either the gender identities or sexual orientation of transgender children. Current good practice in primary schools is to accept these children for who they are and allow them to express themselves in whatever way they choose. Schools have started to protect children from transphobic bullying and removing GID in children would encourage more schools to do so.

The evidence (Matzner 2001, Ghasemi 1999) is that the only way to help transgender children feel comfortable and untraumatised is to change the immediate and general social environment to one in which they are more or less accepted. In other words this is a phenomenon which is outside the remit of psychiatry, with the exception of the signal that the APA should send to society that being a transgender child is not a problem and should not be treated as a mental illness.

There will no doubt be plenty of work for child psychiatrists in dealing with the effects of social exclusion and bullying of transgender children, however to maintain GID in children as a mental disorder means that the APA leaves itself open to the charge that it is deliberately making transgender children traumatised by the very fact that it retains this classification. The only course of action which the APA can ethically take on this issue, is to support the insight of Thomas & Thomas (1928) that “If men [and women] define situations as real, they are real in their consequences.” and not to stand in the way of those who wish to change the definition of the existing binary gender system as the only way of perceiving gender. To do anything else seems to me to be a serious breach of your professional responsibility, in a the widest sense, to transgender children. To retain this classification will mean that the APA will no longer be the solution to these children's problems, but will have become part of the problem.

Given the chequered history of the DSM and some diagnoses in the past which, in retrospect can be seen to be quite clearly based on the prejudice and bias of some psychiatrists (eg Rekers 1992), the APA risks substantially losing credibility if it fails to remove this diagnosis.

Ghasemi, Z (1999) A Transsexual in Teheran. In Boenke, M (ed) Trans Forming Families: Real Stories about Transgender Loved ones. Walter Trook. California pp21-25

Gottschalk, L (2005) Response to Zucker Commentary on Gottschalk’s (2003) ‘Same-sex Sexuaity and Childhood Gender Non-conformity: A Spurious Connection. Journal of Gender Studies, 14.2 153-158

Matzner, A (2001) O Au No Keia: Voices from Hawaii’s Mahu and Transgender Communities. Xlibris. Philadelphia

Minter, S (1999) Diagnosis and Treatment of Gender Identity Disorder in Children. In Rottnek, M (ed) (1999) Sissies and Tomboys: Gender Nonconformity and Homosexual Childhood. New York University Press. New York

Rekers, G (1982a) Growing up Straight: What every family should know about homosexuality. Inadequate Sex Role Differentiation in Childhood: The Family and Gender Identity Disorders. Journal of Family and Culture. 2(7): 8-37

Thomas, W & Thomas, D (1928) The Child in America. Alfred A Knopf. New York.

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