Bradley Manning’s statement that he’ll no longer be a “he” but rather a “she” named Chelsea Manning sets the Army private on a path that most transgender individuals have taken.
For many unfamiliar with the “trans” community, such an announcement raises a host of questions. Just getting a count is difficult, but a 2011 report from the Williams Institute, a think tank on sexual orientation and gender identity, suggests nearly 700,000 transgender individuals live in the USA.
The American Psychological Association says transgender is an “umbrella term for persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth.”
Even mental health professionals who specialize in gender identity say there is much about it that is unclear, so classifying it for treatment purposes is challenging.
“It’s different from other mental disorders,” says Jack Drescher, a New York psychiatrist who was part of the American Psychiatric Association’s work group on gender identity, which revised the latest manual of mental disorders, the
DSM-5. “Usually with a mental disorder, we try and change the person’s mind,” he says. “This is the only mental disorder where the treatment is changing the body.”
The new manual changed the diagnostic name from “gender identity disorder” to “gender dysphoria,” which refers to the distress that may be associated with it. Drescher says the challenge was to reduce stigma, yet maintain access to medical care, which can include psychological support as well as hormones or surgical treatment. All the treatments require a diagnosis for insurance, he says.
“It’s not called a disorder, but it is in the handbook of mental disorders,” Drescher says. “The truth is we actually don’t know what it is. Is it a mental disorder or does the cause of gender dysphoria lie somewhere else? We don’t know
what causes it, so there’s no absolute reason why it has to be in the mental disorders section, except as a fact of history, it’s always been there.”
The DSM is the Diagnostic and Statistical Manual of Mental Disorders, but until the manual’s second revision in 1973, homosexuality had been included as a mental disorder. Now Drescher is working on a committee of the World Health
Organization, which is revising another standard diagnostic tool, the International Classification of Diseases (ICD). The revision is altering both the name and classification, he says. What had been called “transsexualism” is now recommended to be “gender incongruence” in the ICD-11, slated for 2015. The proposal is to move the gender diagnosis out of mental disorders and put it in another, yet undecided, section.
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