Don't have answers.

(Alert: some disability theory is presupposed here. If you're struggling, give a shout in the comments.)

I've been wanting to write something about the DSM V since the draft was published back in February, at which time I noted that it was looking grim for queer folk. But every time I started to write about it, I got stuck.

The Diagnostic and Statistical Manual of Mental Disorders (DSM, currently on edition IV-TR), is produced by the American Psychiatric Association, and carries considerable weight in North America and Europe, although it is intended primarily for use in the USA. The World Health Organisation also has a rough parallel -- Chapter V of the International Classification of Diseases (aka, the ICD-10).

The DSM and the ICD almost go out of their way to pathologise queer people, although there is no longer any diagnosis of Homosexuality. The DSM-IV-TR and the ICD-10 do, however, pathologise trans identities (Gender Identity Disorder, Transsexualism, Dual-Role Transvestism) and asexuality (terminology varies considerably). They also pathologise a number of consenting sexual practices like fetishism, BDSM, making "obscene" telephone calls. And, because there wasn't enough heteronormative fail already, they also pathologise anxiety due to not knowing if you're gay or straight (Sexual Maturation Disorder), and having non-long-term relationships (Sexual Relationship Disorder). Notably, there is no disorder of Being An Unmitigated Heterosexist Shit Disorder, so we can safely conclude that heteronormativity is a factor here.

For some time, there has been a campaign to have Gender Identity Disorder (GID) removed from the DSM-V.

...Every time I sit down to write this post, this is as far as I get. Because at this point, I feel that I should say something about how appallingly heteronormative it is that gender identity should be pathologised.

Which is all very well, as far as it goes.

But what exactly is wrong with all the other people who are pathologised by the DSM? Is there something wrong with asexual people? With people who have non-heteronormative sex? Or people with non-sex/gender DSM diagnoses like...autism? As long as the protest chant is "trans people aren't crazy", there's an unspoken rider: "not like those other people, who are".

Moreover, since the campaign is to have GID removed from the DSM but still have (free) medical transition available as an option for people who want it, it seems to me that such a change wouldn't actually de-pathologise GID: it would replace categorisation as a mental disorder with categorisation as a physical disorder. It's not clear to me that saying "there's something wrong with trans people's bodies" is preferable to saying "there's something wrong with trans people's minds", because, well, there's nothing wrong with trans people, and that should go without saying. It seems to me that we each get to negotiate gender in the way that seems most appropriate to individual circumstances, preferences, and needs. For some people, that will mean wearing skirts. For others, trousers and leather jackets. For others, it will mean transition. But I find it deeply problematic to say that some of the people who wear skirts or trousers are "normal", and some are "crazy"; or that the people who wear skirts or trousers are "normal" and the people who transition are "crazy". If gender is a pathology, then either everyone who negotiates a gender binary is "crazy" or no one is.

It seems to me that the choice we're being asked to make is entirely wrong. Jay Sennett writes:

This constant hating on people with so-called real mental disorders has got to stop. Frankly from the perspective of a society that wants everyone to goose-step to strict gender roles, I’m surely a heretic. But our salvation will never be found in goose-stepping to the belief that they are somehow differnt from us.

[...] Given a choice between a mental health diagnosis or a medical one, I opt out. They are two sides of the same coin. They are both needed by us to obtain medical services and used by others to diagnose and medicalize and manage in a systemic way our so-called differences.

I don't have any answers. I'm not sure I agree 100% with everything Jay Sennett writes, but it seems to me that rejecting the pathologisation of gender and sexuality without rejecting the basic dichotomisation between the "crazy" and the "heteronormative" (or "non-disabled" or "non-crazy") is not going to work for us. That is, a politically workable solution may be closer to rejecting the DSM framework entirely.

(Not all the behaivours in the DSM-IV and DSM-V are ones we would want to say are fine and dandy, by the way. The DSM-V, for example includes a diagnosis for coercing sexual activity. It's not clear to me there's any political advantage to pathologising this behaviour, however. That is, the existence of bad behaviours as diagnoses may not be a reasons to keep the DSM around.)

Like I said, I don't have answers. Just lots of questions.

Thoughts?

--IP

[Crossposted at Modus Dopens.]