Diagnostic & Statistical Manual: Changes

This blog is a transsexual perspective on the updated description of Gender in the Diagnostic & Statistical Manual of Mental Disorders.  This is the definition that takes primacy in world literature so it is important.

Until DSM-5 the term to describe Gender Dysphoria was “Gender Identity Disorder”.  Many commentators compare this, erroneously in my view, with the former classification  of homosexuality as a “disorder”. Same sex orientation is a naturally occurring phenomenon and does not require medical intervention to sustain it as an identity.  

The changed definition of Gender Dysphoria, it is argued,  originates in calls from a  sub-group of Trans Activists who disliked the inclusion of the word “disorder”. They  wanted to de-pathologise Gender Dysphoria but, crucially, not create a bar to funding for medical intervention.

Note that activists prefer terms such as “Gender Affirming” hormones/ surgeries. This is all part of the same narrative which claims that some people are born the opposite “gender” but need remedial surgery to correct a tragic mistake in their sexed bodies.

Another actor in the drive to change the definition, I would suggest, is the hugely profitable Gender Industrial Complex . They need to emphasise those being treated had capacity able to give “informed consent”. Removing the idea that there is any disordered thinking at play helps make this clear.

I am going to focus on the work of Doctor Ann Lawrence. An autogynephilic transsexual.  You can normally access Dr Lawrence’s work here. Dr Ann Lawrence. At the time of writing the website is under revision so here is an archived link, should you wish to go to the primary source,  Archived Link

First up.   The new classification eliminates the subtypes based on sexual orientation.  Anyone who has been following this topic will know that the presentation of homosexual transsexualism is very different from that of heterosexual males.   The addition of people with an identity,which is neither male nor female, also makes an appearance.  Since this is nonsensical in terms of “sex” this illustrates the way “Gender” is given primacy over “sex”.

I will return to Dr Lawrences earlier critique, in another post, but here Dr Lawrence is interested in two specific changes.  Firstly  new framing that Gender Dysphoria is a distress, not about one’s sex, but about one’s “gender”.  Secondly the idea that, post gender transition, you “lose” the Gender Dysphoria diagnosis.   Both these aspects have significant implications for the sex based rights of  women and the rights  of Transsexuals to access long term psychological care.  ( Dr Lawrence is here concerned with the rights of Transsexuals, not those of women.)

Dr Lawrence is not a proponent of “born in the wrong body”, as a statement of literal fact. Dr Lawrence who used an alternative version  “men trapped in men’s bodies”. Not a phrase that endears Dr Lawrence to the loudest voices in the Trans Community.

The DSM-5 shifts the language from Sex to Gender. It asserts the primacy of a “Gender Identity”  over biological sex.

Its a political choice.  By changing the emphasis to gender the issue is decoupled from sex.  Read on for the people who seem to have won the day.  Spoiler.  It isn’t women! It also isn’t people with differences in sexual development (DSDs).

People with disorders of sexual development are often deployed in this “debate”.  I agree with Dr Ann Lawrence.  They are indeed being used as a smokescreen.  People with DSDs have complex, and often distressing, conditions: it doesn’t mean that they are a “third” sex or that we are not a sexually dimorphic species.  This is the response of Claire Ainsworth whose article here pops up regularly to argue about how many sex categories exist:

People with DSDs, don’t figure prominently in client referrals to Gender Identity Clinics and they are not , in fact, “trans” or any other “identity”.   In fact a survey of British Gender Identity clinics resulted in the abandonment of routine karyotype tests because people with chromosomal abnormalities are not a feature of their referrals.  Source Karyotype Tests

Their inclusion here seems to be to further a narrative that sex is not clear cut and to imply that trans people have some kind of “intersex” condition and therefore they need to be all under the same umbrella.  In fact people with DSDs are likely to be hurt by their inclusion under this heading:

So Intersex advocates were ignored.  We are ignoring the different etiologies of homosexual transsexuals and heterosexual transsexuals. We are ignoring Women’s rights. Finally we have an autogynephlic transsexual who is also being ignored, in favour of other autogynephilic transsexuals?  Muddying the waters with intersex references allows some transsexuals to fantasise that they have a neurological disturbance, an “intersex” or #LadyBrain.  This again helps only a subset of males in flight from a condition they do not wish to be named.

Autogynephilia is a condition rooted in shame and denial.  These men do not want to be reminded of the origins of their condition so you have to deny it too.

Women are being re-defined, against our will, because of a male fantasy!  Let that sink in. Women are so disregarded in our culture that porn sick men are allowed to re-define us out of existence or relegated to a subcategory as “non-men” or “non-transwomen” or “Cis-women”. Some transsexuals are honest about their pathway from “sissy porn” / “she-male” fascination.  Most vehemently reject this characterisation of their path.  Andrea Chu doesn’t

Let us return to what Dr Lawrence has to say about the impact on transsexuals.  While reading this I want you to remember that this entire movement was sold on the basis that it was to protect this tiny minority.  Here Dr Lawrence explains that the new DSM-5 allows for the label of “Gender Dysphoria” to be dropped after “transition”.

This fits the fantasy. You have merely had “gender affirmed” treatments to align your mismatched head with your body. You are Cured! Except Dr Lawrence points out this does not fit with the clinical reality.

The post-operative, or post-affirmed, transsexual is still not “cured”.  In fact the excessive desire to eradicate the truth of their condition is symptomatic their condition.  Even the diagnosis of “Gender Dysphoria” generates a feeling of “Narcissistic Injury” and therefore cannot be allowed to stand, irrespective of the material facts.

Dr Lawrence then quotes from the long term follow up of transsexuals which drew some sobering conclusions about the cohort they followed:

The conclusion of that study  here did not to question whether “affirmative” surgeries were the best solution. It did, however, emphasise that mental health care should be continued even after “transition”.  I would love to see more Trans-Activists focus on the long term health, physical and mental, of people with Gender Dysphoria.  However this seems a forlorn hope when a clinical diagnosis seems to be dictated by a group in denial of their condition.

The power of this tiny minority, within a minority, , to dictate the terms of their own diagnosis is noted.

To conclude. If you still think this is about protecting people with a genuine disorder you are wrong. This is a men’s sexual rights movement and it is trampling over women, gay youth, people with DSDs and is a daily assault on reality. All to appease a tiny minority within a minority.