Moving towards de-psychopathologisation: a global chorus

(Most recent uploads in white highlight)

The National Board of Health and Welfare in Sweden has removed gender identity disorder of childhood, dual-role transvestism, and several other diagnoses relating to sexual and gender diversity from its version of the ICD-10. France has removed transsexualism from the list of psychiatric disorders. The Government of Iran has taken steps to terminate the classification of transgender people as mentally disordered. The pressure grows for psychiatric depathologisation of gender and gender identity variance. 

As at July 2010 (thanks for information to Justus Eisfeld, Co-Director, GATE - Global Action for Trans* Equality) we can report that there is a proposal in Germany for a new name/gender change law, introduced by Volker Beck MP of the German Green party. Justus believes that this proposal for a new law should be used as a best practice example for laws on name/gender changes.  The proposed law provides for name and gender change based on self-idenficiation only, without evidence from mental health (or any other)  professionals. It also avoids long court procedures and wait times, and leaves open the possibility to revert to earlier gender if needed. Official English translation.


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See also the following voices (in rough contra-chronological order) on the issue of de-psychopathologisation

A Declaration by STRAP (Society for Transsexual Women of the Philippines) in Support of the Stop Trans Pathologization 2012 Campaign.  ...' Rejects the pathologization of gender identities and expressions and supports the call to Stop Trans Pathologization by the year 2012; Affirms that the development of gender identity and expression is part of the right to the free development of personality; Affirms that gender identity and expression is a matter of self-determination and as sacred as the right to life itself; Affirms that the role of the psychiatric and medical communities over the lives of transgender people is not to pathologize and stigmatize them but to provide patient-centred care that upholds that highest possible standards of health'

The Documents of the International Congress on Gender Identity and Human Rights (The 'Barcelona Documents') (Preliminary version: (June 6th 2010). See 'Gender Identity and Access to Health' Principle 5: 'Gender identity and expression should not be pathologised'. The principle begins as follows: 'the pathologising model of trans-specific healthcare is damaging and abusive of transpersons. Pathologisation injures the human rights of integrity and free expressions for persons with gender variance and promotes 'transphobia'. this model gives rise to a disabling environment that discourages people from seeking trans healthcare and can lead to illness and even s uicide.'

 

The De-psychopathologisation Statement issued by the Board of Directors of the WPATH (World Professional Association for Transgender Health, formerly HBIGDA (Harry  Benjamin International Gender Dysphoria Association)  (issued May 26th 2010)

Statement reads (in full) : The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide.  The expression of gender characteristics, including identities, that are not stereotypically associated with one's assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative.  The psychopathologlization of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalization and exclusion, and increasing risks to mental and physical well-being.  WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people.  A commentary.

 Thai translation:คณะกรรมการอำนวยการ WPATH เรียกร้องให้ทั่วโลกยกเลิกการจัดความแตกต่างทางเพศสภาพเป็นความเจ็บป่วยทางจิต. การแสดงออกถึงลักษณะทางเพศสภาพรวมถึงอัตลักษณ์ทางเพศสภาพที่อาจไม่สัมพันธ์กับเพศสรีระแต่กำเนิด เป็นปรากฏการณ์ที่พบได้ทั่วไปในวัฒนธรรมที่หลากหลาย ซึ่งไม่ควรถูกตัดสินว่าเป็นความเจ็บป่วยหรือแง่ลบ การจัดลักษณะและอัตลักษณ์ทางเพศสภาพเป็นความเจ็บป่วยทางจิตนั้นเป็นการตอกย้ำหรืออาจทำให้เกิดการตีตรา ทำให้มีโอกาสเพิ่มขึ้นที่จะเกิดอคติและการเลือกปฏิบัติ ทำให้ TG สุ่มเสี่ยงมากขึ้นต่อการถูกกีดกันและแบ่งแยกทั้งทางสังคมและกฎหมาย และเพิ่มความเสี่ยงต่ออันตรายทั้งทางสุขภาวะร่างกายและจิตใจ.  WPATH ขอเรียกร้องให้องค์กรภาครัฐและองค์กรวิชาชีพทางการแพทย์ได้ทบทวนนโยบายและแนวทางการปฏิบัติงานของตนเพื่อขจัดการตีตราต่อบุคคลที่มีเพศสภาพแตกต่าง A Thai commentary

 

Cuban Multidisciplinary Society for Sexuality Studies, Statement on Depathologisation of Transsexualism, 2010

 

The Letter from Asia-Pacific Transgender Network to the American Psychiatric Association, 2010

 

The Call for De-psychopathologisation made by MSM-GF (The Global Fund for MSM and HIV), 2010  

Extract: ' A psychiatric diagnosis of Gender Identity Disorder fosters stigma and discrimination, escalating vulnerability of transgender persons to social exclusion and disease' 

 

TransgenderASIA's call for removal of gender identity variance from the psychiatric manuals, 2009 . English and Spanish versions (posted on Transgender Day of Remembrance, 20th November)

 

Issue Paper 'Human Rights and Gender Identity' (Thomas Hammarberg, Commissioner for Human Rights, Council of Europe), 2009.

Section from page 24 (Section on Access to Health Care), and referring to psychopathological di9agnoses in ICD-10 and DSM-IV) :  These classifications are in turn problematic and increasingly questioned by civil society actors and health care professionals. Such classifications may become an obstacle to the full enjoyment of human rights by transgender people, especially when they are applied in a way to restrict the legal capacity or choice for medical treatment. It needs to be noted though that this question is a significant dividing line within the transgender movement itself. Many transgender people feel threatened by a possible change in the classification systems, since they fear it could result in further restrictions in accessing transgender health care. They consider that because health care systems require a diagnosis to ‘justify’ medical or psychological treatment, it is essential to retain a diagnosis to ensure access to care. Others, however, argue that being diagnosed as having a mental disorder stigmatises individuals in society and makes them objects of medicine, rather than subjects who are responsible for expressing their own health needs. Alternative classifications should be explored in close consultation with transgender persons and their organisations.From a human rights and health care perspective no mental disorder needs to be diagnosed in order to give access to treatment for a condition in need of medical care.  (my emphasis, SJW)

 

The 'Stop Trans-Pathologisation' Equadorian Manifesto, 2009

 

The Malta Trans-Rights Declaration, 2009

 

The Report ('Moving from Intentions to Action') of the Second International Experts Meeting on HIV Prevention for MSM, WSW and Transgenders, in Amsterdam, November 5-6, 2009. Available by way of pdf link at http://www.schorer.nl/76/schorer-internationaal/expert-meeting-2009/.

On page 19, the report issues the following call for action: Gender identity variance (“transgenderism”) should be reclassified from its current classification as a mental health disorder in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM) and the World Health Organisation’s (WHO) International Classification Of Diseases (ICD). Instead it should be classified as a medical condition. This would provide a diagnostic category in the ICD that would accommodate the needs of those gender identity variant people who require medical care for their condition, but without the stigma attached to mental disorder.
It is noteworthy that this report is issued in the context of a meeting on HIV prevention

 

Principles Regarding Health Care for Transpeople (here called Gender-Variant people).  ILGA World Conference, (Transgender Pre-Conference Meeting. Health Care Sub-group)Geneva, 2006. (, Published as an endnote to a journal article )

Principles 1 and 2:  All people have the right to freedom of gender identity and expression (the right to gender-variance).All should have the freedom to exercise that right without psychiatric pathologisation or imposition of other people’s moral judgments (without being judged as either mad or bad).

 

The International Bill of Gender Rights (1995).

Right No. 7 (The Right To Freedom From Psychiatric Diagnosis Or Treatment) states: Given the right to define one's own gender identity, individuals should not be subject to psychiatric diagnosis or treatment solely on the basis of their gender identity or role. Therefore, individuals shall not be subject to psychiatric diagnosis or treatment as mentally disordered or diseased solely on the basis of a self-defined gender identity or the expression thereof.

 

The Health Law Standards of Care for Transsexualism, from the International Conference on Transgender Law and Employment Policy.(1993). 

Principle 1 states: Transsexualism is an ancient and persistent part of the human experience and is not in itself a medical illness or mental disorder.

 

....... and ......

 

Professionals Concerned with Gender Diagnoses in the DSM

GID Reform Advocates

STP2012: The Stop Transpathologisation 2012 Campaign

SASS ROGANDO-SASOT'S SPEECH AT THE UNITED NATIONS (10th December 2009)       YouTube video link (Total viewing time = 10mins 47 secs)            Transcript

An highly eloquent and moving affirmation of the right to gender variance,  and a denunciation of the prejudice, discrimination, harassment and violence which gender variant persons suffer worldwide. Delivered, at the United Nations in New York, by a leading activist transpinay (a Filipina woman of transgender experience).