Removing the diagnosis: Not the answer?

A month ago I joined Amnesty and a room full of transgender rights activists at Christiansborg to discuss Amnesty’s 2016 campaign for transgender equality. High on the agenda: remove ‘transexualism’ from the list of mental diagnoses.

Support for this cause is overwhelming. Transgender people aren’t sick! Get with the times! Right?

Initially I cheered along, indignant that Denmark had been in the forefront of removing homosexuality as a mental illness but has proved itself to be such a loser with trans rights. However, while I do not think being transgender is a mental illness, I also don’t think removing or moving the diagnosis will address what I see as the core issue transgender people face: fair and equal access to health care.

I was invited to Amnesty’s Christiansborg party because my girlfriend is a kickass, highly vocal transwoman. I thought it would be cool to visit the heart of Danish structural power because I’m a nerd like that. I do not have first-hand experience with “Sexologisk Klinik” or being trans – I’m cis. Trans politics are important to me as a queer person with trans friends and lovers.

There’s absolutely nothing wrong with being transgender. I do think there’s something perfectly fucked about a society that accepts predicting a baby’s future on the basis of their external genitals.

False parallel: homosexuality and transgender status

Denmark lead the way with legal rights to gays and lesbians. However, it is exceedingly true that Denmark has gone from being a progressive international voice to a shockingly bollox trans healthcare provider. Diagnosing homosexual people was purely bigoted and nonsensical because people don’t need medical attention to specifically address their homosexuality. Not all transgender people need medical care – but many do.

It makes sense to retain a diagnosis for transgender people to ensure the right to this medical care. I’d love to help contest the paradigm that deems transgender a disorder by highlighting that our sick world’s refusal to to accept trans people is the problem. But in the meantime a lot of trans people need health care.

Categorizing transgender people as mentally ill implies that there is something wrong with the mind that doesn’t match the body. Making the diagnosis a somatic disorder would conversely indicate that there’s something wrong with trans bodies that don’t match trans minds.

This mind|body dichotomy is fabricated to make sense of complication. We know that so-called mental health disorders manifest measurably in the brain. The medical mind|body divide seems to grow blurrier the more we learn. Treatment for mental health disorders primarily address the mind, not body. Given that the best medical treatment for transgender people addresses the physical body, it is odd that the diagnosis remains a mental disorder.

Trans people need a diagnosis of some sort to receive medical care in the health care system we have made. Where that diagnosis sits is frankly not as interesting to me as improving the quality of care for transgender people because I don’t think there’s anything wrong with having a mental illness diagnosis. I absolutely recognize that mental illness stigmas rub off on transgender people – so why don’t we work on the stigmas surrounding mental illness?

Mental Illness is not shameful

So, we keep the diagnosis but move it to the somatic (physical body) category!? I simply do not think this will be the silver bullet that some imagine it to be. Moving the diagnosis will not address the prejudices amongst health providers and across society that make it acceptable for transgender people to be the only group in Denmark not guaranteed treatment.

The focus on removing ‘transsexualism’ (the official, shitty term) from the list of mental diagnoses says a lot about our stigmatization of mental health disorders. The sentiment that there’s something wrong with being ‘sick’ or mentally ill scares me. This rhetoric also erases the transgender people who happen to be mentally ill as well. If all patients were respected in the healthcare system and society as people who could benefit from medical care, the physical/mental health classification would be purely a way of describing the patient’s needs.

When depressed people seek treatment they are given tests to screen for depression. When transgender people seek treatment they are tested for personality disorders, low intelligence, and sexual perversion. The problem here is not simply that transgender people are seen as mentally ill and thus unfit – the problem is transphobia.

Transgender people need the right to informed medical treatment

From my perspective, the best reason to change the way transgender people are diagnosed is to ensure they can’t be discriminated against on the basis of being transgender. Transgender people are fit to make decisions about their lives and bodies. Being trans should not be used as an excuse for the government or health care system to strip away rights. As the law and health care climate stands now in Denmark, it is very easy for the national ‘Sexologisk Klinik’ to delay or deny transgender people access to medicine, surgeries, and other treatment purely on the basis of their transgender status.

In Denmark you’re given a diagnosis for being born. I don’t have one because I immigrated here as an adult. Neither does my girlfriend because she changed her legal gender and CPR number so her medical records only go back a year. Lacking this diagnosis places us outside a norm along with other immigrants and transgender people. To my knowledge, doctors don’t use my lack of a birth diagnosis to discriminate against me. However, given the right stigma and political backing they could theoretically do so – just as they do with transgender people.

Diagnoses are meant to help prescribe people the medical treatment they need and want. The social implication of a diagnosis, however, is that one can or should be cured of a problem. Having a diagnosis that is given just to trans people – no matter how it’s classified – can be used to discriminate against people because they are trans.

Let’s mess with the health care system’s cisnormativity

The notion that everyone is cis until proven trans needs to be uprooted – also in the healthcare sector. Here’s an idea. Advocate for diagnoses that facilitate access to specific medical treatments.

I have been on various hormone replacement regimes to address my hormone levels. I was diagnosed with PCOS years before moving to Denmark and took steroids. I no longer choose to take them, but my doctor in Denmark was happy to give me the prescription when I did. There was no need for me to describe whether or not wearing a dress turns me on to get access to these drugs. I didn’t even show her any documentation of the diagnosis. I just showed her the half-empty bottle of pills I had been taking and told her that I am a woman and my hormone levels were outside a ‘normal’ range. Trans women are also women whose hormone levels are outside a ‘normal’ range.

In a couple of decades when I go through menopause I will most likely be given estrogen supplements to make me healthier and more comfortable through this hormonal change. Note: they won’t need to know if I think about my parents when I masturbate to prescribe those pills.

A transfeminine person who wants hormone replacement therapy could receive the same diagnosis as me: a person whose hormone levels fall outside the typical female range. If she also needs surgery to be healthy and well in her body she could receive another diagnosis – something like “person who does not have a vagina and wants neovaginoplasty”. I’m open to better wording. The point is to give diagnoses based on a person’s medical needs – not on the fact that they are transgender or cisgender.

There already is a diagnosis in Denmark for lacking a vagina, (‘DQ520’ – check it out), lacking a testicle (DQ550A), lacking ovaries (DG500), and so on. It’s definitely possible to talk about health and genitals without resorting to a cis/trans dichotomy.

Any person should have the right to receive medical care if they need to change their hormone levels or physical body to live fully and freely. It really doesn’t matter if they’re cisgender or transgender. As long as they receive advice on the benefits and risks of their medical choices and can give consent there’s no explanation for denying a transperson that treatment apart from transphobia.

To reiterate, declassifying transgender as a mental disorder might benefit transgender people by distancing trans from the stigma of mental illness. That is, it would help transgender people who do not also have mental health diagnoses.

Still, I don’t think that alone will do away with the cisnormativity of our healthcare system. If my girlfriend and I can receive the same diagnosis as women with a hormonal imbalance, I will know that our rights are equal in this system.

Written by , 3/1/2016 5:44:18 AM.

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