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tyresiasAlright, so where to start. I have this project now overdue for my history of science, sex and race. It's a brillant project, that I've absolutely adored working on. It's been hard though not to stray from it and indulge in other related issues. Finalyl I failed ot keep on track and went on a slight tengent. To help understand what the heck I am on about I will attach parts of my project. It is a rough draft and geared towards a history course (e.g. not for the legal ends I'm now trying to conceive) The project is not in fact an essay but a "how would I analyse said object and its relationship to sex and race a in historical context" type of deal. So if you don't see a thesis, that's cause it's not there. The point is leading to the question I have mroe or less formulated at the end of the 6 pg description of the object. My project, in a nutshell, is GID as it appears in the DSM. I am aware I have a bunch more to do around race, but I'm already past the space limit of 5 pages, so I'm trying to edit what I have already before adding this critical aspect of analysis to it. :D
My question to you my friends on LJ is as follows:
Could someone not go to court prove that the usage of the DSM by psychiatrists in Ontario violates the Canadian Charter of Rights and Freedom? The charter says no discrimination based on ANY gender or sex. The DSM is full of gender bias that is explicitly implied thru the very language used to discuss so-called gender identity disorders.
Ultimately the claim could prove that usage of the DSM anywhere in Canada goes against our consitutionally protected rights (yeah for the charter being one with the Constitution!) I mean even if this is true, it would require a heck of lot of money I don't have, but I'm sure Egale would love to jump aboard of this along with many other organization and any lawyer looking for make a name for themselves by doing a landmark case should it go to the supreme court of this land.
Diagnostic criteria for Gender Identity Disorder
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
(4) intense desire to participate in the stereotypical games and pastimes of the other sex
(5) strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Code based on current age:
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
Specify if (for sexually mature individuals):
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Sexually Attracted to Neither
Cautionary disclaimer:
The specified diagnostic criteria for each mental disorder are offered as guidelines for making diagnoses, because it has been demonstrated that the use of such criteria enhances agreement among clinicians and investigators. The proper use of these criteria requires specialized clinical training that provides both a body of knowledge and clinical skills.
These diagnostic criteria and the DSM-IV Classification of mental disorders reflect a consensus of current formulations of evolving knowledge in our field. They do not encompass, however, all the conditions for which people may be treated or that may be appropriate topics for research efforts.
Specific additional disclaimer for behaviour not resulting from substance abuse:
Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early adulthood.
The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life.
Symptoms are seen in at least two of the following areas:
Thoughts (Ways of looking at the world, thinking about self or others, and interacting. )
Emotions (Appropriateness, intensity, and range of emotional functioning. )
Interpersonal Functioning (Relationships and interpersonal skills. )
Impulse Control.
I have chosen to look at the Diagnostic Statistical Manual and in particular to the condition known within this object as gender identity disorder. This object consists of three parts. First a diagnosis based on symptoms broken down into four sections as well as the extent that the condition must reach to render it a disorder. Following the diagnosis are the psychotherapeutic methods that are recommended to treat the condition. All diagnosis and recommended treatment then fall under the cautionary statement that governs the whole content of the manual. The American Psychiatric Association authors the DSM.
This manuscript contains all contemporary mental illnesses recognized and named by the ASA. Since the object chosen was a particular disorder it is a temporally malleable object as the name and characteristic of the condition have changed from one edition of the DSM to another. For each condition there is a list of symptoms that allow psychiatric professionals to assess the likelihood for diagnosing a disorder and this too therefore changes from one edition of the manual to another, as the disorder has been redefined and precise. Regardless of which diagnosis one is focusing on there is a disclaimer for the entire book, which pertains to all conditions. It lays out that not all individuals will display all symptoms and that only a medical professional is truly capable of assessing whether or not the symptoms are sufficiently present to form a diagnosis.
There is two part to any diagnosis deemed a disorder. Each illness commences with a list of characteristic behaviour. If these combined behaviours or patterns of thoughts prevent the person from functioning in an appropriate way in every day life that said individual has a disorder.
The first publication appeared in 1952 and contained 60 diagnoses. Since then it has undergone 3 major revisions (DSM II, DSM III and DSM (V) and 2 minor ones (DSM III R and DSM IV R). The next edition, DSM V, should be published in 2010. There are elements that permeate entire editions from one publication to another. An example of this would be the major shift from DSM II and DSM III. In the second edition all diagnosis were embedeed within the real of psychodynamic. The implication of this was that all mental disorders were the result of environmental conditions. DSM III removed much of the psychodynamic, and thus put forth the notion that some disorders were not the result of particular environmental conditions but rather inate drives from within a person that would have appeared regardless of life experience. This is a significant shift that had profound impact on gender identity disorders.
The history of sexuality and gender performance has been intertwined with psychiatry in North America ever since the first manual was published. The reason being that various sexual acts deemed perversions were named and given diagnoses. This in turn created medical grounds and backing to perceive the individuals performing acts deemed perversions as less then and deserving of medical incarceration or requiring medical intervention to alter sexual behaviour. With time both the name for the acts and the view of the acts themselves have undergone great evolution.
It is important to note the language used in the DSM when analysing its place in history. First off in the cautionary disclaimer, there is clear indication that the manual represents the inaccuracy of the diagnosis. It uses the word “guidelines” because the ASA recognizes that no two individual will experience a condition in the exact same way and therefore the symptoms are just general ones and the degree of their severity will flux from one person to another.
Another key element to note in the object is the symptoms and circumstances that render a state of mind the designation of disorder. In the particular case of gender identity one has a disorder if the criteria listed from A to C cause D . Here we see the ASA dictate the degree of severity in gender dysphoria that will cause a person to be diagnosed as having a mental disorder. Section D states “The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” That is to say, the reason someone is considered to be deserving of psychiatric intervention do not stem from the behaviour in itself. It is whether or not the individual that has gender dysphoria is able to continue functioning with society as it currently stands. This implies that should society become a place where gender performance held little to no importance and therefore society would not cause significant distress, no one would qualify as having G.I.D. It is important to point the latter point out to demonstrate the importance that society currently holds to gender demonstration and performance, as it is significant enough for the ASA to assign a disorder to anyone who fails to conform with it since it will be source of tribulation. This analysis of the object shows the importance the ASA holds towards behaviours considered too abnormal by society. Along with this comes the demonstration of why such behaviour is problematic in the historical context the DSM is used in, as well as whom bears the responsibility for the disruption from so-deemed normal circumstances. Thus we see the DSM not only reflect the ASA’s view on gender performance but the link of the DSM with the dominant societal group that the ASA caters to.
This leads into the place of race analysis of the object. Gender performance varies greatly from culture to culture and with time. The ASA is choosing which gender performances are not only desirable but psychiatrically acceptable each time the DSM is published. In 1952 all sexual behaviour deemed perversions were lump together. Each publication has seem greater differentiation within the perceived perversions as well as the delisting of some under specific circumstances. Initially homosexuality, sexual sado-masochism, transvestic fetishism and gender identity (among many others not listed here) were merely viewed as variation of a single theme. In 1973, in the midst of the changing view around psychodynamic (discussed below), homosexuality was effectively delisted. The same is now true of nearly all elements of sexual sado-masochism and transvestic fetishism. Gender identity related disorders were relisted on their own along with their paraphilias.
The characteristic of the person must be long standing, regardless of temporary environment and present without the intake of controlling substances. In other words, the onus lies on the person to demonstrate that the gender dysphoria is chronic, independent of particular life experience as well as sufficient enough to prevent the individual from functioning the cultural norms and expectations assigned by the medically determined sex of birth.
The DSM was written for many reasons that pertained to 1952. The manuscript was altered and so one would assume that it is because the circumstances have either changed or the understanding and perception of particular mental condition have altered and therefore the ASA wanted the manual to reflect those alterations in perceptions and environment. As a result the DSM is in part an indicator of certain socio-historical factors, as they were understood by psychiatrics at the time of each publication.
Another component to the manual is its non-medical usage. The authors are American medical professionals entrenched in the medical system that governs the United States. The health insurance companies in the States looks to the ASA as the best authority to write a book that outlines the conditions that require medical attention as well as the treatments they require. The reason for this is that the insurers must determine which conditions they will cover and to what extent and for what treatment. Thus the conditions that the American Psychiatric Association defines as an illness are the only ones that the health insurers will consider for coverage. Furthermore, the ASA provides guidelines for treatment, which means that once more the insurers choose to depend on the medical professionals to set the appropriate course of action for so-called illnesses and the insurers plan coverage accordingly. In other words, the health insurance companies in the United States hold the ASA as the ultimate authorities with much esteem and rely on them to not only identify the conditions that require medical intervention but also the ways in which the intervention will take place.
Another non-medical usage of the DSM is in the legal and educational realms. Conditions that appear in the DSM can either be used as legal defences or as grounds to require special educational circumstances. This shows a similar situation as in the previously discussed non-medical usage of the manual. Once more we see psychiatric evaluations that go beyond influencing medical interventions. People with recognized diagnosed disorders that commit legal offences can rely on it as a substantive portion of their defence. Thus we see the American psychiatrists entering into the legal realm in a significant way. This gives a fair account of the importance of the manual in a larger historical context. It helps to put in a frame part of the reason for the manuals ongoing publication and signification in a larger societal context.
The DSM was written for specific reasons, the author has much prestige and privilege; the manual holds consequence for the entire body of citizens that live in societies that have psychiatrists that abide to it. Furthermore the author governs which cultural norms and gender performances fall within the frame of acceptable and normal.
In which ways have passed criteria / symptoms for sexual perversions and current ones for Gender Identity Disorder in the DSM a reflection of the racial and sexual expectations as well as the importance of these factors for the American Psychiatrist Association as well as North American society subsequently?
My question to you my friends on LJ is as follows:
Could someone not go to court prove that the usage of the DSM by psychiatrists in Ontario violates the Canadian Charter of Rights and Freedom? The charter says no discrimination based on ANY gender or sex. The DSM is full of gender bias that is explicitly implied thru the very language used to discuss so-called gender identity disorders.
Ultimately the claim could prove that usage of the DSM anywhere in Canada goes against our consitutionally protected rights (yeah for the charter being one with the Constitution!) I mean even if this is true, it would require a heck of lot of money I don't have, but I'm sure Egale would love to jump aboard of this along with many other organization and any lawyer looking for make a name for themselves by doing a landmark case should it go to the supreme court of this land.
Diagnostic criteria for Gender Identity Disorder
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
(4) intense desire to participate in the stereotypical games and pastimes of the other sex
(5) strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Code based on current age:
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
Specify if (for sexually mature individuals):
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Sexually Attracted to Neither
Cautionary disclaimer:
The specified diagnostic criteria for each mental disorder are offered as guidelines for making diagnoses, because it has been demonstrated that the use of such criteria enhances agreement among clinicians and investigators. The proper use of these criteria requires specialized clinical training that provides both a body of knowledge and clinical skills.
These diagnostic criteria and the DSM-IV Classification of mental disorders reflect a consensus of current formulations of evolving knowledge in our field. They do not encompass, however, all the conditions for which people may be treated or that may be appropriate topics for research efforts.
Specific additional disclaimer for behaviour not resulting from substance abuse:
Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early adulthood.
The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life.
Symptoms are seen in at least two of the following areas:
Thoughts (Ways of looking at the world, thinking about self or others, and interacting. )
Emotions (Appropriateness, intensity, and range of emotional functioning. )
Interpersonal Functioning (Relationships and interpersonal skills. )
Impulse Control.
I have chosen to look at the Diagnostic Statistical Manual and in particular to the condition known within this object as gender identity disorder. This object consists of three parts. First a diagnosis based on symptoms broken down into four sections as well as the extent that the condition must reach to render it a disorder. Following the diagnosis are the psychotherapeutic methods that are recommended to treat the condition. All diagnosis and recommended treatment then fall under the cautionary statement that governs the whole content of the manual. The American Psychiatric Association authors the DSM.
This manuscript contains all contemporary mental illnesses recognized and named by the ASA. Since the object chosen was a particular disorder it is a temporally malleable object as the name and characteristic of the condition have changed from one edition of the DSM to another. For each condition there is a list of symptoms that allow psychiatric professionals to assess the likelihood for diagnosing a disorder and this too therefore changes from one edition of the manual to another, as the disorder has been redefined and precise. Regardless of which diagnosis one is focusing on there is a disclaimer for the entire book, which pertains to all conditions. It lays out that not all individuals will display all symptoms and that only a medical professional is truly capable of assessing whether or not the symptoms are sufficiently present to form a diagnosis.
There is two part to any diagnosis deemed a disorder. Each illness commences with a list of characteristic behaviour. If these combined behaviours or patterns of thoughts prevent the person from functioning in an appropriate way in every day life that said individual has a disorder.
The first publication appeared in 1952 and contained 60 diagnoses. Since then it has undergone 3 major revisions (DSM II, DSM III and DSM (V) and 2 minor ones (DSM III R and DSM IV R). The next edition, DSM V, should be published in 2010. There are elements that permeate entire editions from one publication to another. An example of this would be the major shift from DSM II and DSM III. In the second edition all diagnosis were embedeed within the real of psychodynamic. The implication of this was that all mental disorders were the result of environmental conditions. DSM III removed much of the psychodynamic, and thus put forth the notion that some disorders were not the result of particular environmental conditions but rather inate drives from within a person that would have appeared regardless of life experience. This is a significant shift that had profound impact on gender identity disorders.
The history of sexuality and gender performance has been intertwined with psychiatry in North America ever since the first manual was published. The reason being that various sexual acts deemed perversions were named and given diagnoses. This in turn created medical grounds and backing to perceive the individuals performing acts deemed perversions as less then and deserving of medical incarceration or requiring medical intervention to alter sexual behaviour. With time both the name for the acts and the view of the acts themselves have undergone great evolution.
It is important to note the language used in the DSM when analysing its place in history. First off in the cautionary disclaimer, there is clear indication that the manual represents the inaccuracy of the diagnosis. It uses the word “guidelines” because the ASA recognizes that no two individual will experience a condition in the exact same way and therefore the symptoms are just general ones and the degree of their severity will flux from one person to another.
Another key element to note in the object is the symptoms and circumstances that render a state of mind the designation of disorder. In the particular case of gender identity one has a disorder if the criteria listed from A to C cause D . Here we see the ASA dictate the degree of severity in gender dysphoria that will cause a person to be diagnosed as having a mental disorder. Section D states “The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” That is to say, the reason someone is considered to be deserving of psychiatric intervention do not stem from the behaviour in itself. It is whether or not the individual that has gender dysphoria is able to continue functioning with society as it currently stands. This implies that should society become a place where gender performance held little to no importance and therefore society would not cause significant distress, no one would qualify as having G.I.D. It is important to point the latter point out to demonstrate the importance that society currently holds to gender demonstration and performance, as it is significant enough for the ASA to assign a disorder to anyone who fails to conform with it since it will be source of tribulation. This analysis of the object shows the importance the ASA holds towards behaviours considered too abnormal by society. Along with this comes the demonstration of why such behaviour is problematic in the historical context the DSM is used in, as well as whom bears the responsibility for the disruption from so-deemed normal circumstances. Thus we see the DSM not only reflect the ASA’s view on gender performance but the link of the DSM with the dominant societal group that the ASA caters to.
This leads into the place of race analysis of the object. Gender performance varies greatly from culture to culture and with time. The ASA is choosing which gender performances are not only desirable but psychiatrically acceptable each time the DSM is published. In 1952 all sexual behaviour deemed perversions were lump together. Each publication has seem greater differentiation within the perceived perversions as well as the delisting of some under specific circumstances. Initially homosexuality, sexual sado-masochism, transvestic fetishism and gender identity (among many others not listed here) were merely viewed as variation of a single theme. In 1973, in the midst of the changing view around psychodynamic (discussed below), homosexuality was effectively delisted. The same is now true of nearly all elements of sexual sado-masochism and transvestic fetishism. Gender identity related disorders were relisted on their own along with their paraphilias.
The characteristic of the person must be long standing, regardless of temporary environment and present without the intake of controlling substances. In other words, the onus lies on the person to demonstrate that the gender dysphoria is chronic, independent of particular life experience as well as sufficient enough to prevent the individual from functioning the cultural norms and expectations assigned by the medically determined sex of birth.
The DSM was written for many reasons that pertained to 1952. The manuscript was altered and so one would assume that it is because the circumstances have either changed or the understanding and perception of particular mental condition have altered and therefore the ASA wanted the manual to reflect those alterations in perceptions and environment. As a result the DSM is in part an indicator of certain socio-historical factors, as they were understood by psychiatrics at the time of each publication.
Another component to the manual is its non-medical usage. The authors are American medical professionals entrenched in the medical system that governs the United States. The health insurance companies in the States looks to the ASA as the best authority to write a book that outlines the conditions that require medical attention as well as the treatments they require. The reason for this is that the insurers must determine which conditions they will cover and to what extent and for what treatment. Thus the conditions that the American Psychiatric Association defines as an illness are the only ones that the health insurers will consider for coverage. Furthermore, the ASA provides guidelines for treatment, which means that once more the insurers choose to depend on the medical professionals to set the appropriate course of action for so-called illnesses and the insurers plan coverage accordingly. In other words, the health insurance companies in the United States hold the ASA as the ultimate authorities with much esteem and rely on them to not only identify the conditions that require medical intervention but also the ways in which the intervention will take place.
Another non-medical usage of the DSM is in the legal and educational realms. Conditions that appear in the DSM can either be used as legal defences or as grounds to require special educational circumstances. This shows a similar situation as in the previously discussed non-medical usage of the manual. Once more we see psychiatric evaluations that go beyond influencing medical interventions. People with recognized diagnosed disorders that commit legal offences can rely on it as a substantive portion of their defence. Thus we see the American psychiatrists entering into the legal realm in a significant way. This gives a fair account of the importance of the manual in a larger historical context. It helps to put in a frame part of the reason for the manuals ongoing publication and signification in a larger societal context.
The DSM was written for specific reasons, the author has much prestige and privilege; the manual holds consequence for the entire body of citizens that live in societies that have psychiatrists that abide to it. Furthermore the author governs which cultural norms and gender performances fall within the frame of acceptable and normal.
In which ways have passed criteria / symptoms for sexual perversions and current ones for Gender Identity Disorder in the DSM a reflection of the racial and sexual expectations as well as the importance of these factors for the American Psychiatrist Association as well as North American society subsequently?
