The Riddle of Gender - Deborah Rudacille [123]
The great majority of the people whom I encountered while doing the research for this book did not appear to suffer from any kind of mental pathology or derangement. They were competent and productive people with homes, families, and jobs they enjoyed. This is particularly true of those who had completed the process of transition or who were post-transition. Those who are still working through transition, on the other hand, often suffer enormous stress as they attempt to renegotiate relationships with family and significant others, with co-workers, and with their own sense of self. This is a years-long process, which does eventually end. But there is no “exit clause” in the DSM, as Katharine Wilson and others have pointed out, by which someone who experiences a high degree of discomfort and distress prior to transition is considered cured afterward.
Indeed many people, including those who chose not to undergo surgery and/or take hormones at all, experience relief after admitting to themselves and others that they are transgendered. Accepting and integrating this new identity and seeking out a community of people who love and accept them despite their “difference,” some find their gender dysphoria transformed to gender “euphoria,” as they are released from the bonds of shame and secrecy. “Brad” described his first visit to the Tom Waddell Center, in San Francisco, to me as a kind of homecoming. “It was a wonderful situation, because it was through the city health plan and it was free and they totally understood me and supported me. Even though when I first went there, I was sitting in a hallway with all of these really ugly women, I mean really ugly, some of the freakiest fucking scary women you’ve ever seen in your life and some really strange-looking men. But I was at home. They accepted me for who I was even though I still had not transitioned yet.”
Many people who argue that GID should be removed from the DSM support a reclassification as a medical diagnosis. “Louis Gooren, one of the major Dutch researchers on transsexuality, was finally asked just in the last year to contribute a chapter to one of the major endocrinology textbooks about transsexuality, which is I think the proper place for it,” says Ben Barres. This perspective was shared by most of the trans physicans and scientists whom I interviewed for the book. “It’s not as if there is no data,” says Dr. Dana Beyer, who, like Dr. Barres, was exposed to a synthetic hormone in utero.
Many of my transsexual sources were extremely reluctant to support the deletion of GID from the DSM, however, until a formal medical reclassification had taken place—possibly in the I CD (International Statistical Classification of Diseases) produced by the World Health Organization. The ICD is used internationally to track morbidity and mortality of diseases, and unlike DSM, it is updated yearly. All of the diagnostic codes in the DSM-IV (published in 1994) and the DSM-IV TR (published in 2000) were selected to match valid ICD-9 codes. However, as the ICD is updated yearly and the DSM-V will not be published until 2010, there will be discrepancies. A reclassification of gender identity disorder from a psychiatric to an endocrinological condition in the ICD would have a major impact—but as that reclassification has not yet occurred, some argue that it is important to retain the DSM diagnosis for both medical and political reasons despite its flaws. The DSM diagnosis affirms the legitimacy of gender variance and at the same time pathologizes it—making gender variance something more than the perverse lifestyle choice that fundamentalist Christian and other critics