Transgender clients face unique challenges within health system – Oregon Mental Health Archive
By Jenny Westberg
This article may not be suitable for children.
In December 1973, a psychiatric breakthrough wiped out all signs and symptoms of mental illness for millions of Americans.
It wasn’t a new drug. It was an ex cathedra pronouncement by the American Psychiatric Association, declaring that homosexuality was not, in fact, a mental disorder.
The change meant that more than 100,000 Oregonians went to bed one night with a diagnosable psychiatric problem and woke up the next morning with none at all.
Thirty-seven years later, however, being transgender — nothing more — was still enough for a psychiatric diagnosis, with a seven-page listing in the official diagnostic manual, the DSM-IV. Clinically, it was called Gender Identity Disorder (GID).
GID was a gateway requirement for surgical transition. That means some people have little choice; like it or not, they have to submit to a psychiatric diagnosis that identifies them as “disordered.”
There are all sorts of reasons to get rid of GID. It lacks clinical sufficiency. It supports the idea that transgender persons are “sick” or “weird.” It treats distress as a psychiatric symptom, even when it’s due to discrimination and harassment.
At the same time, there are people who really need surgery, and removing GID from the DSM-IV could add to their difficulties. Portland therapist Reid Vanderburgh, MA, says it can be hard to object. “Most people bite the bullet and accept a GID diagnosis,” he says. “The desire for surgery trumps any activist instinct they might have to fight back and NOT accept it.”
But Vanderburgh, who has transitioned himself, manages to avoid the term “GID” in clinical practice.
“I don’t include GID in my referral letters, for either hormones or surgery,” he says. “I find that my letters are accepted.”
“This leads me to question the actual usefulness of the diagnosis,” says Vanderburgh. “Is GID really necessary at all?”
Resources (some links/phone numbers may have changed)
Reid Vanderburgh, MA, LMFT, 503-341-7001; www.transtherapist.com
Julie Trana, MS, 503-330-5312; www.julietrana.com
Sexual Minority Provider Alliance; http://www.glbtcounseling.com/directory.html
Oregon State University LGBTQ, “I might be transgender…”; http://oregonstate.edu/lgbtqqia/question6
HealthCommunities.com; http://lgbthealth.healthcommunities.com/transgender/index.shtml
Jenny Westberg is a board member of The Mental Health Association of Portland, a nonprofit advisory organization that supports advocacy efforts on issues around mental health. Information about their work is available at the Oregon Archive.
©Jenny Westberg. Author’s permission required to use the above. Include copyright information. The above is part of my original article.
