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OutServe Magazine | April 17, 2014

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Trans is not a Mental Illness

Trans is not a Mental Illness
Brynn Tannehill


By Brynn Tannehill

Over the next few weeks I will be writing a series of blogs devoted to the questions surrounding open transgender service. This first blog addresses the issue of whether or not transgender people can be mentally stable enough to serve.

There was the equivalent of a 8.0 Earthquake in the psychiatric community this past May. Although very few people outside the transgender community noticed it, there was a casualty. Its name was Gender Identity Disorder (GID). The funeral was poorly attended, and the only people mourning it were right wing ideologues and rabidly anti-LGBT organizations who feel that LGBT people need to be as stigmatized as possible by the medical and psychological communities.

On May 4th, 2012 the American Psychiatric Association released its proposed revisions to the Diagnostic and Statistical Manual (DSM). As of May 2013, these changes are expected to be finalized when the DSM goes to print, and the previous version of the DSM (v 4) will be revoked. GID had been removed, and was replaced by a different term: gender dysphoria. Besides having a different name, the new DSM-5 makes it clear there are substantive differences in how the psychiatric and psychological communities now sees gender dysphoria:

  • Gender dysphoria is not a mental disorder
  • It does not necessarily imply any loss of functionality in day to day life
  • It should be treated as a medical condition, not a psychiatric one
  • Health care for gender dysphoric individuals is a legitimate need
  • Gender dysphoric individuals are not delusional, nor is any other mental difficulty implied by gender dysphoria
  • (Medically) untreated dysphoria is associated with significantly increased risk of distress and suffering

While transgender people were elated at the changes, there also was a distinct feeling of “well duh!”

For 45 years there have been transgender individuals who have functioned at the highest levels of their fields. Lynn Conway is one of the people most responsible for the microprocessor revolution of the 60s, 70s, and 80s. She was also on Board of Visitors at the United States Air Force Academy, and a civilian two-star equivalent at DARPA. Dr. Christine McGinn was an astronaut qualified flight surgeon in the Navy. Amanda Simpson is a Presidential appointee to the position of Special Assistant to the Secretary of the Army. Dr. Chloe Schwenke is a Presidential appointee to a director’s position at USAID. The list goes on and on, but it puts to rest the notion that gender dysphoria is a debilitating mental illness. It’s a medical condition that doesn’t prevent people from doing their jobs, and often those people are doing them extremely well.

Being trans hasn’t been an adverse indicator for security clearances since the mid-1990s. Given that, the government has tacitly recognized that gender dysphoria doesn’t imply an inability to function, nor does it imply a dysphoric person is untrustworthy.

It also begs the question: if the U.S. government was and is willing to trust Lynn and Amanda with the highest levels of decision making and responsibility for national security, why is it also unwilling to trust a gender dysphoric culinary specialist third class with making sloppy joes?

While the Associated Press and some LGBT media outlets picked up this story, there are few outside the trans community aware of this shift. The paradigm among the public, and even amongst some members of the LGB community, remains that trans people are mentally ill or dysfunctional. This is not altogether different from how the public saw the APA’s decision to remove homosexuality from the DSM in 1973: it took a long time for this position to become the conventional wisdom as well.

The practical effects of this change are yet to be seen. Current regulations reflect a medical position and terminology almost as outdated as Gay Related Immune Deficiency Syndrome (GRID). This view is embedded in U.S. law: the Americans with Disabilities Act specifically singles out “transsexuals… and those with gender identity disorder” as classes specifically not protected by the law. In fact, trans people are lumped in with pedophiles, pyromaniacs, kleptomaniacs, exhibitionists, and voyeurs in the law. These restrictions were deliberately put into the law by then Senator Jesse Helms, to avoid government protection of undesirables. The VA is also prohibited from providing surgical intervention to transgender individuals. The Affordable Care Act (ACA) prohibits discrimination based on gender identity, but it does not require coverage of any issues related to gender dysphoria.

The military regulations and instructions related to transgender individuals also rely on older definitions and understandings of gender dysphoria. To remain relevant (and not laughable), the sections related to “transsexualism” and “gender identity disorder” will have to be updated during their next scheduled periodic reviews.

Some opponents of open trans service will point out that trans people are statistically more likely to suffer from depression than the general populace. True. But so are LGB people, and for many of the same reasons: social isolation, ostracization, abandonment by family, harmful labeling, internalized homophobia or transphobia. These are all factors common to both groups. Despite higher rates of depression, the LGB community is given the opportunity to serve. Indeed, the US Supreme Court ruled as far back as 1978, in City of Los Angeles Department of Water and Power v. Mahart et al, that discriminating against groups based on probabilities was unconstitutional. While the military is not bound by constitutional law the same way the civilian world is, the old adage, “what’s good for the goose is good for the gander,” seems fitting.