Antonia D'orsay

The End Of Disorder

Filed By Antonia D'orsay | February 10, 2010 7:00 PM | comments

Filed in: Media, The Movement, Transgender & Intersex
Tags: Blanchard, Bradley, DSM IV, DSM V, gender, Gender Incongruence, GID, How to spot a transsexual, medication, NARTH, Psychiatry, Psychology, sex, Stigma, Trans, transgender, transsexual

On February 9th, 2010, The American Psychiatric Association's Diagnostic and Statistical Manual, version 5 (DSM-V) revision working groups released their Proposed Revisions for the areas in the manual under consideration for deletion, removal, revision, and addition.

The current version of the DSM -- version 4, text revision, aka DSM-IV-TR, was released in 1994. The DSM-III was released in 1980.

The DSM-III revisions began in 1974, after a lengthy series of efforts by a small group of Doctors led by Joseph Nicolosi, Benjamin Kaufman, and the late Charles Socarides to prevent the delisting of Homosexuality in the DSM-II. If those three names seem familiar, it's because although they quit the APA in 1972, in 1992 they formed the organization NARTH.

During a recent fracas here at Bilerico, I pointed out that Homosexuality was never really taken out of the DSM. In light of current events described below, let's look at how it was that the GLB community was duped, and the Trans community took its place.

The person in charge of the DSM-III was Robert Spitzer. Some of you may recall the name from 2001 when he said in a paper that highly motivated individuals could successfully change their sexual orientation from homosexual to heterosexual. What many folks may not realize was that in 1974, as he was getting the go ahead to start work on the DSM-III, he argued, successfully, to put into code in the DSM-II at the time (the 7th and 8th Printings), a designation of "sexual orientation disturbance."

This replaced homosexuality in the DSM-II, and was commonly referred to at the time (up through 1980 when the DSM-III was replaced) as "sissy boy syndrome."

Robert Spitzer is generally credited with the way that mental illness is categorized in the modern day. Its a pretty academic thing, so suffice to say that he's one of the most influential people in psychiatry and psychology since Jung, Freud, and Skinner -- he's the ultimate A-lister.

The initial DSM-III writing was pretty much finished within a year, and then a snag hit that stalled it something fierce. NIMH did field testing on the diagnostics involved in the write (that is, the federal government), and there arose a pretty big fight over the concept of Neuroses. NIMH wanted it in the book, while Spitzer and the DSM-III crew wanted it out.

A compromise was reached. "Disorder" was followed by (Neuroses) and ego-dystonic homosexuality replaced "sexual orientation disturbance" from the DSM-II.

This was in 1979. Six years after homosexuality was supposedly removed from the DSM.

Keep that in mind, people. You were lied to by the leaders who claimed victory in delisting homosexuality. There are still copies of the later printings of the DSM-II and the DSM-III out there, and you can do the research for yourself.

At the same time, Transsexualism was first listed in the manual. That is, until 1980, there was no transsexualism in the DSM.

In 1987, the DSM-III-R came out, again under the guidance of Spitzer. Categories were renamed, and by this time Psychiatry had gained a strong measure of value and trust in the public sphere.

It was at this time, as well, that homosexuality was finally so deeply buried in the manual that most people more or less figured it was dead, as Sexual Orientation Disturbance became "sexual disorder not otherwise specified."

Except in one area, and that one area was "sissy boy syndrome," which, at this point, was renamed and dropped into a category called Gender Identity Disorder along with Transsexualism.

It was applied to children, and thus we gained Gender Identity Disorder in youth as the childhood diagnosis of homosexuality.

The shift was complete. In my last article I noted that 63% of LGB folks were linked by something, and that something was the predictability of gender variance in children as a precursor for being gay, lesbian, or bisexual.

Now you know why and how. Most GLB folks gave up the ghost in terms of fighting the APA by 1990, since by that time people such as Ray Blanchard, J. Michael Bailey, Kurt Freund, Susan Bradley, Kenneth Zucker, Richard Green, and Simon LeVay had come along and begun doing work that, ultimately, supported the idea that being gay is inherent and inborn.

Indeed, in the end, they proved it.

However, they had a problem as a group of researchers, and that problem was what to do about all the kids who were still listed.

It should be noted that the above people are all linked together. Most of them have done extensive work with a body formerly known as the Clarke Institute, now part of CAMH. This is a Canadian institution, and most of them are not only the leaders in their fields, but also are on the board or editors of the peer reviewed journal Archives of Sexual Behavior. Which is also where most of them publish.

And it should also be noted that the above people see gay as ok, and trans as absolutely terrible and without merit. Indeed, they see trans people as merely gay folks who are just too afraid or freaked out about being gay and so they change their sex.

Two of them favor what most trans folk consider to be reparative therapy -- with a positive goal being making the kids gay, not trans.

Kelley Winters is one of the folks who contributes, and she writes on issues of gender identity reform. Kelley has, in the past, noted that Zucker, one of the people who favors reparative therapy for young kids who will grow up to be gay, is on the committee to revise the DSM. So is Ray Blanchard.

They are not friends of the Trans community, and especially not friends of transsexuals. They are, in fact, considered to be just as dangerous to us as the religious extremists who hate all of us.

And yet, they are some of the best friends of the LGB community. Seriously. And their work in LGB stuff is top notch, but we Trans folk are so alien to them, and we throw off their pet theories so much because they think of us as simply gay people and cannot escape that mindset, that rather than listen to us, they have consistently tried to shoehorn us into their own ideas -- which are decidedly not trans.

All of which leads us to the DSM-IV and DSM-IV-TR, which essentially formalized the concepts we generally see described as "transgender" and finally shifted the focus entirely from the "gay" side to the "trans" side. In these publications, transsexualism was renamed Gender Idnetity Disorder, and all of it was put into "trans". Except one group of paraphilias, where the individual people act out of sexual (intercourse type) gratification and desire.

That group was called Transvestic Fetishist. Kelley's recent article talks about how that really needs to be taken out.

Well, as noted at the top here, the DSM-IV is expected to be published in final form in May of 2013, and accepted in 2012, and so the working groups have released new versions of all the stuff above.

For the first time in years, Disorder is not found in the diagnosis for Trans folk. It is in the classification for Transvestic Fetishist, however. And TF has a few new wrinkles added to it, as well. One of which allows it to be used as an alternative for diagnosing trans folk.

Trans folk no longer have Gender Identity Disorder. They have Gender Incongruence.

What is that?

Well, I've actually been sorta talking about that for the last couple months. In my series of articles on Trans, Sex, Gender. When I wrote them, I talked about how these things I was describing aren't merely theories in the sense of being unproven and untested, and that they weren't merely "fringe" concepts, but were the mainstream ideas about those things.

In the comments here on occasion, some have said that this revision would be terrible for transfolk. That it would result in all kinds of restrictions and so forth -- gloom and doom pronouncements, and I've pretty steadfastly noted that it would be nothing of the kind.

The new drafts released show a markedly broad understanding of trans experiences, and reflect the diversity I spoke of and the science behind the articles that I wrote. I leave it to the reader to guess how it was I knew all those things.

And, finally, in the GI in Children has, at long last, been narrowed with the goal of reducing the ethical consideration involved in treating gay folks for being gender variant. This was done by more clearly defining it and requiring more than two factors, so that it focuses on just the trans youth.

One worry is that it goes a bit too far and may block potential treatment of kids in need.

So, in truth, it looks like homosexuality will finally be erased from the DSM sometime in 2013.

Don't you think its about time we moved trans stuff out of the DSM and into the medical condition books?

Leave a comment



I see there at it again I heard a story on NPR about the new list and was woundering how we would fair.Yes ts most deffently time were treated as a medical not mental condition.

Hello Antonia,

Do you think it is worth noting that "Gender Incongruence" is still a sub heading under the "Sexual and Gender Identities category"?

When I take that into consideration I find this quote from Meyer-Bahlburg about confusion confusing:


It appears reasonable that sense of self variations would be kept separate from sexual performance issues. The introduction of the term "Disorders of Sexual Development", however, creates a new disorder that wasn't there before. Meyer-Bahlburg has me really confused because on the one hand he talks about a person's sex differentiation, then seems to say that referring to sex differentiation as sex would be too confusing, so let's call it gender. How does the way someone differentiate sexually become gender?

Not incidentally, many intersex people are in very serious disagreement with the term "DSD" and it's nomenclature based on outdated understandings of "chromosomal sex" because of it's pathologizing implications along with the history of non consensual medical interventions performed on intersex people based on what their chromosomes said they should conform to.

I see a number of problems with this. There seems to be a pattern. First, when homosexuality is taken out of the DSM, it is replaced by Transsexualism. Then transsexualism is replaced with gender identity disorder. Intersex has always been in there for people born with intersex variations who feel the doctors made the wrong choice when assigning them a sex under the GID-nos category. Now intersex has been taken out and is referred to as "Gender Incongruence" "With DSD", with the word disorder kept in under the general heading of "Gender Identity Disorder" and in the "Subtype" for Gender Incongruence.

The GID-nos category implied that intersex variations were not as significant as what sex a person's chromosomes dictated they are "supposed to be". To have obvious physical characteristic that are not congruent with what one's chromosomes say which sex they are supposed to be doesn't seem to matter to some clinicians. Under the GID-nos classification, the implication was that the original sex assignment was correct and a "gender identity" not congruent with the sex assignment was the sort of "mental defect" spoken of in the O'Donnobhain case.

The term intersex was changed by certain people involved with pediatric endocrinology and others around 2006, ostensibly because of concern of what the term intersex might imply to parents of intersex children and because of the stated need of doctors to have intersex variations characterized as disorders. Many people saw homophobic and transphobic implications involved with that point of view; along with the negative implications of the term "disorder", in regard to treatments that might be requested by the intersex person and treatments that might be imposed on the intersex person without consent, presented.

The fact that things are not simple or straightforward in real life, I believe, is no reason to speak of a persons sex when it is convenient for someone, then turn to the vague and abstract term gender when acknowledging someone's sex characteristics or differentiation when they are not congruent with what someone's karyotype the medical profession, or others, would insist their sex should be determined by.

I feel this has implications for transsexual people. Transsexual people who opt for medical interventions will have sex characteristics that, at least in some way, will not be congruent with their karyotype.

There are many more reservations I have about this new proposal. Zucker's reparative therapies are not only believed to be harmful to children who may grow up and prove to be transsexual but, also, to children who might grow up to be feminine gay or masculine lesbian adults. There are many questions about Zucker's involvement with intersex people because of the therapies he promotes to reinforce the assigned sex of a person. It is fairly well understood that an intersex child may reject a sex assignment. I think some find that there is a conflict of interest right there. But, there are many problems for gay, lesbian, transgender and transsexual people with the interventions he uses to suppress a person's natural inclinations.

The classification of Transvestic Fetishism pathologizes someone with a fluid gender identity which is not an improbability for many people, especially intersex people. Some people are naturally inclined that way. Crossdressing is not pathological.

No one has mentioned anything about "hypoactive sexual desire disorder"or hyperactive "sexual desire disorder" which seem very subjective and judgmental assessments.

I think. over time, in spite of all the good things that have come from Kelly Winters' efforts and hard fought for achievements, this proposal leaves a lot to be desired.

Hi Edith,

I'm in the process of doing a general review of the diagnosis right now that will appear at a later date.

I'm generally coming at this from the basic standpoint of "a good compromise makes no one happy", and when one steps back (and, as is absolutely and utterly *essential* to this, completely disregards identity and affinity groups) on can see that to some extent that was what was gone for here.

It's fairly obvious from the particular papers cited that there's a strong consensus in terms of several underlying aspects based on available research done so far, but that there is also resistance to challenging the Spitzer model and system or organization.

In regards to the category Gender Identity and sexual disorders, the working group makes it clear in their rationale that they as a team do not support the inclusion of the diagnosis in that category, but do not go so far as to propose a new grouping (which reflects the dominance of the Spitzer model). I've made it fairly clear in the past that I would rather see it grouped in with the E, O, or P categories in the ICD, and my understanding is that many members of the working groups share similar ideas. Howeer, they are limited bythe structure and schemataofthe DSM itself, and that means finding one where it would be fitting, and that's a grave challenge overall even from a psychologists perspective if you find that the category it's in now isn't applicable.

As for the section you highlighted, what they are speaking to in that commentary is not the DSD itself (a physiological issues) but the potential for the additional variances due to the individual's Sex Identity and Gender Identity (which are critical components of this process that are required to understand the position of the authors) possibly conflicting with the manner in which they are raised or live.

In short, an IS person (and I was involved with ISNA prior to the DSD debacle and stepped away when it was taken in that direction) who is of indeterminate sex at birth might be raised as a female and yet have the Sex identity and Gender Identity of a male. As it stands now, such a person is treatable only under the current dx of NOS, should they decide for themselves to have surgery.

I will refer to my articles here and at my own site regarding Sex, Gender, and Trans, as well as the concepts of Affinity groups and identity, as in nderstanding these concepts, it becomes apparent that the goal is to move the treatment entirely away from a sex specific focus to a gender specific focus, which is in keeping with the understanding that the efforts of psychiatry are more about what they can actually work with, as opposed to what they cannot (that is, physical issues such as Sex identity and Gender identity).

In regards to the pattern c9mment, Transsexualism was not replaced by GID. It was renamed GID. The two things are identical otherwise, and interchangeable.

Nor does the proposal change the DSD into GI -- the two are still very much distinct, and the cross over is for th0se situations such as the one described above, since the current model for DSD treatment says you must choose to be one or the other to get treatment, and this allows for treatment regardless of choice, as well as opening it up for greater choice.

One example here might be someone who has PMDS. Externally and socially they can appear to be typically male, be raised as male, and not have the issue discerned until in late adulthood. If their Sex Identity and Gender identity reflect a female perspective, they would need to transition in order to achieve congruence, but might encounter resistance since they do not demonstrate sex atypical aspects warranting surgical intervention via the DSD protocols.

So the subtype is not meant (nor does the profession have the particular potency given the limitation of human development) for general use in the sense of "oh, you are IS, and I say you will be a girl so we'll do this" but rahter on the basis of the IS person doing it on their own.

It is, thusly, recognition of the fact that some IS people are gender incongruent, and they more or less get screwed over treatment wise.

That's not to say I'm fond of it (I would have preferred it not be a subtype but rather an additional classification if they were going to do such), but that's where it is.

So this actually reinforces the point of IS variations not being significant regardless of the type and term, and that the original sex assignment is indeed incorrect (as described in the intitial rationale for changing the terminology to incongruence).

So it does nt address treatments to which the IS person might have been unwillingly submitted, but rather treatments which they voluntarily seek out. And this is important, since many IS people were and are driven from the generally communites if they happen to have a Sex Identity or Gender identity that is fixed and stands in sharp contrast to the political efforts of the various bodies.

(the only reason it matters they are IS is for subtyping, and that serves only as a note,. Subtypes are not signifincantly used in daily practice without significant development of them, which the revisions lack at this time)

I should also point out that Gender is not a vague and abstract form in the fields being discussed. It is an extremely well supported and heavily documented concept with specif8c and precise meanings that are almost universally misunderstood in colloquial parlance (a good exampl ebeing that many people outside the felds -- including many trans folk -- often have no idea what sex identity is, and what the difference between it and gender identity is, although they often use the concept of Gender identity incorrectly).

You do raise important consideration regarding Zucker's work and its overarching effect on cisLGB folks. I would caveat this, however, by notng that there is a new tool introduced for aid in diagnostics and by the far more restrictive requirements for diagnosis presented in the area of focus for Dr. Zucker: children ages 4 to 12. That much more restrictive approach is actually directly related to his theories, as they are rahter obviously trying to narrow it down to just the 22% or so who are, in the end, Gender Incongruent. That will give him a bit of toruble, but will also potentially have the effect of enabling a more clearly delineated campaign for the ending of his reparative efforts.

TD (TF) and the "gender confused" are particularlay troublesome and here I tend to agree that they should be the primary focus of efforts within the comjunity to remove or discard, but it must be on grounds significantly more important in terms of theoretical structures than just "I really don't like them".

THis is why I've already noted that I would approach it from a duplicative aspect, since they duplicate an existing dx that is far jore developed and inclusive than they are. It is unnecessary and rather unlike the Spitzerian model to repeat them.





Wow, is this dishonest.

Why not GIVE the definition with the name, Antonia? Why just make a statement, knowing that statement is going to rile some people up?

Ego-dystonic homosexuality is not a "replacement" for homosexuality in the DSM (any version) but is instead the name given to descrive those persons who:

ego-dystonic homosexuality Type: Term

1. a psychological or psychiatric disorder in which a person experiences persistent distress associated with same-sex preference and a strong need to change the behavior or, at least, to alleviate the distress associated with the homosexuality; no longer a DSM-recognized diagnosis; now included under sexual disorder, not otherwise specified.

In other words, it's the mental condition suffered by gay men and women who are having mental and behavioral difficulties accepting being homosexually oriented.

If you're going to be as dishonest in your political campaign, I certainly hope you are not elected to public office.

I wasn't dishonest, Eric.

It's still homosexuality, and it was still there. Which is the extent of what I noted.

That you seem to think I did something *more* than that is rather odd to me, as I was fairly direct and clear and didn't mince any words.

On the other hand, you did do something I said to do above -- to look it up yourself. To educate yourself on the matter.

Speaking of which, look up the DSM-II dx for homosexuality. Then apply the same standards to yourself that you applied to me.

Yes, Toni, you were, and are, being dishonest.

It's not "homosexuality" that is being labeled as a disorder, it is the inability, or unwillingness, of a person to accept their homosexuality as being disordered.

If you wanted to "backwards engineer" that definition, and attempt to make the meaning clearer - what it's saying is homosexuality is just another normal sexual orientation, and someone who is unwilling/unable to accept themselves as being homosexual are the ones with the problem.

loss of credibility | February 11, 2010 9:22 AM

Eric -- thank you for pointing this out. Is this "research" to the author -- half quotes used for your own political ends? Despicable. You will make the PERFECT politician -- all hubris, smoke and mirrors to get what YOU want, everyone else be damned.


I'm assuming you are referring to Toni, here, who just happens to be running for office in Maricopa County, Arizona.

While I also used the term "dishonest" in reference to Ton's writing, and compared that to her quest for political office, I'm going to retract that statement now.

Toni has a cause. Like most people with "a cause," she can sometimes interpret outside information in a manner that best advances her cause. I understand this, completely, and have, myself, at times behaved in the same manner.

Her "cause" is to have the mental-health references and components of being "trans" (whether it's being transvestite or transsexual) removed from the latest DSM - the reference material from which mental health disorders are diagnosed. I understand, and respect, the need to advance her cause; I also understand how that mindset could cause her to mischaracterize what the current DSM actually states.

She wants me to take what the DSM-IV now says... well, what is says about me, the homosexual, and by referencing the DSM-II (from 1974) apply it to her "trans" cause.

Unfortunately, I can't do that, as she's omitting one key component in pre/post 1974 DSM diagnoses.

By 1974, the "homosexual community" was, to a degree, coalescing; while there are major differences between the components of the gay community that still exist, there was a high degree of unity on one, specific, viewpoint: Being gay is not a mental disease; we are not crazy, we can all, honestly, say our emotional attractions have always been toward those of our same gender."

But, even as witnessed within the last few months in posts made to "published columns" here at Bilerico, that same coalescing is not apparent in the "trans" community. Yes, it's a much more complex community than just being gay or lesbian... but until that community can define itself - until it can find their own coalescence - then the medical health community is going to (and in my belief, rightly) include a "mental disorder" component in the diagnosis of, if nothing else, transsexuality.

When a person rejects reality, and replaces reality, with their own mental image, to the medical/psychiatric community, that is a delusion.

I understand, for a transsexual, the "reality" of their situation is not real; it is the mental image of themselves that is the "reality," and (for, I'd guess, the overwhelming majority of transsexuals) the physical "reality" must be changed to conform with the mental reality. Thankfully, that choice is an option in today's medical world - but the selection for which persons qualify for option of that choice is hampered by the mental health care professionals diagnostic organization's checklist for such qualification... not to mention, that option is removed for the people who don't specifically match all the "checkpoints" of that body's list of qualifications.

Further complicating matters, from that diagnosing body's viewpoint, is the simple fact that not all transsexuals wish to have their physicality re-formed. If the mental health component of a transsexual diagnosis is removed, are these transsexuals then forced to undergo such physical re-formation as a medical necessity in order to qualify for the continual dispensing of hormones and other medications? If the mental health component were removed, and the transsexual had health insurance which stated the only authorized continuing treatment was the surgical re-formation of the transsexual's body, does that transsexual then have the ultimate "freedom to seek medical treatment" removed from them?

And if the mental health component is removed, how does a health insurer, or even a health-care practitioner, "treat" transsexuals, who are content (if not happy) to merely disguise themselves as members of their opposite gender and transvestites who disguise themselves as members of their opposite gender for reasons that are different from transsexuals? Are transvestites then forced to undergo a regimen of hormonal and other therapies to bring their "therapy" in-line with therapies given to transsexuals?

That's some of the reasons I believe the DSM should still reflect a mental health component to a definition of "trans." There's simply too much pain that could be inflicted, medically, on someone with a "trans"-anything definition should that mental-health component be removed.


Did you just call me delusional?

likely not with intent to hurt, but absolutely with a huge degree of privilege.

I didn't respond to most of it because it is, in fact, an argument from privilege, and, therefore, flawed.


"Privilege"? Like my past, and my life, is at some status you perceive - as it is entirely your perception - to be at some higher plateau than someone else's? I've never made that claim, nor would I.

For some reason, Toni, in this thread of commentary to your post, you're animus toward posters who make comment that differs from your own has become more and more directed at me, personally... to the point you've responded, negatively, to things I've said (or your perception of what I've said) in threads in which I've not been a participant.

You made a statement concerning the DSM.

You claimed a specific disorder in the DSM "proved" that homosexuality had never been removed from the DSM.

I pointed out where that was untrue, and the actual section to which you pointed bolstered the fact homosexuality had been removed from the DSM.

You continue to espouse that so-called "Gender Identity Disorder" is a link of commonality between everyone in the lesbian, gay, bisexual and trans community.

You've responded with disdain when anyone - including a trans person - has stated differently.

In this thread, when your deceit was revealed, instead of the equivalent of "ooops. Me bad," you continued to defend your deceit, based on some convoluted reasoning on your part.

Now, you start with the more personal jibes. "Privilege."

If anyone has been writing from a sense of "privilege," Antonia, it would be you - especially when you simply dismiss the facts because your perception is different, and insist your perception is THE correct perception.

You are correct that I am writing in general from a sense of privilege -- everyone is. In my case, the privilege is that of way too much education.

It can also be argued that I do so from a "passing" privilege, both cis and white.

However, it's fairly obvious from your comment that you do not understand the nature of privilege, and, therefore, do not see your own privilege as a cis person.

Privilege, in this context, is not about who has it better or worse, Eric. It's about who has certain expectations as a result of their social situation and who does not.

In this case, I was referring to cisprivilege. I describe white privilege and class privilege in my agreement that I am coming from such.

You carry an invisible knapsack, Eric, and you might might want to unpack it.

Or google "Cis Privilege".

I understand the concept of "Cis privilege," Toni, and I reject it, completely.

A "checklist" of "Cis privilege."

There's not a single question in that checklist to which someone would not answer yes; therefore they are exhibiting cis privilege.

So, Toni, if "cis" is someone who has the body their mind expects, and the body society expects, how do you juxtapose that label with the thought "we are all trans."? Hmm...


Many people who are known for expressing the most transphobic views in public, react very badly to the term “cisgender,” claim that it is a slur, that it is imposing gender on them. It’s none of these things – it simply means “someone who is not a transgender person.” However, saying that it is a slur is transphobic, because if “cisgender” is a slur, then how can you justify “transgender” as anything else? Imagine if “heterosexual” or “white” were considered slurs.This is an othering tactic – by claiming that “cisgender”, “cissexual”, or “cis” is an offensive slur, you’re saying outright that you’re unwilling to allow trans people to stand on equal footing with you. That you’re normal and they’re deviant. That you require the right to name trans people as other, but that trans people have no right to name you as privileged and oppressor. That it is normal to assume that not being transgender is the natural way to be, in the same way that not being gay or lesbian is assumed in straight society.

I have never stated I consider "trans people" as "other," or "deviant," or that we are not on equal footing; in fact, I've stated, repeatedly, the exact opposite: That a person is whatever gender they present themselves to me to be. I have four sisters, one of them, as a 17-year old, won the "Mr. Paul Bunyan" award from our local 84-Lumber yard in 1877. She sawed faster and cleaner, she hammered a nail faster, she threw a barnyard beam furthest - and the majority of her competitors were middle-aged, male contractors. Another, younger, sister, in her teen-age years, was a beauty queen.

So what? I have absolutely no expectations of anyone based on their gender. Believe it or not, there ARE some of us out there.

I am not an enemy; in fact, if you scroll up in this thread, there are times I defend you.

If YOU find it important to label persons to fit into cubbyholes from which you, yourself, cannot mentally escape...

Well, then, I feel sorry for you.

Eric, in rejecting cisprivilege, you are relying on such.

Indeed, you are actively seeking to normalize cis lives over trans lives -- to make cis the default, and trans the Other.

You are welcome to reject it, however. People reject the concepts of Gender, the ideas of evolution, the thought that the world revolves around the sun, that people ever walked on the moon and that the twin towers was an act of terrorism.

Doesn't change it's accuracy, however.

I cannot answer yes to number one on that list, Eric. When I travel, I feel a requirement to carry all my documentation with me -- passport included, even in the US.

I cannot answer yes to the second one, Eric.

Or 3, or 4, and so on.

Because what I can expect, Eric, is that sooner or later some asshole is going make me have to deal with it.

SO when you say "There's not a single question in that checklist to which someone would
not answer yes; therefore they are exhibiting cis privilege." you are, immediately, wrong.

Because I am someone, Eric.

None of which means that you don't think we are equal or that you don't feel we are just as good or whatever. Privilege is not about that, Eric, because it's not entirely something you *actively* think or know or understand.

Privilege is institutional -- societal, and it's not something you can escape. I cannot suddenly lose privilege because I'm educated any more than a typical white person can for being white or a guy can for being a guy. It just is.

And by its nature, when you have it, you don't see it -- which you demonstrate wonderfully in your rejection and denial of it.

And its a truism that when someone is introduced to their privilege, they get a little pissy about it (I do, as well, and I'm far more aware of it than most people because of my liminal status).

Additionally, it's not a cubbyhole -- unless you think *human* is a cubbyhole. Its a descriptor, not an identity (although some people can choose to make it such if they want).

I don't identify as trans, Eric. I am such, however, regardless. It's still accurate, it's still truthful. The same applies to one as cis.

Finally, you make the same errant assumption that many people make, by assuming that trans and cis are mutually exclusive.

They aren't. Situational membership challenges that. It's like saying gay and straight are mutually exclusive, when they aren't, for the same reasons.

And I know you read that stuff, because you and I talked about it then.

It is not black and white, Eric. It is black, white, yellow, blue green, red, indigo, violet, orange, and even more.

Oh, and I missed a privilege of mine: heterosexual privilege. (at least, for now...)

Apparently, Kian, you didn't read the next paragraph.

I was simply stating one of the "textbook" definitions of "delusional."

I just wanted some clarity, so thank you. I feel that I should add that should you want to have a non-heated discussion with a trans person, you should probably refrain from using the d word, regardless of how well it fits your argument.

Ego Dystonic Homosexuality, as I understand it from a conversation with a psychiatrist, by and large applied to candidates for the ex-gay movement. It made not wanting to be gay a disorder. I've no problems with that; I am more than willing to consider the ex-gays as disordered.

Agreed -- I've not disputed that intent of use.

The same argument is being pressed for intent of use of TF (TD), though, and yet it will still be part of the whole damned nightmare for trans folks.

I don't consider ex-gays disordered. I consider them tortured.


Who cares what the DSM-II says?

Let's say someone takes their 2010 Corvette to a GM-certified repair shop, and presents a list of problems they're experiencing with their car to a repairman in that shop. That repairman pulls down his GMRD manual, goes through a checklist of those problems and determines that the carburetor of the car is in need of repair/replacement.

All well and good... except the 2010 model is fuel-injected; the General Motors Repair & Diagnostics book the repairman used is from 1974, and has been replaced by "x" number of manuals in the last 39 years - the repair shop owner just hasn't bothered to keep up.

At that point, if nothing else, the car owner should report that repair shop to whatever governing agency GM has in place to have the shop's certification revoked.

But let's say the car owner doesn't, and allows the repair person to rip out the guts of his Corvette and force a carburetor onto his car. It's going to be an uncomfortable fit, and if the car still works at all, it's not going to work correctly, and the "fix" is going to, ultimately, create other, bigger, problems for the car... all based on the repairman's complete unwillingness to update his professional library and keep himself knowledgeable about the changes in his own profession.

So, if a therapist/psychologist/psychiatrist is working from 35 year old (and older) resource material to form a diagnosis, they have failed to keep themselves "in the know" concerning their own profession, and are in the position of doing real harm to their patients.

They should be reported to as many governing agencies as the patient can find; their licenses should all be revoked until such time as they demonstrate an up-to-date skill set.

If the patient is unwilling to do so, and seeks treatment with that therapist/psychologist/psychiatrist based on that "mental health professional's" diagnosis, then that patient could be said to be suffering with "ego-dystonic homosexuality."

What such a diagnosis does not cover, however, is whether that patient originally presented with symptoms that match that diagnosis, or whether those symptoms were thrust upon him by the viewpoint of a "health care professional" working from decades-old reference material.

Would anyone trust a mental health professional who, today, made a diagnosis of "manic depression," as opposed to "bipolar disorder"? Or, going back even further, made a diagnosis of "temporary hysteria," instead of "post natal separation anxiety"?

Of course not... but our good friends at NARTH and Exodus, International and Love Wins Out are free to use outdated and inaccurate reference material as snake-oil to attract those who suffer from ego-dystonic homosexuality and offer them a "cure." I'm absolutely certain the majority of those organization's "customers" are persons who are on the borderline of acceptance of their sexual orientation, but are pushed into "conversion therapy" by the loved ones in their lives.

That most "conversion therapy" carnivals have backing, financial or otherwise, provided by religious institutions gives them First Amendment grounds to continue their "therapies." While, in my opinion, that situation is morally wrong, I am not willing to strip the First Amendment from the Bill of Rights, nor do I think anyone would be... with the First Amendment gone, there goes freedom of speech, as well as the invisible wall that prevents our government from becoming an extension of whatever religion is currently en vogue with voters.

But, I'd think, most of these organizations would have to have at least one accredited medical therapist on staff; I don't think the reporting of, and the fight to have the certifications of those therapists from, those individuals would be a violation of their, individual, First Amendment rights, as the oaths and pledges made by those individuals in exchange for their accreditation normally include pledges of serving the patient's needs, and ultimate health, before the therapists' needs and health.

Ultimately, with no licensed, accredited health care professionals to hide behind, those conversion-therapy hell holes would lose any and all sympathy and support. They'd be revealed as nothing more than a bunch of people who banded together to impose their morality on others... a homosexuality-centric KKK whose goal is to "get the fags," if you will.

And just like when fighting the KKK - a once respected institution in America (and not just in Southern states) now seen as an object of ridicule and disgust - it's going to be a long fight, taken one "chapter" at a time.


That's not entirely true. While these losers do view being gay as a "better outcome" than being trans, I don't think you can say that they see being gay as okay. J. Michael Bailey, in particular, views homosexuality as a "genetic mistake", and has made statements advocating the eugenic elimination of queer people should it ever become possible to run pre-natal screenings for queernesss. I don't know if the views any of the others mentioned are quite so extreme, but it wouldn't surprise me if they are.

Eric is correct. And after over 25 years in the psychiatric profession, I can say that no one in mainstream (or even "informed") psychiatry would have placed the label of "sexual disorder, NOS" on a child or adult for being gay.

One would like to think that, and the key is truly reputable.

Not all are.

True...but as a writer, have some humility and stop trying to defeat your readers. You made your point; there have been counter points raised. Be gracious and keep some credibility.

Thanks for posting this, very interesting, Antonia. I disagree with one item, though, and that is where you say that it has been proven that being gay is inherent and inborn.

While there has been some interesting evidence tending to show that homosexuality has inborn components, I don't think it is fair to say that they "proved" that being gay is inborn.

I have concerns about that argument because it has been wrongly used to suggest that being gay is a genetic defect and therefore curable by medical means.

Dr. Weiss,

Though I sympathize with your statement, I must disagree - I believe the propensity for being homosexual is entirely organic/genetic. I'm not qualified to say it's based on any gene or chromosome; it may be as complex as the interplay between a nucleic acid and some ribozyme during fertilization.

I disagree, completely, with those who state there's some sort of "rearing" component in homosexuality, as the supporters of such statements will, at any given moment, claim a cause for homosexuality is "a distant, emotionally unreachable father combined with a nurturing, overprotective mother," and in the next instant claim the cause is "a distant, emotionally unreachable mother combined with a nurturing, overprotective father."

Talk about possessing and consuming one's own cake!

My personal belief: homosexuality is inherent. The thought/feeling of being homosexual may be nothing but fleeting... until that homosexual is involved in their first homosexual encounter, whether that encounter is sexual in nature, or just a relationship between two persons of the same gender that the (forgive me the use of this term, please, as I know it's horribly outdated and negatively stereotypical) "latent homosexual" knows/feels is deeper than "simply being friends."

Once that "encounter threshold" has been breached, the homosexual person simply knows there is "no going back" for them; they've connected with a part of themselves that is instinctual to them.

My response to those types is usually, "If all it took to make someone gay was bad parenting, EVERYBODY would be gay." Same goes for using those arguments on trans people.

Here I agree, Eric, as the weight of the evidence is greater than the weight of the theory.

Then again, the same can be said for Trans folk.

Even discarding theories which have a questionable merit to the average lay person (and example being Blanchard's birth order theory), the sheer consistency of data over the sum of the variable physiological studies indicates such.

Then again, I have other reasons for such that allow some to place my position under suspicion as dishonest.

There is a differnce between an inborn characteristic leading to a normal variant(Sapphism, Homosexuality) and a pathologic change resulting in an undesirable outcome.

I LIKE being a Lesbian; I am happy being a Lesbian, I revell in the ability to love a woman. Hardly a disroder.

In other words, there is nothig to cure.

and apparently, in the upcoming DSM V transsexuality will just be a status in trnasition to woman(or man) and when you reach the other side of the line, you are cured. Having known a number of women of operative history at this point, I think that describes their lives on point.

The DSM has a fundamental flaw that needs to be addressed. In the case of LGBT individuals the pathology is not in being LGBT. The pathology is in the people who are bigots and jerks towards LGBT individuals.

I'd like to see the DSM include a diagnosis for using religion to justify a person's pathological desire to be a bully.

Or consider the many people being treated for anxiety and depression who have nothing wrong other than having little choice but to work for abusive employers. The mental pathology is with the employers who are generally narcissistic jerks.

I'd love to see progressives, LGBT and otherwise, aggressively take steps to minimize the damage of the people who are really mentally ill in our society such as those described above.

One of the most interesting things about the internet is that it allows a lot of people to see stuff and have the option of commenting in many different ways.

The majority of folks simply don't comment. That's pretty much a given -- in my old marketing classes we called it the rule of 10 -- every letter you get from an unhappy customer is equal to ten others who kept their mouth shut.

Another chunk of people comment on posts and such. They speak out -- such as Eric, and the always somewhat negative and name changing "loss of credibility" above (for whom I'd lost credibility the moment they found out I'm a psychologist).

Then there are those who send emails to people, and boy howdy did I get some good ones. Not merely ripping me a new one for this column, but affecting certain aspects of my outlook (something startling as I'm very slow and studious in that process, so it means they sent something that significantly impacted my reasoning).

That said, I'll address some of the issues which I agree are rather contentious in my post.

First off, on the statement that homosexuality was not removed, I do not retract it. I specifically avoided noting the methodology of how the variable diagnostics were used, but one point remains, and still remains, to this day:

Children who will grow up to be gay are still considered mentally ill. THis was done knowingly and with awareness, and anyone who does any history research on the diagnoses to do so will be aware of it.

Sissy boy syndrome never left, and was entered into the books in order to deal originally with it, and is the basis for what became Gender Identity in Youth.

This is based on the predictor I spoke about early -- 63% of adults GLB adults were gender variants in childhood, and, therefore, trans.

The amount of research here is extremely strong and very powerful, and although as a trans person myself I'm very much concerned with the names attached to that data, the data is pretty much rock solid.

It was included in there because of an overwhelming idea in science *at the time* that homosexuality and bisexuality were at least partially based in socializing factors.

Those same gender variant kids include about 20% of them who go on to be trans of some sort -- most often cross dressers of some form or another.

This is also part of why there is a split in the diagnosis for GID between early and late. See the column that was published after mine for another part of the reason.

As Eric noted, part of my reasons for highlighting ego-dystonic homosexuality in particular was indeed somewhat political and done for effect. The other reasons is that such a diagnosis is still applied today to persons who present with an uncertainty, and I happen to find that the uncertainty is almost uniformly caused not by internal factors but by social pressures -- iow, theya re suffering from anxiety and shame and guilt thrown at them by the world around them and the fact they are trying to come to grips with such.

EDH was *intended* to be used for folks who are pretty much like that, but instead has been used to simply declare *all homosexuals* as having such, regardless of the ethical questions that raises, and many of those same people are behind and part of the "ex-gay" movement, and that's one of their justifications for such.

So please feel free to think that it was removed if that makes you feel better. It doesn't change the fact that while the name is different, it's still present, and that the particulars of why it is present are based in issues that were not entirely germane to what I was writing about.

Next, more than one person has privately taken issue with my noting that Niccolosi was involved with the removal. This is correct, and I apologize for it. As has been noted, including by people involved in much of what got me going on this, he's a bit young.

Lastly, there are some considerations to make regarding the specifics of my timeline. Since most of what I wrote was essentially off the top of my head and without really running off to check for particular specifics on dates, I might have fuzzed things a bit unintentionally -- possibly by one or two years. The overall progress seems to me to be still stable and reasonably accurate for the purposes of the column itself, but may cause some trouble for persons doing new research. As with anything I write, I encourage anyone to do work for themselves as while I can sit here and tell you the sky is blue, you really won't *know* until you walk outside and take a look for yourself.

So I apologize for the minor timeline issues that may have accrued as well.

Thanks to the commenters for a most engaging discussion, and it's nice to know that people are and can be as passionate about this subject as I am.

One last note, to save me time, directed at something that was said by Eric Payne.

Trans folks do, in fact, have a strong, abiding, and widespread consensus that all of this should be removed from the DSM.

The concerns that arise are related to things other than being trans itself, almost all of them related to economic and sociopolitical considerations on what the effects of doing so will have on the ability to get treatment.

So, on behalf of a great many people, I encourage you, Eric, to take the time to actually get half a clue about the trans community, as your current clue level is right around a tenth.

But, to your credit, you are at least working on it.

Geez, Antonia, you crammed your comment chock-full, didn't you? Since this response is completely at my own speed, I'm merely being illustrative when I ask for a moment or two, here, to read it. Hold on.

Since I'm mentioned, by name, I have to make a response to this statement:




If you're claiming you lost credibility wiht me because you are a psychologist, that's completely untrue, however, now knowing you are a psychologist (I thought I had seen you reference yourself as such in previous postings, but I don't like to rely on simply my remembrances), I will say the "loss of credibility" I do feel toward you is now heightened, as you should have felt some sort of responsibility to truthfully quote the DSM, instead of merely throwing out the label of a disorder under the guise of "See? "Homosexuality" is still in the DSM!!!" That's nothing but baiting, Antonia... a form of fear-mongering.

And to continue to put forth your interpretation of "sissy boy syndrome", in my opinion, only further adds to your discredit, as the definition to which you refer means something else altogether.




But, Antonia, the only one who is equating "homosexuality still being" in the DSM with other "disorders" that are in the DSM is you, and the parents of children who play with "gender specific" toys.

But why is a toy gender specific? Because a parent (or grandparent, or aunt... uncle... cousin... next-door-neighbor...) says it is. To a good therapist, who understands the subtleties of diagnostic procedures, they are not. They are just toys, and the therapist would be better off suggesting to the presenting parents is is they, and not the child, who need to alter their mindset.

Toni, in 1976, I underwent "treatment" for my homosexuality at Philhaven Mental Hospital, in Lebanon, PA, at the insistence of my father - being a minor, and with the laws in place in 1976, I had absolutely no say in the matter.

The treatment was... unpleasant. If one were to inspect the skin of my penis carefully, one can still see the "oval edge" where one of the pads burned away some skin; the new skin grew in, but there was a slight differentiation in color between the old and new skin growths that never quite melded. There are still two "clip" marks burnt into permanent scar on both the left and right side of my scrotum that, 34 years later, are still occasionally infected.

I was verbally assaulted, continuously, by so-called "doctors." Complete strangers to me were encouraged to physically abuse me about being a faggot.

This was AFTER homosexuality was removed from the DSM. If anyone were to show me that the DSM still referenced homosexuality as a mental disorder, I'd be in the front lines of the parade screaming for a change to be made.

But that isn't what you've shown.

What you've shown is "gender identity disorder" is still listed in the DSM and, again, have attempted to link GID with gay men and women... and that's simply not the case. I was undergoing that "conversion therapy" not because I was a male showing gender confusion, but because I was a male who was emotionally/sexually attracted to other males.

I have a rich and colorful history that runs the gamut of nearly every type of abuse (physical and mental) that can be heaped upon a person, as well as nearly every type of "goodness" a person can obtain.

I speak almost exclusively from personal experiences; if I don't, I document the sources from which I obtained, and interpreted, information.

In essence, I am, even in my private life, a newspaper reporter and columnist.

And a damned good one.


If your purpose was "somewhat political," Antonia, then you were intentionally being dishonest in its usage. You wanted the shock factor.

Not only is that beneath you, but it's simply repeating the tactics of our foes - scare 'em! Scare 'em! The children! Think about the children! - and is beneath you, Antonia.

And if you know a therapist is intentionally inflicting upon their patient some societal or religious viewpoint that could cause their patient to be diagnosed with "ego-dystonic homosexuality," Toni, then don't you have a moral and professional obligation to have that professionals' ethics committee (or the equivalent thereof) investigate that therapist? Hell, even lawyers are obligated by their profession's ethics to "turn snitch" on other lawyers who are violating certain codes of conduct... and I can think of no stronger "Code of Conduct" for a medical professional than to make an accurate diagnosis of their patient.



Ah, how sweet... a put-down followed immediately by a back-handed compliment. Sort of like a "Republican Apology: I'm sorry if what I said/did made you think I meant what I said/did."

Toni, I may have only "half a clue" about the trans community. I'll willingly admit that.

But I'll tell you what I do know:

I'm not telling all trans people that, at some level, they're homosexuals, too.

I'm not misrepresenting some diagnostic tool simply because of a word in the title of that tool.

I'm not holding adult people, today, to some "Gender Identification Disorder" diagnosis because 20 years ago they played with a toy seen as gender-specific to their opposite gender.

You, however, are.

I have absolutely no animus toward you, Toni; I'm truly sorry you feel I do. I use forums such as these to hold a conversation. I won't even call it a debate, because it's not. There's nothing in these comments we're going to resolve.

As in any lengthy conversation, things might be said which anger the other contributors to the conversation. That's simply to be expected.

Hi again, Eric.

I was not claiing I'd lost credibility with you. THe second person noted was being dug at since they find it difficult to do much more than crap on posts of mine.

I had no responsibility to quote the *diagnostic criteria* as that's not what I was talking about. The DxC is irrelevant to the points I'm noting in the article itself.

As for truthfully, I fulfilled that, as well -- this is not an indepth examination of diagnostic trends but of classification trends. There's a notable difference there.

Regarding Sissy Boy syndrome, do some reading of Richard Green and and the work of Zucker and Darryl Bem before you repeat the idea that it has nothing to do with homosexuality.

It's not *merely* my idea. It's an established fact, and, as I've noted, applies to 63% of the GLB pop. Whether you like it or not.

And you *should* look into it as the whole thing is far more than gender specific toys, which is a fascinating over simplification commonly used.

I should point out that it is not a gender specific toy just because of the people you mentioned -- you really should study the way kids toys are marketed and designed to start with these days.

Did I talk about how reparative therapy was conducted? No, I mention that's its done. I was given testosterone as a child and intentionally forced to engage (however half heartedly) in typical masculine activities and given many, many role models who all would have been awesome marlboro men. (and, incidentally, around the same time, too, and with just as much say in the matter.) And I had the same treatment, as well (because I was "growing up to be a little faggot", Eric).

That's reparative therapy as well, Eric. Regardless of the time and the nature, it still leaves scars that last and endure decades after it.

Want to compare drama stories? Or do you want to talk about the contuinuing potential use for such things, and the way it has been used to justify such stuff.

I speak from studying the materials available, and have as a general rule the pointed refusal to cite my own work (in part because I hate the old name).

I am not a newspaper reporter and columnist, Eric. I am an activist and a politician and a bitch at large -- as well as a sociologist (Psych in an informative field).

And a damned good one.

Eric, one thing to know about me is that I am not above something. I am more than willing to get in the gutter.

"Birthright", my recent column here, is an essay that does exactly that -- get in the gutter with the folks who oppose us. And it does what's critical: it takes their message away from them. THey want to say its all about preseving family, and yet to preserve family, they seek to preserve their own.

And why isn't it about the kids? One of the organizations I support very strongly and another I'm on the board for work with kids. Kids who are gender variant, Eric (that is, With GID). Most of whom grow up not to be trans but gay and lesbian and bisexual.

Basically, in case you didn't get it, I'm saying in my article that *finally* the APA is getting the message that being gay is not part of the whole thing, and that for decades they've thought it was (as Zucker profoundly demonstrates).

Regarding ethics -- I agree absolutely, except that I do not have a moral obligation, personally., My morality is not subject to the same core rules of structure, and that essentially steps out of it. Ethically is a completely different story (and unrelated to my moral foundation), and I do agree that they should be reported.

Catch: most often, they are not, as most often, their clients are unaware of such. There is the reality and there is the goal. Indeed, one of the first pieces of advice I give to other transfolk is that if the therapist they see even begins to talk about treating their GID, to get up and walk out and never return.

RE: backhanded compliment: well, ya sorta did the same yourself. I do give as good as I get :D

On a more serious note -- you are working on it, and that counts for a lot. A hell of a lot, and I can *see* you working on it each time we have these exchanges. I can see the interest -- and let's be frank: part of that interest is because I consistently tie the LGB and T together.

I'm not here to speak to the chorus, Eric. As a columnist and journalist, you know well you need both an angle and a hook.

What you fail to realize, though, is that the authors of the DSM stuff (and, in this new revision, the author of a section other than Gender Incongruence) *are* saying that transfolk are just gay people. Not me. Not you. Them. THe revisions to the DSM on the trans stuff directly are finally saying they are not.

Did I not communicate that well enough through example?

I am not misrepreenting a dx tool, I am talking about that word being in its title. The End of Disorder refers to the cessation of that term in a title -- it likely follows. I'm not holding someone to a 20 year old diagnosis -- how you manage to get to that point is beyond me. I don't feel you have animus towards me (again, that's the other person).

I'm pretty exacting, Eric. For me, one of the biggest mistakes that I can make is to say something I don't mean. One of the problems, though, is that I don't always get heard as people decide that I mean something other than what I say.

I got used to it long ago, but it certainly does promote interesting conversations, and I'm not above letting people do that for my own ends.

Hi Antonia,

It's high time that people be able to express their masculine and feminine sides regardless of their physical body without being labeled "mentally ill." In the U.S. before colonization, Indigenous culture held space for 4 genders. Forcing people to deny who they are leads to real mental illness. If society would accept that the divine feminine and masculine lives in all of us and that we are entitled to express the combination of masculine and feminine energy that is most natural to us then we would all be a happier and healthier, less sexist, less homophobic, transphobic world.

We must stop pathologizing "gender non-conforming" people. Even that term imples that there is a "true normal" way of being.

If we can't fix it for DSM-V. I know there will be a DSM-V-R.


The DSM-V-Draft doesn't mean the "end of disorder", for many people it is the "beginning of disorder" cause people like Zucker widened their territory. They added more gender-incongruent folks into the "book of psychic disorders" and intersex people do found themselves into it too. But still we don't have the acceptance that trans-women are as biological as any other women... they still talk about "gender issues" and aren't willing to accept the existance of transsexual woman as woman and transsexual man as man. I feel very ashamed that there are so many transpeople out there who are too blind to see ther true montivation of those people around Zucker: To strengthen the gender-stereotypes (cause everything that differs from these sterotypes in future will be in the DSM V, when the tomatoes won't be used...)...