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WPATH’S Recs

WPATH, the World Professsional Association for Transgender Health – the organization formerly known as HBIGDA, or the Harry Benjamin Internaltional Gender Dysphoria Association – has issued a statement/report on their recommendations for the “gender incongruence” (formerly known as GID, & previously as gender dysphoria) for the upcoming DSM V.


You can read the whole of the 9 page .pdf here.

Here are excerpts:

The WPATH Consensus Group believes that gender variance is not in and of itself pathological and that having a cross- or transgender identity does not constitute a psychiatric disorder (Knudson, DeCuypere, & Bockting, in press). However, the WPATH Consensus Group did not reach consensus on whether or not the diagnosis should be retained or removed. Instead, participants chose to present a continuum of positions ranging from removal to reform with the majority advocating for reform (Knudson, DeCuypere, & Bockting, in press; Ehrbar, in press, for a discussion of the pros and cons for removal or reform).

Instead of broadening the diagnosis, the WPATH Consensus Group recommends a narrowing of the diagnosis to those who experience distress associated with gender incongruence (Knudson, De Cuypere, & Bockting, in press). Therefore, we disagree with the absence of a distress component in the proposed criteria. It appears that in an honourable attempt to be inclusive of the wide spectrum of gender variance and gender variant identities, and to account for healthy, well adjusted individuals who might seek hormonal or surgical interventions, the workgroup decided to remove any component of distress or suffering which lead many transgender and transsexual individuals to seek treatment (see also Meyer-Bahlburg, 2010). Above all, it is treatment for the latter group, those who are experiencing distress or suffer, which justifies and might necessitate a diagnosis. If there is no distress or suffering and no treatment is desired, why is a diagnosis needed?

The WPATH Consensus Group recognizes that although some children present with gender dysphoria, it persists in few into adolescence or adulthood (American Psychological Association, 2009). Many of the behaviours captured in the proposed criteria are seen by many as variation in normal development, although sometimes heavily stigmatized, which a diagnostic label might reinforce (Pleak, Herbert and Shapiro, 2009). The WPATH workgroup charged with reviewing and making recommendations for revision considered to recommend removal of the childhood diagnosis, yet consensus on this issue was not achieved. What we did reach consensus on is that, if a childhood diagnosis would be retained, it should only apply to those with a desire to be of the other gender or an insistence that he or she is of the other gender, reflective of persistent and severe internal dysphoria associated with incongruence between sex assigned at birth and gender identity (Knudson, DeCuypere, & Bockting, in press).

(thanks to Courtney)

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Co-Signers of the Letter to the APA about GID

Here is the final list of the co-signing organizations & individuals of the Callen-Lorde/Gay Center letter to the APA about the DSM V revision of GID:

Co-signing Institutions:

  1. CenterLink: The Community of LGBT Centers, New York, NY
  2. Agnodice Foundation, Lausanne, Switzerland
  3. Brainpower Research and Development Services Inc
  4. Brooklyn Community Pride Center, Brooklyn, NY
  5. Capital District Gay and Lesbian Community Council, Albany, NY
  6. Center on Halsted, Chicago, IL
  7. The DC Center for the LGBT Community
  8. Equality Ohio, Columbus, OH
  9. The Gay Alliance in Rochester NY
  10. Gay, Lesbian, Bisexual and Transgender Community Center of Colorado, Denver, CO
  11. L.A. Gay & Lesbian Center, Los Angeles, CA
  12. Legacy Community Health Services, Houston, TX
  13. LGBT Community Center Coalition of Central Pennsylvania, Harrisburg, PA
  14. The LOFT LGBT Community Services Center, White Plains, NY
  15. Malecare, New York, NY
  16. Mazzoni Center, Philadelphia, PA
  17. Milwaukee LGBT Community Center, Milwaukee, WI
  18. National Coalition of Anti-Violence Programs (NCAVP), New York, NY
  19. National LGBT Cancer Network, New York, NY
  20. New Mexico GLBTQ Centers, Las Cruces, NM
  21. New York City Anti-Violence Project, New York, NY
  22. New York Trans Rights Organization (NYTRO), White Plains, New York
  23. Out With Cancer – The LGBT Cancer Project, New York, NY
  24. Pride in Practice, Silver School of Social Work, New York University, New York, NY
  25. Rainbow Heights Club, Brooklyn, NY
  26. Sacramento Gay & Lesbian Center, Sacramento, CA
  27. San Francisco LGBT Community Center, San Francisco, CA
  28. Services and Advocacy for GLBT Elders (SAGE), New York, NY
  29. Spectrum LGBT Center, San Rafael, CA
  30. Third Root Community Health Center, Brooklyn, NY
  31. YouthPride, Inc., Atlanta, GA

The following individuals have requested their names be added to this letter in show of support:

  1. Alison Aldrich, LCSW, Clinical Assistant Professor, NYU Silver School of Social Work, New York, NY
  2. Alison Alpert, New York, NY
  3. Angie Canelli, MA MHP LMHC NCC, Gender and Sexual Minority, Specialist, Seattle Counseling Service, Seattle, WA
  4. Brenda Solomon, Ph.D., M.S.W., Graduate Program Coordinator and Associate Professor, Social Work at The University of Vermont, Burlington, VT
  5. Craig Sloane, LCSW, New York, NY
  6. David J. Brennan, MSW, PhD, Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
  7. David Steinberg, San Francisco, CA
  8. Deanna Croce, LMSW, New York, NY
  9. Dennis Holly
  10. Devon Claridge, Brooklyn, NY
  11. Dr. Karra Bikson, Assistant Professor, NYU Silver School of Social Work, New York, NY
  12. E Maxwell Davis, Ph.D., LISW, Assistant Professor, Human Development & Women’s Studies, California State University, East Bay, CA
  13. Elizabeth Mullaugh, Board Secretary, LGBT Community Center of Central Pennsylvania, Harrisburg, PA
  14. Fareen Ramji, LMSW, Brooklyn, NY
  15. Foresta Castañeda, MSW, Middlebury, VT
  16. Franklin Brooks, Ph.D., LCSW, Chairperson, Committee on Lesbian, Gay, Bisexual and Transgender Issues, National Association of Social Workers, Maine Chapter, Portland, ME
  17. Helen Boyd, author and lecturer in Gender Studies, Lawrence University, Appleton, WI
  18. Holly Rider-Milkovich, Director, Student Wellness Center. New York City College of Technology, New York, NY
  19. Jane Mildred, MSW, MA, PhD, Amherst, MA
  20. Jean Sienkewicz, MSW–Offender Re-Entry Housing Specialist, Burlington Housing Authority, Burlington VT
  21. Jase Schwartz, BA Psychology, MSW Candidate, Hunter College School of Social Work, New York, NY
  22. Jeff Brody, LMHC, ATR-BC, Licensed Mental Health Counselor, Board-Certified Art Therapist, Licensed School Adjustment Counselor, Braintree, MA
  23. Jeremy D. Schwartz, MSW Candidate, Student Senator, NYU Silver School of Social Work, New York, NY
  24. Jessie Jacobson, Los Angeles, CA
  25. Joyce E. Garee, LMSW, Albany, NY
  26. Justus Eisfeld, co-director, GATE – Global Advocates for Trans Equality, New York, NY
  27. Karalyn Shimmyo, LMSW, Brooklyn, NY
  28. Kayleen White, Thornbury, Victoria, Australia, former co-convenor of Victoria’s TransGender Victoria
  29. Laura Booker, LCSW, New York, NY
  30. Lex Moran, New York, NY
  31. Mauro Cabral, co-director, GATE – Global Advocates for Trans Equality, Córdoba, Argentina
  32. Melissa Sklarz, New York, NY
  33. Michael Miller, MSW Candidate, 2011, Silver School Of Social Work, New York University, New York, NY
  34. Michelle Kay, MS, FNP, New York, NY
  35. Misty L. Wall, PhD, MSSW, LCSW, Assistant Professor, School of Social Work, Boise State University, Boise, ID
  36. Nerissa Belcher RN, Decatur, GA
  37. Nickerson Hill, LMSW, Masters of Public Health Candidate, Center for the History and Ethics of Public Health, Columbia University Mailman School of Public Health, New York, NY
  38. Nicole Paige, New York, NY
  39. P. Swan, MSW, Seattle, WA
  40. Paisley Currah, Professor, Brooklyn College-CUNY, Brooklyn, NY
  41. Pamela Bianco, Staten Island, NY
  42. Pega Ren, Ed.D., Registered Clinical Counsellor, Board Certified Sexologist, Vancouver, British Columbia, Canada
  43. Rebecca Capri-Durkee Transgender Health Advocate, Boston, MA
  44. Robin Mangini, New York, NY
  45. Romy Reading, MA, New School for Social Research, New York, NY
  46. Rosalyne Blumenstein LCSW ACHP-SW, Therapy2Go, Los Angeles, CA
  47. Samuel Lurie, Director, Transgender Training and Advocacy
  48. Sand Chang, PhD, San Francisco, CA
  49. Sari Surkis, MBA, MSW Candidate, New York, NY
  50. Sean M. Endress, MA, LCSW, Albany, NY
  51. Sebastian Colon-Otero, LMSW, Brooklyn, NY
  52. Shelley Schwartz, Chappaqua NY
  53. Sherry Tripepi, MSW, EqualityToledo, Toledo, OH
  54. Stacey Peyer, MSW, LCSW, CalSWEC Field Consultant, CSULB Department of Social Work, Long Beach, CA
  55. Steve Prentice, LMSW New York, NY
  56. Steven Lipsky, LCSW, CASAC, New York, NY
  57. Sue Langer, LCSW, New York, NY
  58. Susan E. Roche, Ph.D., M.S.S.W., University of Vermont Department of Social Work, Burlington, VT
  59. Tim Pierce, President, Community Alliance and Action Network, Joliet, IL
  60. Toby C. Siegel, Astoria NY
  61. Trey Polesky, MSW, Bloomington, IL
  62. Tyler Blake Kim, New York, NY
  63. Yosenio V. Lewis, Transgender Health Advocate, San Francisco, CA
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Response to the APA’s New GID

Callen-Lorde and the Lesbian, Gay, Bisexual, and Transgender Community Center, both of New York, have written a response to the APA’s revised DSM diagnosis for Gender Identity Disorder — which is now being re-named Gender Incongruence. They make a few important and valid points in a statement which is tidy, well-written, and well-argued. I’m impressed & will be added as a signatory.

Re: Comment on the proposed “Gender Incongruence” in the draft revision of the of the Diagnostic and Statistical Manual of Mental Disorders, version 5
(DSM-5)

American Psychiatric Association:

The undersigned providers of and advocates for medical and mental health services to transgender and gender non-conforming communities welcome this opportunity to offer feedback and comment on the American Psychiatric Association’s draft revision diagnosis for Gender Identity Disorders (GID), “Gender Incongruence” (GI).

The lead organizations facilitating this response are Callen-Lorde Community Health Center and the Lesbian, Gay, Bisexual, and Transgender Community Center of New York City. Each of these organizations started providing community services in 1983 and together serve over 2,000 people of transgender experience with primary health care and hormone care as well as substance abuse, mental health, and community building services. Our organizations, as well as the other signatories to this letter, represent the largest settings providing health and social services to transgender and gender non-conforming people and their families in the United States.

We appreciate the APA’s proposed “Gender Incongruence”(GI) diagnosis is an effort intended to de-stigmatize gender non-conformity and improve transgender-identified people’s access to mental health care. We agree with the intention behind this effort; however, we endorse an alternative viewpoint, based on our years of collective practice knowledge. We believe GI will continue to inappropriately pathologize gender non-conformity, maintain barriers to medically necessary health care, and lend justification to gender based stigmatization and discrimination.

Prior to addressing the reasons behind our recommendation, we would like to respectfully address the process by which the APA undertook this effort.
From the vantage point of LGBT health and community centers, the conceptualization of “Gender Incongruence” occurred without valuable and necessary input from community providers who serve and are accountable to significant numbers of people affected by this diagnosis. The November 2008 Report of the DSM-V Sexual and Gender Identity Disorders Work Group indicates that the “sub-work group has addressed feedback from interested advocacy groups and other stakeholders. Surveys were sent to more than 60 organizations.” While other agencies have provided feedback in this process, we are concerned that the institutions that provide the bulk of medical and mental health services to transgender people nationwide were not asked for input. We have reached out to LGBT community health centers and LGBT community centers; none of these key, high-volume, client-centered, community-driven stakeholders seem to have been included in the research or vetting process. Without input from a representative sample of such organizations and their clients, the conclusions of the sub-work group regarding GI cannot be considered generalizable.

Our specific concerns regarding the validity and utility of the proposed inclusion of GI are as follows:
– Gender non-conformity is not a mental disorder: The proposed definition of a mental disorder in the DSM-V expressly prohibits the inclusion of diagnoses that are “primarily the result of social deviance or conflicts with society” (APA, 2010). The “Gender Incongruence” diagnosis inherently contradicts this tenet. Whereas the criteria for other psychiatric diagnoses are lists of symptoms that impair functioning, the proposed criteria for GI are a list of characteristics of gender non-conformity. There is no evidence or need for treatment that decreases gender non-conformity or crossdressing, as noted in “Transvestic Fetishism.” The GI diagnosis obfuscates the root cause of the distress many transgender people experience – pervasive discrimination. It is commonly acknowledged among mental health providers that being gay, bisexual or lesbian is not a disorder, but that the social impact of stigma, discrimination and homophobia can cause the individual great distress. GI falsely assigns dysfunction to the gender non-conforming person, rather than within the social environment.

– An inappropriate pathway to transgender-specific medical care: There is legitimate community concern that removal of a mental health diagnosis would limit access to transgender-specific medical care. While a minority has succeeded in using the legal system or in fulfilling their insurer’s requirements for coverage to access care, the majority of people needing transgender-specific medical care are denied coverage. GI maintains these barriers to care. Medical interventions are better substantiated by the use of medical diagnoses, not psychiatric diagnoses. Access to transgender-specific, medically necessary care can be directly and more effectively addressed by utilization of a revised medical diagnosis in the International Classification of Diseases (ICD). The psychiatric needs of transgender people are better addressed by existing psychiatric diagnoses.

– GI lays the groundwork for unethical and harmful reparative therapy: A GID diagnosis has historically been misused to justify treatment of “pre-homosexual” children in the hope of preventing or delaying the development of a positive and healthy gay or lesbian identity. With adults, transgender-specific medical intervention is often offered only if reparative therapy fails to relieve distress and improve social functioning.
The GI diagnosis will continue to lend false credence to interventions that foster shame, encourage children and adults to betray their true selves, and delay healthy identity development. This practice is harmful and unethical.

In summary, we propose all diagnoses addressing gender non-conformity and identity be eliminated from the DSM-5. The mental health needs – when present – of gender non-conforming people are addressed by existing diagnoses. We ask the APA to formally renounce reparative therapy addressing gender non-conformity in children, adolescents and adults. We acknowledge that a diagnosis must exist for those who require medically necessary transgender-specific care, and ask the APA to advocate for a viable transgender-specific medical diagnosis in the ICD. Finally, we respectfully request that the APA include lesbian, gay, bisexual and transgender healthcare institutions and community centers in these processes.

Sincerely,

Callen-Lorde Community Health Center
The Lesbian, Gay, Bisexual & Transgender Community Center of New York City Continue reading “Response to the APA’s New GID”

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US Tax Court Rules GID Expenses Deductible

From TaxProf Blog:

In a long-awaited decision, a fractured (8-5-3) Tax Court today ruled in O’Donnabhain v. Commissioner, 134 T.C. No. 4 (Feb. 2, 2010), that male-to-female gender reassignment surgery qualifies as a deductible medical expense under § 213, reversing the IRS’s position in Chief Counsel Advice 200603025.  The 8-judge majority held that:

  • TP’s gender identity disorder is a “disease” within the meaning of  § 213(d)(1)(A) & (9)(B).
  • TP’s hormone therapy and sex reassignment surgery were for the treatment of disease within the meaning of  § 213(d)(1)(A) & (9)(B), and thus not “cosmetic surgery” excluded from the definition of deductible “medical care” by § 213(d)(9)(A).
  • TP’s breast augmentation surgery was directed at improving her appearance did not meaningfully promote the proper function of her body or treat disease within the meaning of § 213(d)(9)(B), and thus was “cosmetic surgery” excluded from the definition of deductible “medical care” by § 213(d)(9)(A).

Judge Gale wrote the 69-page majority opinion, joined by Judges Cohen, Colvin. Marvel, Morrison, Paris, Thornton, and Wherry.  Judge Halperin (12 pages), Judge Holmes (joined by Judge Goeke) (23 pages), and Judge Goeke (joined by Judge Holmes) (6 pages) wrote separate concurring opinions.  Judge Foley (joined by Judges Gustafson, Kroupa, Vasquez, and Wells) (8 pages) and Judge Gustafson (joined by Judges Foley, Kroupa, Vasquez, and Wells) (21 pages) wrote separate opinions concurring in part and dissenting in part.

Amazing news. GLAD is having a community conference call with the attorneys who worked on the case, and NCTE is supporting the call. For more info on how to participate, check after the break.

Continue reading “US Tax Court Rules GID Expenses Deductible”

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Trans Salon

In today’s Salon, a nice piece about the failure of Thomas Beattie, and another about the romantic failure of Jennifer Finny Boylan.

Mara Keisling, quoted in the first piece:

Mara Keisling, the executive director of the National Center for Transgender Equality, resents the way that the Thomas Beatie flap has overshadowed more important developments. “The media hasn’t gotten a message yet that they ought to get a life,” she snaps. Last week, Congress held its first-ever hearing on discrimination against transgender employees, and on June 17, the American Medical Association passed a resolution stating that it “supports public and private health insurance coverage for treatment of gender identity disorder,” but these items have received nowhere near Beatie’s media attention.

& Boylan, quoted in the second:

The women I knew, for their part, liked the fact that I had a feminine streak, that I seemed to be sensitive and caring, that I didn’t know the names of any NFL teams, that I could make a nice risotto. A lot of straight women love a female sensibility in a man, an enthusiasm that goes right up to, but unfortunately does not quite include, his being an actual woman.

The romances didn’t last, of course. Because, let’s face it: I was keeping the basic fact of myself camouflaged. How are you supposed to fall in love when you’re so frequently lying?

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Colbert Report’s “Stonewalling”

The Colbert Report Mon – Thurs 11:30pm / 10:30c
The Word – Stonewalling
www.colbertnation.com
Colbert Report Full Episodes Political Humor Mark Sanford

(I got myself in trouble a long time ago for writing a short story about a lesbian teenager who went to her first support meeting at The Gay Center & who found her voice silenced by the voices of the young men around her. I called it “Stonwalled” and my gay but closeted writing professor was not happy with me about it.)

(h/t to Lena Dahlstrom)

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Foster Pets

April 1st kicks off Prevention of Cruelty to Animals month. I don’t think there’s anything I hate more than the abuse of the goobers who trust us & depend on us. I know there are plenty of people out there “avenging Dusty” but I’d like to suggest we do that in a cool & groovy, pay it forward kind of way instead of in vengeance. (There is definitely a lot of animals out there that need your attention more than that kid does)

During these crap economic times, a lot of people are having to give up their animals, or, at the very least, can’t take care of them for a while in order to pay other bills.

If you have the space, think about fostering an animal or two; our local fostering organization will actually pay you per day to foster, and has a page of other useful information.

You can check in with North Shore Animal League as well, who are another favorite of ours, or the ASPCA (so maybe they can take those heartbreaking ads off TV).