Transgender identity would instead be categorized under the sexual health umbrella, which could significantly impact acceptance of transgender individuals in health care and social spaces.
The World Health Organization is currently considering reclassifying transgender identity in its International Classification of Diseases. Though the WHO previously labeled transgender identity as a mental disorder, a recent Lancet Psychiatry study has led the organization to reevaluate that decision. Now, the WHO is discussing re-categorizing the term under its sexual health umbrella—which could have major implications for how transgender people are viewed in both health care and society.
This new conversation is the result of a study that shed light on the complex relationship between transgender identity and mental illness. The study, which drew on a sample of 250 transgender individuals, found that while many transgender people experience mental distress, most of that distress is linked to experiences associated with being transgender—like family, social, or work or scholastic dysfunction. It’s not that being transgender is a mental illness in and of itself, it’s that identifying as transgender can lead to rejection, violence and other things that cause mental distress. These findings clearly challenge the WHO’s decision to label transgender identity as a mental disorder, which is why the organization is currently rethinking its original designation—and why it’s doing so right now.
If this story sounds familiar, that’s because it is. Until the late 1980s, homosexuality was classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While that’s not the same thing as the WHO’s ICD, the two serve a similar purpose: being the go-to resource for defining health conditions and tracking global health trends. The DSM renamed homosexuality as “sexual orientation disturbance” in 1973, and changed its name to “ego-dystonic homosexuality” before removing it from the list of mental disorders altogether in 1987. “I’ve never heard a gay person lament the loss of the diagnosis of homosexuality,” Diane Ehrensaft, a developmental and clinical psychologist specializing in gender, tells SELF. “[And I don’t] think we will find many transgender people—if any—[who] lament the disappearance of a mental health diagnosis—as long as we continue to ensure the provision of all medical services.” Ehrensaft explains that classifying transgender identity as a mental disorder “declares a mental illness where there is none,” which can leave transgender individuals facing increased stigma in an already rejecting world.
Though there’s no official count of how many Americans identify as transgender, LGBT demographer Gary Gates has estimated that the number falls around 700,000. (It’s worth noting that this data is based on two studies—one from 2007 and one from 2009—so it’s not necessarily representative of the actual transgender population in the U.S.) Regardless of the exact figure, the WHO’s decision has the potential to impact a significant number of Americans—and Americans who are disproportionately at risk for things like poverty, suicide, and various forms of discrimination, at that. “It is extremely damaging to label someone’s identity as a mental disorder,” Jamison Green, transgender rights activist, tells SELF. Stigmas associated with transgender identity and mental health can impact someone’s ability to get hired, receive a promotion, and to feel confident enough with the surrounding world. “There’s a huge, huge problem,” he says.
While the WHO hasn’t made any official decisions yet, reclassification could potentially have beneficial outcomes for members of the LGBT community. “What we have to look at is social ramifications of the experience of transgender people,” Green says. And one of the things the WHO’s decision would do, he says, is clear up some of the cross-cultural confusion surrounding gender and sexual orientation. “It’s a very complex subject, and there’s very little known about it from a clear technical perspective,” Green says. Still, moving away from classifying transgender as a mental disorder is a positive step, he says, because transgender identity is linked to a person’s physical nature (gender confirmation surgery, potential roots in endocrinology, etc.) in many ways.
That said, the decision to potentially re-categorize transgender identity under the sexual health umbrella is a little complicated—and could potentially be a step in the wrong direction. “I think it kind of misses the mark,” Green says. He mentioned that sexual health issues include things like the inability to orgasm and, in some cases, pregnancy—not gender identity. “There is nothing sexual about gender when it comes to health,” Ehrensaft reiterates. “It’s all about who you know yourself to be—as male, female, or other—and how you want to present your gender to the world. Anything having to do with sex organs and sexual functioning is a different issue.” Still, it’s a step nonetheless. “That’s sort of the mentality that we’re having to deal with—that’s there’s something wrong with a person if their gender doesn’t match the sex of their body,” Green says. “So where do we [classify] that so people can be properly treated in a humane fashion, rather than in a damaging one? There’s a struggle.”
So far, the proposed reclassification has been approved by every committee that’s discussed it—leaving it under review for the latest edition of the WHO’s ICD. Geoffrey Reed, a professor who worked on the Lancet Psychiatry study, told the New York Times that the re-categorization wasn’t receiving opposition from the WHO and suggested we might see the change as soon as May 2018, when the newly revised version of the ICD is approved.
“Trans people, like anybody else, have identities that need to be respected,” Green says. “And all of the people who are affected by these sex and gender misunderstandings—and our lack of scientific knowledge—do not deserve to be vilified or stigmatized or punished in any way. That’s what we’re trying to move toward in the awkward world of policy making.”
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