Disorders.

[Loretta Ann]

http://www.behavenet.com/capsules/disor ... riddis.htm

BehaveNet® Clinical Capsule™:

DSM-IV: Transvestic Fetishism

Heterosexual males with this paraphilia dress in female clothes (cross-dress) to produce or enhance sexual arousal, usually without a real partner, but with the fantasy that they are the female partner as well.
Diagnostic criteria for 302.3 Transvestic Fetishism
(cautionary statement)
A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With Gender Dysphoria: if the person has persistent discomfort with gender role or identity


Gender Identity Disorder

Individuals with this mental disorder are uncomfortable with their apparent or assigned gender and demonstrate persistent identification with the opposite sex.
Diagnostic criteria for Gender Identity Disorder
(cautionary statement)
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
(4) intense desire to participate in the stereotypical games and pastimes of the other sex
(5) strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What do you think about this?

Darlene.

[Virginia]

Hey Sis,
Interesting, and I agree with a lot of it and it mostly has been said before in other ways. However the part about it being a "mental disorder." I can relate only to my pre-Op TS friend Brandi. She was simply a girl born into a male body. Not her fault, not a mental disorder, just a fact of nature. I have had the opportunity to watch her closely when she is not aware of my studying her. She is a "she" her gestures come so natural, her nutruring of those around her, i.e., her son, her brother and his girl friend, me!!!! We as CD'ers can learn a lot of this but for her it just comes natural. I had her and her son and his friend out on my boat and the kids were swimming and you know as men it would throw them in the water, turn on the radio pull out a beer and relax - not her, she was watching them like a hawk, the whole time they were in the water!
No I don't think it is a mental disorder, even for us as crossdressers. We have a gift which we accept and want to share. For us to want to interact with others from our anima's perspective is not a mental disorder and no one will ever convience me otherwise!
Love,
Virginia

[Absaroka]

You have to understand a bit about how DSM4 was written. There was a strong push to keep from diagnosing people who were basically happy with themselves and not hurting anyone else. Back when DSM3 came out I worked in an institution and read the whole thing. Hence the part about how this is causing signifigant distress over a period of time.

With tregards to tranvestic fetishism it means that if the person is happy about this and it isn't causing them problems then they do not have this disorder no matter how much they crossdress. We could get into a long discussion of how much of this is due to societies reaction to us. Treatment might be simply a case of helping the person to accept that they do this and stop feeling guilty about it.

With regard to the person feeling they are of the other gender obviously there is some sort of disorder going on even if it is merely a physical disorder. I would guess that being rasied as a gender you feel you are not would however engender some confusion and that assistance sorting it out might be helpful.

I guess the next part is about a different kind of labeling. Who says having a mental or emotional disorder is something to be ashamed of anyway? It is a disorder because it gets in our way. So we need to address it in whatever way is best. To tell the truth I have several other DSM diagnosis's. Substance abuse and anxiety disorders. Currntly the substance abuse is in remission but it is not gone. Nothing to be ashamed of. Just something to address in a variety of ways.

Andrea

[Beauty]

Hi Darlene,

That was pretty deep. I identified with a lot of the stuff in GID. The thing is I think these days plenty of CD'rs do to. When was the study done?

Thanks for the post and find.

Beauty

[Loretta Ann]

When was the study done?

I don't know Beauty....Perhaps Andrea would be more equiped to provide us with that answer than I.

Darlene.

[CJ]

Hi all,

Beauty,

This isn't a study; it's the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Basically, it's a psychiatrist's bible. You go to see a psychiatrist. She asks you what ails you (in the jargon, this is called "presenting"). With your answer in hand, she cracks open the DSM, looks for your disorder, and then prescribes a course of treatment (meds, therapy, etc.) based on the info she finds there.

The DSM is now in its fourth incarnation. Here's a clarification (from the PsychNet web site):

With no completely new DSM in the offering until 2006 or later, in 2000 the American Psychiatric Association revised the text of DSM-IV to include new research information that had been developed since first publication in 1994. This text revision (TR) included a very few changes in the criteria, designed mainly to correct what were perceived as errors in the original text.

Here is the essence of these changes:

Personality Change Due to General Medical Condition is now allowed in a patient who has dementia, such as Alzheimer’s dementia.

Tourette’s Disorder and all of the Tic Disorders no longer require that symptoms cause distress or impair functioning.

Several of the Paraphilias (exhibitionism, frotteurism, pedophilia, sexual sadism, and voyeurism) can now be diagnosed if they are acted upon, even though they may not cause the person whose behavior is in question distress or impaired functioning as a result.

I'll remind you that Transvestic Fetishism is classed as a Paraphilia (literally, a "love of something off to the side"--presumably, off to the side of the normal object of sexual desire... for a human being, that would be another being, not his or her clothing). What the last paragraph of the excerpt above means is that a psychiatrist can now legitimately diagnose someone as a being a Fetishistic Transvestite, even if, as Andrea says, that person is "happy" with who he is.

Aside from these minor revisions (hence, the DSM-IV-tr, for "text revision"), the contents of the current edition of the DSM date back to 1994.

Now, I'll have you note that, in the excerpts Darlene included in her original post, there are two words that appear above each of the two disorders mentioned and those two words are: cautionary statement. This disclaimer is very important. It means that the description that follows is subject to interpretation, revision, and reformulation. This, because a large aspect of both transvestism and gender identity disorder is social in nature, not just psychological. When distress there is (and, more often than not, there is distress), it's largely due to the rigidity of social customs and norms with which the crossdresser and transsexual are grappling. This is plainly so once you consider that, in many other cultures around the world, room is made for these men who feel like women (often, as in the case of the Berdache, a sacred place and role is given to these men).

This is what this tells me (and at least two of the contributing psychiatrists on the DSM's editorial board will be pushing for this in future editions of the manual): yes, our sexuality (and/or gender) is atypical--it's not the norm--but that doesn't mean that it's not okay or acceptable to be who we are, especially given that social norms and customs are notoriously arbitrary and can (and do) change--often at breakneck speed.

Now, something else I saw in the cross-gender criteria is this (for TG'd girls): a "marked aversion toward normative feminine clothing". This is a loaded word, "normative." In its most basic sense, it means not "normal" but "normal-making." There's a big difference. "Normal" refers to what is; "normative," to what should be. The DSM is a descriptive book (think of it as an Audubon Wildlife Guide for the mind); based on a given symptom ( a description), it will recommend a course of action. It isn't meant to be a prescriptive book ("prescriptive" being a synonym for "normative"--as in, "you should try to act this way, not that way"... the Holy Bible, for instance, is a prescriptive book). No, the DSM (or, rather, its editorial board) doesn't want us to stop being who we are; it justs wants to help us alleviate the pain that comes with being who we are. By their own account, the DSM's authors (all psychiatrists or other medical field degree-holders) generally don't believe there is a "cure" for GID (or that it's even necessary to look at this as a disorder at all--really, how do you cure someone from wanting to be who they are?--so much as it's necessary to help relieve the suffering of a person whose identity falls outside the social norm).

So, please, take the lofty pronouncements of the psychiatrists' bible with a grain of salt. When I had that fateful meeting with my boss a couple of months ago, where I laid out my gender issues on the table for discussion, he told me a funny story. Some years ago (before I started working there), at the monthly staff meeting, he came up with an interesting exercise. He asked each of the employees at the meeting to look in the DSM (back then, the DSM-III) and see if they could find possible diagnostic criteria that would apply to each of them, individually. Well, not a single person in the room found themselves left out of the DSM. Some had, like Andrea above, several "disorders." And to think that our job as community workers is to assist people trying to cope with mental illness! This might be a case of the blind leading the blind if I ever saw one. But, no, we do what we do partly because of who we are (my boss always says that we "have to be crazy to work here") and partly because we've learned to cope with our own troubles to a certain extent (say, by arming ourselves with the tools we need to achieve a certain balance in our lives--mental health is about balance, above all).

You know, we call ourselves crossdressers (or transgenderists or transsexuals or what have you) but, in my experience working with people who find themselves listed in the DSM, I rarely encounter anyone who defines himself or herself by the title of that listing; for example, someone with schizophrenia will rarely say, "I'm a schizophrenic." No, he or she will, rather, say, "I'm a person who has schizophrenia." This places the emphasis squarely on the fact that they're a person, first, and a person struggling with a mental illness, second. In the same way, all of us here, on this forum, are persons first, and [insert your brand of gender identity here], second. Taking the DSM for a sacred text makes us forget this truth sometimes.

Love,
CJ

[Beauty]

Hi CJ,

Thank you for the very detailed explanation. I think I get it now. You're saying the DSM is a guide on many things and not a focus on one thing. If I want to look up y behavior I can get a general idea from it. So don't take it as a manual for what these DSMs are, as they are more generalized. I think that's it?

That was really an interesting history of the way things work. 2006, eh? That should be interesting. It was also interesting that you can fit into more than one, but it all makes sense now that it's an Audubon Wildlife Guide for the mind. It's not to be taken so literally.

Thanks CJ!!!!!!!

Beauty

[Aeryn]

Great post CJ. As a social worker and I am quite used to having a copy of the DSM sitting about. I remember looking at the dx that Darlene posted in an attempt to understand me (social worker, heal thyself).

I am not familiar the tr version but what CJ posted is interesting (about not having to be in "distress" to get the dx).

The trouble with the DSM (IMO) is it seeks to label everything. But in this age, everything needs a label so we can understand it and "cure" it.

The other problem is it does not necessarily account for cultural (although for many dx it does take this into consideration). I would argue that CDing is part of our culture, or counter culture, if you choose. In many cultures CDing is acceptable. In our Western, puritan culture, it has been deemed not acceptable. But many things our puritan ancestors deemed not acceptable are becoming more accepted. Our culture is shifting, it just hasn't caught up with CDing yet.

Okay, I am starting to ramble so I'll stop now.

[CJ]

Hi all,

Great post, Aeryn!

Yep, the DSM is an Audubon Field Guide to the mind, in a way, but it focuses on those minds that, purportedly, aren't working well. This is where it gets a bit iffy; as Aeryn says, what we here consider a "disordered" mind is sometimes considered a healthy one in another culture.

My friend, Marie, is the social worker on the mental health team of her community health clinic. The neighbourhood she works in is the most multicultural and multiethnic one in the entire country (close to 60% of the neighbourhood's residents are immigrants who speak a language other than French or English, Canada's two official languages). She has no choice but to take into consideration cultural factors when seeing her clients (especially ones newly arrived here). For example, a person we, here, would diagnose as having schizophrenia, is considered by the family (or even by the person herself) as being either possessed by a demon or as being the victim of black sorcery. To them, it's plain and as clear as can be. Needless to say, Marie has had to shore up her understanding of the bases and practices of ethnopsychiatry (psychiatry with a view toward accounting for cultural differences). This, quite aside from having to work through translators. Can you imagine that? It's difficult enough already just to understand why a person comes to seek help and how that person presents, but it's twice as hard to have to do that through an interpreter... how do you explain to someone who doesn't speak your language that, say, the underworld has put the smoke of evil spirits in your eyes because your newborn grandchild has a turtle-shaped mark on her shoulder? Here, in North America, we'd say: okay, 10mg of Zyprexa, bid. But doing so, using our own tools to "fix" a malaise that originated in a different culture, is missing the point. You need to talk with that person, to see what her illness or trouble means to her. This is where the DSM fails.

Beauty,

A better analogy might be, the DSM is a little like a Chilton's auto repair guide: it labels the parts of your car or engine (so that you know where they are and what they're supposed to do) and then it tells you how to fix them. It makes no assumption about whether or not your goal is to make your car run the way it was designed to, nor even about whether or not you're satisfied with it if it doesn't run the way it was designed to. Plus, many people are happy about the modifications they've made to their car, even though they stray far from the original design. On this, a Chilton's guide will be silent. It does not judge.

In a way, the DSM is a bit like the Constitution: it tells us what we, ourselves, think or believe is a well-adjusted mind (or society, in the case of the Constitution), it gives us ways to reach that balance, and it's a document that can be modified (or amended) precisely to make room for those minds (or citizens) that fall outside the norm to some extent. As such, the Diagnostic and Statistical Manual is as much a politically loaded document as is the Constitution itself. For example, under the growing pressure of the nascent Queer movement, homosexuality was reclassified in the 1974 edition of the DSM; it's no longer considered a "disorder" but, rather, a simple lifestyle variation. Inevitably, gender variance is heading that way, too.

I know I'm prattling on but these issues are important. It breaks my heart sometimes when I see a human being who's unable to define himself on his own terms, relying instead on the terms of a professional establishment that aims to categorize and label individuals on the basis of their weaknesses rather than their strengths, on what is wrong about them rather than what is right.

Okay, 'nuff said.

Love,
CJ

[Virginia]

What is that song??? "Can't Touch This!" If ever I have seen a graduate course in human behavior compacted into the above posts, I certainly bow to you ladies and your brillance. I don't know if I can speak for some or any of the other girls here, but "Thankyou God for letting me find this forum!!!!!!!" a small prayer of thanks to Her!!!
I love you all!!!!!
Virginia

[Beauty]

Beauty

[Elizabeth]

Hi girls,

The key to having a disorder of any type, paraphillias, is "significant distress". As CJ pointed out, these diagnoses are extremely political. The Significant distress line was added to DSM-IV as a compromise with those who wanted to abolish all the paraphillia's, recognizing these are these behaviors are cultural taboos, not illnesses.

It is widely beleived that when DSM-V comes out these paraphillias will not be in them as they are useless right now. They are useless because to have a diagnosis you must have "significant distress" and that distress may not be caused by societies disapproval of these taboos. I would be very suprised to find that there have been very many diagnosis of these so called "disorders" since DSM-IV was released.

It does need to be a goal of all transgendered people to see the status of "transvestic fetishism" removed as a disorder. It is important that society not think of crossdressing as a mental disorder. It will allow many people to be more accepting of us when they dont' have to justify being with a "sicko".

This is politics after all. Just a group of people who will decide it. And just as homosexuals were labeled as sexual deviants, justifed by the medical community before 1974, there legitimacy as normal human beings was predicated on that documents failure to list them, after 1974.

Love always,
Elizabeth

[Absaroka]

And we have probably only scratched the surface........

A couple of thoughts. We have this idea of the perfectly normal person. I believe that the DSM probably even has a diagnosis of "no mental disorder" o.e. normal. But lets consider physical health for a moment. WHat is a the physical condition of a healthy 90 year old? Probably getting ready to die..........so what is normal good physical health for a 90 year old? And emotional health is perhaps even less understood. Lets just say that we all have some years and have aquired some scars........just as I have couple of nasty physical scars I have some nasty emotional ones.

Onto the effects of societal repression on mental health. Many Jews ( and others like Gypsies) who survived the concentration camps were permanently scarred emotionally. In fact the life expectancy for POWs generally is less than it is for others. DSM has a label for this too. It is called post traumatic stress disorder. Back in the day when soldiers suffered this it was called combat fatigue or shell shock.

So we know without a doubt that really severe stress can bring about emotional disorder. An enlightened therapist treats this as something that is not the patients fault but is however their responsiblilty to deal with if they want to improve the quality of their life.

On to a level of stress lower than combat or Auschwitz. Someone lives every day with society telling them that they are somehow "less than" and that to even question this supposedly natural order of things is terribly dangerous. A woman living under the Taliban, a fundamentalist close minded gay person, or a Black person in the old South would be examples. Obviously not all of these people develop a psychiatric disorder, just as not all combat soldiers get combat fatigue. But the chances are greater.

And now we are in to the territory of what used to be called "radical therapy" It's not the patient who has the problem, it is the society that drove the patient crazy that has the problem. Fix society and the patient will get better. R.D. Laing and Thomas Szotz among others were resepcted psychiatrists who said that perhaps only the madman is truly sane, which you will probably also find somewhere in Shakespeare near only the fools are wise theme. And yes society does make normal people crazy, especially women. Read Phyliss Chessler. In fact an awful lot of societies do this. And then of course there is the other extreme where the person who hears voices and does as they say is considered a holy person.

I don't agree with all of this by any stretch of the imagination. It all sounds too much like the alcoholic who keeps drinking because life is so unfair to them. And who knows how many problems were started because some one heard the equivalent of the bumper sticker joke "I can't go to work today, the voices told me to stay home and clean the guns" and that someone was the shaman or holy man or Adolf Hitler. And in my former career in mental health (a long time ago when DSM 3 had just come out) I have known too many schizophrenics and manic depressives who seemed to get a lot better just from medication. But at the same time it must constantly be asked (preaching to the choir again here) what role society has in making us have some sort of diagnosis.

Andrea

[Cathy L. Anderson]

you will probably also find somewhere in Shakespeare near only the fools are wise theme.

Good call. How about: "The fool doth think he is wise, but the wise man knows himself to be a fool."

Concerning the DSM, that "durned silly manual," its real function is administrative--to supply a five-digit code for statistical purposes (e.g., an insurance company wants to keep track of what services they pay for). It was never intended as a clinical handbook. Regrettably, grad and med schools took the lazy route and began to use it as such.

All DSM diagnostic categories are (1) at best, gross approximations; and (2) merely *descriptive*. Many different dynamic processes can result in the same outward behavior; what matters for counseling are the deeper issues.

Beyond this are obvious problems specific to the tv fetishism diagnosis. Note that it can be diagnosed merely based on nonsexual CDing. But then would be a paraphilia? And note that heterosexuality is required. What about a gay or bi CDer?

As a practical issue, be careful of any therapist who seems too attached to the DSM. Since both these categories entail significant psychosocial distress, you have the option of getting a diagnosis based on the symptoms of the distress--e.g., "adjustment reaction."

Cathy

[Virginia]

Wow!!!??? Is there a test, I'll never pass the test! What if I just audit the course, hope that is acceptable. I will have to read and reread all this a dozen times or more for it to sink in, but it is fantastic! This girl is soooo fortunate to have such brilliant sisters.
Love ya,
Virginia