The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication of the North American Psychiatric Association (APA). In 1980, in the publication of its third version, transsexuality was included and typified as a "Gender Identity Disorder". In 1994, the DSM-IV Committee replaced the diagnosis of "Transsexualism" with that of "Gender Identity Disorder". The International Disease Code (ICD) also started to consider "transsexualism" as an illness.
Since gender became a diagnosable category in the early 80s, this is the first time that there has been a global movement to remove transsexuality from the list of illnesses identifiable as mental disorders. The Stop Trans Pathologization movement gains support in several countries, which reveals the resistance capacity of multiple voices that unite against the power of the APA and the CID. On October 22nd – World Day to Fight for the Depathologization of Trans Identities – there are demonstrations in Africa, Asia, Europe, Latin America and North America. Currently, there are more than 500 organizations engaged in this fight.
In these documents there is a harmful subtlety not yet understood by gays, lesbians, transsexuals and transvestites. The entry of the genre as a nosological category authorized doctors and professionals in the psi sciences. (psychology, psychiatry and psychoanalysis) from all over the world to care for and "treat" children, adolescents and adults who do not behave "appropriately" for their gender. What symptoms would draw attention to a possible gender "disorder"?
A boy who likes to play with dolls, a girl who has a preference for so-called masculine games, for example. But what's wrong with a boy playing with dolls? The fear that he has latent homosexuality. The professional who will treat this child will not be able to diagnose him as homosexual, since it has been decades since he has been pathologized. However, the father may leave the office with a report that his child suffers from "childhood gender identity disorder". In the popular saying: we exchange six for half a dozen. Homosexuality continues to be "treated" and it is the gender that has been the passport to practicing institutionalized homophobia.
There are many expressions of gender, a multiplicity of feminine and masculine. What are the indicators to define “gender normals”? Who are the “gender patients”? The DSM and the ICD end up producing institutionalized violence. It is important to remember that both codes suffer from the same problem: they lack scientific legitimacy. How to prove the idea of gender normality? There is no clinical examination that supports the thesis that masculine attributes (competitiveness, boldness, rationality) are inherent to men, nor that sensitivity and emotionality are hormonal characteristics that define femininity. Genders are not determined by biological structures. We all carry masculine and feminine attributes. This is why it is a mistake to think about gender identity. We don't have a gender identity.
Gender expressions do not reveal the subject's sexuality. These two dimensions must be thought of in a displaced way. Being a gay man does not define the attributes and multiple possibilities of living the gender. In these documents, gender only has coherence when referred to sexuality, and heterosexuality functions as the referent of health and normality.
The DSM and the CID guide States and their operators (doctors, psychologists, psychiatrists, judges, social workers, teachers) in determining who can have access to citizenship and who will be excluded from it. Many transgender people who eagerly await gender reassignment surgery fear that the removal of transsexuality from the category of mental disorder would authorize States to exclude full financing of the entire transsexualization process and would make the struggle to pay for the transsexualization process more distant.
But it is the State's duty to ensure practical means to guarantee universal and equal access to health and well-being. This is the right of every citizen. Assistance from States must be complete, including with regard to changing the name on the legal identity documents of trans people, without making it conditional on surgery or other medical procedures or psychiatric examinations. The fight to remove transsexuality from the DSM and ICD opens up the possibility of starting to fight for a world without gender.
*Berenice Bento has a PhD in Sociology. Professor at the Federal University of Rio Grande do Norte (UFRN). Coordinator of the Tiresias Center/UFRN. She is the author of the book "The reinvention of the body: sexuality and gender in the transsexual experience"
