Sunday, 29 August 2010

The ethics of gender identity disorder

The title of this paper from last year, Colin Ross' Ethics of Gender Identity Disorder, caught my eye. Unfortunately I don't have access to it, but the abstract seems pretty interesting;

"Gender identity disorder is unique among all DSM-IV-TR diagnoses. It is the only disorder in which treatment is designed to confirm, reinforce, and validate the belief that is the basis of the mental disorder. In all other diagnoses, the symptoms in the diagnostic criteria are viewed as pathological and the goal of treatment is to remove the symptoms. In gender identity disorder, however, the body is altered to match the belief that is said to be a symptom of mental disorder. This is self-contradictory. Either gender identity disorder should be dropped from DSM-V, just as homosexuality was dropped from the diagnostic system, or gender reassignment should be discontinued. The core contradiction in the current approach to gender identity is an ethical problem in the mental health field."
Since I lack full access to the paper, I obviously can't comment on any potential subtleties of the argument contained within - but I can (and will) comment on the abstract's claims.

Gender identity disorder, just to start things off, is the formal diagnosis given to transsexuals. The four following criteria need to be met for a diagnosis of GID;

  • Individual has a long-standing and strong identification with another gender
  • Individual has long-standing disquiet about the sex assigned to them, or a sense of incongruity in the gender-assigned role of that sex
  • Individual does not have physical intersex characteristics.
  • Individual has significant clinical discomfort or impairment at work, social situations, or other important life areas.
Ross' argument (or his abstract's, at least) is that treatment of GID encourages the patient's identification with another gender, and that this is a contradictory reinforcement of what the DSM has labelled as a pathological belief. This, I think, is a reasonably good point.

A possible response is this. The belief of the individual with GID that they relate more closely to the opposite sex's gender role is indeed a symptom of a mental disorder, but it is not the mental disorder itself; the problem (that which is causing the individual distress) is the disjunction between their gender identity and their physical sex. By treatment attempting to more closely align the individual's gender identity and sex, we are not reinforcing a belief which is itself a mental disorder, but instead removing or alleviating the causative factor of the individual's distress. This, I take to be the central factor of psychiatric treatment; to diminish or eliminate the distress caused to the individual, not to necessarily remove the mental state which initially caused the distress. A patient with GID who finishes treatment content with both their gender identity and physical sex has thus successfully been treated, no matter whether it is the gender identity or physical sex that has been altered in the progression of treatment.

Taken in this light, treatment of GID is not self contradictory. The disorder is due to a disconnect between the individual's gender identity and physical sex; treatment, whether aiming to alter the individual's gender identity or physical characteristics, is seeking to remove this distressful disconnect. My recommendation for the DSM-V would thus not be to remove GID, or to cease advocating gender reassignment for those diagnosed with GID, but to instead emphasise in GID's diagnostic criteria that it is the disjunction between the patient's gender identity and physical gender which is pathological.

These thoughts are necessarily limited, due to having only an abstract to respond to, but that was my initial response to Ross' suggestions. No doubt I'll be thinking about the problem more in the next week or two, as I attempt to distract myself from writing a dissertation.

For reference;
Ross, C.A. (2009), Ethics of Gender Identity Disorder, Ethical Human Psychology and Psychiatry, 11(3), 165-170

Saturday, 21 August 2010

The Marc Hauser Scandal: An Overview

I haven't had a huge amount of time to devote to this blog at the moment, primarily thanks to an impending dissertation deadline. At some point I'll finish writing a review of the London Reasoning Workshop (the basic gist being that it's well worth attending if you're at all interested in the psychology of reasoning).

Something appearing frequently in the news at the moment is the story about Harvard professor Marc Hauser having some of his research retracted due to allegations of misconduct. This is a good overview of news reports about the case so far;

Most of these links, it must be noted, were taken from Brian Leiter's rather excellent blog.

The most worrying potential consequence of Hauser's misconduct, I think, is the "ripple effect" that the New York Times' headline refers to; Hauser's co-authors' research may now also be placed under suspicion, and then their co-authors' research may be viewed with suspicion, et cetera, et cetera... For the most part, however, the declaration by Harvard that Hauser is "solely responsible" for the misconduct may serve to quell such doubts.