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