Tuesday, December 30, 2008

Framing Discussions of Mental Health

This post is really only half thought-out as it is a recurring issue for me that I still haven’t properly settled in my mind. As many of you know, transgender people are considered to be suffering from “Gender Identity Disorder (GID)”. This diagnosis is crucial to pursuing things as basic as competent medical care, name changes, and at times proving discrimination lawsuits. Yet the majority of transgender people abhor this diagnosis as it suggests that transgender people, unlike cisgender men or women need someone else to tell them who they are, and that this identity must be done in the purview of the institutions of medicine.

I agree with this position – there is nothing disordered about me, or about being transgender. However, when trans folk talk about getting GID out of the official manual of the DSM-V there tends to be an undertone of ableism that I simply can’t shake. The premise for many of these actions is that transgender identities aren't disorders. However other folks with mental health disabilities could just as easily argue that their identites aren't disordered either, so I worry that these reforms reinforce the divide between folks with cognitive, developmental, or emotional disabilities and those who are considered to be able-bodied.

I am stuck in my theorizing on this issue. Transgender identity is not a mental health issue, but the effect of living in a transphobic world force many transgender people and allies into needing assistance mentally surviving. However, as long as GID remains in the DSM-V it will be used against those who are the least able to defend themselves – predominantly youth and people without the means to communicate with other transfolk. I recently heard Pauline Park speak on this subject and her remarks on the ways in which transyouth are suffering (corporal punishment, electric shock therapy, isolation etc.) made me question the narrowness of the movement to remove GID from the DSM-V.

Clearly transyouth can’t be the only group manipulated by medical industrial complex. As if to prove this point to me, the book I’m reading Andrea Smith’s Conquest: Sexual Violence and American Indian Genocide has provided me with ample clues as to how racial constructions of mental health have been used as justifications for medical mistreatment and experimentation on indigenous people across the globe, and folk of color in the US. She writes “[Colonialists believed that] Indians lacked the language that would allow them to comprehend God…” Smith goes on to link this colonial belief to the ways in which choices have always been made for American Indians with the belief that they are “’in an arrested state of social development’” unable to care for their land or children. Thus, they are experimented on medically and for several generations children are forcibly removed from Indigenous homes, all due to the racist and colonialist concept that American Indians aren’t mentally healthy.

Therefore, it would be wrong to suggest that GID should be removed as it is the only incorrect diagnosis in all of the DSM-V. Clearly many other diagnoses are based on issues of racism, sexism, and capitalism. What I’m still trying to frame is this: how do we remove the disability categories based in racism, homophobia, and sexism without reifying that mental disability is stigmatizing or somehow wrong?

I do not believe – cannot believe – that transgender people are misinformed or not able to know who they really are. But neither do I believe that people with cognitive, learning, or mental disabilities are misinformed or unable to know who they are.

It is becoming certain in my mind that the only choice is to overhaul the entirety of the health care system as it can not possible assist us in our needs when we are not considered right enough to know our own needs. The diagnosis of not being able to care for oneself is rooted in capitalism – that bodies only have value when they “meet capitalist expectations of self-sufficiency and productivity”. Folks who might finish a task in a different way due to different cultural norms, or who might take longer to finish a task aren’t considered valuable under the structures of the DSM-V. In order to best serve the needs of folks who may require mental health assistance perhaps the only logical – and obvious - conclusion is to have the folks with needs to be met write out these standards of care.

I am still thinking on this subject, and clearly I’m not the person who should be making these demands, but I have become so annoyed by the ableism in the organizing against GID in the DSM that I needed to at least put down some semblance of my thoughts.

* Smith, Andrea. Conquest: Sexual Violence and American Indian Genocide. South End Press: Mass, 2005. p. 52 & 57 (quote from Pat Robertson) & 87.


Sarahmarie said...

I hadn't thought about there being an ableist agenda underlying the push to delist GID in DSM-V. However, upon reflection, you are onto something here.

At the same time, there is a fundamental difference that must be considered. Virtually every other condition listed in DSM has an effective ameliorating tratment regimin. For transsexuals the only effective response is to be on the outside what we know we are on the inside. Sufferers from no other condition can say that.

Mik Danger said...

Thanks for your comments! I have never read the entirety of the DSM, only the parts that pertained to me (GID, depression, eating disorders) and therefore made me angry. I appreciate your comment, as it sounds like you might be more heavily involved in this than I am.

in case anyone is still reading this post, Mercedes Allen just did a really interesting (and long) post about "transsexual Medical care" here: http://www.bilerico.com/2009/01/the_future_of_transsexual_medical_care.php

Bad Decision Maker said...

Thank you for posting this... I just read Pauline Park's 2007 speech and was thinking about it, and this post was about the only relevant thing that came up when I searched for that and ableism.

Some of what she said was awesome and so right; placing the pathology back on a messed up society rather than the person that doesn't fit into the way it polices gender. However, I also think that fighting ableism, including mental health issues, is important, and I was a little uncomfortable with the impulse to distance from those pathological "actually sick" people, as if they are actually abhorrent, and as you say: "neither do I believe that people with cognitive, learning, or mental disabilities are misinformed or unable to know who they are."

Mik Danger said...

Thank you, BDM! I'm really bad at reading the comments section but i appreciate your thoughts!!

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