I"m transgender: why does the WHO say I have a mental disorder?

It was in November 28 years ago when I saw a psychiatrist for the first time. I was 17. The school year was just finishing and I lived in Córdoba, Argentina, with my father and siblings. I had the same friends from kindergarten to high school. I knew their families, they knew mine; all of them had come to visit when my mother died, all of them were there when I held a party and kissed my first boy. All of them believed that I was crazy. After the first meeting with the psychiatrist, she prescribed me anti-psychotic medication – I was officially crazy.

But the doctors had other words for it: I had a gender identity disorder, that is to say, a serious mental health disorder.

I had been assigned female at birth but identified as a guy. Even worse, I identified as a guy sexually attracted to other guys. For the psychiatrist, my father and for many people around me, it was a disorder. For me, it was what it is today: just the person I am.

People like me, who identify as a different gender from the sex assigned to them at birth, have been historically pathologised, classified as people with mental disorders. In 1990 the World Health Organisation (WHO) started using the 10th version of the International Classification of Diseases (ICD), which include so-called “Gender Identity Disorders” in its chapter five on Mental and Behavioural Disorders.

Almost two decades later, the WHO is performing a comprehensive ICD revision, and a new version (ICD-11) is expected to be approved by the World Health Assembly in 2018.

Many trans activists from all over the world have been monitoring the ICD revision and reform process since the beginning – as we did around the reform of the Diagnostics and Statistical Manual on Mental Disorders, produced by the American Psychiatric Association. For us, the ICD process represents a historic opportunity to achieve trans depathologisation while ensuring full access to fundamental rights: legal gender recognition, access to gender affirming healthcare, and coverage under public and private healthcare systems.

To treat trans people as psychologically abnormal suggests that just being ourselves is a disorder. In many countries it also means that someone else – a psychiatrist, a psychologist, a therapist – needs to provide a specific diagnosis for us to have access to those key but basic rights: identity, freedom of expression, bodily integrity, autonomy and healthcare.

Currently, trans people rely on someone else’s authority to be recognised by the state with our name and gender, and to take informed decisions about our own bodies. This means that we are subjected to human rights violations, justified by the legal interpretation of those diagnostic categories pathologizing us, including those of gender identity disorder, gender dysphoria and transsexualism.

Different countries require trans people to be sterilised to apply for legal gender recognition, including 23 countries in Europe, while 22 European countries require trans people to divorce. In many places trans people, including children and teenagers, are subjected to “conversion” therapies – pseudo-scientific therapies to change their gender identity and gender expression.

Others, like me when I was a teenager, get treated with anxiety and anti-psychotic medication.

Despite these human rights violations, and the damaging ICD classification, the number of countries that respect trans people’s rights is growing. My own country, Argentina, is the first – and, so far, the only one – to grant access to legal gender recognition, gender-affirming healthcare and its coverage based on the human right to identity. Other countries, such as Malta, Mexico, the Netherlands, Bolivia, Sweden, Norway and Denmark are making advances in getting rid of requirements incompatible with human rights standards – to recognise trans people’s human rights.

Last year, Denmark announced it would no longer define being transgender as a mental illness, making it the first country to do so; and this year Sweden said it would do the same. A 2016 study found transgender identity should no longer be classified as a mental disorder, citing that the distress experienced by trans people was primarily a result of social rejection and violence, not the result of being transgender.

The world is undoubtedly changing. And how diseases are classified in changing as well.

In 2012 WHO announced the intention of removing all trans-related diagnoses from the chapter on mental health in ICD-11 – and to include a new category, called Gender Incongruence, in a different, non pathologising, chapter.

The proposed category will be divided into Gender Incongruence of Adolescence and Adulthood (GIAA) and Gender Incongruence of Childhood (GIC). GIAA is being critically accepted by many of the trans community as a far from perfect compromise to depathologise trans while ensuring access to fundamental rights.

Conversely, GIC is strongly rejected. Being a diagnosis to be only applied to children before puberty, it pathologises gender diversity in childhood. Trans and gender diverse children, and all children exploring their gender identity and expression as well as their sexualities, need love, acceptance, information and support – and no diagnosis is necessary to meet those needs. Access to hormonal blockers in puberty must be granted without depending on pathologising children because of who they are.

The completion of the ICD process in 2018 will hopefully bring good news for trans people around the world – but even the best possible ICD-11 version won’t be enough to change everything by itself. Legal pathologisation needs to continue to advance, to transform the rights landscape we are surviving in for good. Trans access to healthcare (including general healthcare) still needs to become a reality in too many places. And there is something else: achieving depathologisation will also open the way to justice. By struggling to put an end to human rights violations grounded on pathologisation, we are craving the time and place to talk about their victims’ human right to adequate reparations.

Mauro Cabral Grinspan is the executive director of Global Action for Trans Equality.

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I"m transgender: why does the WHO say I have a mental disorder?