October 24, 2012

On how American psychiatry persecutes transgender crossdreamers and crossdressers

I know there are pragmatic souls out there that do not worry to much about crossdreaming, crossdressing and other transgender conditions being in the American Psychiatric Manual.

"What is the big deal?" they ask.

"Fetishistic transvestism, autogynephilia and autoandropphilia are just terms used by specialists. Sticks and stones may break your bones but words will never hurt you."

I recently came over a new paper on the paraphilias (perversions) listed in the DSM-IV (the current version of the  American Diagnostic and Statistical Manual of Mental Disorders). The text is a clear illustration for why it is so important to get crossdressers and crossdreamers out of the manual.

Being included in this section of the manual is much, much  worse than being hit by sticks and stones, believe me!

Judged by your company

Here are some paragraphs from the abstract:: 

"An overview and demographic description of each of the current DSM-IV-TR paraphilias (i.e., Pedophilia, Transvestic Fetishism, Exhibitionism, Fetishism, Voyeurism, Sexual Masochism, Frotteurism, Paraphilia Not Otherwise Specified) are provided. Most of these are medical descriptions of sexual offenses..."

It doesn't say that crossdressers are sex offenders -- not explicitly . But, seriously, by grouping crossdressing together with practicing pedophiles, it is extremely hard not to make the association.

In other words: Here are some presumably well educated scientists who read this section as a list of sexual offenses. How can anyone think that this will not be read this way by non-experts?


No treatment

The authors then go on to describe the next part of their paper:

"...Discussion is provided regarding a paraphilic description of rape (i.e., Paraphilic Coercive Disorder) that may appear in DSM-5. The effectiveness of current treatments (behavioral, cognitive–behavioral therapy, chemical/physical castration; and the use of selective serotonin re-uptake inhibitors) for each of these paraphilias is examined."

Wow!  In the next incarnation of the manual, the DSM-5, crossdreamers may be grouped together with rapists. Property prices are definitely bound to go down in this neighborhood!

As regards the treatment of all these paraphilias, the writers admit they have found none.

"It was found that there are too few well-designed studies to provide support for evidence-based practice with any of the paraphilias, based on Chambless and Hollon (1998) criteria (i.e., evidence should be based on: two + well conducted studies/two + independent researchers, three + small experiments reporting data from at least nine participants). It is suggested that more high quality research studies need to be conducted into the treatment of paraphilias."

So there you have it: Transgender people are grouped with child molesters and rapists, and there seems to be no hope for any of them.

Transvestic Disorder

The paper itself does not actually say much about crossdreamers  (the "transvestic fetishists"). The researchers are publishing in a journal on violent behavior, and it is a little hard to picture your closeted crossdreamer as a violent predator.

When describing and discussing the various paraphilias, the authors therefore spend a lot of time on pedophilia, exhibitionism etc, but only one paragraph on transvestic fetishism:

"Transvestic Fetishism typically describes heterosexual men being aroused by the thought of self as a female, and hence cross-dressing (autogynephilia), or more rarely by women cross-dressing as men (autoandrophilia)..."

Autogynephilia is actually not synonymous with crossdressing, as these scientists seem to believe, but that does not change the gist of my argument. Crossdreaming does not belong to this family.

As for a treatment of the crossdreamer "disorder" they have nothing constructive  to say:

"We could find little evidence for the psychological treatment of this paraphilia, as it rarely comes to the formal attention of authorities/treatment providers. The nature of this interest can typically be seen as a social, rather than a legal, transgression."

In other words: The authors accept that crossdreamers and crossdressers are included in a list of "sex offenders", even though they find it hard to define what the offense is.

Naming and shaming

To me all of this can mean only one thing: The so-called "experts" writing these diagnoses are not out to help, but to  label and control.

Crossdreamers are the kind of fascinating insects some scientists  love to put under their microscopes. They dehumanize us.And they do so in a completely nontransparent matter where there is no democratic way of stopping their violent abuse of people who often need help, not more harassment.

The Celestial Emporium of Sexual Deviations

But what is it they want to control, exactly? At first glance the various conditions listed under paraphilic disorders have little in common.

Actually, the DSM section on paraphilias reminds me of Jorges Luis Borge's amazing text on the Celestial Emporium of Benevolent Knowledge's Taxonomy, where an imagined  ancient Chinese classification system of the animal kingdom forces the reader to rethink his or hers own way of seeing the world.

The list divides all animals into one of 14 categories:
  • Those that belong to the emperor
  • Embalmed ones
  • Those that are trained
  • Suckling pigs
  • Mermaids (or Sirens)
  • Fabulous ones
  • Stray dogs
  • Those that are included in this classification
  • Those that tremble as if they were mad
  • Innumerable ones
  • Those drawn with a very fine camel hair brush
  • Et cetera
  • Those that have just broken the flower vase
  • Those that, at a distance, resemble flies
The imagined Chinese Emporium tells us of  the development of subcategories that seem both random and incomparable.It is often used as an example of how haphazard people's attempts at ordering the world may be.

Scientists are expected to be more stringent and more logical than this, of course. Still, the DSM classification of paraphilias  is similarly  meaningless to me.

A peaceful crossdresser dreaming of being a woman has nothing in common with a rapist or a child molester, or at least no more so than a soccer player,  a Tibetan bell maker, a F16 piliot, a colorblind man with a mole on his right cheek, a Catholic priest or a winner of the Nobel's Prize in theoretical physics.

In fact, the DSM definition is only understandable in the context of the scientists' own cultural prejudices: Unusual sexual practices  are apparently bad in their opinion, and ultimately associated with that which is dark and dirty -- in this case rape and pedophilia.

Red tinted glasses

The scientists make an unscientific jump from superficial similarities to causality.

In their eyes these conditions are all in violation of a proper kind of sexuality. Therefore what causes them must be sexual in nature. And since what causes them is sexual in nature, they belong to the same category. This is a circular argument that ultimately rests on the cultural prejudices of the scientists only.

Another way of sorting the world

It is actually very easy to make an argument that these different conditions may  not be sexual in origin. For the sake of argument, consider the following hypotheses (and these are hypotheses only, used to exemplify an alternative categorization. I have no idea what really drives a voyeur).

Is rape really the result of a sexual deviation? Maybe rapists are people who  express their anger and hatred by sexual means. Maybe the cause is an inborn or psychologically generated resentment towards women, or -- for that matter -- all people. The fact that rape is more common in war and violent environments tells us that the driving force might just as well be fear and aggression, not sex.

Do child molesters really share a sexual orientation towards children? Or are they for some other reason unable to establish adult emotional ties with people their own age and therefore regress to an age more innocent? Could  the main driving force is emotional isolation and loneliness, and not sex?

Exhibitionist,  "rubbers" and peeping toms may be driven by sexual excitement, but the cause of the behavior does not have to be sexual desire alone. Much sexual game playing between people is signified by exposure and genital contact. Maybe the cause of the deviation from normal behavior is  a  lack an adequate social inhibition, and not the sexual desire in itself?

Many experts in the field argue that crossdreaming and crossdressing are not fetishes, but an inborn transgender condition that seeks to express itself by a wide variety of behaviors, sexual arousal being just one of many. Therefore they do not belong to the same box as the fetishists.

In other words: You may put up another set of causes that makes the reason for having a separate category for sexual paraphilias dissolve like toxic smoke in the air.

Paraphilia defined

Blanchard has suggested the following definition of paraphilia:

"The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically, consenting adult human partners. "

Note that the definition is not based on the cause or origin of the "mental disease" but on the cultural more's of Blanchard's own upbringing.

And Blanchard is completely obsessed with deviations from his own norm of proper sexuality. He has given the English language an endless list of names of new perversions, from  hebephiliacs (people who lust after young teenagers) to gynandromorphophiliacs (men who love transwomen).

If we read his definition as is it stands, even masturbation becomes a paraphilia. The rush you get from being sexy and attractive will also fall outside the norms.

Learning from the treatment of homosexuals

Homosexuality, however, is excluded. Blanchard's definition clearly considers same sex sex OK as long as it includes sexual interest in "gential stimulation" and "preparatory fondling".

Homosexuality was removed from the DSM in 1973. Why?

Well, the real reason is partly political and partly medical. The sexual liberation of the late 1960's and the increasing number of faculty and students coming out as gay made it hard to uphold the idea that gay men and women were perverts. Most of them functioned well mentally and socially.

Homosexuality was removed from the manual because they were clearly not mentally ill. Indeed, it was new studies of well functioning homosexuals that finally made the medical establishment give in and accept this.

Now, if we go back to the suggested DSM-5 definition of paraphilia, we see that Blanchard & Co recognize that most crossdreamers (autogynephiliacs and autoandrophiliacs) are not mentally ill. They therefore argue that you should include only those that are.

The authors of the paraphilia paper puts it this way:

"Blanchard (2010) suggests that erotic cross-dressing can be labeled transvestism only if the practitioner is distressed or impaired by it and that this problem can be solved in the DSM-5 nomenclature by changing the name of the diagnosis from Transvestic Fetishism to Transvestic Disorder."

What they are referring to here is Ray Blanchard's "get out of the sexist jail card":

Only the crossdressers and crossdreamers who are distressed or impaired are to be considered perverts, meaning that I, who suffer from gender dysphoria, is a pervert, but the casual crossdresser is not.

If you are listed in the book, you must be a pervert

Sounds great, doesn't it?

Well, not really. Again because most people, doctors included, are -- for good reason -- unable to understand the difference between a undistressed non-pervert and a distressed pervert, especially if they are called by the same name.

The lesbian and gay movement understood this, which is why they fought so hard to get homosexuality out of the paraphilia category altogether

A division between distressed and undistressed gay and lesbians, would not stop the stigmatization of homosexuals.  As long as some homosexuals were labelled mentally ill because they were homosexual, all homosexuals would be associated with this "perversion".

Today, homosexuals may still be diagnosed with a mental illness, like depression or obsessive compulsive disorder. But these illnesses are not considered aspects of homosexuality.

Indeed, if the doctors associate the mental suffering of some homosexuals  with their sexual orientation, it is because the social ostracism has made them ill, and not that the are essentially perverts.

So the same experts who now consider the suffering of homosexuals an effect of social bigotry, continue to stigmatize transgender people, causing the same kind of suffering they used to inflict on homosexuals.

Gender Madness in American Psychiatry

Trans activist and researcher Kelley Winters explains it in this way in her book Gender Madness in American Psychiatry: Essays From the Struggle for Dignity:

"A well intended clinical significance criterion was added to GID [gender identity disorder], TF [transvestic fetishism] and most diagnoses in the DSM-IV, to require clinically significant distress or impairment to meet the accepted definition of mental disorder. 

"Unfortunately, it failed to distinguish intrinsic distress of gender dysphoria from that caused by external societal prejudice and intolerance: what Dr. Evelyn Hooker termed 'ego defensive' response. Therefore, the clinical significance criterion failed to counter the stereotype that all gender variance is disordered. 

"The criterion was brushed aside by Drs. Kenneth Zucker and Ray Blanchard (members of the Sexual and Gender Identity Disorders teams for the DSM-IV and DSM-5 editions) as 'muddled' and having 'little import'. However this position contradicted APA's [the American Psychiatric Association's] definition of mental disorder..."

This definition says that whatever its original cause, the condition must currently be considered a manifestation of a behavioral, psychological or biological dysfunction in the individual and not be caused by social, environmental or cultural factors.

Winters continue:

"The shift in focus from gender dysphoria to gender nonconformity in recent DSM editions has implicated a growing number of gender-variant people with mental disorder and sexual deviance who meet no standard of 'dysfunction in the individual'".

Winters clearly sees the parallel to the persecution of homosexuals:

"The diagnostic category of Transvestic Fetishism (TF) labels cross-dressing by heterosexual males as a paraphilia or sexual deviance, devaluing expression of femininity. These labels reinforce social stigma of madness and perversion for all gender-variant people with consequences very similar to those described by Dr. Kameny and Barbara Gittings for lesbian and gay people in the 1970s:

'(1) To support and buttress the prejudices of society and to assist the bigots in the perpetration and perpetuation of their bigotry; and, at least equally important (2) To destroy the homosexual's self-confidence and self-esteem, impair his or her self-image. degrade his or her basic human dignity.'"

Winters argues that the reason the trans-community opposes the transvestic-fetishism diagnosis is very much the same as the reason the psychiatric diagnosis of homosexuality was deemed inappropriate.

Indeed, as Andrew Hinderliter has pointed out many of the ones involved in removing homosexuality from the manual, believed that the removal would logically lead to the removal of all "deviations". Instead the experts made desperate attempts at finding new definitions that would help them exclude homosexuality while at the same time keep the other "paraphilias" in the manual. These tactics were motivated by gut feelings, and not any proper scientific logic or findings.

Pride and Prejudice

It turns out the only thing that brings the paraphilias together is the fact that the so-called experts who write the text have their own sexual hang-ups. They use their positions of power to give these hang-ups a scientific status. Science is then used as a weapon to control and discipline those that do not share their ideas.

We have been here before. Psychiatrist used to lobotomize and sterilize "hysteric" women who showed the guts to claim that women were equal to men. Psychiatrist used electroshock and torture to force homosexuals in line.

As society changes around them, the bigots are forced into retreat.  In the Scandinavian countries sadomasochism, transvestism, and fetishism have been removed from the psychiatric manuals, as their inclusion is considered offensive and stigmatizing.  In the US, however, it seems that the crossdreamers and the transgender still haven't got the traction needed to unmask this misuse of power.

I am amazed to see that there are women on an American committee that persecutes crossdreamers. They should know better. And if Andrea James is right, there are also gay people in the committee, which may be the reason why "homosexual transsexuals" (i.e. male to female transsexuals who are attracted to men, and female to male transseuxals who are attracted to women) are not included under the paraphilia heading.

If this is true, we are facing one of the worst betrayals in the history of  the oppression of minorities.

So what about the rest?

Some of you might wonder if I feel the rest of the paraphilias should be in the manual. I neither can nor will answer for all of them, for the simple reason that  I find it hard enough to keep track of transgender issues.

Still, in a day and age where one of the most popular books among mothers and house wives is Fifty Shades of Grey, a pornographic tale about bondage, I must say that I find it hard to explain why sadism or masochism should be included.

And if someone gets turned on by silk stockings, rubber or latex, that is nobody's business as far as I am concerned. Ray Blanchard should get his kicks elsewhere, and not from categorizing  fetishists.

Note that a lot of women report erotic  rape fantasies, and I am sure you might find similar numbers for men. But fantasizing about forced sex, whether you imagine yourself the active or passive part, does not make you a pervert. Couples make up role playing games in their own homes acting out these fantasies in a safe setting. That is all right with me, as long as the fantasy remains a fantasy.

In my view rapists, child molesters and other abusers are criminals. They violate the rights of defenseless people. What they do is therefore primarily a matter for the courts. To the extent they need psychiatric help, the doctors should help them handle their obsession, and not drag decent people down the drain with them.

See also Blanchard and the DSM-V, redefining paraphilia

DSM-V: What about autogynephilia?

Andrew C. Hinderliter: DSM-5 Paraphilias Bibliography

Anthony R. Beech , Leigh Harkins: "DSM-IV paraphilia: Descriptions, demographics and treatment interventions" in Aggression and Violent Behavior Volume 17, Issue 6, November–December 2012, Pages 527–539.

Ray Blanchard: "The DSM Diagnostic Criteria for Transvestic Fetishism" Arch Sex Behav
DOI 10.1007/s10508-009-9541-3


10 comments:

joanna Santos said...

Of course I agree jack. We have no business being in the DSM especially if we are high functioning, not harming anyone else and simply only questioning our gender. I am clearly not a fetishist so I don't really worry about what the document says but before I was less sure I admit that I found references to transvestism being being a paraphilia somewhat troubling.

Deborah Kate said...

Your hostility does seem to be becoming increasingly intemperate, Jack.

I think there is an important distinction between cold scientific detachment and malicious vilification. Blanchard's term 'paraphilia' is not synonymous with 'pervert': 'pervert' is charged with judgement and contempt, 'paraphilia' isn't.

Categorisation is not the same as condemnation. It is right that psychologists identify and investigate minority sexualities - this is something you do yourself, Jack.

I am grateful to Blanchard for identifying my sexuality. Without 'autogynephilia' I would not fit, not being a crossdresser or a transsexual. Without 'autogynephilia' there would be no 'crossdreaming' - surely your term is a renaming of Blanchard's category.

I haven't read enough Blanchard to know to what extent subtle antipathy informs his interpretation, but I'd need proof (through direct quotation) to convince me that he is as crudely hostile as you make out. Similarly with Anne Lawrence, who identifies as autogynephiliac herself.

Love,
Deborah xx

Jack Molay said...

@Deborah

Yes, I am getting more angry. That is true. And the main reason is a feeling of helplessness in the face of a misuse of power for which there is no appeal.

Mind you, I am not contesting the right of Blanchard to present his theories for the scientific community. Science is also about testing unorthodox theories and findings up against the sharp eyes of your peers.

What I am protesting against is the fact that a theory for which there is no real proof or scientific consensus is used in an official manual that influences the treatment of transgender all over the world. This stigmatization causes guilt and shame we could be without.

You may read Blanchard in original. I included many of his papers in the library of Crossdream Life. You can start reading his work here.

Note, however, that Blanchard always writes in scientific journals, which makes it easier for him to hide his sexism behind the scientific jargon. Still, the fact that he calls androphilic transwomen homosexual men, is a dead give away to me.

His good friend and colleague J. Michael Bailey let the cat out of the bag when he wrote a book presenting the theory in a more popular manner (The Man Who Would Be Queen), where androphilic transwomen were reduced to sex hungry gay men "well suited to prostitution" and gynephilic tranwomen were reduced to ugly perverted men.

But you can find all of this in Blanchard's paper as well, although written in a more palatable language.

Madeline Wyndzen has a great analysis of his book here. I also recommend her discussion of Blanchard.

For a critique of Blanchard I recommend the papers of Serano and Moser, both of which are included here. I have discussed Moser's critique here, Serano's here.

There was a time when I was grateful for Blanchard having given us the "autogynephilia" concept, as I -- like you -- finally found a term that made my own suffering visible. Indeed, this whole blog would have seen the light of day, hadn't it been for Blanchard.

But his explanation for crossdreaming is not only wrong. It is toxic, which is why I find myself spending more time on debunking not only his theory, but also his overall strategy of forcing his stereotypes down our throats via the DSM.

joanna Santos said...

What also irks me is the lack of scientific rigor in the work of Bailey and Blanchard. Since this is already such a difficult condition and bias can easily infiltrate the so called research it can readily slip into shoddiness. The more I scratch the surface the more I am convinced that much of what is being postulated is not going to hold up in the long term. Don't get me wrong in that I yearn for an explanation as to what drives this condition but I would prefer that the conclusions be more solidly based.

Farham Erikson said...

In our therapy in Cambridge, we leave labels behind and try to focus more on the real feeling of a person. It was never about gender preference, it's always about being our own person.

ACH said...

It's worth remembering that when transvestism was added to the DSM, crossdressing was a crime in much of the US.

One of the most bizarre things about the paraphilias section is that not only is it a medicalization of morality, in social contexts where a "between consenting adults" standard is increasingly common it's not even our morality that's being medicalized.

On the issue of being listed next to pedophilia, I suspect that this is one of the pressures against removing TF from the DSM: If they remove it, a lot of religious conservatives will use this in promoting their anti-gay slippery slope argument. Can't you hear them now, "First, they removed homosexuality. Now they've removed transvestism. What's next?" And then they'll happily provide their answer...

Jack Molay said...

@ACH

They actually used similar arguments to keep slavery, deny poor people the vote, deny women the vote etc etc. But what I find fascinating is that in 50 years time they will probably defend gay marriage as passionately as they now oppose it.

Anonymous said...

Obviously they are concerned for the safety of our victims - you know, the fantasy version of us in our own psyches. They're only trying to protect our inner female from our outer male. She's very vulnerable in there, at our mercy... Psychiatry IS for treating the suffering, a help-based service, correct? Seriously, I was just skimming the "Essentials of Abnormal Psychology" textbook ( V. Mark Durand / David H. Barlow 4th ed. 2006. ) It's a basic intro-level textbook with prominent DSM connections throughout, as if the emphasis on DSM caterogization gives or removes validity to the situation, becoming greater than the actual psychology. They do try to point out at least the dilemma of each individual being a unique case and how that conflicts with DSM. Of course it may have been updated (?) - but i guess this info is still true to some extent: "those with one paraphilia TEND to have at least a few more, often several at a time." Perhaps accidentally alluding to a mix of violent aggressive ones involving innocents and solitary harmless fantasies. No official distinction. Here's a tough example from wiki regarding erotic asphyxial deaths - see where it fits (?):
"In some fatality cases, the body of the asphyxiophilic individual is discovered naked or with genitalia in hand, with pornographic material or sex toys present, or with evidence of having orgasmed prior to death. Bodies found at the scene of an accidental death often show evidence of other paraphilic activities, such as fetishistic cross-dressing and masochism. In cases involving teenagers at home, families may disturb the scene by "sanitizing" it, removing evidence of paraphilic activity. This can have the consequence of making the death appear to be a deliberate suicide, rather than an accident." I can't say that should be ignored, and don't see how it can be catagorized without demonizing us innocent crossdreamers. The requirement to categorize here i think is the root of the problem, period. Taken on a personal level, its also been the root of my problem with myself - I'm fine with my quirks as long as i don't buy into labeling them. Perhaps a solution could involve a new DSM sub-category: "paraphilias in individuals who lack empathy", thus sorting out the good guys and bad guys? Of cource more time, effort, expense and concern would be required to pull it off. And a great deal of shouting from us. I think it all boils down to medical coding, for payment / insurance purposes - only. Appropriate for the future of the profession - I suppose if it is to exist everyone first and foremost must be paid.

Sam Z said...

Jack, do you believe Blanchard even is a supporter of homosexuality or does he concider it to be a paraphilia too? Since he denies Transsexual M2F lesbians I figured he might be even more old fashioned...

Jack Molay said...

@Sam Z

There was some speculation that Blanchard himself might be gay, and this was why he distinguished between paraphilic autogynephiliacs and "homosexual transsexuals", the latter group never labelled paraphiliacs by him.

The fact that he has spent so much time trying to find an evolutionary explanation for homosexuality pointed in that direction.

His recent interview with Motherboard makes it clear, however, that he consider all of us deviants, also homosexuals.

It is also clear that he has no respect for any type of transgender, using derogatory terms like "sissies" and "trannies". This man is a walking disaster causing much embarrassment for his profession.

He could still be gay himself, I guess. After all, Anne Lawrence has dedicated her life to his theories, in spite of being a crossdreaming trans woman herself. But I am beginning to doubt it. There is too much contempt here, too much sexism.

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