DSM-V – The Other Shoe Drops

Given that a bunch of trans people may click through here from the Lambda Literary article, I figured I should post something trans-related. Sadly there is something that very much needs talking about. I’ve put it under the cut because it is very long.

Since my first post on the draft of DSM-V, the American Psychiatric Association’s diagnostic manual, I have been waiting for the other shoe to drop. The news seemed too good. And with people like Kenneth Zucker and Ray Blanchard involved it seemed inevitable that some hidden agenda would be uncovered. Now it seems that we know what they are up to.

The draft of DSM-V appears to be a classic case of political compromise. On the one hand psychiatrists who are well-disposed towards trans people will be able to diagnose the new condition of “Gender Incongruity,” which for the first time the APA acknowledges can be “cured” simply by enabling the patients to live their lives in their preferred gender. However, Blanchard, Zucker and their allies have another option. It is also possible to diagnose trans women as “suffering from” the condition of “Transvestic Fetishism” in the subcategory of “Autogynephilia”. And this is very harmful diagnosis.

Most of you are probably scratching your heads at this point. Let me explain.

The first thing to note about Blanchard and Zucker is that they refuse to accept trans people’s narratives as valid. So if someone apparently biologically male comes to them and says she believes that she is a woman, the only diagnosis they will accept is that this person is crazy.

The other important characteristic of these guys is that they tend to explain everything in terms of sexual perversion, so if they find a patient that they think is crazy, they have to explain her craziness in terms of some sort of perversion, or “philia”, as they like to call it.

(Personally I think that there needs to be a new mental illness defined specifically for psychiatrists who have an unnatural compulsion to explain everything in terms of sexual perversions, but that’s just me.)

So Blanchard and Zucker have to be able to explain trans people in terms of sexual perversions. Note that they are not particularly interested in trans men (i.e. Female-to-Male transitions). I’ll come back to that later. It is trans women that they are obsessed with.

They divide trans women into two groups, based on their sexual orientation. Trans women who are androphilic (i.e. attracted to men) they have decided are “really” gay men who are so ashamed of their sexuality that they want to become women so as to become “normal”. (This is also a favorite theory with hard line feminists.) These people they are happy to diagnose as suffering from Gender Incongruity and pass on for surgery. However, trans women who are gynophilic (lesbians) are diagnosed as “suffering from” this new condition called Autogynephilia. Basically that means being sexually obsessed with the idea of yourself as a woman.

Let’s backtrack a little to talk about Transvestic Fetishism. This is what we used to call Transvestism, and is used to be an “illness” only if it caused distress. Under the draft of DSM-V it is now an illness regardless of whether the patient is distressed or not. It is also gender-specific. Only men can be diagnosed with it. So if a woman wears clothes that the psychiatrist deems appropriate to a man that’s fine, but if a man wears clothes that the psychiatrist deems appropriate for a woman then he’s automatically diagnosed as crazy, even if he exhibits no other symptoms. The idea with autogynephilia is that the patient becomes so obsessed with dressing as a woman that he wants to become one. The supposed diagnostic criteria are a) that the patient is sexually attracted to women, and b) that the patient sometimes becomes sexually aroused while dressed as a woman.

As I said, this whole thing is deeply harmful to trans people, and it reveals a lot about the social prejudices of the people behind it. To start with it is homophobic. Blanchard and Zucker already have a nice little earner going in preying on gullible parents who worry that their little boys are not masculine enough and may grow up gay. The prescribed treatment is to bully them mercilessly. For adults the “cure” that Blanchard and Zucker propose for gay men is to diagnose them with Gender Incongruity and put them in for surgery. This is exactly the same as what happens in Iran.

Secondly the whole idea that women who dress like men are perfectly normal whereas men who dress like women are, by definition, crazy, is deeply misogynist and is designed to reinforce social ideas of male superiority.

Thirdly the lack of respect for the patients’ own narratives is very poor practice. What is the point of having psychiatrists who have made up their minds in advance that their patients are liars?

And finally the whole idea of autogynephilia is something of a trap for unwary trans women. Because it is a diagnosis that its proponents have invented and are keen to find examples of, there is an ever present danger of being so-diagnosed because you said something that sounded suspicious.

To start with anyone who is into this sort of nonsense is also likely to have pretty antediluvian ideas about female sexuality. So if you confess to becoming aroused by anything other than the presence of an attentive male (and particularly if you confess to masturbating) then you are likely to be diagnosed as Autogynephilic. And secondly trans girls undergoing therapy have the bodies of teenage boys, which are such a mess of hormones that they are liable to become sexually aroused by seeing a donut. I suspect that it will prove depressingly easy to be diagnosed with this fancy new invented “illness”.

I should note that Blanchard & Zucker are prepared to allow people that they diagnose with Autogynephilia to go forward for surgery. However, that is at the price of having been labeled a narcissistic sex pervert, and with no option for being declared “cured” as there is with Gender Incongruity.

Fortunately the trans community is pretty good at spotting bad psychiatrists and warning people away from them. Nevertheless, if you are a trans woman who happens to live in a city where the local psychiatrists follow the Blanchard-Zucker line, and you can’t afford to go elsewhere, you are in deep trouble. It would be far better for trans people if the APA were to eliminate Autogynephilia from the DSM, and ideally they should kick out Transvestic Fetishism while they are at it.

For further information see the excellent Mercedes Allen.

6 thoughts on “DSM-V – The Other Shoe Drops

  1. “(Personally I think that there needs to be a new mental illness defined specifically for psychiatrists who have an unnatural compulsion to explain everything in terms of sexual perversions, but that’s just me.)”


  2. Oddly I don’t think they’ve got a line yet on women who become aroused by the image of themselves dressed as women. But give them time. There’s always DSM VI for that, by which time ‘normal’ will have been catalogued out of existence altogether

    1. I’m not sure that the “dressed as women” is very important to them. I think it is the thought that women might become sexually aroused without the agency of a man that frightens them.

  3. What about female-bodied gay trans men who become sexually aroused by dressing as women? Would we make their brains explode?

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