Hey! I made it into the DSM!

If you start off knowing what the DSM is, it should not come as a surprise that there are references to our behaviors contained in it. If you don’t know what the DSM is, now may be a great time to find happier reading.

OK … still here? Then, just quickly for the uninitiated, The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. Fair enough. Sounds like a useful thing for a shrink to have handy ‘round the old couch. But the DSM, now in its 4th edition, has influence and impact miles away from the couch.

The production and maintenance of the DSM entails the constant labors of various committees, sub-committees, posses and lone wolves. They meet, they talk, they work out language, kick the language upstairs for editing and commentary, make required fixes and then line up for lousy chicken entrees and the pasta salad before heading out for a round of golf ( ... I find it interesting that you selected a 4 iron … why do you think it is important for you to avoid the water hazard in front of the green? ... ) at the annual conference.

Invariably, the contents and the language expressed in the DSM reflect a number of biases. A bias towards the benefits of psychiatric intervention. A bias towards yielding to the loudest and most charismatic voice on the committee. A bias towards ensuring that arenas of research and treatment that are presently driving income and billable hours remain open.

These biases, (and many truly positive and caring ones too) are solemnized and legitimized in the process of printing and binding. Numeric codes are created that facilitate billing mechanisms. Research gets funded. Causality and treatment protocols are agreed upon. Pharmaceutical sales reps pitch up on doorsteps with satchels brimful of nicely merchandized samples. Careers are made and unmade.

The big bias goes unsaid though. Wait for it … something is wrong, something is broken, something is bad. Something wants a cure. This is the bias that I take issue with.

As gentle as the language describing Transvestic Fetishism in the current DSM is, the money shot is that the Cross Dresser engages in this activity at least in part as a self-treatment for depression. You might fairly draw different conclusions, and I have referred only to summary language, but I have a hard time drawing any other conclusions.

Yes, depression is real and, for many, debilitating. I think though that we can all agree that too wide a net has been cast over the issue. We have fairly carelessly pathologized a pretty universal aspect of the human condition. Depression is too big an issue for me to take on, fear not. But if you would like to spend a few minutes reading some terrific thoughts on the topic, I happily point you to Louis Menand’s recent New Yorker essay.

Back to the DSM now. Echoes of the past are surfacing now in the drafting of DSM-5 which is due in 2013. Between 1970 and 1973 language having to do with homosexuality was changed to de-stigmatize this long standing condition of humanity. Hooray for earthlings! It was quite a struggle. I recommend the investment of an hour of your time to listen to Ira Glass’s indispensable This American Life episode on the debate that swirled within the APA, and the mechanics of change associated with the de-pathologization of homosexuality. This is as good as radio gets.

Similar discussions having to do with Gender oriented “disorders” are no doubt being broached (love that broach, where did you find it?) now. Actions are being taken too, and I lay claim to one action. I came across a petition sponsored by the International Foundation for Gender Education yesterday. I then signed it.

Now, while I enjoy the odd late breakfast at the International House of Pancakes, I do not know of the work of the International Foundation for Gender Education. If you are familiar with their work, I would greatly welcome a note that helps me confirm in my own mind that they are the real deal. Until I do confirm that, I do not feel as though I can implore you to join the chorus of petitioners. I am of the belief though that a chorus is required, and I am actively seeking membership in the most full throated one there is.

In all of this, I seek not to diminish the very real truth that the caring profession of Psychiatry has been central to helping countless troubled souls better understand themselves, and find a path to peace. Nor do I suggest that Cross Dressing or any expression of gender related exploration is necessarily free from some manner of fissure in the tissues of our minds. This is complex stuff, and stuff that my mental fluff is certifiably not capable of wrestling down alone. Hence, this blog my dears.

I do believe however that the clinical de-stigmatization of much of what we feel, and much of how we act upon our feelings is a necessary step. We are participants, like it or not, in a long parade of many similarly, formerly marginalized people. Now I will think on what shoes to wear for the parade.

Are you in? Comments most sincerely welcomed here.