©Copyright 2011 by Paula J. Caplan All rights reserved

Psychiatric diagnosis as tool to push gender conformity

It appears that the authors of the next psychiatric manual plan to include Gender Dysphoria of Childhood.* Entire books would be required to do justice to the many problems with this category, but it is founded on sex-based stereotypes about what everyone should think, feel, find interesting, and how they should move and dress. [1] Did you see the recent story about a couple who have caused an outcry because they are not revealing the physical sex of their new baby, wanting the child to grow as free as possible from explicit and implicit, blatant and subtle messages about the "right" ways to be? [2]

The problem rooted deeply in our society is the enormous number of aspects of thought, emotion, behavior, and dress are classified as appropriate only for girls or only for boys. This is not inevitable. As Sandra Bem's brilliant work on gender schema theory shows, cultures vary widely in the extent to which they have such rules. [3] Some cultures more than others allow varieties of cognition, feeling, behavior, and dress to be matters of individual ability or inclination rather than being bound by, "You can't do this! You are a BOY! Or GIRL!"

Just consider: It would certainly be possible to raise a child who does not feel, "I am a boy, so I'd damned well better love trucks" or "I am a girl, so I am supposed to be tender and nurturing." Or wear blue but not pink. Or be thrilled about a new toolbox. But it's hard to find many people who are doing that kind of childrearing in the United States. And as the story of the new baby shows, a lot of folks panic at the prospect of not knowing a child's sex. They think, "How will we know how to treat the child, then?" Hmm, how about like a human being, since we all have so much in common to begin with?

Torontonian Bob Metcalfe, an expert on dysfunctional families, sex, and gender, wrote to the parents who are not telling people the sex of their new baby:

"You've challenged one of our most fundamental (and mistaken) societal concepts - that all of us humans are by nature divided into two completely disparate poles; male and female. Society insists from our birth, and before if possible, that all of us must be identified and categorized with one, and only one, of these two labels. No other possibilities are allowed or considered. Consequently the first question asked is invariably, 'Is the baby a boy or girl?'

People will be insistent that this question be answered because our societal beliefs, traditions and conventions are based on this specific categorization from birth. To challenge this is to challenge the security and comfort that people feel within these beliefs, traditions and conventions. A comparison would be the effect it would have had in the deep south of the United States for white parents to announce that they were going to raise their children within a racially equal and racially unaware environment with the children of their black slaves. This is nothing less than heretical or radical.

Undoubtedly professionals of all sorts will express their outrage that you are ‘misusing' or mistreating your child by refusing to identify herm as male or female. This is nonsense. Pay no heed. The real risk of harm that you and Storm are facing is from those who are outraged."

Imagine that blue-eyed kids were the ones who were pressured to fit all the stereotypes that males are supposed to fit, and brown-eyed kids, the ones that females are supposed to fit. Some from each group would end up hating their eyes, wishing their eyes were of different colors, feeling miserable. Yet the DSM-5 authors' description of Gender Dysphoria is about just that kind of thing. So we create and perpetuate a society that is extensively dichotomized based on the person's sex, and then we decide that any individuals who don't fit the mold for their sex is mentally ill. Does that make any sense at all?

It is all the more alarming in light of the fact that Big Pharma and medical and surgical equipment and prosthetic companies are big businesses who stand to make a buck from wanting people with the "mental illness" of Gender Dysphoria of Childhood to have chemical treatments and surgeries of various kinds. Fundamentalist religious groups add further pressure to their members who want to remain in the folds of their faiths.

This is not about whether people should have the choice to have their bodies altered, but it is about two things: (A) It is about rigid rules making them feel they have the wrong bodies or wish they were otherwise different ... and then, rather than working to decrease the rigidity of those rules and thus the suffering they cause, pressuring them and their parents toward physical or other changes in the children, and (B) Imposing not only a psychiatric label but permanent physical changes, many of them painful, on those not old enough to give legal consent. There is a huge variety of reasons that people might wish their biological sex were different, and children's feelings change over time and for a host of reasons.

There is debate among various groups that identify themselves as under the LGBTQ umbrella about permanent physical changes and what terms to use for different people. But surely one principle on which we can all agree is that the consequences of societally-created problems should not be diagnosed as individual, intrapsychic disorders. Then let us help children, adolescents, and adults who don't fit the stereotypes for their sex to find ways to lead happy lives rather than strengthening the soul-destroying message that they are sick and need to change...or be changed.

*There is also a category for Gender Dysphoria in Adolescents, as well as one for Gender Dysphoria in Adults, but I focus here on the one applied to children, because they are the least capable of consenting to being labeled mentally ill; to drug treatment, including both hormones and psychiatric medication; and to various kinds of surgeries. But much of what I say above applies to applying this label to people at any age.

[1] Kate Richmond & Kate Sheese. Gender interrupted: Controversy and concerns about Gender Identity Disorder (GID). http://awpsych.org/index.php?option=com_content&view=article&id=96&catid...

[2] http://www.embracethechaos.ca/2011/05/-parents-keep-gender-of-baby-secre...

[3] Bem, S. L. (1987b). Gender schema theory and its implications for child development: Raising gender-aschematic children in a gender-schematic society. In M. R. Walsh (Ed.), The psychology of women: Ongoing debates. (pp. 226-45). New Haven: Yale University Press.

About the Author

Paula J. Caplan, Ph.D.

Paula J. Caplan, Ph.D., a clinical and research psychologist, is an associate at Harvard University's DuBois Institute and former fellow in Harvard Kennedy School's Women and Public Policy Program.

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