Democratising diagnoses? The role of the depathologisation perspective in constructing corporeal trans citizenship

Abstract

In the scope of the current revision process of the diagnostic manuals Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Other Health Problems (ICD), an international trans depathologisation movement has emerged that demands, among other claims, the removal of a diagnostic classification of gender transition processes as a mental disorder. The call for submissions launched by the American Psychiatric Association (APA) and World Health Organisation (WHO) seems to provide the opportunity for a participation of civil society in the DSM and ICD revision processes. These developments open up a number of questions for us that will be discussed in this article. We conducted a meta-narrative review to explore the trans depathologisation movement's contribution to the DSM and ICD revision process, uncover evidence of a 'democratised turn' in the process, and any depathologisation proposals implemented in trans healthcare practices, human rights frameworks and legal gender recognition processes. We argue that the trans depathologisation movement have had little impact on medical practices in trans health care. However, there is some movement in local health services towards an informed consent model for limited healthcare interventions. Within some European and South / Central American legal frameworks, the depathologisation movement's demands to free legal gender recognition from medical interventions and examinations have, in different degrees, been incorporated into legal recommendations and enacted in some recent gender recognition laws.

Trans health care from a depathologization and human rights perspective

“…Trans authors and allies observe an interrelation between these human rights violations and the contemporary Western medical model of transexuality that psychopathologizes gender expressions and identities which differ from the social expectations related to the sex assigned at birth [9,11,[13][14][15][16][17][18][19][20][21][22][23][24][25]. This medical model, raised in the twentieth century, replaces partially and coexists with previous conceptualizations of gender transition as a sin or crime [15,23] and is questioned by a more recent conceptualization of free gender expression and identity as a human right [26][27][28][29][30][31][32][33][34].…”

“…In spite of this recent advancements, in different world regions, trans people continue receiving psychiatric diagnoses, are forced to reparative therapies aimed at modifying their gender expressions or identities, or have to undergo psychiatric assessment processes based on binary and heteronormative assumptions in order to get access to hormone treatment or trans-related surgeries [1,2]. In many countries, Gender Identity Laws establish diagnosis, hormone treatment, genital surgery, sterilization, and/or divorce as requirements for legal gender recognition [4,5,26,[39][40][41]. Furthermore, trans people continue being subjected to discrimination and transphobic violence [1][2][3][4][6][7][8].…”

“…Over the last decade, international trans depathologization activism and scholarship emerged that denounce current diagnostic classifications, pathologizing clinical practices, legal frameworks, and research practices and propose alternative frameworks [26][27][28][29][30][31][32][33][34], preceded and accompanied by critical theoretical reflections contributed over the last decades [11,[13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Jurisdiction in Trans Health

“…Instead, strategic calls for depathologization -abolishing psychiatric monopolies over trans phenomena -are more widespread. 142 While the need to rebalance the power dynamic between doctors and trans patients is noted, acknowledging conscience need not amount to overriding medical expertise. Demands for treatment by informed consent are heard more often than those for 'completely unfettered' access to treatment on demand.…”

Governing Legal Embodiment: On the Limits of Self-Declaration

“…40 As they were not, self-declaration failed to address trans and intersex people's embodied concerns. In different circumstances, self-declaration might form part of a wider movement toward the 'depathologisation' (Theilen 2014;Davy et al 2018), or 'decertification' of gender status (Cooper and Renz 2016). In Denmark, however, authoritative medical discourses around trans phenomena have been left unchallenged, and problems in gaining access to health care remain.…”