Here’s why it would be a big deal for the WHO to re-classify transgender identity.
By Jared Keller
(Photo: Sara D. Davis/Getty Images)
At long last, the World Health Organization may finally confirm something transgender people have known all along: Being trans is not some sort of disorder.
The New York Timesreports that the international public-health agency is considering re-classifying transgender identity, removing it from its list of “mental disorders” in the organization’s authoritative International Statistical Classification of Diseases and Related Health Problems (ICD). The change, which the Times reports has been approved by various WHO committees, will enter into force with the publication of the next edition of the ICD in 2018. And while it seems like a minor bureaucratic change, the new classification of transgender identity would likely serve as a sign of growing inclusion for trans communities around the world.
The deliberation over transgender identity is significant for the WHO. Homosexuality was only declassified as a mental illness with the last revision to the ICD in 1992, nearly two decades after the American Psychiatric Association declassified homosexuality in its Diagnostic and Statistical Manual of Mental Disorders (DSM). As cultural norms around homosexuality changed, so did the clinical and scientific consensus that shape the institutions of everyday life, from schools to churches to military service. Public awareness and acceptance around transgender issues have similarly been on the rise, albeit at a slower pace.
There’s a practical impact surrounding the clinical definitions of medical tomes that goes beyond convention halls and doctors’ offices.
A 2014 analysis by the University of California–Los Angeles’ Williams Institute found a 40 percent jump in support for transgender Americans between 2005 and 2011; likewise, some 67 percent of Americans say they feel “well informed” about transgender people, and 89 percent believe transgender people “deserve the same rights and protections as other Americans,” according to a 2011 Public Religion Research Institute survey. And while the Williams Institute notes that transgender rights have typically lagged around the gains enjoyed by gay, lesbian, and bisexual Americans, the medical re-classification of transgender identity from abnormal deviation to, well, normal may signal a near-arrival of the “transgender tipping point” that Time magazine heralded in 2014.
“It’s sending a very strong message that the rest of the world is no longer considering it a mental disorder,” ICD chief technical consultant Dr. Michael First told the New York Times. “One of the benefits of moving it out of the mental disorder section is trying to reduce stigma.”
These shifts in thinking around gender and sexual identity often involve more gradual changes to clinical language. The Timesnotes that the APA changed the definition of homosexuality to new designations like “sexual orientation disturbance” before abandoning alternate diagnoses entirely in 1987; the WHO’s 1992 change came with a similarly arcane designation of “ego-dystonic sexual orientation.”
The transgender community is likely to face this sort of clinical shifting of the goalposts, the APA’s Jack Drescher predicts to the Times. After all, transgender identity has already gone from “sexual deviation” in 1968 to “psychosexual disorder” in 1980, to “sexual and gender identity disorder” in 1994, all before becoming “gender dysphoria” in the fifth edition of the DSM,in 2013.
But there’s a practical impact surrounding the clinical definitions of medical tomes that goes beyond convention halls and doctors’ offices. Consider the ongoing controversy surrounding transgender bathrooms in states like North Carolina. While lawmakers who pushed forward anti-trans bathroom legislation claimed to have done so under the auspices of “religious freedom,” the discrimination based on gender identity comes with a subtle barb of disgust, as Nico Lang smartly observed in the Los Angeles Times.
Kansas State Senator Steve Fitzgerald, for example, stated in July that “You’re either male or you’re female, and it’s not changeable…. It’s reality. Inability to deal with that reality, or to recognize that reality, is disoriented, and can be disoriented to the point of insanity.” Tennessee House Representative Susan Lynn similarly wrote on Facebook that “[N]o one should be forced to entertain another’s mental disorder, and it is not healthy for the individual with the disorder.” To anti-trans lawmakers, transgender identity isn’t a sin — it’s an illness.
It’s clear that those who are opposed to LGBT rights aren’t following the same trends of public acceptance mapped by the Public Religion Research Institute, Pew, or other polling agencies. Acceptance by a major health organization can help kneecap spurious and bigoted policies before they have a deleterious effect on Americans. A recent study published in the Journal of Homosexualityfound that nearly half of those transgender Americans who were denied access to a restroom also attempted suicide, capturing “a distinct relationship between the stress of not being able to use bathrooms … and one’s mental health.”
By denying scientific ammunition to justify damaging and discriminatory policies, the WHO would be sending a simple message: LGBT people aren’t broken, and they sure don’t need to be fixed.