The world is obsessed with taxonomies, I told myself upon reviewing some of the Diagnostic and Statistical Manual – Fifth Edition (DSM-5) diagnoses. The American Psychiatric Association (APA) revamps and republishes its “bible” about every 20 years. The dubious, new edition will apparently appear in 2013.
People must find it soothing to categorise things. It makes a chaotic world simple to understand, to interpret and to analyse. What can be more precious than a framework to view things through? It abolishes nuance, ambiguity and uncertainty. Of course there is always the fallback category – Not Otherwise Specified. An old office joke goes something like this: a document marked “do not file” is filed in the Do Not File file.
The catch-all approach works well for only certain demographics within certain periods and the taxonomy is also mostly congruent with socially acceptable practice.
This exact notion and enunciation may explain my aversion for structure and total lack of obsession with organised environments. My tax files are somewhere. I’ll find them but don’t ask me to. As a bean-counter I cannot think of anything more laborious and heinous than filing something while at home. I do not care for unexpected traffic congestion, it brightens the scenery. It gives me time to look at my surroundings, whereas we would just normally drive mechanically on the same highways without ever noticing interesting things along the way.
If you think you are completely unaffected by taxonomies, think again. Everything from the law to art to Medicine is neatly categorised. Medicine made criminals of people, and to this day where criminality has been waived the social implications, ramifications and stigma still remain and these do have the uncanny ability to influence every aspect of your life right down to economics.
Medical taxonomy decides how your doctor will treat you, or mistreat you, depends on the doctor. Classifications imply certain things and impose a set of features on your personality, which might otherwise not have been there. An official (though unwarranted) diagnosis might mean you cannot get that apartment. It might mean that you could be fired from your work. It might mean you could be harassed, defamed, assaulted and killed. One only needs to look at Uganda, Jamaica, Iraq and Iran as worst case scenarios.
Before 1973, homosexuality was in the DSM, which basically made all lesbian, gay and bisexual people mentally ill and in many societies, criminals. The APA declassified homosexuality as an illness and now goes a step further and clearly states that conversion therapy/reparative therapy (pray-away-the-gay) is unfit for medical practise and causes much harm.
While the DSM might prevail over America, the rest of the world uses the World Health Organisation’s (WHO) International Statistical Classification of Diseases and Related Health Problems - 10th revision, or more commonly known as the ICD-10. The current tenth version does not contain “homosexuality” as a mental illness effective from 1990. In fact the current text of the ICD-10 explicitly states “sexual orientation by itself is not to be regarded as a disorder” at the introduction to F66 (Psychological and behavioural disorders associated with sexual development and orientation).
While the steps taken by the APA and WHO are definitely beneficial to a large number of socially rejected individuals it still to this day stigmatises and vilifies transgender, transsexual and other gender variant individuals. The ICD-10 includes Gender Identity Disorder (GID) as elaborated on in section F64. The DSM-5 seems to be no more progressive and classifies GID in section 302.85 - Gender Identity Disorder in Adolescents or Adults.
The ongoing work on the DSM-5 was and still is not without criticism and controversy. It was reported that 70% of members on the DSM-5 task force have clear conflict of interest being puppets of Industry. The DSM-5 is also marred by the appointment of Kenneth Zucker and Ray Blanchard. Dr. Zucker is infamous for utilising reparative therapy to cure gender-variant children. Dr. Blanchard conjured up a derisive diagnosis called Autogynephilia which further vilifies transgender people and classifies some as having a paraphilia (sexual perversion). How uncanny is it that these two are responsible for things related to Gender Identity Disorder? Uncanny is perhaps better replaced by abhorrent.
There was a petition to remove the two “esteemed” doctors from the task force and another article Bitterness, Compulsive Shopping, and Internet Addiction - The diagnostic madness of DSM-V by Christopher Lane ridicules the propositions in the DSM:
The American Psychiatric Association risks losing sight of that distinction by grimly—and rather inexpertly—debating whether avid shopping should be considered a sign of mental illness. The fifth edition of the association's Diagnostic and Statistical Manual of Mental Disorders is expected in 2012. The APA isn't just deciding the fate of shopaholics; it's also debating whether overuse of the Internet, "excessive" sexual activity, apathy, and even prolonged bitterness should be viewed, quite seriously, as brain "disorders." If you spend hours online, have sex more frequently than aging psychiatrists, and moan incessantly that the federal government can't account for all its TARP funds, take heed: You may soon be classed among the 48 million Americans the APA already considers mentally ill.
Also take into account that the whole process of drafting the DSM-5 is cloaked in secrecy as members of the task force had to sign a nondisclosure agreement. Robert Spitzer, the head of the DSM-III task force went mad at learning about this and said: “When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you’re going to have people complaining all over the place that they didn’t have the opportunity to challenge anything.”
Do you trust a process and an imminent publication like this?
The only positive is the input by Dr. Drescher according to the New York Times:
Dr. Jack Drescher, a New York psychoanalyst and member of the sexual disorders work group, said that, in some ways, the gender identity debate echoed efforts to remove homosexuality from the manual in the 1970s.
“You had, in my opinion, what was a social issue, not a medical one; and, in some sense, psychiatry evolved through interaction with the wider culture,” Dr. Drescher said.
France is leading the way by declassifying transgenderism as a mental illness.
One might say that South African law protects us from discrimination brought on by these taxonomies, but neither section 9 of the Bill of Rights nor The Promotion of Equality and Prevention of Unfair Discrimination Act explicitly mentions gender identity as a prohibited discrimination criterion, it is inferred or implied via gender. This needs to be rectified.
You see, the cosmic irony is that taxonomy might stigmatise and vilify you but another is necessary to protect basic human rights of equality and dignity. Could taxonomies be a shining example of a necessary evil?