Depathologising gender diversity in childhood in the process of ICD revision and reform

Abstract

From 2007 on, the World Health Organisation (WHO) has been revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD), with approval of ICD-11 due in 2018. The ICD revision has prompted debates on diagnostic classifications related to gender diversity and gender development processes, and specifically on the 'Gender incongruence of childhood' (GIC) code. These debates have taken place at a time an emergent trans depathologisation movement is becoming increasingly international, and regional and international human rights bodies are recognising gender identity as a source of discrimination. With reference to the history of diagnostic classification of gender diversity in childhood, this paper conducts a literature review of academic, activist and institutional documents related to the current discussion on the merits of retaining or abandoning the GIC code. Within this broader discussion, the paper reviews in more detail recent publications arguing for the abandonment of this diagnostic code drawing upon clinical, bioethical and human rights perspectives. The review indicates that gender diverse children engaged in exploring their gender identity and expression do not benefit from diagnosis. Instead they benefit from support from their families, their schools and from society more broadly.

Trans health care from a depathologization and human rights perspective

“…Over the last few years, the demand of depathologizing gender diversity in childhood and adolescence has achieved an increased relevance in trans depathologization activism [1,2,28,30,33,[54][55][56][57][58][59][60][61][62][122][123][124][125], including the following demands: (1) removal of the diagnostic classification of gender diversity in childhood from DSM and ICD; (2) support to gender diversity in childhood and adolescence in the family, social, school, and health care context; and (3) legal gender recognition for children and adolescents.…”

“…Regarding the diagnostic classification of gender diversity in childhood, various international and regional activist networks published declarations demanding the removal of the diagnostic code "Gender incongruence of childhood" from ICD, and trans authors and allies contributed critical theoretical reflections on the diagnostic classification of gender diversity in childhood in the DSM and ICD [1,2,28,30,33,[54][55][56][57][58][59][60][61], preceded by critical reflections elaborated over the last decades [20,21]. This demand also received the support of clinicians and researchers [62] and European bodies [90,91].…”

“…Among the main arguments in favor of removing the diagnostic code, trans authors and allies highlight the lack of clinical utility, the Western character of a conceptualization of gender diversity in childhood as a problem that requires health care, the potential stigmatizing effect, and a contradiction between a removal of diagnostic codes related to sexual orientation and the maintenance of the Gender Incongruence of Childhood code [1,2,20,21,28,30,33,[54][55][56][57][58][59][60][61][62]. Furthermore, the critical discourses counter reasons contributed by the defenders of the diagnosis [126,127], arguing that a specific diagnosis for gender diverse children is not necessary for covering psychological support, justifying access to puberty blockers, or promoting research and training [1,2,20,21,28,30,33,[54][55][56][57][58][59][60][61][62].…”

Ungodly Genders: Deconstructing Ex-Gay Movement Discourses of “Transgenderism” in the US

“…Scholarship on scientific cisgenderism investigates biological, sexological, sociological, psychological, and other invalidating discourses. Scholars have shown how science is an ideology that reifies the sex/gender/sexuality system (Fausto-Sterling 2012;Laqueur 1992;Lorber 1993) and how scientific cisgenderism is used to pathologize (Ansara and Hegarty 2012;Butler 2006;Lev 2006;McGann et al 2011;Serano 2007Serano , 2010Schwend et al 2018;Winters 2009), dehumanize (Bettcher 2013), and disenfranchise (Greenberg 2006) transgender people. A recent survey (Clark and Jackson 2018) on global attitudes shows that among Western countries, US-Americans are the most likely (32%) to believe that transgender people are mentally ill. Further, among all 27 countries surveyed, US-Americans are the most likely (36%) to say that society has "gone too far in allowing people to dress and live as one sex even though they were born in another" and the most likely to believe (32%) that transgender people "are committing a sin".…”

“…This is especially concerning for minors, and others who have the least control over religious, medical, and legal decisions made on their behalf, often without their assent. The World Health Organization's recent decision to remove "gender dysphoria" from the ICD-11 is encouraging but does not allay concerns (Schwend et al 2018;Mallory et al 2018) about youth subjected to "change" attempts by counselors. In most countries (including a majority of the US), such "therapies" are not proscribed by law or professional mental health associations.…”