An article published last week by The Lancet Psychiatry reported on the outcomes of the field study performed in Mexico on the proposed category of Gender Incongruence.1 Those outcomes provide clear evidence-based confirmation: trans-related categories must be removed from the ‘Mental and behavioural disorders’ chapter in the International Classification of Diseases.
That has been precisely the historical position held by trans activists, organizations and networks during the last decade.2-4 The celebration of this achievement must be accompanied, however, by some critical reflections on the following issues:
- Good news for trans adolescents and adults should not make anyone forget that in the context of the same process of ICD revision and reform, WHO is proposing the category of Gender Incongruence of Childhood (GIC) for pre-pubertal children. Trans activists, organizations and networks, health researchers and providers, as well as human rights institutions, firmly oppose the introduction of GIC in ICD-11.5-12 As previously affirmed, that category is not only unnecessary, but also dangerous: it perpetuates the pathologization of gender identity, gender expression and bodily diversity in childhood and justifies so-called reparative therapies. Gender diverse children – and all children exploring their identities, expressions and sexualities – and their families can be adequately supported without the need of pathologizing categories.
- Trans activists, organizations and networks involved in the ICD reform process not only demand trans-related categories to be placed outside of the ICD’s ‘Mental and behavioural disorders’ chapter, but also call for dismantling all forms of stigma, discrimination and violence associated with mental illness.13, 14 Being and expressing ourselves is not and should not be considered a disorder; however, mental health issues – including access to adequate and affordable mental healthcare – are still a key issue for our communities worldwide. Human rights violations against trans people and their impact on our mental and physical wellbeing deserve to be critically addressed by WHO and other international institutions.
- Access to healthcare, including gender-affirming healthcare, is a human rights issue.15 Limitations imposed by private systems, including insurance companies, must not become an uncontested reality. Worryingly, that has been the approach of some experts involved in the process, and of some mainstream media covering it. This approach not only naturalizes and endorses the corporativization of health. It also invisibilizes the situation of those who are routinely excluded from access to healthcare by a system that makes profits out of diagnosing people and that selectively chooses which diagnoses to cover based on perceptions of profitability.
Good news about the field study in Mexico doesn’t mean that the ICD revision and reform process is over. We are confident that the remaining field studies, as well as the reports on the legal and policy implications of the ICD reform, will reveal the same evidence-based compatibility with trans people’s human rights. However, the final ICD draft still has to be completed, and it has to be voted on by the World Health Assembly in 2018. Much work remains to be done – and this is the right time to join us doing it.
We call on WHO, international and regional institutions, as well as media, donors and allies, to acknowledge the tireless efforts of trans activists, organizations and networks in this process; to join our struggle against exclusionary medico-legal classifications and to recognize the urgency of trans depathologization as it is a long overdue human rights imperative.
References
1 Robles R, Fresán A, Vega-Ramírez H, Cruz-Islas J, Rodríguez-Pérez V, Domínguez-Martínez T, Reed GM. Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. The Lancet Psychiatry 2016, July 16. http://dx.doi.org/10.1016/ S2215-0366(16)30165-1
2 GATE, Global Action for Trans* Equality. It’s time for reform. Trans* Health Issues in the International Classifications of Diseases. A report on the GATE Experts Meeting. The Hague, November 16-18, 2011. Available from: https://globaltransaction.files.wordpress.com/2012/05/its-time-for-reform.pdf
3 STP, International Campaign Stop Trans Pathologization. Reflections from STP regarding the ICD revision process and publication of the DSM-5, 2013. Available from: http://stp2012.info/STP_Communique_August2013.pdf
4 TGEU, Transgender Europe. TGEU’s Position on the revision of the ICD 10, 2014. Available from: http://www.tgeu.org/sites/default/files/TGEU%20Position%20ICD%20Revision_0.pdf
5 GATE, Global Action for Trans* Equality. Critique and Alternative Proposal to the “Gender Incongruence of Childhood” Category in ICD-11. GATE Civil Society Expert Working Group Buenos Aires, April 4-6, 2013. Available from: http://globaltransaction.files.wordpress.com/2012/03/critique-and-alternative-proposal-to-the-_gender-incongruence-of-childhood_-category-in-icd-11.pdf
6 STP, International Campaign Stop Trans Pathologization. STP Press Release: International Day of Action for Trans Depathologization 2015, October 24, 2015. Available from: http://www.stp2012.info/STP_Press_Release_October2015.pdf
7 TGEU, Transgender Europe. TGEU calls upon WHO to support gender variant children, not label them as “sick”, October 24, 2015.
8 Gender DynamiX. Cape Town Declaration Gender Incongruence in Childhood, 2014. Available from: http://www.genderdynamix.org.za/wp-content/uploads/2014/07/Cape-Town-Declaration_29-July-2014.doc
9 ILGA-Asia. Statement on Gender Incongruence in Childhood, October 27, 2015. Available from: http://ilga.org/the-ilga-asia-trans-pre-conference-statement-on-gender-incongruence-in-childhood/
10 ILGA World, Statement on Gender Incongruence in Childhood, 10 May 2016. Available from: http://ilga.org/what-we-do/gender-identity-and-gender-expression-program/gender-incongruence-childhood/
11 Winter S, Ehrensaft D, Pickstone-Taylor S, De Cuypere G, Tando D. The psycho-medical case against a gender incongruence of childhood diagnosis. Lancet Psychiatry 2016;3(5):404-405.
12 Cabral M, Suess A, Ehrt J, Seehole TJ, Wong J. Removal of a gender incongruence of childhood diagnostic category: a human rights perspective. Lancet Psychiatry 2016;3(5):405-406.
13 Suess A, Espineira K, Crego Walters P. Depathologization. TSQ, Transgender Studies Quarterly 2014; 1(1-2):73-77.
14 Cabral M. Desvelos (notas desveladas sobre la patologización de la transexualidad). El Teje 2009;5:3. Available from: http://www.rojas.uba.ar/img/libros/el-teje/teje_05.pdf
15 Theilen, J.T. (2014). Depathologisation of Transgenderism and International Human Rights Law. Human Rights Law Review 14(2):327-342.