By Riddhi Tyagi:
Up until now, the World Health Organisation puts being transgender under the category of mental illnesses. Yes, you read that right.
This will, however, change this year when the WHO revises the current edition of the International Classification of Diseases (ICD-10), a global codebook that impacts disease diagnostic manuals the world over.
The ICD-10 came into being, way back in 1990. he WHO must soon understand the importance of how far we have come as a society and how far science, in general, has evolved. Isn’t it enraging to know that being transgender currently shares space with termed mental illnesses like paedophilia.
The plan to revise the ICD has been pushed aside time and again, first in 2012, then 2015, then 2017, and to this year. Finally, the buck stops here.
Being trans was compared to other illnesses like Bulimia and Anorexia, because of the way body conformity and realisation works. Trans people experience anxiety about the difference between their physical body and their gender identity. This is called ‘gender dysphoria’, to be more specific.
However, gender dysphoria, unlike body dysmorphia (seen in Bulimia and Anorexia) is not an illness in itself although both terms are often confused. Being trans has been attached to a mental disorder because trans people have suffered from social anxiety and depression all these years. The distress comes with attaching a certain identity to yourself, the fear of whether people will accept your identity, and the anxiety of not having certain facilities society should allow them. It comes up when ticking the ‘gender’ box on any form, when not conforming to any of the assigned pronouns, and even when going to the washroom (the ‘He’ or ‘She’ question). Shall we then tag people being themselves as an illness just because the society is at fault?
A study published Tuesday in the journal Lancet Psychiatry argues and urges for the declassification from mental illnesses. “A condition is designated as a mental illness when the very fact that you have it causes distress and dysfunction”, said Geoffrey Reed, a professor of psychology at the National Autonomous University of Mexico, a consultant on ICD-11 and co-author of the study. The study clearly states that being a transgender is not a disease.
“We found distress and dysfunction were very powerfully predicted by the experiences of social rejection or violence that people had,” he said. “But they were not actually predicted by gender incongruence itself.”
According to Reed, it’s actually the external factors which play a big role and causes all distress. “The societal stigma, the violence, and the prejudices. Remove them, and all that remains is the feeling of ‘gender incongruence’,” continued Reed.
The label proposed in ICD-11 in a new chapter called “Conditions Related to Sexual Health,” is scheduled to be medically and biologically oriented.
In 2013, the Supreme Court of India had given a direction to all Indian states to improve the conditions of transgender people in India. This community has experienced discrimination in all spheres of life be it in education, at the workplace, or for their medical needs. The transgender community in India is highly vulnerable to mental and physical illness, majorly due to lack of economic opportunities, even forcing them to engage in sex work.
Despite all appreciated efforts it is hard to say that in India the stigma is absent. In fact, as Reed points out, the external factors owing to the anxiety and distress are present all over.
For the longest time, homosexuality was included as a mental illness in The Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatric disorders guidebook. The diagnosis for the same became “sexual orientation disturbance,” in 1973. In 1987 it was completely done away with as more and more gay rights advocates spoke up. If the classification of being trans as an illness is done away with (as was done with homosexuality), a huge part of the problem would be solved.
However, Reed also explains that “The risk would be if we took conditions related to gender identity out of the classification altogether, it would undermine the access to health services that transgender people have.” He added, “They wouldn’t have a diagnostic code that conveyed eligibility.”
Therefore a lot depends on how the ICD-11 language will be out in order to not stigmatize being transgender as well as classifying the anxiety of gender identity so that trans people opting for sex-reassignment surgeries can avail the benefits.
Laxmi Narayan Tripathi, transgender rights activist, Hindi film actress and Bharatanatyam dancer. (Photo by Subrata Biswas/Hindustan Times via Getty Images)