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Body Integrity Identity Disorder in the DSM, or not?
Written by Sean on Friday, August 1, 2008
As those of you who read this blog regularly know, I support the inclusion of Body Integrity Identity Disorder (BIID) in the DSM. As you also know, there are many who oppose that position. I recently read a most interesting interview with Vivianne Namaste, discussing issues of "politics" of transsexuality. Some of the things there make you think.
You can read the interview here: Addressing the Politics of Social Erasure: Making the Lives of Transsexual People Visible
First, and not related to the DSM, Vivianne describes how many of the scholars writing about transsexuality tend to focus greatly on the "identity" part of being transsexual, yet forget the experience of being transsexual. They don’t focus much on issues such as employment, access to health care, etc. In the author’s words:
[...] this work is always, and only, about identity. It limits itself to how and why transsexuals decide to live as members of the "opposite sex." Or it uses transsexuals to speak about the relations between social norms and gender identity. So what is left out of academic accounts of transsexuality is any real understanding of what everyday life is like for transsexuals. So while critics are churning out books, articles, and essays on transsexuals and the transgendered, they have nothing to say about the very real circumstances in which transsexuals live. They cannot offer us even a tiny piece of information about transsexuals and the law, or access to health care, or the struggles that transsexuals have with employment, or the situation of transsexuals in prison.
There is nowhere near as much research and published academic writing on BIID as there is on GID. The limited amount of writing about BIID means that it is difficult to identify trends. But looking at the published materials, I do see a lot of talk about identity, and medico-legal ethics, and not a hell of a lot more. Some authors seem to use BIID as a soapbox to illustrate their point on other, somewhat irrelevant to BIID, issues. This is not helped by the fact that there are no published papers by people who have BIID (with the exception of the assistance of Greg Furth on a couple of Money papers, and the Furth & Smith book). Let us keep this in mind and keep an eye out. Perhaps at some point we’ll be able to change that.
Back to the point - DSM or not? Opponents to the inclusion of BIID in the DSM say that there’s nothing wrong with having BIID. They say that it’s just a difference. With my disability rights advocate hat on, thinking "social model", I concede the point: we’re all on a spectrum, it’s not a fence, a line drawn in the sand. But still wearing that hat, I’m thinking that having a mental illness isn’t wrong, in and of itself. Yet that is the label opponents to the DSM seem to fear.
They say that homosexuality was removed from the DSM decades ago, and that transsexuals are actively advocating for the removal of GID from the DSM. Hmm, ok. The difference between homosexuality and BIID (in the context of inclusion in the DSM), is that BIID requires medical intervention to achieve peace of mind (or self-injury if medical intervention is lacking, but, the point is, if a doctor is involved, things are safer…). So, "intervention required" is a major difference.
In that, GID and BIID are similar. Whether you consider BIID a mental illness, from a medical or philosophical point of view is irrelevant. We need some sort of medical intervention if we wish to reach our goal. Same for GID. Doesn’t matter if you agree or disagree about "mental illness" status. Medical intervention (be it hormones, or surgery or both) is required for reaching the goal (that is for those transsexuals who are unhappy living at any stage of "pre-op").
Wilchins has been not only active, but instrumental, in lobbying for the de-listing of gender identity disorder from the manual of psychiatrists, the Diagnostic and Statistical Manual IV. And Feinberg also supports such a position, notably in publishing the "International Bill of Gender Rights" in her book. This Bill also contends that gender identity disorder has no place in the psychiatric diagnostic manual. If such a lobby is successful, it will mean that it will be impossible to pay for sex reassignment surgery either through a private insurance company or through state/provincial health insurance. [...] So here we have a case of some transgendered activists, influenced by social constructionist theory, who argue that they are the cutting edge of social change. Yet they are involved in political work which is deeply conservative.
[Emphasis added]
This is important. If GID is removed from the DSM, there is no reason for health insurer to pay for hormones, surgeries and other treatment.
I’m not seeking assistance or support from health insurance for my surgery. It would be nice if it was taken care of by the health insurance, yes. But that is not my goal. My goal is to receive treatment. And similarly to health insurer that can say "it’s not a defined medical condition, so I won’t pay", if BIID is not included in the DSM, doctor can say "it’s not a defined medical condition, so I won’t help".
Tags: BIID, Body Integrity Identity Disorder, DSM, GID, Surgery, Transsexual, Treatment
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11 Comments
Nothing will happen if BIID comes to the DSM. Why? Do you really think that scientists are more interested in work about BIID because it´s a part of the DSM? Never. If BIID comes to the DSM we will handeld from Blanchard as sex monster. No thank you.
3 On 1 August, 2008, Sean said:
John, glad you like the post.
Samantha, I think you are wrong. Inclusion in the DSM does not imply sexual deviance. The label John Money had given the condition, Apotemnophilia is indeed one of sexual deviance.
But Dr. Michael First saw that it is not a sexual need (for some people it is, but not for most). Not everything in the DSM is sexual in nature, far from it.
I *really* do not understand why people are so negative about being labelled with a mental illness. That, to me, tells me more about these people’s prejudices than anything else.
And yes, I really think that doctors (not scientists) will be better able to work with us once it is in the DSM. Right now, they cannot do anything at all. They have no justification, nothing to back up their assistance if they get in trouble. If BIID is codified in the DSM, then, it is seen as more “legitimate”. I believe this completely and totally.
Labeling people with a mental illness who think about themself as non ill people is paternalism. Today like Transsexuality thinking your sex or body in an other position it´s for many people a normal way of life. Body Modification, lifing in an other sex, Body painting, extreme Body Modification is s comon part of our culture. And it´s oldfashioned bringing all this free life to a medical book. So what will we read next? Abortion is a new kind of illness? No changing sex and the body is a part of our life since 20 or 30 years in a form a sub culture. I understand that transsexual people hat a good life as patients. But I think now it´s time to realise that changing sex is normal in our world and thinking.
There are some good websites about stigmasation of people by the medical community. One of them:
http://www.power2u.org/articles/recovery/new_vision.html
I agree, Sean. The inclusion of BIID in the DSM is a practical matter of some importance. The philosophical question about whether we are nuts is a different issue. I happen to think that I am nuts. It doesn’t bother me if other people think I’m nuts.
Maybe “illness” isn’t the right word. I think of my need for braces as a disability, not really an illness. Is there a difference between the two? Is “disability” even a proper word?
Often, our language puts limitations on our thinking (I wonder if this discussion would be easier in French - I think French has more adjectives than English); maybe BIIB and GID just need some new terminology.
The fact remains, though; they won’t help us if it can get them in trouble.
The reason for cosmetic seargery is also nit an illness and you get it if you want. An ill position is not a strong basis for the needed change of the opinion of conservative doctors. I swear you, if you wait until BIID is an illness you and other will be dead.
9 On 2 August, 2008, Sean said:
Bracey, whether you say “illness”, “disorder” or “condition”, we have *something*.
As for Samanta, or Stefani, or Alex, or Albrecht, or Henrik, or whatever your real name is, you tire my ass. I realise English is not your first language so you have problems comprehending the nuances of what is said. But I do wish you paid attention.
It does not matter whether we believe BIID is a mental illness or not. It does not matter if we label is a “psychological condition”. The fact is, unless it’s in the DSM, there will be no surgeons willing to assist.
What would you have us do?
BTW, people who undergo cosmetic surgery have to justify it in ways that are pretty close to what we say. See this academic paper about this topic:
http://biid-info.org/The_Rhetorical_Limits_of_the_%22Plastic_Body%22
10 On 2 August, 2008, Sean said:
Samanta, another question: What are you so afraid of? What is so scary at the idea of being labelled “mentally ill”???
BIID *MUST* be included into the DSM-V for one simple reason: to make an end to all these wrong diagnoses. So far there is much room for false diagnosis. And the only way to educate doctors is to establish an own, correct diagnosis for BIID. Second, one more important question is, what ICD-10 classification should be given to BIID? We not only need inclusion into DSM-V, but also badly need a new ICD-10 classification so doctors can make the correct diagnosis in the future. Wrong diagnosis can cause extreme damage to patients, the only way out is DSM-V inclusion and an own ICD-10 classification for BIID.
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1 On 1 August, 2008, John said:
Sean,
Excellent post and I strongly agree with you. In fact, removing something like GID from the DSM might not only take possible insurance coverage out of the picture, it might entirely remove surgical options. No accredited hospital will do that kind of surgery if no medical reason exists. Of course, that would also kill any chances for recognition of BIID as a valid condition.
As for their comparison of GID with homosexuality, in my opinion, the situation is very different. At one time the medical community attempted to treat gays–and in one case, such treatment led to the suicide of computer pioneer Alan Turing.