Transexuality is not a disease Calling for the
elimination of transexuality from the DSM and ICD
We, as participants of the Latin American Regional Dialogue on Sexuality and Geopolitics that took place in Rio de Janeiro (Brazil) from August 24th-26th 2009, wish to join efforts with the international campaign Stop TransPathologization 2012, and to this end, we put forth the following statement:
In 2012, the American Psychiatric Association (APA) will publish the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This document, as it is written today, describes transexuality as a ‘disorder of gender identity.’ This definition has been adopted by the Code of Diseases (ICD).
The pathologization of transexuality is based on the assumption that genders are determined by body dimorphism; the absence of a penis and the existence of a vagina are considered the necessary conditions for female gender identity, while the presence of a penis is considered a guarantee of male gender identity. This determinism – supported by a system of medical knowledge and power that produces and deploys hegemonic discourses on sex and gender – provides the foundation for public health and human/civil rights policies that determine which people are recognized as human. The conception of humanity determined arbitrarily by the medical community violates the right to identity and to the social recognition of diversity.
The practice of producing supposedly ‘healthy genders’ – through surgical interventions, hormone therapies, and psychiatric or psychological treatments – is widespread in those countries where the medical establishment is particularly powerful. The scientific validity of the medical premises on which these procedures are based has been highly contested. The level of arbitrariness of this medical knowledge becomes evident in light of the deep conceptual changes implied by the changing psychiatric nomenclature used in each new edition of the DSM, particularly with regard to ‘sexual and gender identity disorders.’
Human Rights abuses against intersex persons
The subordination of gender identities to the assertions of medical science continues to produce irreversible damage to persons, whose autonomy is violated when they are subjected to early medical interventions aimed at appeasing societies’ gender normalizing anxieties. Every day, boys and girls born with genitals that – on the basis of medical assumptions – are considered ‘atypical’ are submitted to surgical procedures aimed at ‘correcting’ their appearance; it is assumed that ‘normal genitalia’ promote and sustain the formation of ‘healthier’ gender identities.
This medical assumption is not valid. In response to these medical interventions, citizens of a wide range of countries have organized and mobilized to denounce the human rights violations to which they have been subjected and to call for the abolition of surgeries performed without the informed consent of those who are submitted to them. Because this medical practice is inconsistent with human rights principles, particularly the rights of children, a number of countries, including Somalia, have signed UN documents that aim to balance parens patriae (rights of parents) with the rights of children to autonomy and dignity. The United States has not signed these documents; it has favored the rights of parents to the detriment of the rights of children.
Human Rights abuses against transexual persons
The diagnosis of transexuality is another legacy of this longstanding history of naturalizing sexual and gender identities. We contend that many gender expressions and a multiplicity of ‘femalenesses’ and ‘malenesses’ exist. What are the indicators used to define who is or is not ‘gender-normal?’ Who are the so-called ‘gender-impaired?’ The DSM and ICD, in their roles as ‘legitimate systems’ of medical nomenclature, reproduce patterns of violence, even when their classifications lack legitimating scientific evidence. They create normative parameters that guide states, as well a wide range of experts — medical doctors, psychologists, psychiatrists, judges, social workers and teachers – in their decisions about who can or cannot be fully recognized as a citizen. When transsexual- and transgender-identified people decide to go through the complete sex-assignment processes, which includes surgery, they are subject to medical protocols that restrict their autonomy and expose them to humiliating circumstances. They are submitted to a number of mandatory procedures based on the assumption that they cannot make their own decisions on matters related to their life and that their ‘disease’ compromises their self-determination. Transexuality, as expressed and lived by transsexual persons and travestites, is not a disease or disorder. It is an identity that calls into question our understanding of what gender is and opens up opportunities for greater recognition of individuality. The de-pathologization of transexuality does not prohibit states from financing the various stages of sex reassignment. When transexuality is no longer considered pathological, states should still ensure health care for this population. We advocate for equal and universal access to the highest standard of health as a non–negotiable right of all persons. It is important to emphasize this dimension because a false polemic has developed in recent years that if transexuality were to be excluded from the DSM and ICD, states would deny funding for medical procedures related to sex reassignment. Our position is that when people want to undergo procedures to adjust their bodies to match their gender identities, states must support their rights to access required medical care.
Medical models of human sexuality have been marked by theoretical inconsistencies and have legitimated dehumanizing practices. History has already taught us that biomedicine has not been able to confine homosexuality to the boundaries of the disease model. Homosexuality is increasingly recognized as an expression of diversity in human sexuality. We, the participants of the Latin American Regional Dialogue on Sexuality and Geopolitics, demand that the APA fully revise its non-scientific and unethical positions on transexuality, which have created a medical and legal scenario that is inconsistent with the full citizenship of all persons, regardless of their sexuality and gender identity.
To preserve the diagnoses of ‘gender disorder’ and ‘gender dysphoria’ is to continue to feed an exclusionary system. Additionally, it is the state’s duty to redress human rights violations perpetrated by the medical establishment by providing medical and legal support to the affected populations. This includes the changing of names and civil identities independently of compulsory surgeries, other medical procedures and psychiatric diagnoses, in cases of both transexuality and intersexuality. We call for:
- The immediate elimination of transexuality from international manuals of medical diagnosis.
- Full public funding for sexual and gender reassignment for all persons who decide to undergo the procedure.
- The immediate abolition of surgeries aimed at ‘correcting’ the gender of intersex children and the adoption of international medical protocols to protect their rights.
The undersigned
See the undersigned
1. Adriana Vianna (UFRJ, Brazil)
2. Ana Paula da Silva (USP, Brazil)
3. Anibal Guimarães (ENSP/Fiocruz, Brazil)
4. Corina Rodriguez Enriquez (CIEPP, Argentina)
5. Elias Vergara Mayer (IEAB, Brazil)
6. Fabíola Cordeiro (CLAM/UERJ, Brazil)
7. Franklin Gil Hernandez (Universidad Nacional de Colombia)
8. Gabriel Gallego Montes (Universidad de Caldas, Colombia)
9. Gloria Careaga (UNAM, Mexico)
10. Jandira Queiroz (SPW/ABIA, Brazil)
11. Jane Russo (IMS/UERJ, Brazil)
12. Jaris Mujica (Pontifícia Universidad Católica del Peru)
13. Juan Carlos Raxach (ABIA, Brazil)
14. Lohana Berkins (ALITT/Cooperativa de Trabajo Nadia Echazú, Argentina)
15. Lucy Esquivel (RedTraSex, Paraguay)
16. Mara Viveros
17. Marcela Romero (RedLacTrans, Argentina)
18. Maria Elvira Benitez Dias (CLAM/UERJ, Brazil)
19. Maria José Rosado-Nunes (CDD, Brazil)
20. Maria Luisa Heilborn (CLAM/UERJ, Brazil)
21. Maria Mercedes Gómez (St. Mary’s University, Canada)
22. Marina Maria (SPW/ABIA, Brazil)
23. Mario Pecheny (Argentina)
24. Oscar Ugarteche (UNAM, Mexico)
25. Prof. Dr. Fermin Roland Schramm (ENSP/Fiocruz, Brazil)
26. Profª Dra. Heloísa Helena Gomes Barboza (Faculdade de Direito/UERJ, Brazil)
27. Profa. Dra. Berenice Bento (Universidade Federal do Rio Grande do Norte, Brazil)
28. Rafael de la Dehesa (City University of New York, EEUU)
29. Regina Facchini (PAGU/Unicamp, Brazil)
30. Rogério Diniz Junqueira (INEP/MEC, Brazil)
31. Rosa M. Posa Guinea (IGLHR, Paraguay)
32. Rulian Emmerick (UFRJ, Brazil)
33. Sonia Corrêa (SPW/ABIA, Brazil)
34. Tamara Adrian (Adrian & Adrian Abogados, Venezuela)
35. Thaddeus Blanchette (UFRJ, Brazil)
36. Vagner de Almeida (SPW/Columbia Universtity Secretariat, Brazil/EEUU)
37. Veriano Terto (ABIA, Brazil)