Well, what do you know!
After considering all the various comments to the DSM-V proposals, the experts have decided to keep the Transvestic Fetishm category. Autogynephilia (being aroused by the idea of being a woman) remains in the next version of the American psychiatric manual -- at least for the time being.
"In a Controlled Environment: This specifier is used if the individual is in an environment where access to alcohol and controlled substances is restricted, and no criteria for Dependence or Abuse have been met for at least the past month. Examples of these environments are closely supervised and substance‐free jails, therapeutic communities, or locked hospital units."
However, the committee has clearly found that having a diagnosis limited to men only, is politically incorrect. So, lo and behold, the experts are now willing to concede that there are also female to male crossdressers. Autoandrophilia (the love of oneself as a man) has been added to the list of transvestic disorders.
In a sick way, I guess you could call this progress. My dear autoandrophile brothers, you are now also to be considered perverts!
In remission
The experts have also added two more modifiers, where the doctor is to specify whether the condition is in remission or in a controlled environment.
ACH over at the Asexual Explorations Blog argues that "paraphilia in remission" could mean that someone need not actually meet criteria A and B to receive one of these diagnoses:
"I suspect that this specifier will encourage people to ignore the actual diagnostic criteria."
Maybe, but it could also mean that you would include people who have displayed signs of crossdreaming before. You could say that this would mean that you would remain a "pervert" even if you no longer display signs of your "perversion", so you would remain a "pervert" in the eyes of the doctors forever.
However, this does not make much of a difference, as there is no cure for crossdreaming. Sure, crossdressers can stop crossdressing, but he or she cannot stop crossdreaming. Hence, a lack of signs and symptoms mean zip, nada, nothing, unless -- of course -- your goal is to suppress behavior and not to help the client live a better life.
I believe the text "in a controlled environment" points to situation where the individual is an environment where he or she cannot express his or her crossdreaming.
It does not say so in the text, but I found the following reference to the phrase from the DSM-IV.
"In a Controlled Environment: This specifier is used if the individual is in an environment where access to alcohol and controlled substances is restricted, and no criteria for Dependence or Abuse have been met for at least the past month. Examples of these environments are closely supervised and substance‐free jails, therapeutic communities, or locked hospital units."
How a crossdresser or crossdreamer ("autogynephiliac/autoandrophiliac" in this terminology) is to live in a controlled environment is beyond me, unless -- of course -- some of these doctors continue to believe that you can cure crossdressing and crossdreaming with aversion therapy and forced isolation.
Crossdreaming cannot be cured. It is part of the hardware, not the software. Blanchard knows this, so it seems to me that he has been run over in the committee by someone who is more conservative than he is.
Crossdressing as top category
The fact that "transvestic disorder" remains the top category, while fetishism, autogynephilia and autoandrophilia are subcategories also shows us that Blanchard has lost his struggle to make autogynephilia (or whatever the new sex neutral term will be) the top category.
There is even a new tab with a questionnaire helping the doctor to determine the severity of the condition. They are all about crossdressing.
As I have said before, the current text means that people like me -- crossdreamers who do not crossdress -- are not covered by the text. That is plain out silly, and makes no sense scientifically.
I am unhappy about much of what Blanchard has written, but what is really valuable in his research is the fact that he has been able to show that crossdressing is just one of many expressions of an underlying condition. This underlying condition -- which I call crossdreaming -- does not alway lead to crossdressing.
What is clear from all of this is that we have a committee where several members do not understand the complexity of the issue at hand. If they had followed Blanchard's lead the text would at least have been coherent. Now it reflects an insane mix of various view points and approaches.
Even if you do believe that crossdressing and crossdreaming are categories that should be included in such a manual (which I don't) you should at least expect that the experts who write the criteria to be able to deconstruct their own text and make it logical.
What a mess!
Here is the text as it stands now.
A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving cross‑dressing.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)
With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)
With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)
Specify if:
In Remission (During the Past Six Months, No Signs or Symptoms of the Disorder Were Present)
In a Controlled Environment
All of which goes to show that psychology and psychiatry are nothing more than politics masquerading as science.
ReplyDeleteMy interpretation of the "in remission" part is that if someone has ever met criteria A and B, they have the "disorder" rather than only if someone presently meets both criteria A and B. Of course, the only way you can say someone who presently does not meet criteria A and B meets the diagnosis is by ignoring the actual text of it. On this point, I think we are in agreement, but I hadn't expressed myself clearly enough on my blog.
ReplyDeleteI take "in controlled environment" to refer to people in prison and people in psychiatric hospitals--that way, the paraphilias are by definition incurable. This would support the pretextual way they are used in sexually violent predator commitment.
The "in remision" bit seems to reflect something the Blanchard said in Literature Review on transvestic fetishism:
there are many men who report that crossdressing was once sexually arousing but that it has ceased to be so, and these reports may be accurate (especially if one holds a narrow view of erotically motivated behavior as behavior that is necessarily accompanied by penile erection). The DSM-III phrase at least initially in the course of the disorder avoided the absurd possibility that a man could outgrow the diagnosis of transvestism in later life simply by failing to experience (or attend to) sexual excitement when he cross-dresses. This was a more nuanced formulation than that used in later versions of the DSM.
He suggests keeping the diagnostic criteria the same, but making a comment in the supporting text that would contradict the diagnostic criteria.
@Christine
ReplyDeleteActually, all science has its own politics and all scientists are -- like the rest of us -- normal human being with their own agendas. But good scientists are aware of this and make use of the scientific method to counteract such tendencies. In this case, they fail completely.
@ACH
Thank you for this clarification. It is very useful.For a process that is supposed to be transparent, open and inclusive, I must say the texts are amazingly hard to interpret for outsiders.
For a process that is supposed to be transparent, open and inclusive, I must say the texts are amazingly hard to interpret for outsiders.
ReplyDeleteThis is a really huge problem given the fact that the DSM is supposed to be useful for educational purposes.
Hi there
ReplyDeleteJust wanted to say how brilliant I think your blog is Jack and to plug my own blog which I set up the other day. I've also adopted the term 'crossdreamer' if that's ok with you.
My blog will be some of my own personal musings on the nature of autogynephilia as well as just a place for me to store my links.
I will likely be commenting on some of your posts here in my own blog and referencing some of your posts if you are comfortable with that - particularaly issues such as the Shy Male which I found really interesting.
Cheers
Atari Tiger (Tina)
Please tell me how a woman can cross dress if women in general are allowed to dress in any form they wish without an identified of gender. What identifying article of clothing would a women wear that would categorize her as a crossdresser? WOW! Talk about being politically correct.
ReplyDeleteSean again, have to get a Google account, in response to Oran.
ReplyDeleteIt may take a woman a bit more effort to crossdress, but it is hardly impossible. Use of fake beards/mustaches are a common signifier, specific selections that are far more common on men even if available to women, gestures and voice choices common to men. Hair cuts and stances are common ways to alter a gender perception. Habits like cigar smoking or tobacco chewing are often done in gender specific ways.
The point is that a man can easily be determined to be attempting to adopt another gender role strictly on clothes, for women, crossing the gender line requires dressing the part AND adding in some other signifier. The therapists and researchers are missing the point if they focus on the clothes to the exclusion of the adoption of other signs of another gender's role.
Go to a drag king show or watch Wild Orchid to see some examples of both poorly done and well done gender crosses by women. Hell watch some daytime talk shows, the topic comes around a couple times a year.
Jack,
ReplyDeleteAre you trying to say that there is no one who is extremely sexually turned on by wearing women's clothes? And that they are sexually excited so much and so often that it cripples or destroys their life? The same thing applies to autogynephilia or crossdreaming... What if it is so intense that it seriously screws up their life?
It seems to me as though men who crossdress or crossdream and have no intense, overwhelming, sexual issues that screw up their social or emotional life have no place at all in the DSM...
"Are you trying to say that there is no one who is extremely sexually turned on by wearing women's clothes? And that they are sexually excited so much and so often that it cripples or destroys their life? "
ReplyDeleteNope. There are those for whom crossdreaming becomes crippling. But I guess that is what might happen if you are left no natural outlet for your sexualty or your real identity. But if this is the case, it is not crossdreaming that IS or causes the disease, but the lack of recognition, understanding and respect.
This whole topic is ver sad. The real problem is that psychiatry is masquerading as a science. Their is little scientific about it. If cross dressing is a disease or disorder then what is the cure? Doctors are supposed to make people better when they are sick. Psychiatrists do nothing of the sort. They are a sad joke and pathetic by definition. I cross dress full time as a girl, I am happy, well adjusted, have a good job and a loving partner. By what definition am I mentally ill?
ReplyDeleteBlanchard is the type of researcher that is good at categorization. There is nothing wrong in that. Good science requires a thorough discussion of typology. The problem is twofold: (1) He never questions the underlying premise: Deviation from the norm is bad. (2) He never really tries to explain what causes the condition, nor does he have any suggestion for therapy.
ReplyDeleteMy understanding is that prettymuch all DSM disorders have some kindof '...and the disorder must cause significant disruption to the person's wellbeing and/or ability to work' disclaimer included as part of the diagnosis.
ReplyDeleteSo basically if it's not a problem to you, then it won't meet the medical community's definition of a medical problem.
But like Robyn P touched on: for some rare people the effect on their lives could indeed somehow be THAT bad, and for those rare cases the medical establishment is willing to help.