Wednesday, July 28, 2010

Dr. Kelley Winters Keynote Speech.

Here is the keynote speech Dr. Kelley Winters delivered at the Colorado Gold Rush Conference in Denver earlier this year.

A little about Dr. Winters from the TYFA website

Dr. Kelley Winters is a writer and community advocate on issues of transgender medical policy. She is the founder of GID Reform Advocates, member of the World Professional Association for Transgender Health, and Advisory Board Member for the Matthew Shepard Foundation and TransYouth Family Allies. She has presented papers on the psychiatric classification of gender diversity at annual conventions of the American Psychiatric Association, the American Psychological Association, the American Counseling Association and the Association of Women in Psychology. Her articles have appeared in a number of psychology and psychiatry journals and in two books.

Kelley assisted in drafting the current human rights ordinances in Boulder and Denver, Colorado. She was instrumental in trans-positive reform of Colorado drivers license policy in 2006 and in adding Gender Identity and Expression to employment policies of the Hewlett-Packard Company. Kelley received the Colorado Pride Award from Equality Colorado in 1999 and the and 2002 Sonja’s Dream Lifetime Achievement Award and 2007 Melissa Chapman Award for Social Change from the Gender Identity Center of Colorado.

Dr. Winters also authors the GID Reform weblog which can be found here.

Gender identities and gender expression that differ from expectation of assigned birth sex remain very much classified as mental disorder and sexual deviance by the American Psychiatric Association. The consequences of this undeserved stigma to our human dignity, social legitimacy in our affirmed roles are enormous and devastating. We lose our jobs, our homes, our families, our children, our civil justice and our access to medical care to defamatory stereotypes that place an unfair burden of proof upon all gender transcendent people to continually demonstrate our sanity, our competence and our human worth.

The current diagnostic criteria of GID and TF describe transition itself as symptomatic of mental illness, especially so for gender nonconforming children and transwomen. This burdens our supportive medical and mental health providers to re-spin, to repackage, this flawed nomenclature as congruent with social and medical transition, when in fact it was written to contradict transition. As a consequence, only a privileged portion of us who need access to hormonal and/or surgical care are afforded access. Worse yet, trans youth and even adults remain subject to psychological gender reparative and cruel aversion "therapies" intended to shame affirmed gender identities into dark and solitary closets.

The Fifth Edition of the DSM is scheduled for publication by the American Psychiatric Association in 2013. It is the first major revision since 1994. Critical decisions for the diagnostic categories and criteria have already been considered, and the DSM-5 work group authoring the sex and gender categories was sadly stacked to favor bias intolerant of gender diversity. After a period of unprecedented secrecy, draft language for proposed gender diagnoses were disclosed on February 10^th for a period of public review and comment through April 20.

This is a pivotal point in the history of our community, as the DSM-5 will likely impact the lives, civil liberties and medical care of all gender-transcendent people through the 2020s.

In spite of the barriers that we face with mental health policymakers, I have hope for positive change in the DSM-5. The proposed Gender Incongruence diagnoses for adults, adolescents and children (formerly called Gender Identity Disorder) represent some forward progress on both issues of stigma and barriers to medical transition care-- the first forward progress that we have seen in 30 years of DSM revision.

Most significant, is a statement of explanation by the subcommittee that for the first time refutes the false myth of "disordered" gender identity:

"We have proposed a change in conceptualization of the defining features by emphasizing the phenomenon of 'gender incongruence' in contrast to cross-gender identification per se"

This clarification that diverse gender identities are not in themselves the focus of mental pathology is historically unprecedented, since the introduction of Transsexualism to the DSM in 1980. This statement alone provides a powerful educational tool to advocates for our community.

Moreover, the proposed Gender Incongruence category for children has been reformed so that children must show dissatisfaction with birth-sex assignment to meet the criteria and can no longer be diagnosed strictly on the basis of gender role nonconformity. Again, this is an unprecedented step forward for kids who transition in their social roles and for gender nonconforming kids who are not trans but were pathologized in the past.

However, much work is needed to clarify these new criteria so that they do not continue to diagnose difference. For example:

* "Incongruence" is not clearly defined to mean incongruence as experienced by the subject. It could still be misrepresented to mean nonconformity to cultural gender stereotypes.

* The new criteria have retreated from clinically significant distress as a focus of diagnosis, which supports the medical necessity of treatment.

* Ambiguous language continues to misrepresent transition and desire for medical transition care as symptomatic of mental illness.

* The offensive term "Disorder of Sex Development" is used to describe people born with intersex conditions.

* For children, nonconformity to anachronistic gender stereotypes is still emphasized as symptomatic of mental disorder.

* These categories are placed in the DSM section of Sexual Disorders, though describing emotions and behaviors that are not necessarily sexual.

In spite of these, I am for the first time optimistic that the DSM subcommittee authoring these Gender Incongruence diagnoses may be willing to listen to our concerns for more positive reform.

I believe that we stand at our own inflection point in the history of an affirming trans movement, one that our youth in this room will look back upon as adults.

As brothers and sisters in the community, as parents and allies, as medical and mental health providers, please lend your attention and your voices to issues of social stigma and transition medical care access that are rooted in these mental health policy decisions.

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