The International Statistical Classification of Diseases and Related Health Problems (ICD) is a tool created by the World Health Organization (WHO) in order to do transversal reports on how health systems work. It has been useful to compare and see where resources are invested. In the document each analysis has a code that it has allowed to know, for example, how while a country develops, increases the obesity of its inhabitants.
When in 1977 the transsexualism was included as a mental disorder to describe the persons that do not identify with their assigned sex at birth, this international classification became in a dreadful document for trans persons.
Rodrigo Sierra, the adolescent psychiatrist from Espacio Seguro affirms that these classifications are very important in his specialty to know when a behavior is or not a disorder. For this reason, that the transsexuality exit from the criteria for diagnosis of mental diseases for him means that be transgender do not deserve any psychiatric diagnosis.
“From the theoretical, I consider that is a progress”, affirms, especially for the prejudices that the mental health have. “The fact that is out of mental illness takes away a stigma immediately, but it is not enough. A cisgender person is not in any chapter, so why that difference. Different would be to create a chapter with all diversities, where all of us are included, not only trans people”.
The request of certificates is something that Rodrigo questions, aiming toward the procedure based on the informed consent, which it not must be necessarily applied by a psychiatrist. “It does not have a real ground because the attentions should be much more comprehensive in all specialties. Many colleagues say “I do not have training in this [to apply consent in these cases], so the questioning that arises me is why it does not make them noise. I understand that your formation and your specialty do not include it, but when you come across with something that you ignore, you study it. Moreover, it is clear that there is not any psychiatric pathology that can make someone believe that he or she is or is not transgender without disrupt other aspects of life.” Respect to the rol of the psychiatrist, he said: “A psychiatrist can help educating of the considerations that must have to consent in the case of people with history of psychiatric pathologies.”
With the classification change, what will happen with the psychiatric certificate request to access to treatments or interventions that transform the gender expression? Only based on what ICD says, psychiatrist would have nothing to certify. The step to the sexual and reproductive health diseases leaves open the answer on who will make the “diagnosis”.
For what is necessary “diagnose” the identity? Mainly, for the use of health insurances. Nevertheless, this is questioned by the coordinator of OTD Chile, Michel Riquelme. “In the practice, there are health insurances that the ICD do not recognizes and are still covered. The problem today is not so much that reference in the part of sexual and reproductive health, but the way that it is mentioned yet it is still talking of diagnosis and symptoms. Deep down, they continue telling us that is not right to feel trans and that perpetuates the idea of abnormality with which we have been always loaded”.
Nevertheless, why a document is drafted not in accordance with Human Rights pathologizing trans identities for by a health economy issue? “There are many specialists who believe it is a disease, perhaps because they do not support it as a psychiatric disease, but they are elaborating a thesis that is a biological disease. For example, affirming that the embryo received more sexual hormones which do not correspond to the biological sex. That is why we continue talking about a cause and always, if there is a cause, it is said that is something abnormal avoiding the idea that is part of the human diversity. Y think that also affects against their own gender identity: they say “if these weird people is normal, then who I am? For there to be normality exists there must be abnormality. Then, on their structure of thought when they compare with us, immediately they put us in the place of the abnormal to remain as “normal” for themselves”.
With this change, is there something to celebrate? “Yes, it will remain in the history as a great step, occurring something similar that occurred with homosexuality. When it was eliminated from the psychiatric manuals for first time, it was not completely eliminated, the name was changed by ego-dystonia homosexuality. Probably, it will happen the same, if in the future the gender inconsistency is eliminated from the part of sexual health, it will be remembered the date in which it was removed from the mental disorders”.
What comes now is the implementation in the health systems, especially because the Diagnostic and Statistical Manual of Mental Disorders (DSM) still considers trans persons have a mental pathology. Its implementation will depend on the health operator selected for you or the country where you are. For example, in Chile the most relevant manual in the academy is DSM, not so much the ICD, so our work as activists will be to make a strong impact so that the policies that apply shall be from the WHO and the ICD, displacing the DSM in this regard.
If this happen, together with the necessary and urgent updating of the clinical pathway of 2011 and in accordance with the Gender Identity Law, which should be approved soon in the Congress, the Minister of Health will have the obligation to reconsider his criteria of attention considering the needs of transgender persons and incorporate a focus on human rights. However, another essential point is that the health professionals move forward together with the new regulations.
“In Chile, there are doctors who treat trans persons and they consider more important the paper written by doctors from United State than the ones written by the ICD or DSM and it has its own protocols. There will be a discussion on what is the most important, what is first: a paper written by a doctor or what the WHO says. Which one is more important? Because today you can say to a doctor that according to my human right, the doctor cannot bind me to do tests against my will and the doctor does not care, the same obliges you and if you do not have the certificate simply does not treat you There is an authoritarian bias on their part and a lack of knowledge of human rights and the UN recommendations”.
Translated by: Javiera Saavedra R.