Tuesday, January 13, 2015

Stuff Just Got Real With The ICD-11 Revision

With the outrage building is the international trans community about our Russian peeps being under attack with the BS driving ban, something unfamiliar to many US based trans folks but central to this oppressive drama has come to our attention in the USA.

The UN's World Health Organization puts out every few years the International Classification of Diseases or ICD Manual.

The ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and has been used in WHO Member states since 1994.  

So why is the ICD important?  The ICD is not only the standard diagnostic tool for epidemiology, health management and clinical purposes, it is used by physicians, nurses, other providers, researchers, health information managers and coders, health information technology workers, policy-makers, insurers and patient organizations to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records.

In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. Finally, ICD is used for reimbursement and resource allocation decision-making by countries.

Translation:  insurance companies use it for coding purposes, too.

And as witnessed in Russia recently, the ICD has been used to attack and pathologize the trans community for decades.   As Dr. Kelley Winters, who tracks these issues on her GID Reform blog said on my Facebook page on January 10: 

"They've been used every day to attack us, for generations, by conservative bigots on the right and Raymondites (TERFS) on the left. Gender reparative psychotherapies are still practiced from the Clarke Institute (CAMH) in Toronto, to private practices and "religious counselors" in every state. Countless more trans children are shamed into the closets of their birth assignments by parents, doctors, shrinks, school administrators and school counselors, based on these bigoted and scientifically baseless diagnostic policies. Leelah was just one of many youth who lost their lives to the stigma and false stereotypes promoted by these policies."

Homosexuality was removed from the ICD in 1990, and trans people in several nations including Canada's Jenna Talackova have been pushing to have the same thing happen for transsexuality in the ICD-11, which is currently being revised.   It is scheduled to be released in 2017.

The World Professional Assn for Transgender Health (WPATH) and the American Psychological Assn. (APA) have also called for the depathologization of transsexuality.

According to Dr. Winters, this is what is currently happening in those ICD-11 efforts.

Kelley Winters"The current plan of record for the ICD-11 is mostly good news-- to eliminate trans related (transsexualism, GID, GID-childhood, and transvestic) categories from the mental disorders chapter (chapter 5/ F-codes) and replace them with non-mental codings, named Gender Incongruence, in a new chapter on Sexual Health (chapter 6). Gender Incongruence of Adults and Adolescents (GIAA) will be used to facilitate access to hormonal and/or surgical transition care for those who need it -I support this new category, though I think its descriptive text needs clarification and more age flexibility (for adolescents who may need access to blockers or medical care before Tanner Stage 2 characteristics are outwardly visible." "A second new category proposed for the ICD-11, Gender Incongruence in Childhood (GIC) is controversial. Since children do not get hormonal or surgical treatment and need no coding for them, there is no clear benefit of a pathology coding for trans (including socially transitioning) children. Yet the stigma of pathology/defectiveness and the torture of consequence gender-conversion/gender-reparative psychotherapies puts their lives at risk. Global Action for Trans* Equality (GATE) has proposed a less harmful alternative proposal to replace the GIC coding in the ICD-11. My own opinion is that there should be no GIC childhood coding in the ICD-11 and that the alternative GATE proposal (I helped define it) should be implemented instead."

So as you can see, the revisions to the ICD-11 are of critical importance to us in the USA and the international trans community not only in terms of our human rights fight.

It is also a fight to assert our very humanity as trans people in the face of increasingly organized efforts by the Southern Baptist Church, right wing politicians and the TERF's to deny it

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