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transgender
Dr. Marshall Forstein on Zucker, DSM-V, etc.
A letter posted at QuenchZine (emphasis mine):
Before people get overly hysterical about the Gender Identity Work group for the DSM, some things need to be made clear.
The letter you are asking us to sign onto is inaccurate in many ways and does not help our cause. Let me clarify what I know as someone who has worked with the American Psychiatric Association for many years.
1- there are TWO professional associations: Both unfortunately go by A P A
a) one is the American Psychiatric Association [this is a MEDICAL society of physicians who specialize in psychiatry]
b) the other is the American Psychological Association [this is a non- medical society of psychologists who are not medical doctors but have a PhD or PsyD or EdD in psychology, either clinical or research or academic or all.]
The American PSYCHIATRIC Association is the organization that publishes the DSM. This is a guide to diagnosis and NOT to Treatment.
Dr. Zucker, although not my preferred choice to head the work group on Gender and Sexuality, does not decide himself what the American Psychiatric Association publishes in the next DSM. In fact, there is a lengthy, and complicated process of peer review based on PUBLISHED scientific literature- in fact, the way we got homosexuality OUT of the DSM [1973] was to force the scientific program committee to produce evidence that homosexuality was an illness, and then in 1989 we removed ego-dystonic homosexuality because there was no evidence to support it and we suggested that there was also ego-dystonic heterosexuality that was a phase of people coming to understand their inner nature.
Sexual orientation is NOT even an issue for the DSM committee to consider. Transgender Identity is a bit more complicated, especially in childhood. The DSM work group will struggle with these issues in coming up with criteria for what to diagnose as a true gender identity disorder. I WANT TO EMPHASIZE THAT TREATMENT RECOMMENDATIONS ARE NOT A PART OF THIS ENDEAVOR.
Any treatment recommendations that the American Psychiatric Association makes are the result of significant process of creating EVIDENCED based research.
I am currently the Chair of the Work group on Practices Guidelines on HIV Psychiatry for the American Psychiatric Association, and so am intimately aware of the process. Guidelines go through rigorous research review for controlled studies in order to make recommendations. Hundreds of people review these guidelines before publication, and the same will be true of the criteria set forth by the work group on the DSM gender identity subcommittee.
EVEN if there is literature out there that disturbs those of us who are comfortable with the concepts of transgender identity, unless it meets peer review by legitimate journals ( i.e. non religious based periodicals) it will not be considered in the development of criteria for diagnosis or treatment.
I hope that what I have written makes us pause a bit before we do something to alienate even our supporters and friends in the American Psychiatric and the American Psychological Association who have been very pro-gay and pro-trans in their deliberations so far. There will always be a vocal minority that claim otherwise, but the process is vetted by many people committed to scientific integrity and evidence.
I have alerted the Association of Gay and Lesbian Psychiatrists to the announcement of Dr Zucker's appointment and we will be addressing the implications of this within the psychiatric and psychological professional groups. I will also be talking with the Medical Director of the American Psychiatric Association and the Director of the Research group that oversees the DSM to convey the concerns that people have about the "transphobia" that may emerge.
In good conscience, however, I cannot sign a petition that is inaccurate and misleading - it may do far more harm than good. Clarity of the scientific evidence, asking the right questions of the committee, and addressing the criteria that will be put forth for review before it is ever considered ready for publication is the only way we will be taken seriously.
Please let me know how I can help to keep the issues clear.
Marshall Forstein, M.D.
Associate Professor of Psychiatry
Harvard Medical School Director, Adult Psychiatry Residency Training
The Cambridge Hospital
The Cambridge Health Alliance
Via TS Roadmap.
Before people get overly hysterical about the Gender Identity Work group for the DSM, some things need to be made clear.
The letter you are asking us to sign onto is inaccurate in many ways and does not help our cause. Let me clarify what I know as someone who has worked with the American Psychiatric Association for many years.
1- there are TWO professional associations: Both unfortunately go by A P A
a) one is the American Psychiatric Association [this is a MEDICAL society of physicians who specialize in psychiatry]
b) the other is the American Psychological Association [this is a non- medical society of psychologists who are not medical doctors but have a PhD or PsyD or EdD in psychology, either clinical or research or academic or all.]
The American PSYCHIATRIC Association is the organization that publishes the DSM. This is a guide to diagnosis and NOT to Treatment.
Dr. Zucker, although not my preferred choice to head the work group on Gender and Sexuality, does not decide himself what the American Psychiatric Association publishes in the next DSM. In fact, there is a lengthy, and complicated process of peer review based on PUBLISHED scientific literature- in fact, the way we got homosexuality OUT of the DSM [1973] was to force the scientific program committee to produce evidence that homosexuality was an illness, and then in 1989 we removed ego-dystonic homosexuality because there was no evidence to support it and we suggested that there was also ego-dystonic heterosexuality that was a phase of people coming to understand their inner nature.
Sexual orientation is NOT even an issue for the DSM committee to consider. Transgender Identity is a bit more complicated, especially in childhood. The DSM work group will struggle with these issues in coming up with criteria for what to diagnose as a true gender identity disorder. I WANT TO EMPHASIZE THAT TREATMENT RECOMMENDATIONS ARE NOT A PART OF THIS ENDEAVOR.
Any treatment recommendations that the American Psychiatric Association makes are the result of significant process of creating EVIDENCED based research.
I am currently the Chair of the Work group on Practices Guidelines on HIV Psychiatry for the American Psychiatric Association, and so am intimately aware of the process. Guidelines go through rigorous research review for controlled studies in order to make recommendations. Hundreds of people review these guidelines before publication, and the same will be true of the criteria set forth by the work group on the DSM gender identity subcommittee.
EVEN if there is literature out there that disturbs those of us who are comfortable with the concepts of transgender identity, unless it meets peer review by legitimate journals ( i.e. non religious based periodicals) it will not be considered in the development of criteria for diagnosis or treatment.
I hope that what I have written makes us pause a bit before we do something to alienate even our supporters and friends in the American Psychiatric and the American Psychological Association who have been very pro-gay and pro-trans in their deliberations so far. There will always be a vocal minority that claim otherwise, but the process is vetted by many people committed to scientific integrity and evidence.
I have alerted the Association of Gay and Lesbian Psychiatrists to the announcement of Dr Zucker's appointment and we will be addressing the implications of this within the psychiatric and psychological professional groups. I will also be talking with the Medical Director of the American Psychiatric Association and the Director of the Research group that oversees the DSM to convey the concerns that people have about the "transphobia" that may emerge.
In good conscience, however, I cannot sign a petition that is inaccurate and misleading - it may do far more harm than good. Clarity of the scientific evidence, asking the right questions of the committee, and addressing the criteria that will be put forth for review before it is ever considered ready for publication is the only way we will be taken seriously.
Please let me know how I can help to keep the issues clear.
Marshall Forstein, M.D.
Associate Professor of Psychiatry
Harvard Medical School Director, Adult Psychiatry Residency Training
The Cambridge Hospital
The Cambridge Health Alliance
Via TS Roadmap.