The American Psychiatric Association thinks so, or is history repeating itself?  The new DSM-V, the medical profession’s bible for diagnosing, is set to come out in May after delays caused by several areas of controversy.  But, the APA has a legacy of uneasy relations with the lesbian, gay, bisexual and transgender community, having included homosexuality in the DSM‘s list of psychiatric disorders until 1973.  Some transgender activists want issues of gender identity kicked off the list of mental illnesses too.

Transgender is an umbrella term used to describe people whose gender identity (sense of themselves as male or female) or gender expression differs from that usually associated with their birth sex. Many transgender people live part-time or full-time as members of the other gender. Broadly speaking, anyone whose identity, appearance, or behavior falls outside of conventional gender norms can be described as transgender. However, not everyone whose appearance or behavior is gender-atypical will identify as a transgender person.

Wikipedia says:  Beginning therapy is recommended for all people who are frustrated by their gender, especially if they desire to transition. People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body benefit by talking through their feelings in depth with someone who will listen indefinitely. However, gender identity is new to psychology and research is still in its infancy.

Some believe a person with a diagnosed Gender Identity Disorder (GID) experiences distress and/or disability and it may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often over-simplified to mean that simply being transgender means a person suffers from GID which is not true. This has caused much confusion to transgender people and those who strongly seek to either criticize or affirm them. Transgender people who are comfortable with their gender, whose gender does not directly cause inner frustration, or impair their functioning, do not have GID and are not applicable for a related mental disorder. GID is not permanent and is usually resolved through therapy and transitioning, especially its social aspects. GID does not refer to people who feel oppressed by the negative attitudes and behaviors of others.

Transgender issues are new in the scientific field and affect relatively few people, so understandably many mental healthcare providers know little about transgender issues. People seeking help from these professionals often end up educating the professional rather than receiving help.

 The issues around psychological classifications and associated stigma have recently become more complex since it was announced that colleagues from The Centre for Addiction and Mental Health (CAMH), a consortium of mental health clinics at several sites in Toronto will serve on the DSM’s Sexual and Gender Identity Disorders Work Group. CAMH has aims to ‘cure’ transgendered people of their ‘disorder’, especially in children.

 The issue is that a person who is unclear about his gender identity, just like a person who is  lesbian or gay should not have to face cruelty and stigma based solely on their sexual preference or identity. Kudos to President Obama for making history on New Year’s Eve when he appointed the former Mitchell Simpson, who now identifies himself as a female named Amanda, to a position as a senior adviser in the Commerce Department. Simpson apparently is the first transgendered individual become a presidential appointee to the federal government.

  Amanda Simpson now serves as a senior advisor in the Commerce Dept.

People in the LGBT community can experience double stigma when they also live with a mental illness. The National Alliance on Mental Illness supports the LGBT community in its Multi-cultural Action Center.  For more information visit www.nami.org

It’s already starting…..including right here on the Tucson Citizen site……..the man, Major Nadil Malik Hasan was “crazy.”  If you have read any of my blogs before, you know how important it is to me to try and create a world where people living with mental illnesses do not feel stigmatized and one of the first steps is to stop using horribly discrimating terms like “crazy” or “crazed.”  Yes, I agree that someone who goes on a rampage killing 12 people and wounding at least 31 others is not of sound mind, but why don’t we take a look at why this happened? 

If you believe, as I do, that mental illnesses are illness just like any other, than why was this man, who supposedly treated other people with brain disorders, not receiving treatment himself?  Did  anyone not notice how he was struggling?  According to the “God Blogging” post on this site, NPR interviewed others at Walter Reed who said he was. 

Which brings us back to the same problem, the same issues that continue to plague people with mental illness and their families.  Because of the stigma, because of the inattention by our health care system that doesn’t think the mind is part of one’s physical health, because of an overburdened mental healthcare system, because people suffering from a mental illness can feel isoloated and abandoned by their support structure, people with diagnosable brain disorders are falling through the cracks.  One again, as President Obama called this tragedy, “a horrific” catastrophe has occured in this country.

Who knows what was going on in Hasan’s head……Certainly listening to war stories from our returning Veterans experiencing Post Traumatic Stress Disorder was not an easy thing to do, but why is it that no one saw the signs, especially when he was set to deploy at the end of the month? Maybe Major Hasan will be able to shed some light on our questions.

President Obama shared his vision for health care reform—and stressed his support of mental health parity—at a New Hampshire town hall meeting on Aug. 11.

Linda Becher, an audience member, specifically asked the president about access to mental health care and its impact on society. The president acknowledged the seriousness of mental illnesses and the reality that many existing insurance policies do not cover them on the same terms as physical illnesses. President Obama also expressed his desire to include mental health care as part of health care reform.

Watch President Obama speak about mental health care at 48:43 or read the transcript below.

QHello, Mr. President. My name is Linda Becher (ph). I’m from Portsmouth and I have proudly taught at this high school for 37 years…I’ve been lucky enough to have very good health care coverage and my concerns currently are for those who do not. And I guess my question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

THE PRESIDENT: Well, you raise the — (applause) — you know, mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who’s got a broken leg. But a broken leg, nobody argues that’s covered. Severe depression, unfortunately, oftentimes isn’t even under existing insurance policies.

So I think — I’ve been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

This all sounds good, but I don’t know if  we will see any kind of health care reform if some of the fear mongering doesn’t subside. Terms like “death panels” certainly don’t help to move the legislation, in any form, forward.  Personally, I like what I hear about Switzerland’s health care system…..A basic plan is provided and they have the option to “upgrade” at their own expense if they choose.  That’s all I want……basic coverage for everyone!

Here’s what healthcare reform will do:

* Health care reform will stop insurance company abuses like  refusing to pay a claim or give you coverage because of “pre-existing” conditions. (Been there)
– Your out-of-pocket expenses will be capped. (Methinks bankruptcies will decrease!)
– Insurance companies won’t be allowed to charge women higher rates than men (been there) or drop you if you get sick.
– Insurance companies will have to cover your children until age 26 instead of dumping them at 19. (been there – they should at least  be covered under family plans while they are in  college!)

* Health care reform will hold down rising costs. (been there – I now have less than adequate coverage because I can no longer afford my old plan)
– A public health insurance option will force private insurers to compete and will lower costs for everyone. (yeah!)
– By requiring companies to pay their fair share, we’ll stop them from dumping their health care costs on the rest of us. (when I owned a small business I offered health insurance to my employees……it helped keep my personal premium cost down!  Now I understand that’s not necessarily the case if there is one employee with expensive health issues – that’s wrong, too!)

* Health reform means affordable health care will be there for you, no matter what. If you lose your job, or your children lose their coverage. (  we have all heard stories about kids moving back in as adults!) 

- When you retire affordable health care will be there for you. (it’s called Medicare and it was vehemently debated and accused of being “socialism”  when passed)

THE REALITY:   health care costs are spiraling out of control, and we all deserve quality and affordable care. Health care reform simply can’t wait.