Depathologizing transgender identity is critical to advance legal protections and constitutional recognition.

-Jamila Dawn Mitchell

Editor’s Note: June is LGBTQ Pride Month. At Black Youth Project, we will be exploring gender, sexuality, transgender issues and queer theory, and we are interested in publishing works that address these topics and the things surrounding them.

by Jamila Dawn Mitchell

Transgender identities will no longer be considered a mental health disorder by the World Health Organization (WHO). The 11th edition of International Statistical Classification of Diseases and Related Health Problems, or ICD-11, has been unveiled at the WHO’s 72nd World Health Assembly take place from May 20 – 28, 2019. Transgender identity diagnoses are detailed under ICD-10 “Chapter V: Mental & Behavioral Disorders” along with other conditions such as depression and borderline personality disorders.

That will change during the Assembly once the WHO officially removes transgender identities from Chapter V under ICD-11, according to The International Lesbian, Gay, Bisexual, Trans and Intersex Association, or the ILGA. The IGLA reports that transgender related issues have been moved to “Chapter 17: Conditions Related to Sexual Health” in the ICD-11 with further advocacy for the WHO to continue to remove psycho-pathological language from what the medical field refers to as “transgenderism.”

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Activists are currently working to ensure transgender people are no longer pathologized as having anomalous conditions or a medical disorder. Until now, by definition, transgender identity has been considered a disorder, an anomaly, instead of as an actual gender. Under the current ICD-10 and the Diagnostic & Statistical Manual 5TH Edition (DSM-5), transgender people are diagnosed as having mental disorder conditions such as gender dysphoria, and this kind of thinking adds a major barrier to how transgender people are serviced as patients.

Patients commonly will have more than one ICD-1O diagnosis code listed within their records that will change or be missed between different providers. For instance, if a child is seen by a pediatrician due to symptoms related to the Flu, their records would include a diagnosis (DX) code for every noted symptom such as cough (R.05), fever (R50.9), or and if lab results prove it, influenza (J10.1). If this patient happens to be a transgender person receiving testosterone injections for hormone replacement therapy (HRT) by an endocrinologist, chances are a different provider will prescribe treatment overlooking how it may negatively interact with HRT medications.

Providers are typically specialized and medical visits are focused on a particular condition, thus not every diagnosis may be carefully considered. Transgender people that are undergoing HRT gender affirmation surgery have health concerns that cis gender people may not have. Reducing transgender identity to a mental health diagnosis and not treating transgender people as an actual gender increases the risk of health issues due to medical maltreatment.

Another consequence of transgender identity being conceived of as a disorder is that it impacts both privatized and nationalized healthcare. Pathological designations drive standard operating procedures (SOP) designed by law, private medical practice, and healthcare coverage. Right now, transgender people are required to meet with psychologists to essentially prove they meet the criteria for Gender Identity Disorder before medical providers will provide HRT and gender affirmation procedures.

Even if a provider recognizes the humanity of their transgender patients, they are required to follow the rules and standards set by the Federal government, private hospital/medical boards, and insurance companies. Even with acceptance by Federal and medical board guidelines, a transgender patient may not have access to treatment due to the private decisions of insurance companies that are allowed to have extensive custom terms for covering healthcare costs under ICD-10.

In the U.S., transgender people suffer great disparities in healthcare. According to a 2012 survey reported by the Center for American Progress, transgender people are less likely to have insurance coverage and nearly half of transgender respondents said they delayed seeking care for a sickness or injury due to an inability to afford treatment. Requiring transgender patients to receive psychoanalysis for treatment and insurance coverage drastically increases healthcare costs.

There aren’t many medical professionals that can appropriately treat trans people, because transgender identity is commonly not part of the primary medical curriculum. Many transgender people, especially in rural areas, are forced to travel far to find understanding mental health providers before they are even able to find medical doctors. The costs under ICD-10 for pursuing treatment, health appointments, and obtaining insurance coverage fuel unnecessary health issues that drive poorer health for transgender people.

In a process the IGLA and other advocates refer to as “depathologizing”, under ICD-11 transgender people can see quality of life improvements. Depathologizing is declassifying something as a medical or mental disorder. Disorders are treated to prevent and/or reduce symptoms with the theoretical goal to “cure” the patient. Gender is the humanity of a person, thus advocates for transgender people want the medical world to stop trying to erase the human existence of transgenders under the guise of a mental disorder.

Depathologizing transgender identity is critical to advance legal protections and constitutional recognition. As it stands, transgender people are only recognized as binary persons with a mental disorder characterized by severe distress with living as the assigned gender at birth. This prevents the world from seeing trans people as real people deserving equal human rights under domestic and global laws.

Within the U.S., there is fight for transgender people to be treated equally under the law. The National Transgender Discrimination Survey by the National Center for Transgender Equality showed that 26% of trans people lost a job due to bias, 50% were harassed on the job, 20% were evicted or denied housing, and 78% of trans students were harassed or assaulted. Yet, only 26 states have laws prohibiting discrimination against LGBTQ people according to the Movement Advancement Project (MAP). Recently, President Trump’s Administration has made steps to roll back national healthcare protections for transgender people that were established under the Affordable Care ACT, or ACA. Thus, equal rights advocates in the U.S. are organizing to pressure Federal government to pass an Equality Act that would amend U.S. civil rights laws to explicitly include protections on the basis of sexual orientation and gender identity.

Right now, anti-transgender parties benefit from the current ICD-10 diagnosis of gender identity. Transgender folks are not opined by the courts as protected under sex-based anti-discrimination laws, because no precedent has been set to recognize their gender identity. This means that transgender people can be refused housing, employment, and other crucial needs.

There might have been a possibility for the Americans With Disabilities Act of 1990 to be used in court to benefit transgender people in the short-term, since transgender identities have been classified as mental disorders. However, the comprehensive issue with that plausible defense would refute recognizing transgender people as actual persons and maintain all of the issues transgender people face with no actual resolve.

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Even with the new WHO ruling, many will still see transgender people as having a disorder and will not perceive them as actual people of a real gender. Transgender people face healthcare and economic disparities that ruin their right to a standard quality of living with protections for housing, employment, healthcare, and civil rights. These problems are perpetuated by old classifications of transgender identity that prejudicially treats transgender people as simply “ill” and disorderly conditions.

Removing transgender identities from mental health classifications the World Health Organization’s 11th edition of International Statistical Classification of Diseases and Related Health Problems has constitutional implications, and it could help lead to the global institution of equal rights and improved living standards for transgender people everywhere.

Jamila Mitchell is a writer that comes from across the disciplines of business management, non-profit development, and community organizing. Educated in economics and  business management at the Milwaukee School of Engineering Rader School of Business, Jamila has used her knowledge assets on neoclassical economics as an advocate and grant writer for various causes such as mental health treatment. She has worked on numerous political  campaigns including the Fight For $15 pro-union national campaign, voter rights, and various President Obama’s 2012 re-election campaign.