Transsexuality will no longer be classified in France as a mental illness

May 17, 2009

Flag of FranceVia Le Provence, mangled into English by Google Translate:

Transsexuality will no longer be classified in France as a mental illness, a government decision Saturday qualified as “historic” by the associations, on the eve of World Day against homophobia and transphobia.

Health Minister, Roselyne Bachelot, has taken these days “High health authority for a decree transsexuality leaving the category of psychiatric disorders”, said a spokesperson of the ministry.

So far, transsexuals enjoyed an exemption from user fees for medical care under a long-term ALD23 classified for “persistent or recurrent disorders”.

For the Department of Health, it is a “strong signal to the whole community”, transsexuals feeling “this admission ALD23 as stigmatizing”.

This classification, derived from that of the World Health Organization (WHO), was also linked to the fact that transsexuality was on the list of diseases identified in the medical manual DSM (Diagnostic and Statistical Manual of Mental Disorders) which refers the medical profession, just as homosexuality was there a few years.

In an article published in Le Monde dated Monday-Sunday, many people [including] first secretary of the Socialist [party] Martine Aubry, the Communist Marie-George Buffet, Green Daniel Cohn-Bendit and the Nobel Prize [winners] Françoise Barré-Sinoussi (medicine) and Elfriede Jelinek (literature), have requested WHO “to no longer consider transsexuals as mentally disordered.”

This is because the WHO had decided on 17 May 1990 [to remove] homosexuality from its list of mental illnesses, that date was chosen for the World Day against homophobia celebrated from Saturday and Sunday in many places .

It is symbolic that France chose that moment to be “the first country in the world” to “delete [transsexuality from] the list of mental illnesses,” commented the IDAHO Committee (International Day Against Homophobia and transphobia).

This “historic decision” is also “an explosion of hope for all trans people in the world,” said Joel Bedos, Secretary General of the IDAHO Committee.

The association Homosexualités et Socialisme (HES) has “welcomed” the announcement that also answers “to a claim of long-range” of the lesbian, gay, bi and trans de France (LGBT). For UAS, it is time now to move from symbol to action, fighting against violence and discrimination […].

image from Le Provence

(The full text of the announcement in French can be found in this PDF of a Microsoft Word document originally posted on the IDAHO website)

I absolutely agree that classifying transsexuality as a ‘psychiatric disorder’, a ‘mental illness’, a ‘disease’, is wrong – it stigmatises us in ways that only compound the negative, discriminatory and profoundly damaging views of trans people that mainstream cis society already holds.

What does concern me is if, in the forthcoming DSM-V revision, the condition is either completely decategorised (I believe that would allow healthcare authorities such as Britain’s National Health Service (NHS) and specialist healthcare insurers worldwide to stop offering support and essential services to us) or recategorised into such an extreme paraphilia that we are even more stigmatised by its pathologisation.

Worryingly, this second proposal has already been outlined by Ray Blanchard (chair of the Paraphilias Subcommittee and inventor of the mental illness he terms autogynephilia) in a paper presented at the Annual Meeting of the Society for Sex Therapy and Research (SSTAR) in April 2009 (link here; see also Julia Serano’s piece for Feministing, “Why feminists should be concerned with the impending revision of the DSM”, link here).

My fear is that this unilateral move by France, although initially seeming to be a positive thing, may actually provide ammunition for the members of the APA Task Force and Sexual and Gender Identity Disorders Workgroup in their quests to medically mandate us out of existence. Janice Raymond must be proud of them.

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Previous posts about the DSM on this blog:

11 Responses to “Transsexuality will no longer be classified in France as a mental illness”

  1. queenemily Says:

    It’s a risky move, and while de-pathologisation is important, it needs to be done so that trans people are still able to transition safely and cheaply. A simultaneous relisting as strictly medically necessary would be the best way to do this, I think. It’s a medical condition, not a psych one. Cuts down on the gatekeepers, and still gives coverage.

    Cos does this mean that in France trans people are no longer eligible for fee-exempt treatment?

    Cos that would be disastrous, risking legit medical supervision for all but the wealthiest, and meaning that other people are more likely to go for grey-market meds and less testing.

    It’s *well* suspicious that Blanchard sees de-listing as an option, because he does not have anything in mind besides destroying us.

  2. Helen G Says:

    A simultaneous relisting as strictly medically necessary would be the best way to do this, I think. It’s a medical condition, not a psych one.

    Well put.

    Cos does this mean that in France trans people are no longer eligible for fee-exempt treatment?

    That I don’t know, but it seems to me that it paves the way.

    […] meaning that other people are more likely to go for grey-market meds […]

    Assuming we can afford to…

    …*sigh*…
    Pessimistic Helen is pessimistic.

  3. Henry Hall Says:

    Magnifique, formidable!

    Sweden yesterday, France today, the world by next year.

    As to treatment it means that transfolk in France will be treated on a basis of needing physical, not psychological, intervention.

    This arises out of a recognition that whereas legal sex (only two flavors) is different from scientific sex (myriad flavors), so also medical sex is different from either. A person’s Medical sex is simply the sex assignment that best helps to promote that person’s health.

    The distinction is crucial, the purpose of medicine is to promote individual health. Classifying “transsexualite” (as it is known in France) as a mental disorder arose out of an idea that the purpose of medicine is to promote society’s health or the purpose of medicine is to promote science.

    Once one makes this leap that medical sex is not legal sex and medical sex is not scientific sex it all drops neatly into place. However our enemies will resist making that leap and claim to be scientists.

  4. Helen G Says:

    As to treatment it means that transfolk in France will be treated on a basis of needing physical, not psychological, intervention.

    Which seems, to me, to be ignoring the facts that (a) not all trans people are binary identified, and (b) not all trans people wish to transition through to surgery.

  5. Henry Hall Says:

    Helen G. writes: > Which seems, to me, to be ignoring the facts that (a) not all trans people are binary identified,

    Ture, not all trans people are binary identified – nor should they be nor does being non-binary give rise to a need for treatment. This is an issue for society, not for individuals.

    Helen G. further writes: > and (b) not all trans people wish to transition through to surgery.

    True, some will want hormones or surgery or both or neither. In each case Frenchfolk are likely to get their wishes.

    As to psychiatric treatment, if desired, the need (if any) arises out of sequellae (secondary considerations). Transgender and/or transsexual people will have to join the queue with non-trans people if they want treatment for depression, PTSD or whatever. No special treatment for being trans.

  6. Elly Says:

    While I wouldn’t say it’s my definitive conclusion, from what I have understood and the discussions I have got with other trans people, my opinion on this decision is that it’s bullshit.

    The fact is, France’s HAS (Haute Autorité de Santé, the authority which takes some decision concerning health) delivered a recent report concerning trans support that is very wrong, that imposes an heavy psychiatrisation, with some really problematic stuff (they want us to go through official gatekeepers and not just a trans-friendly shrink you were given the name, surgery must be the ultimate goal, a long real life test is required before real hormones, hormonal treatment is in two phases: first a chemical castration, then, maybe one year after, hormones. I’m not a doctor but I don’t think it’s very good).

    This report has been denounced by many trans and LGBT associations, so it’s hard not to think that the so-called “declassification” is just a distraction. Because, it doesn’t really change much, it’s not a real declassification from ICD or DSM (France has little power to do that), only the label concerning social security.

    It’s a good way for the health minister (Bachelot) to distract trans associations from real problematic stuff from the recent report (and the reforms she is leading concerning hospitals in general), and a good way for France, which is one of the legally most transphobic country of Europ, to make people think it’s the country of human rights.

    And some associations and spokepeople, usually not trans people (strangely) applause to this.

    (For the record, the same minister of health, Bachelot, annouced that gays would have the right to give their blood. Then, a few months later, she explained that actually, it was necessary that they would be banned from that. So, well, it’s not even sure that she will not defend that trans are mentally ill in a few months)

    “Cos does this mean that in France trans people are no longer eligible for fee-exempt treatment?”

    In France you can have fee-exempt treatment if you have an “ALD” (long-term affection, don’t know how to translate exactly). There are various categories of ALD, and the only thing that this decision seems to actually change is that instead of being labelled “psychiatric”, it will be labelled “unspecified”.

    This decision could be slightly good (because there is less stigmatization) or slightly bad (it could make things more complicated), but it doesn’t seem to be a revolutionnary thing at all. It’s just communication.

    This being said, it’s a recent thing and maybe there are some details I’ve got wrong, and maybe it’s actually a very good thing, but I seriously doubt it.


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  10. Henry Hall Says:

    @Elly wrote: “France’s HAS (Haute Autorité de Santé, the authority which takes some decision concerning health) delivered a recent report concerning trans support that is very wrong, that imposes an heavy psychiatrisation, with some really problematic stuff”

    And that is true. Those who wish to read this April 2009 report for themselves (it is of course written in French) can read it here:-

    http://www.has-sante.fr/portail/plugins/ModuleXitiKLEE/types/FileDocument/doXiti.jsp?id=c_765329

    or, equivalently, http://tinyurl.com/lw7rxt

    Frankly, I find it to be great news that Mme. Bachelot has slapped the HAS in the face over this. Her directive expressly orders that treatment of transsexual people is to be continued but psychiatric diagnosis of transsexualism is forbidden. It is for HAS to solve how to do that, they must solve it as they have been ordered to do so. It will be interesting to see exactly how they do.


  11. […] Transsexuality will no longer be classified in France as a mental illness, according to a government decision announced on the eve of World Day against Homophobia and Transphobia. […]


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