File photo: Iris/Scanpix DK.
From January 1st, 2017, transgender will no longer appear on Denmark’s definition of mental illnesses, the Ministry of Health has confirmed.
The move would make Denmark a groundbreaker if the World Health Organisation (WHO) does not make a similar move before the autumn, news agency Ritzau reported.
“At the moment, transgender is listed as a mental illness or behavioural problem. That is incredibly stigmatising and in no way reflects how we see transgender people in Denmark. It should be a neutral diagnosis,” Social Democrat health spokesman Flemming Møller Mortensen told Ritzau.
“The WHO is currently working on a new system for registering diagnoses. It has been working on it for a very, very long time. Now we’ve run out of patience, and want to send out a signal saying that if the system is not changed by October, then we in Denmark will go it alone,” said Mortensen.
Full Story Here. A huge shout-out to Denmark, for realizing that every day of waiting increases the stigmatization of transgender people, and wanting no part of that any longer. Now, the rest of the world needs to catch up.
Well done, Denmark.
Psychology has always been in a precarious position because of its way of determining what is “disorder”ed behavior. Since the underlying mechanisms of many psychological problems are not understood, the field is left cataloguing overt behaviors -- and assuming that certain behaviors have an underlying cause and aren’t just plain old behaviors. I guess it’s necessary because you certainly can’t say “autism isn’t a thing because we don’t know its cause yet” but what about problems that may have an underlying cause but a cultural expression -- like anorexia (which appears to be linked to or the same as obsessive-compulsive disorder, which doesn’t say much because obessive-compulsive disorder isn’t understood either) My reaction to the problem with psychology has been to dismiss the field as useless* but of course it’s not -- psychological findings are crucial with respect to who gets what kind of institutional support and treatment.**
I’m happy to see the Danes are basically ratifying that psychologists don’t know what they’re talking about, once again, by moving diagnoses that are presently impossible to accurately make from one column to another. I hope it helps the trans, and I also help it continues to raise awareness that the psychology industry’s approach of cataloging behaviors is circular reasoning mixed with bullshit. Psychologists saying “this thing we used to say was bad is no longer something bad” allows them to continue to talk about things they do not understand while continuing to pretend that they do.
(* Disclaimer: I have a psych degree, so maybe I looked too closely into the sausage-making process as an undergrad)
(** which, to me, damns it as not only useless but politicized!)
Marcus:
Yes, and that’s a massive problem, because governments allocate monies based on such findings. When the psych field gets something utterly wrong, people end up paying, often in blood.
Caine@#3: It’s horrifying to me that psychology -- a field slightly more advanced than phrenology -- is used to determine medical outcomes. I’d bet a lot that 400 years from now humans will look back at our time with the same kind of horror, “O NOES. They trustd sykology. LOLWHUT.” Or however they say it, it’ll be like our perspective on leeching and DSM I. Oh, excuse me, DSM III. No, I mean involuntary lobotomy.
Psychology should be plowed under and sown with salt. But, like homeopathy and chiropractic and other cons, it’s going to adapt and absorb the results of learning elsewhere, then proclaim “see! we told you so all along!”
Marcus:
Yes. This already happens, so much of new age cons rests on bogus psychological claims. I do think it’s important to try to understand behaviours, but the psychiatric / psychology field never seems to constrain themselves in the least. More and more, it just resembles the babble that is evo-psych.
More and more, it just resembles the babble that is evo-psych.
One big warning sign for me is that psychology is now throwing overboard its founding principles. When I was an undergrad they still taught Freud and Maslow -- and not as historic oddities. But now its shifted away from that (which is good!) amounting to a complete re-invention of the ‘science’ by rejecting the obvious foundational pseudoscience. That’s the same dodge that the chiropractors have attempted -- downplaying the obvious un-observability of “subluxations” in the light of modern body-imaging technology. “OOps! We have no actual basis … (scrabbles around for a minute and pulls something dusty out and waves it) Here! Here’s our basis as a ‘science’!!” Which, of course, is completely anti-science. In a scientific context when your founding principles are destroyed you’re better off starting afresh with principles that haven’t been falsified. When you catch a ‘science’ trying to retcon its origins story, that’s a big red danger flag.
DSM III was the big thing when I was an undergrad, and it was presented as an epistemology for disorders. You are “schizophrenic” if it says so in the DSM III. Well, how do you know what “schizophrenia” is? Easy! It’s composed of other behaviors also defined in DSM III. I used to torture my teachers by asking them why there wasn’t an organic test for these ‘disorders’ (“disorder” implying there is something broken, after all) and it was scary how quickly they’d fall back into pointing at the DSM. And, fortunately, we’ve seen since then that the DSM is a political document, not a diagnostic tool: that “disorder” you used to have? It’s now just a “behavior”. Oh. So that doesn’t mean there’s anything wrong with me except for how I behave? So is “asshole syndrome” a perfectly reasonable thing to diagnose people with? If it’s no different from “narcissistic personality disorder” is there really such a thing as “narcissistic personality disorder”? Psychology failed to study philosophy (as many sciences do) and didn’t come to grips with the concept of vagueness.
I know I’m kinda blog-ranting here and I’ve probably overrun my commenting subscription* but this shit is insanely relevant when it comes to trying to syndrome-ize and disorder-ize other people’s sexuality. I had some interest in this because one of my best friends was a cross-dresser and his attitude was “there’s nothing wrong with me” and as far as I could see, there wasn’t. But DSM said he had a fetish paraphilia and that got me to thinking “are they saying there’s something broken in him?” If it’s purely behavioral, why isn’t golf a paraphilia? I’ve seen pretty maladaptive golf behaviors up to, and including, wearing plusfours. For me, that was the mental encounter that made me LGBT-friendly: DSM destroyed my epistemology and made me realize that “normalness” is an attempt to hijack consensus. Oh, the lot of us play golf so that’s “normal” but you D&D players are suffering from fantasy wish-fulfillment disorder.
(* Are you like Verizon, am I gonna get a $200 invoice for exceeding my monthly comment cap?)
Marcus:
I’m a victim of Verizon, you won’t find me acting like them. <shoots evil glare at mifi unit>
That’s a very good way to express it.
I’ve been nothing but wary of the profession from a very young age. My mother started having me locked up in the mental ward of the hospital she worked at, for brief periods, whenever I seriously pissed her off. I was seven then. When I was a bit older, I was dragged from one psychiatrist to a psychologist to a psychiatrist, and so on. I never said a single word. Exactly one of them told A the truth -- “I can’t do anything, she won’t talk.” The rest of them? Oh, they all knew what was wrong with me. In my head, I was thinking “the fuck you do.”
I’ve been nothing but wary of the profession from a very young age. [reasons]
Holy Shit. I have no idea what to say.
Nowadays, if you don’t fit in, they just crush you with drugs. Psychology has a lot to answer for.
Marcus:
Which seriously makes me feel for kids today, especially ones who are in a similar situation to mine -- I was being abused, on many levels. That was what was ‘wrong’ with me. Not that “treatments” were any picnic way back in the ’60s and ’70s, but there wasn’t this rush to drug the fuck out of people, especially kids.
I do think there’s a place for drugs, but it has to be approached cautiously, and listening to the person who is supposed to take the drugs, every step of the way. One of my friends has paranoid schizophrenia, and chooses to take drugs that keep her well balanced and able to deal with various aspects of her particular brain functions, but she has had a whole lot to say about this, and there was a lot of experimentation to find what works for her, in the minimal amounts. When it comes to kids, I am so hesitant to say that drugs have a place. Maybe they do, but fucking about with a child’s brain chemistry should never, ever be a first, or even second option.
IN families that have mental disorders running in them, if one seeks genetic associations, it turns out that the same alleles are associated with different conditions in different individuals. This supports the claim that psychiatric conditions are not natural kinds. The same allele can cause different conditions in different contexts.
@anat#10:
Genetics and neuroscience are going to save psychiatry. Basically, the psychs will forklift their entire creaking edifice on top of a better understanding of root cause of disorders, and claim victory. I don’t really care, as long as there’s a victory.
It’s unquestionable that some psychological conditions are genetic or environmental/genetic and then the next round of questions is the degree to which our coping mechanisms are learned behaviors, or the damaging expression of the underlying condition is learned behaviors. The relationship between anorexia and obsessive-compulsive disorders is one of those, as are the genetic determinants of some kinds of depression. It’s just all so damn complicated and there are lives at stake. Whenever I think about this, I remember a quote (you have to imagine it in the right voice…) from Bob Dylan when he was narrating his ‘theme time radio hour’ and was talking about a musician who had a checkered history of violence: “I suppose today you’d say he was bipolar, but back then, they just said ‘he was mean'” There’s going to be a huge amount of re-assessment to do when we gain some understanding. The hardest part will be parsing out environmentals from genetics from socialized behaviors. My ex- was severely depressive and had several whacking great PTSD-causing traumas. I don’t think anyone could sit back and say what part of her tendency to disassociate came from where. She certainly couldn’t; she just knew it hurt.
And that’s why I am so angry at these religiously-inspired haters that want to demonize people who have alternative neurochem, or who don’t fall into their neat gender categories. Basically, they’re telling people who’ve already got a hard row to hoe, “jesus wants us to make your life harder, because nyuk nyuk nyuk.” That is, to me, exactly the same kind of evil as saying “hey, you’re economically underprivileged because you’ve got more melanin! lol!” or an infinity of similar bullshit. I hate that so much that I feel like I could shoot laser beams from my eyes and burn these idiots down where they stand. Life’s complicated and hard enough, for fuck’s sake don’t pile onto people who you’ve already decided you’re going to treat badly.
Oh, god, Marcus, shut the fuck up.
I’m on meds, and they’ve done nothing but HELP.
WMDKitty @ 12:
There was absolutely NO need for this fucking shit from you, and I’ll thank you to be more careful in the future. Marcus made one remark about drugs, and it was a valid point. I said much more about drugs than he did, but I guess you didn’t want to tell me to shut the fuck up, eh?
No one said you can’t have meds at all -- quite the opposite.
@WMDKitty #12 -- I was diagnosed with dysthymia when I was in my 20s; it’s now called “chronic depressive disorder.” I started on a low dose of bupropion seven years ago, and it has definitely helped a lot.
But that is not what Marcus was talking about. There is, indeed, a very strong tendency to medicate first without ever actually looking at whether or not the medication is needed or would be genuinely beneficial. Case in point is the child who acts out in school because his parents are distant and abusive, who gets diagnosed after one 20 minute interview with ADHD and ends up drugged into compliance because that is easier than finding out why he was acting out. Very sadly, this scenario is common and just one of many possible examples.
Medicines work; I never said they didn’t. Nor did I say anything at all against making them available.
Psychopharmacists don’t really understand what’s going on, but it works and has tangible benefits. There’s no problem with that, but I do think psychology should be more up front about the fact that they don’t really know what they are doing. They’re fiddling with pieces of the puzzle: yes, serotonin is an important neurotransmitter that has to do with mood, and if we can fiddle with one neurochemical pathway that increases the serotonin level in the brain, that improves some outcomes. Collectively, our understanding of some neurochemicals is better, by far, than the Aztec doctors who trepanned people, or the leeches who bled their patients. The complete causal chain isn’t there, yet, though it maybe will be (in some cases) in a few decades. We know that some people with some alleles tend to exhibit certain behaviors and that certain drugs make them feel better. The dosages and the drugs (as anyone who’s done it can attest) are kind of a crap shoot, so there’s a lot of “try this!” and “we’ll up the dose!” or whatever. Science loves trial and error, but trial and error in the framework of a theory. What’s conspicuously lacking in psychology/psychopharmacology is an understanding of how the alleles express in a way that causes some brains to experience “depression” when others don’t. When I say “psychology doesn’t know what it’s doing” I am speaking as a philosopher: this is an area where knowledge is hard to come by; psychology has always had a big problem around self-reported states (if you can’t trust the person reporting, then how do you know what’s happening?)
Because of self-reporting, it’s very very hard to sort out what’s real from what’s not. I knew one family that had their kid put on Ritalin because he was “hyperactive” No, actually, the kid was badly brought up by parents who did not raise the child supportively so the child would act out in order to get attention. “Hey, kid, take this; it’ll make you sit down and shut up.” The kid turned out moderately OK but has been on a cascade of meds ever since. Here’s a problem with psychology: it cannot act like a science because it’s impossible to do experiment/control tests. You can’t both give the kid Ritalin and not give the kid Ritalin and compare the outcomes. So we can’t tell if the kid would have responded better to Cognitive Behavioral Therapy or maybe just his parents taking him on long walks to exhaust his energy, like mine did.
It’s really early innings. Back when I was an undergrad (in the early 80s) things were a lot worse. At least nowadays they’ve been able to determine things like: anorexics experience better outcomes on certain antipsychotics. OK, that’s great. I just wish psychology had a, you know, theory of obssessive compulsive disorder(s) and their relationship to the neurotransmitters that are affected by certain antipsychotics. I haven’t currently got a stake in this discussion, but one of my exes nearly succeded in killing herself; the reason: a dosage change in a particular antidepressant that has a track record of sometimes increasing suicide likelihood -- and a psychologist who didn’t tell the patient or the patients’ support network, “hey, when you switch off your old drug, you may experience severe depression so be careful of the following…”
@WMDKitty: telling people “shut up” on a blog is stupidly pointless. Our good host may choose to shut me up, but you? Sorry, not gonna happen.
If it wasn’t for the meds I’m on, I’d be dead.
Marcus, you clearly don’t know what you’re talking about — children are NOT “medicated into compliance”. What next, are you going to cite Thomas Szasz as an “expert opinion”?
Caine, I apologize to you, because it’s your space. Marcus… he’s gotta earn it.
WMDKitty:
You’re wrong about this. You need to understand what people are talking about without taking it personally. No one has come down in any way on meds. So far, everyone has agreed they have their place, including Marcus.
Plenty of children are medicated into compliance, or at least, a state which is agreeable to their parents or guardians. This is not something that Gregory or Marcus pulled out of their ass, WMDKitty. This has been a subject of serious, professional discussion for quite sometime, and it’s only now that psychologists and psychiatrists are backing off on the insta-drug as a solution to whatever on the part of kids. A lot of kids are misdiagnosed, and a lot of kids have ended up on drugs which were not necessary. This has nothing to do with meds that are necessary and happen to work well.
Even though my history was a bit before the rush to drugs as the golden answer to everything, I was threatened with drugs more than once, if I did not comply, and we’re talking very serious, dangerous drugs. Every child who has been placed on ritalin did not need to be taking it -- there were at least two decades where drugging children was the thing to do, for any acting out at all. This made headlines, it was news. If that bypassed you, fine, but you don’t get to make a pronouncement that this never, ever happened, when it did happen. It still happens, and while there are children who do indeed require meds, most of them don’t, and fucking about with a child’s brain chemistry because parents don’t want to deal is not something professionals should be complicit in.
There’s also the situation I was in, being severely abused on many levels. If I had been a child in the 80s, I would have been put on a drug regimen.
It’s fine to point out that in many cases, drugs make the difference -- Gregory made that very point. That does not mean there aren’t field-wide problems, mistakes, and deliberate disregard in many cases.