Annalise Ophelian is the director of Diagnosing Difference, a documentary about Gender Identity Disorder, premiering June 20 at Frameline 33, the San Francisco International LGBT Film Festival.
The Rumpus: First of all, congratulations–this film is a great accomplishment, and an excellent look at the issue of gender identity as appropriated by the psychiatric community.
When did “Gender Identity Disorder” first appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM)? How does the definition of this “disorder” overlap or contrast with the way you would define “transgendered”?
Annalise Ophelian: GID first appears in the DSM in the third edition, which came out in 1980. It actually went through several permutations between DSM III, the revision in 1987, and the DSM IV in 2000, but all of the diagnostic categories were really seeking to categorize what psychiatrists and physicians were labeling “disorders” in gender conformity.
What’s interesting is that these diagnoses also emerged as American psychiatry asserted itself as a mechanism for social control, and in response to anxiety about sex and gender that was raised by the gay rights movement and second wave feminism of the 1970s.
I think the main goal of these diagnoses was to create a system of classification through which medical and mental health care professionals could understand this “problem” of people who identified or behaved as a gender other than the one they were assigned at birth.
The term “transsexual” was coined in the mid-20th century, there’s a bit of debate about whether its first use should be credited to American psychiatrist David O. Cauldwell or German-born endocrinologist Harry Benjamin. The term “transgender” really emerged in the 1990s as a part of a growing movement that was informed by reactions to second wave feminism and the gay rights movement of the 1970s.
Transgender is generally accepted as an umbrella term that describes any number of people who identify with or express a gender other than the one they were assigned at birth. I think of the term as a push back to the terms and categories that were imposed on gender variant people by medicine and psychology, and an attempt to de-categorize gender.
Rumpus: Do you think there is a commonly held misconception–either in the transgender community or the larger population–that someone who identifies as transgendered must go through reassignment surgery and/or other medical procedures to “qualify” as transgender? Are people’s expectations of how the transgendered “should” express their gender identity harmful to those grappling with it?
Ophelian: In my own experience as a mental health provider, I’ve definitely seen a wide-spread misconception on the part of non-trans people that the way you really know someone is trans is that they’ve undergone some form of “sex change”. I think it speaks to the general lack of knowledge about trans lives and to the entitlement non-trans people often demonstrate.
In the 1950s, starting with Christine Jorgensen in the United States, there was this interesting relationship between media and medicine in which the transsexual narrative included “being a woman trapped in man’s body.” The historical legacy of the sex change operation is that it created a prescribed path that trans people were expected to follow, which has had a tremendous impact on the ways laws are written. In the film, Dean Spade, who is a professor of law at Seattle University and one of the founders of the Sylvia Rivera Law Project in New York, talks about the damage caused by rules that govern trans lives based on “have you had surgery or not?”
I think the emphasis on sex reassignment surgery (SRS) also sets up medical and mental health care professionals to be ill-prepared to deal with the health care needs of trans people, which may include surgery but on a daily basis are much more likely to focus on a myriad of other issues.
Rumpus: This may seem like a no-brainer, but would you mind commenting on why people are protesting the inclusion of this disorder in the DSM?
Ophelian: Actually, I don’t think it’s a no-brainer at all–I think the issue of Gender Identity Disorder in the DSM is incredibly complicated, and as a non-trans person, I’d actually prefer to see this question answered by someone who is more directly impacted by the diagnosis than I am.
As a mental health care provider, I would like to see GID removed from the DSM because it incorrectly labels healthy variation in gender identity or expression as an Axis I mental disorder, and because it shifts the burden of responsibility away from a society with rigid gender rules and onto those who are being oppressed by those rules.
But the GID diagnosis has also become entwined with receiving medical benefits, and for many many low income people or people dependent on state or federal insurance it’s a gateway to receiving medical treatment like hormone therapy.
Rumpus: How does GID as a diagnosis benefit the transgendered? Or, rather, how would access to care change if this were no longer considered a psychological disorder? Are there many people who argue that GID should remain in the DSM for this reason?
Ophelian: Again, this is a very complex issue, and one I hope we’re able to begin to address in the film. I’ve read accounts of folks who feel validated and explained by the diagnosis, I’ve read accounts of folks for whom the diagnosis was an entry way to services. There’s some reason to think that the diagnosis could be used to keep transwomen from being incarcerated in men’s prisons. There are legal cases in which the diagnostic category could be used to offer protection against a variety of harms.
I can’t say how many people are arguing for or against–I know in San Francisco, my community tends to be much more critical of the diagnosis than supportive of its continued inclusion. What I will say is that at this point, 29 years after the diagnosis was introduced into the DSM, I think it’s time for non-trans psychiatrists and physicians to step back and start listening to what trans people are saying they want and need with regard to the diagnosis in particular and competent medical and mental health care in general. I’d like to see full trans inclusion, participation, and leadership on the DSM workgroup that authors the GID diagnosis.
Rumpus: When did you decide to make the film Diagnosis Difference, and what did you hope to accomplish with it? How did you recruit people to interview? How have people responded to the film thus far?
Ophelian: I decided to make the film about two years ago, primarily as a teaching tool for medical and mental health care professionals. I was so frustrated by hearing non-trans folks talk with expertise about what trans folks experienced, and it made me want a project that showcased experiential experts describing the issues in their own words and images. I sought out participants who had experience using their personal stories as a teaching tool. I also sought out folks who were community leaders, activists, artists–people who I had heard speak or perform, who had taught or inspired me. I also recruited folks using an anti-oppression framework, purposefully seeking out diversity across experiences of oppression and constantly examining my own role as a white, non-trans filmmaker on the process of documenting the participants’ stories.
Imani Henry, an amazing activist and artist in New York, consulted with me very early on in the project, as did Lydia Sauza at the UCSF Center of Excellence for Transgender HIV Prevention. And my partner StormMiguel Florez, who plays the music over the end credits, was involved in countless conversations about how the film was being approached, crafted, and edited.
Rumpus: What did you or the participants do during the recent American Psychiatric Association conference in San Francisco? I read that there were protests outside the conference facility. Did you all participate in these?
Ophelian: I didn’t participate in the recent protests, in large part because I was in the final round of editing when they happened. One point I would like to make about the way I see GID protests often being organized is that there’s this banner of “We’re Not Crazy” that’s often flown by folks who want to see GID out of the DSM. And I think that’s a bit problematic, because there’s nothing wrong with being crazy, with living with mental illness, which is a challenge that millions of Americans meet and deal with every day. And in queer and trans communities, I think there is an especial stigma about living with mental illness–Dylan Scholinski talks very elegantly about this in the film, that for so long we’ve been told we have to be perfect, like everyone else, and that we can’t be crazy because that would mean being gay or trans is crazy. I think it’s important to be able to critique the categorization of gender variance as a mental illness as inappropriate and oppressive while also acknowledging that people who live with anxiety, depression, bipolar disorder, schizophrenia are full and complete humans who deserve respect for their experience.