Friday, September 20, 2013

Don't Rock the Boat! Homosexuality and Gender Identity, Medically Speaking

This post conforms to the blog rules.Caution while challenging the freedom of gender identity! You get called in with three attendings and they have a very polite discussion to make sure you toe the party line.

After our lecture on psychosexual disorders during the psychiatry clerkship, the faculty physician asked whether there were any questions. She is a prim older woman, an excellent and compassionate clinician that I had the privilege of shadowing for a week.

I piped up, because she had just talked about gender identity disorder. "I know homosexuality isn't in the DSM-IV," I said, "but I'm confused about the stage a gay or lesbian person is in right before they come out, when they're uncomfortable in the societal role they're in. Isn't that GID? What I mean is, why is GID a disorder and not homosexuality?"

Oops. I didn't mean to finish that way. I wasn't trying to evangelize or start anyone's wheels turning. Seriously. I just wanted to know how this was consistent. (It turns out there is an answer and I understand that this is sort of consistent now. More on that below.)

Well, the prim psychiatrist asked my peers whether they could answer, and they could. After I had been given an answer, the professor said we could take a break until the next lecture. I stood to get a glass of water as my peers also stood to stretch or get a snack. But I was stopped before I got my drink by the lecturer, who said, "why don't we go ask Drs. J and K about your question?" I obliged, and followed her to another room, where two other psychiatry faculty were lunching and talking.

The lecturer and I sat down, completing the four points of a square. "I will share with you," she said to her colleagues, "a question [mmatins] brought up about gender identity disorder." They mused. They gave the same answer my peers had.

Somehow I got the impression I was being given a talking-to. I was suddenly acutely conscious of my conservative dress and crucifix. Perhaps it was the arrangement of the room, or the abruptness and apparent formality of the meeting, or the fact that they gave the same answer my peers had, or the fact that I was alone with three faculty members, all of whom (I am reasonably confident) disagree with me about whether homosexuality is a disorder.

Anyway, nothing happened and everything was pleasant. I and the professor giving the next lecture left the room. Just an interesting experience....

So, FYI, GID is something described in younger patients (i.e. children under twelve) who are uncomfortable with their gender and its non-sexual dimensions such as dress, play, and future societal role. Homosexuality is described in patients who are sexually attracted to members of their sex. They can identify as masculine or feminine, a unique combination of both, a fluid (throughout life) combination of both, or neither but the defining characteristic of homosexuality is sexual attraction to members of the same sex. GID patients are uncomfortable in their bodily gender; homosexual patients are sexually attracted to the same sex.

It's not impossible that a person with GID be later attracted sexually to persons of their same original biological sex, nor is it impossible that a homosexual person have some discomfort with all the accoutrements of their biological sex. But these persons may carry two diagnoses. I still do not understand why "trans" adults cannot be diagnosed with GID. My attending raised this question but I didn't press it.

So, the moral of the story: pray for children with GID whose parents may be tempted to permit the children to undergo sex-change surgery. Pray for "trans" adults with undiagnosed (not-medically-real-according-to-DSM5) GID who are doing the same thing. Pray for LGBQ adults, who are attracted to members of the opposite sex. And be careful as we (prayerfully and charitably) rock the boat.


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