The National Council on Identity Policy (NCIDP) - Firewire News Case Study: Diagnostic and Stastistical Manual of Mental Disorders revision 5 (DSM V)

The National Council on Identity Policy (NCIDP) was born of the struggles of one tenacious survivor of domestic violence and stalking. The NCIDP continues her work with the help of many. Read more about the NCIDP...

[NEW and of potentially related interest: Identity in International Law; Case Study: Violence at IAAF ]

(Firewire News) - Controversy rages around the proposed Diagnostic and Statistical Manual of Mental Disorders, version V (DSM V). At the heart of that controversy lies the proposals of the Zucker-Blanchard Revision Committee to selectively pathologize individuals based upon their identities.

The DSM is published by the American Psychiatric Association (APA), and is often referred to as "the bible of psychiatry". It is the basis upon which psychiatrists analyze individuals and diagnose "mental disorders". The proposed fifth revision builds upon and expands the pathologies identified and characterized in the preceding DSM IV, the version in current use.

Firewire News reporters learned of the DSM V controversy and asked The National Council on Identity Policy (NCIDP) for an analysis:

1 - Identity at Law part A

In legal terms, at Common Law and in U.S. Law, individual identity is strictly, exclusively and contextually self-determined. (Jonson v. Greaves (KB, 1765); Christianson v. King County (S Ct, 1912); Planned Parenthood of Southeastern Pa. v. Casey (S Ct, 1992); Entick v. Carrington and Three Other King's Messengers (KB, 1765); Lawrence v. Texas (S Ct, 2003); Department of Justice v. Reporters Committee for Freedom of the Press (S Ct., 1989); Boyd v. U.S. (S Ct., 1886); Bram v. U.S. (S Ct., 1897); Weeks v. United States (S Ct. 1914); Cantwell v. Connecticut (S Ct., 1940); Breard v. Alexandria (S Ct. 1951); Shafer v. Farmers Grain Co. (S Ct. 1925); Board of Regents v. Roth (S Ct.); et al.) (see also NCIDP website [Birth Certificates & Identity] [Basic Identity Terms & Meanings] [Overview of Identity] [IIULA - YOU Have the Power]).

For anyone to impair the exercise of that self-determinacy in any way is a violent assault. (Keeble v. Hickeringill (QB 1707) (see also NCIDP website [The Heart of Violence & the Law]).

2 - International Law

Although published in the U.S. and designed for use within the U.S., where the above legal standard strictly applies, the DSM has been known to influence the practice of psychiatry worldwide, and can even be found in use by some practitioners outside the U.S. Therefore, it is also pertinent to note that the above Common Law standard strictly held and constitutionally protected in U.S. Law is also incorporated into International Law. The International Convention on the Human Rights of Children (UNCRC), for example, dictates that individuals have sole and exclusive entitlements in their own identity that cannot be abrogated by others - no governments or other public entities, and not even parents of a child, have any entitlements to that child's identity. This is a human right explicitly protected by International Law.

To then pathologize anyone as paraphilic for their own legal true identity flies in the face of the laws of identity in U.S. Law, Common Law and International Law. (See also: Basic Identity Terms & Meanings).

The DSM V proposes to do this.

3 - History

Indeed, the APA and psychiatry in the U.S. has a long history of using identity as a basis for wrongly deeming individuals to be "mentally ill" - in every case used against a minority group, and in every case used to further marginalize and discriminate against those minority groups. Not long ago in American psychiatry, a black person was mentally deficient just for being black. So too were women, who were also "hysterical" most of the time.

Consistently and repeatedly, social enlightenments reaching the practice of psychiatry have demonstrated the utter and absolute wrongness of identity-based diagnoses. INDEED, the entirety of this ideology, the field of eugenics (also called biological determinism), has been a broadly discredited ideology unmasked as a pseudoscience since the abrupt end of eugenicist programs in Germany in 1945.

4 - DSM V Proposal

The DSM V proposes to return the practice of psychiatry back toward those dark days, greatly expanding identity-based, eugenicist diagnoses as paraphilias. That is, the proposed text seems to indicate that an elderly couple attracted to each other would both suffer a paraphilia called Gerontophilia (attraction to elderly people) by the Zucker-Blanchard Revision Committee, placing both elderly people into the same psychiatric classification (paraphilic) as pedophiles.

Comments one analyst from our psychosocial department, "The recently released (early 2009) proposed DSM revision, intended to be incorporated in the DSM V, appears intent upon returning to the tragic, dark days of identity-based 'mental disorders' to the greatest extent possible. It was only with the publication of the DSM IV in 1994 that a gay or lesbian ceased to be deemed inherently mentally disturbed in the same way that women and other minorities had been previously. That the DSM IV persisted with the category of 'Gender Identity Disorder', or anything similar in any way, was a sad vestige of that tradition of overt bigotry in American Psychiatry. It appears that the Zucker-Blanchard Revision Committee is bent upon restoring such bigotry-based diagnoses to their previous levels to the greatest extent that they can achieve. It appears that under the DSM V, my own parents will be deemed to suffer from Gerontophilia, and thus be classified in the same section of paraphilias as pedophiles. It appears to fall only barely short of returning fully to the dark anti-miscegenation days of the practice of psychiatry."

In addition to the newly proposed Gerontophilia paraphilia, the Zucker-Blanchard Committee has also proposed another new paraphilia: Fat Fetishism. And also caught up in this broad sweep toward a dark, eugenicist past are individuals commonly diagnosed under the DSM IV as "Gender Identity Disordered" (GID) or "Gender Dysphoric". Ironically, it wasn't until publication of the DSM III that Gender Identity Disorder existed as an identity-based psychiatric diagnosis at all.

Between Gerontophilia, Fat Fetishism, and GID, it is abundantly clear that Hollywood-style stereotypical beauty, young, thin, and hyper-feminine (for women) or hyper-masculine (for men), is being "officially" normalized by the Zucker-Blanchard DSM V proposal, and almost anything else is being marginalized, stigmatized and pathologized. "It flies in the face of everything that feminism and the civil rights movements have purported to stand for," adds another analyst, "and is an abysmal attempt to reverse decades of struggle against discriminatory biases surrounding bodily/identity stereotypes."

5 - Identity at Law part B

AT LAW, an individual's identity is wholly self-determined in relation to any given context and moment. That means, as contexts change or individuals change, identity changes, and the identity information that best describes that person's true identity may change from time to time and context to context. This is rooted in the Common Law recognition of what was once clearly understood, widely understood common sense common knowledge: a person's identity cannot be dictated to them, nor ever truly and fully understood by another. (Basic Identity Terms & Meanings).

Moreover, AT LAW, any impairment of that right to strict self-determination of identity, and dictation of identity by another, or disclosure of former identity by another, IS the accusation of conviction for fraud for adoption of the self-determined identity. That is, it is the claim of prior criminal conviction of adopting that self-determined identity for the intended purpose of committing fraud. (Basic Identity Terms & Meanings).

6 - Gender

The Zucker-Blanchard Committee is proposing to wholly ignore the naturally occurring spectrum of identity that had previously been recognized throughout most of human history, and had been well accepted at law (Birth Certificates & Identity). It wasn't until the Cold War fascist McCarthyist movement of the 1950's and 1960's, still inspired by the dying eugenicist philosophies, that this spectrum largely withered from social consciousness within the U.S. With that recent shift, the sociologic idea of a strict binary gender system arrived and it suddenly became common practice to alter the genitals of children at birth, often without even parental knowledge or consent, of individuals born with Congenital Variations of Sexual Development (CVSD).

In modern law, legal determinations of gender, rooted in inheritance rights and military conscription, merely determine status as either male or "other than male", where "female" is legally indistinguishable from "other than male". (Birth Certificates & Identity). That philosophy persists at law, and persisted in the text of many military regulations, including in the U.S., well into modern times and the late Twentieth Century - any inadequacy of the reproductive system or ability to procreate was grounds to disallow admission or for discharge (regulations that once were often disparately cited as the reason for disallowing or discharging GID and other CVSD individuals, but originally conceived in ancient times [prior to gender equity in inheritance and admission of women into the military] to ensure that only legally male, manly-men were permitted to enter military service).

Currently and historically, anyone not qualified to "be male" is lumped together as "other than", regardless of reason for disqualification from status as male. (Birth Certificates & Identity). It is a rule-in/rule-out methodology revolving around the idealized status of a male, and without any specificity beyond that.

With legal gender equity in inheritance considerations of the present era, coupled with Court-decided constitutional prohibitions on dictation of identity (Christianson v. King County (S Ct, 1912); Planned Parenthood of Southeastern Pa. v. Casey (S Ct, 1992); Lawrence v. Texas (S Ct, 2003); et al.), legal gender determination can only be made by the individual, and one needs only prove one's own masculinity to ones self to "be male". (Birth Certificates & Identity).

Under the gender determination system at Common Law prior to gender equity in inheritance, a person's determination as a male hinged upon that individual's ability (or suspected ability) to sire children and carry on the patrilineage (Birth Certificates & Identity). Thus, a condition as basic as Erectile Dysfunction Disorder could disqualify an individual and render them "other than male" (and many military regulations persisting into modern times would have then held the individual unfit for service). This issue may have become particularly pertinent in very recent years as several U.S. states have recently enacted amendments to their constitutions to inhibit gay marriages, amendments often worded to constrain marriages to be between "one man and one woman" (woman being legally indistinguishable from "other than male").

7 - Gender Contextualized

At law, the word "woman" is indistinguishable from the term "other than male", the latter being the precise legal concept inhered in both terms. (Birth Certificates & Identity). Consequently, to offer a theoretical example: IF Zucker of the Zucker-Blanchard Committee suffered Erectile Dysfunction Disorder (EDD), he would be legally "other than male", lumped in with women at law, and therefore barred from marrying anyone except a man by the aforementioned constitutional amendments. Moreover, if he continued trying to live as a man, he would be suffering from Gender Identity Disorder in his own scheme of it, and the existing APA scheme of it. (See also NCIDP website (Birth Certificates & Identity)). An alternative definition of "woman", apart from the meaning "other than male", cannot be adopted into law without also adopting into law a vast multiplicity of additional gender definitions to span the spectrum of naturally occurring gender variations that might not fit such an alternative definition.

In light of the shift to gender equity in inheritance rights, in the above theoretical example, Zucker is free to dictate that his identity is male, despite suffering from (theoretically, remember!) Erectile Dysfunction Disorder. But the current (DSM IV) and proposed (DSM V) have invented marginalizing pathologies to impair this right for a select group of individuals (that in this example would include Zucker himself), enrolling psychiatrists across the U.S. and around the world into systematic, methodical and persistent violent assaults (Keeble v. Hickeringill (QB, 1707)) and accusations of conviction for fraud upon the individuals in that group. (The Heart of Violence & the Law). It is, by design, arrogation of individual self-determination, and a construct of violence often used as an instrument of violence. (Case Study: Terrorists 'Own' San Francisco, Case Study: Violence at IAAF).

8 - GID

At law, no other party has any entitlement to a person's identity. (IIULA - YOU Have the Power). Just as importantly, if not moreso, no other party has any entitlement whatsoever to former identity information. (IIULA - YOU Have the Power).

In the current DSM scheme of things, an individual is diagnosed as "Gender Dysphoric" or "Gender Identity Disordered" beginning from the time that the individual recognizes themselves as previously living in a gender role that was wrong for them. This is not merely marginalizing, it is also patently contrary to applicable legal standards AND rational logic:

1)a) The persistent diagnosis, contrary to the rule of law within the U.S. and Internationally, deems the individual's self-determined identity to be FOREVER "less than", or a qualified and limited identity apart from that individual's true identity (Basic Identity Terms & Meanings) (Identity in International Law);

1)b) establishing a routinized and normalized methodology of perpetrating violent assault and accusation of conviction for identity-based fraud upon victims (The Heart of Violence & the Law);

1)c) and creating an entire lexicon of language that, for many of the victims, are 'words which by their very utterance inflict injury - fighting words' (Chaplinski v. New Hampshire (S Ct. 1942));

2) The diagnosis, contrary to the rule of law wihtin the U.S. AND Internationally, assumes entitlement to, and misanthropically deems appropriate wide entitlement to, former identity information (Overview of Identity) (Identity in International Law);

3) The diagnosis depends upon the legally unsupportable idea of a male-female gender binary when the legal roots of identity determination never established more than whether a person was male or somewhere else along the gender spectrum (Birth Certificates & Identity);

4) The diagnosis, contrary to the rule of law within the U.S. and Internationally, assumes birth identity to be relevant to contemporaneous true identity or legal identity (Basic Identity Terms & Meanings) (Identity in International Law);

5) The diagnosis, contrary to the rule of law, presumes a third-party dictatorial right to establish an individual's identity and impose it upon the individual (Entick v. Carrington and Three Other King's Messengers (KB, 1765); Planned Parenthood of Southeastern Pa. v. Casey (S Ct, 1992); Lawrence v. Texas (S Ct, 2003); et al.).

The current proposals of the Zucker-Blanchard Committee cannot be resolved with the rule of law. Indeed, at law, what that committee proposes to do is to commit a violent assault (The Heart of Violence & the Law) and accusations of identity-based fraud on every individual whom it can find a way to diagnose with GID; inducing organized activities closely resembling those condemned in Cianci v. U.S. (S Ct., 2004).

The NCIDP has several cases on file where normal women (as the DSM IV defines it; sometimes called "cisgendered female", "natal female", "congenital female", et al.), individuals who were not GID, were fraudulently diagnosed with GID by perpetrating providers for the very purposes of enacting violence, abuse and terror upon the victims, and preventing those women from accessing the health care that they needed. (One such case: Case Study: Terrorists 'Own' San Francisco).

The NCIDP and its own founder (About the NCIDP), who first ran across information about GID doing legal research on identity and identity law in general, have always held that the DSM and APA concepts of GID are not only completely contrary to the standards of identity LAW, but also victimizing and contrary to any reasonable standard of ethical regard for human beings and human rights. Our founder (About the NCIDP), after first studying GID and the DSM scheme of it in the 1990's noted, "It's backwards! The individual might be trying to conform to biologically based sociological gender role expectations in early life, an identity contrary to that person's own true identity, and then and only then might be dysphoric and suffering something that might be construed as a trauma-based mental disorder, and in no way resembling a paraphilia. But damnit, as soon as that person comes to terms with their own true identity and sets about adopting that identity-congruent role, the disorder is at its end and the healing begins!"

According to the NCIDP psychosocial department, AND more consistent with the rule of law, the DSM scheme for GID is completely wrong. Any individual adopting a chosen identity congruent with their own self-determined true identity IS that identity, and any GID that may have previously existed in a struggle against that true identity ENDS with adoption of that congruent chosen identity.

The goal of the DSM with GID was to address the disparity between the legally recognized, naturally occurring gender spectrum and the novel sociological concept of a rigid male-female binary. The problem with its construction is that it is an attempt to address societal ignorance of human (and animal) biology by blaming and psychiatrically pathologizing the otherwise psychologically normal individuals who don't fit that novel social construct because of that natural biological/medical spectrum. GID is a diagnostic criteria that is inherently, unavoidably iatrogenic for many judged by it.

In general and from a behavioral view, behaviors significantly inconsistent with a person's identity might normally be expected to be pathologized by the psychiatric field, for which behavioral modification to achieve socionormative standards might be suggested. However, the DSM IV and Zucker-Blanchard DSM V proposed GID construct do the OPPOSITE, pathologizing behaviors that ARE consistent with a person's identity. This backward, inappropriate pathologization stigmatizes and marginalizes individuals and is what the court's have long held to be violent assault. (The Heart of Violence & the Law).

9 - CVSD

In societies like the U.S. where, sociologically, gender-binary expectations have recently arisen with attached biological stereotypes, any bodily inconsistencies with those societal stereotypes are a subset of the set of medical/biological conditions broadly classified as Congenital Variations of Sexual Development (CVSD), most of which have previously also been called Intersex (now outdated) at times in recent history. The medical terminology Congenital Variations of Sexual Development arose because other contemporaneous terms, like Intersex, were appearing to be inadequate as medical terminology.

Broadening the CVSD concept to include a few non-congenital developmental conditions such as Erectile Dysfunction Disorder (non-congenital), the term "Variations of Sexual Development" (VSD) is sometimes used. Most judged under the DSM to be GID are generally within the CVSD, congenital section. Conditions are non-congenital VSD if evolved entirely after birth from some demonstrable later physical disease or injury, as is sometimes the case with Erectile Dysfunction Disorder (such as may be induced by smoking or a high cholesterol diet), for example.

Of a potentially similar concept in recent literature from other sources is the term "Disorders of Sexual Development" (DSD), apparently largely subsuming conditions previously often known as Intersex as well. The full scope and meaning of the DSD terminology is not clear to the NCIDP, and the NCIDP strongly dislikes the use of the term "Disorder", a frequently stigmatizing term. Many conditions subsumed by CVSD, and potentially also by DSD, while less common, are still not uncommon, naturally occurring conditions that may not necessarily require specific medical interventions, or otherwise need to be deemed a "disorder".

Congenital Variations of Sexual Development (CVSD) is a broad medical diagnostic grouping, an umbrella grouping, of medical/biological/anatomical variations from socionormative sex/gender developmental expectations. That is, this medical term can include any condition where the biological or anatomical state of an individual varies from sociological expectations for a male-female binary, as appropriate for an individual's self-determined identity.

The legal expectation is not a male-female binary, but instead a male or "other than male" determination entirely self-determined. Therefore, in simplest terms, it might be possible to think of the CVSD diagnosis as being applicable to anyone whose self-determined legal identity varies from the novel sociological male-female binary expectations in any way.

The legal distinctions of identity make it logically impossible, within the sociopolitical legal system within which it must operate, to validly exclude those that the DSM IV calls GID from other biomedical CVSD conditions, such as Androgen Insensitivity Syndrome (AIS), Aphallia, Clitoromegaly, Congenital Adrenal Hyperplasia (CAH), and others. Indeed, under the CVSD criteria, some whom the DSM IV judges to be GID individuals would instead have fairly minor medical diagnoses, some of which are easily addressed through surgical options if necessary to the individual. Conversely, it appears that the Zucker-Blanchard DSM V proposal might expand the GID diagnosis sufficiently to begin including as paraphilic those previously diagnosed in a purely medical context as Intersex but not GID under DSM IV, whose variations have long been, and more appropriately, addressed in a strictly medical context rather than a paraphilic psychiatric context.

10 - Encapsulation

Many whom the DSM IV judges to be GID individuals have experienced profound, persistent violence, sexual harassment and trauma from birth to gender congruence from sociologically imposed violent oppression of their true identities, and their own struggle during this period of dysphoria to conform to those pressures and repress their true identities. The persistence of the DSM IV diagnostic scheme as it stands, and even moreso as proposed for the DSM V, guarantees that such individuals will continue to face that same kind of profound, persistent violence, sexual harassment and trauma for the rest of their lives, and serves to greatly impair and prevent full achievement of social identity congruence. The greatest psychological need for many such individuals revolves around this sexual violence and trauma, for which there are ample appropriate diagnoses in other sections of the DSM having nothing to do with the paraphilia section.

Removed from the field of psychiatry, and from the legal identity spectrum, the Congenital Variations of Sexual Development (CVSD) medical diagnostic grouping removes the stigma of a psychiatric diagnosis that can't even, from the beginning, be resolved with the rule of law, logic or behavioral psychology. This medical context permits individuals to take whatever actions may be necessary to resolve any biological or anatomical incongruities, and then move on with their lives toward happy, healthy, identity-congruent futures.

At The National Council on Identity Policy, it has long been an internal NCIDP policy to address legal issues of identity more broadly than what may pertain directly to survivors of extreme violence. The DSM IV scheme of Gender Identity Disorder has long been on the radar screen of the NCIDP, recognized early as a gross impairment of the right of individuals in the self-determination of identity, AND as a construction entirely anathema to feminist nondiscrimination principles opposed to judgments [of women] based upon [women's] bodies. Indeed, the proposed DSM V appears to tread deeply down that very path, proposing to establish as a paraphilia "Fat Fetishism" and "Gerontophilia", in addition to continuing and expanding the ill-conceived GID construct. Stereotypically young and thin appear to be the only ideals that the APA doesn't want to pathologize and stigmatize as a psychiatric paraphilia alongside pedophiles - and the APA is contravening every tenet of identity law to do it.

Added NOTE: a team led by Winters and Ehrbar have presented a counter-proposal to the Zucker-Blanchard proposal for the DSM V. The Winters-Ehrbar proposal appears, upon a cursory reading, to offer closer proximity to legal constructs of identity than Zucker-Blanchard's effort to put the DSM V in complete opposition to the law. While the Winters-Ehrbar proposal appears to improve the DSM V position significantly (relative to identity law), it may not offer complete legal compliance with the standards of identity law.