Transgender Advocates Seek New Diagnostic Terms Does a woman who strongly believes she was meant to be a man have a mental condition or a medical problem? Is a man who cross-dresses in need of psychological help? What about a boy who pretends to be a girl in make-believe games and chooses only female playmates? The nation's psychiatric establishment is wrestling with these questions, among others, as it works to overhaul its diagnostic manual for the first time in almost two decades. Advocates have spent years lobbying the American Psychiatric Association to rewrite or even remove the categories typically used to diagnose transgender people, arguing that terms like Gender Identity Disorder and Transvestic Fetishism promote discrimination by broad-brushing a diverse population with the stigma of mental illness. "The label of mental defectiveness really places a burden on trans people to continually prove our competence in our affirmed roles," Kelley Winters, a Colorado scholar who has helped lead the push for changes, said. Although the association's new Diagnostic and Statistical Manual of Mental Disorders is not scheduled to be printed until the end of the year, the updates are taking shape after three rounds of proposed changes. Professionals who have been part of or closely observing the amendment process say the latest wording, while not going as far as many advocates wanted, respects the broader shift in society's understanding and acceptance of what it means to be transgender since the last major revision of the manual was published in 1994. Rachel Sorrow, a transgender woman, smiles as she attends a therapy session with Dr. Dan Karasic, a psychiatrist with the Center of Excellence for Transgender Health, at San Francisco General Hospital in San Francisco, Friday, July 20, 2012. The nation's psychiatric establishment is wrestling with questions on proper treatment of transgender people as it works to overhaul its diagnostic manual for the first time in almost two decades. "All psychiatric diagnoses occur within a cultural context," New York psychiatrist Jack Drescher, a member of the APA subcommittee working on the issue, said. We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories (of male and female.) We wanted to send the message that the therapist's job isn't to pathologize. The most symbolic change under consideration so far for the manual's fifth edition, known as the DSM-V for short, is a new name for Gender Identity Disorder, the diagnosis now given to adults, adolescents and children with "a strong and persistent cross-gender identification." In the manual's next incarnation, individuals displaying "a marked incongruence between one's experienced/expressed gender and assigned gender" would be diagnosed instead with "Gender Dysphoria," a term that comes from the Greek word for emotional distress. While the shift may seem purely semantic, switching the emphasis from a disorder that by definition all transgender people possess to a temporary mental state that only some might possess marks real progress, according to Dana Beyer, a retired eye surgeon who helped the Washington Psychiatric Society make recommendations for the chapter on "Sexual and Gender Identity Disorders." "A right-winger can't go out and say all trans people are mentally ill because if you are not dysphoric, that can't be diagnosed from afar," Beyer said. It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes. Persuading the psychiatric profession to redefine who and who does not qualify for its care has historical precedent as a civil rights issue. In 1973, the APA, responding to pressure from the gay and lesbian community, concluded that same-sex attraction alone was a normal part of human experience, not an illness.