In what could be a monumental move for transgender people, the World Health Organization (WHO) announced Monday that they no longer classify gender incongruence (also known as gender dysphoria) as a mental illness.
The WHO announced the change along the newest version of the International Classification of Disease (ICD-11), an international guideline for diagnosing diseases and other health conditions. In the ICD-11, gender incongruence has been moved from the "mental health" chapter to a newly created "sexual health" chapter. "We had better understanding that this wasn't actually a mental health condition. And that that was causing stigma," Lale Say, MD, coordinator at the Department of Reproductive Health and Research of the WHO, said of the change. Keeping gender dysphoria in the ICD-11, which still classifies it as a health condition, means that trans people who have gender dysphoria can access healthcare needed to feel more comfortable in their bodies. That can mean anything from taking hormones like estrogen and testosterone to having surgery to remove or augment breasts or reconstruct genitals.
Although the change might seem small to many, it's huge for transgender people (especially those who've yet to begin their medical transitions). "People have been working for so many years to depathologize transgender identities across the gender spectrum," says Ady Ben-Israel, PhD, a licensed clinical psychologist who specializes in sexuality and gender. "Normalizing gender diversity is essential to ending discrimination against our communities."
And that's the goal of this new classification, Dr. Say says in the announcement. The WHO expects this move to help remove stigma and make transgender people more socially acceptable (although this idea says something about people with mental illnesses not being socially acceptable). In turn, removing stigma could help to reduce violence against trans people, says Vanessa Victoria Crespo, counsellor and advocate at the New York City Anti-Violence Project (AVP). "Calling gender dysphoria, and in the past sexual orientation, a mental health disorder is what has led people into forced hospitalization, conversion therapy, and the criminalization of trans people for being openly out," she says.
While the move should help with stigma and *fingers crossed* violence, Dr. Say doesn't expect that it will change much about the way transgender people who have dysphoria receive treatment. Yet, some trans people hope that changes as well. Not every trans person experiences dysphoria, but many do need medical interventions to start feeling comfortable in their bodies. And this change could make that process easier. "Hopefully, it will reshape the narrative on who trans people are and how we access healthcare," says Lou Weaver, transgender programs coordinator for Equality Texas. "My hope it will remove the mental health 'gate keepers' that create barriers to trans folks getting the care that they need and want."
Many times, transgender people need to be cleared by a therapist and have a note from a mental health provider before they can access hormones or book a surgery. These are the "gate keepers" Weaver is referring to; they're steps in the process that make it more difficult for trans people to begin their medical transition. "It's removing the person’s ability to make decisions for their own care," he says. "Hopefully, removing the mental health stigma from transgender folks will also remove the barriers that the diagnosis has created."
Regardless, this announcement marks a change in attitudes about transgender people, much like when homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders or DSM (essentially, the American version of the ICD) in the 1970s. Both Dr. Ben-Israel and Crespo hope that the WHO's changing definition of gender dysphoria influences a similar change for transgender people in the U.S. "Many in the community and allies are eager to see the American Psychological Association (APA) remove Gender Dysphoria from the DSM in future revisions," Dr. Ben-Israel says. "For the US-based APA to follow the lead of the WHO is a critical step in reducing ongoing stigma around gender diversity."