DSM-5: Inventing Gender - Identity and Diagnosis Creep.

Transgender Demonstration, California. 2010

"... serious persons ought not to take psychiatry seriously - except as a threat to reason, responsibility, and liberty."  Thomas Szasz  [1]


A glance back, just sixty years in time to the year 1950,  reveals a very different social structure.  The second wave of feminism and the homosexual (gay) rights movements were barely gathering storms on the cultural horizon. The word 'transgender' had not yet been invented. There was no recognisable, politically active, category of people identifiable as transgendered.

To be sure there were individuals, both male and female, who were oriented to same sex relationships.  There were also rare individuals who cross-dressed and who  presented socially as the other sex, but the latter was generally regarded as a sexual orientation issue and  the Adam and Eve depiction of biological sex reigned supreme.  Intersex was largely invisible and arguably still is.  But the classification of  'transgender' as a category of human-kind was not available simply because gender itself had not been distinguished from biological sex at the beginning of the 1950's. [2] [3]

Gender, like culture, is determined by socialisation.  Sex, like race, is determined by biology.  It would be another two decades before that distinction was assimilated into a wholly new psychological paradigm.

In the US the wave of Multiple personality cases began to peak following publication of one book: Sybil, in 1973 [4]

A decade and a half later history repeated itself with false memories, following the 1988 publication of The Courage to Heal. [5]

Man and Woman, Boy and Girl was co-authored by John Money [6] and Anke Ehrhardt. [7]

First published in 1972, (Johns Hopkins University Press) Man and Woman, Boy and Girl brought together and consolidated a raft of Money's theories and ideas, many of which had already been published as journal articles or chapter contributions in other books. [8]

For an example see, Transsexualism and Sex Reassignment, co-authored with Richard Green and published in 1968. [9]

Man and Woman, Boy and Girl was an entry level college text book.  Like many texts of its kind, it might have sat on the shelves of university libraries, presenting just one more theoretical dimension to human psychosexual development were it not for a chapter claiming to have successfully reared  a biologically normal male to believe he was a female.
See also: Ablatio Penis: Normal Male Infant Sex-Reassigned as a Girl [10]

John Money (1970's)

The experiment became known as the John/Joan case. Shortly after this (above) paper was published Money's reports ceased.  Money claimed it was to protect the identity of the child. The real reason for his sudden silence was not brought to light until 1997 when the outcome was revealed publicly. [11] [12]

David Riemer (r) & Identical twin Brian(l)

The boy's story was told in the book, As Nature Made Him,  written by Rolling Stone journalist, John Colapinto. The boy's name was revealed as David Reimer.  Money's experiment ultimately ended with the suicide of both twins. [13]

But long before that happened the belief that it was necessary to socialise human beings as males or females before they could identify as a member one or other sex had entered the realms of psychological lore.  It remains there to this day and is the reason why the term 'gender identity' is used to describe individual human self-awareness as male or female.

From around the mid 1970‭'‬s psychiatric and psychological practice has been predicated on the assumption that 'gender identity',‭ ‬along with its subsequent disordering in cases where social gender role behavior is incongruent with biological sex,‭ ‬provides a full and complete explanation for all manifestations of cross-sex role behavior.‭  ‬Occasional grumbles are heard from transsexual and transgender organisations,‭ ‬but these have mainly to do with the attributed pathology of so-called gender identity.‭  I‬t is less common to question either the value or the validity of 'gender identity' as a theoretical construct.

Yet theoretical construct it is.  Sobering though the thought may be, there exists to this moment not one single scientific study demonstrating that transsexualism (in its classical sense) is caused by a miss-identification with the opposite sex.

Diagnosis Creep” is a term used to describe a phenomenon where a disorder is identified and doctors then begin to see it everywhere." [14]

But diagnosis creep is more omni-directional than that.  A 2009 Missouri Consolidated Health Care Plan document observed:  "... Diagnosis creep occurs when diagnosis criteria are expanded allowing larger populations to become diagnosed with a condition so that insurance covers the costs of treatments." [15]

The false memory epidemic was spread by two vectors: popular culture and an unquestioning acceptance by many therapists who, themselves, often benefited by setting up highly profitable therapy practices.  The 'diagnosis' went into decline only when it was subjected to intense scrutiny by more skeptical mental health professionals. [16]

Remarkably,  once 'diagnosed',  individual behaviour changed to reflect the stereotypical behaviours thought to be central to childhood sex abuse and memory repression.  Adults took on many, if not all, the characteristics of a sex abused child. They sued, they blamed, they broke off familial relationships. Very often, their psychological health deteriorated as the false memories were assimilated - and believed as historical 'truths'. Angry children, distraught parents and uncorroborated allegations - often overshadowing the real tragedy child sex abuse - became the the public face of a psychological epidemic.

"By regarding a phenomenon as a psychiatric diagnosis—treating it, reifying it in psychiatric diagnostic manuals, developing instruments to measure it, inventing scales to rate its severity, establishing ways to reimburse the costs of its treatment, encouraging pharmaceutical companies to search for effective drugs, directing patients to support groups, writing about possible causes in journals—psychiatrists may be unwittingly colluding with broader cultural forces to contribute to the spread of a mental disorder"

wrote Carl Elliott, in The Atlantic. [17]

But psychiatrists do more than that. At worst they collude with theoretical psychologists in the construction of hitherto non-existent psychological disorders:  at best they fail in their duty to rigorously challenge the rationales and beliefs that appear to validate those same disorders.

" ... hundreds of behaviours", says Thomas Szasz, "never before treated as medical problems are now diagnosed as diseases: for example, "gender disorder" and "substance abuse." Have these new diseases been discovered? No. They have been invented, that is, they are the products of medicalization." [18]

Does Szasz's observation explain the current epidemic of 'gender variant behaviours?  What are the effects of the massive diagnosis creep evidenced in successive editions of the American Psychiatric Association's DSM series? Are transsexualism and transgender really the same things?  How is socially constructed gender used to reenforce a cultural model of dyadic sex?

Considering their short history the issues are remarkably complex. The next few articles will attempt to unravel and explore them greater depth.