hen I was nineteen, I was diagnosed with Bipolar Disorder I. I have spent much of my adult life resisting, complicating, and talking back to the damning, stigmatizing narrative of the DSM — the Diagnostic and Statistical Manual of Mental Disorders, now at edition 5. The DSM is the bible of psychiatry and the Mental Health Industrial Complex. Big Pharma is a fan. I even co-edited an anthology challenging the DSM’s biomedical model (with several pieces I authored).
For one piece, I used a pen name because the reality of some of my “symptoms” were too scary to be open about as an untenured professor. But I have tenure now, so fuck it. I’ll tell you a bit more about what has gone on in my head. My soul, actually.
But before I do that, you should know something. This DSM document, this tome, this oppressive brick of a book that I have railed against — it almost got something right.
And that shudder of its near miss shook me a bit.
You see, there’s another closet I’m coming out of just this year too. When my book had its cover in the mock-up stage, I saw my old name and winced. My name was wearing a dress. Not me. When I want to shine, I want a bowtie and a vest. Why would I put that wrong name on something I had worked so hard on? No, that’s not right. I thought. Not anymore, and not ever again.
So I go by LD to pretty much everybody now — that felt right for the cover, and it feels right for me. I also go by Leo. I identify as a masculine-of-center non-binary person. If you haven’t heard this term before, non-binary is on the transgender spectrum, and it means different things to different people.
I use they/them pronouns and honor the complexity of being born in a body assigned female at birth (AFAB) and having (and enjoying!) masculine as well as feminine traits, identities, presentations, etc. But lately, I’m feeling mostly masculine. Dandy and dapper, if you’re curious. I have more than one pair of suspenders and loud wingtip Oxford shoes.
And yes, this process sounds fine and well, yes, dandy, but I’ve also slowly begun experiencing a deep, plaguing sensation of wrongness about the flesh of my chest. This feeling of disconnect between one’s body and one’s mind is commonly called gender dysphoria.
And whaddya know, the DSM calls it that, too.
I don’t want to be classified as having a mental health disorder at all (because all of them are bogus), and now I’m saddled with two.
My diagnosis of “bipolar disorder,” in my opinion, is both a sensitivity towards and reaction to traumas (both personal and systemic) that yields strength, creativity, and passion, and my diagnosis of “gender dysphoria”…well that just makes me fabulous.
As my co-editor Kelechi Ubozoh and I were on tour with the book, one of my dear friends from college, who is also non-binary and trans, asked us from the audience about the DSM’s entry on Gender Dysphoria. Can it be useful? I was inspired by her question.
We discussed how most trans people are required to get a diagnosis of Gender Dysphoria in order to access gender affirming surgeries and hormonal therapy in our current healthcare system. This medical diagnosis makes a material difference in trans people’s day to day lives. At the same time, the fact that gender dysphoria is in the DSM as a mental health diagnosis at all is based on a disease model that robs trans people of agency and causes us real harm.
Do we need the DSM and a medical diagnosis to be there to fulfill bureaucratic needs until we have reinvented the world?
After all, this isn’t the only way things can be. In Uruguay the government pays for gender affirming surgery and hormonal treatment.
I realized after that event that these were important questions. It’s time I consider them in writing.
So I promised you something a ways back that maybe you’re curious about. I promised to let you into this curious mind/body/spirit of mine. Part of my mission in life is to tell my story as a neuroatypical psychiatric survivor to embolden and ease the suffering of others who have faced similar struggles.
I want to put a human face on diagnoses like “Bipolar Disorder I” and help people understand that these categories are useless. And damaging.
All I know is that when I was 16 and I finally started coming to terms with my childhood traumas — sexual abuse and verbal abuse — I disintegrated. I completely lost language and reason. I had symbols. I had plenty of metaphors. But I was lost to meaning because meaning was everywhere like an ocean of salt.
And then I was told by doctors that what was going on was like diabetes? That I needed sedating drugs with devastating side effects for the rest of my life because I was born this way? What really disturbs me is how my perpetrator used this toxic logic to gaslight me. He said I hadn’t been abused. I was just sick. Delusional to accuse him. He said he “wanted me all the way well.” Meaning, accepting I was crazy and that he was innocent would be the mark of my sanity.
Can I tell you something? I had an idea for this piece.
I wanted to research and share here the entry on my particular “bipolar” diagnosis from the DSM, and feel repulsed, and tell you about it, and then you’d believe me, and I’d make this brilliant point. But I can’t do that. I just tried. I couldn’t do it.
I can’t read the DSM entry that is used by my psychiatrist to dole out the meds that I take. (Because life is hard and I need them as a tool. I don’t know if I’ll ever be fully med-free, and that’s okay.) I want to read the DSM entry to tell you this story properly, but I tremble as I consider opening a web browser with that entry.
That is how much psychiatry has damaged me. Dehumanized me. Made me into a thing. Psychiatry has put me on involuntary holds in locked facilities, bound me to beds, shot me in the hip with drugs. Psychiatry continues to tell me to watch my every move, or they’ll do it for me.
Psychiatry doesn’t expect much of me, and when I do something well, I’m an exception and a model, not a human living their life with ups and downs like everybody else.
Psychiatry says I was born this way, and poor me. And see you next month, like parole. Forever.
But the truth is, “bipolar” does not come from my genes. It comes from traumas. I am certain of that. My creative resilience in response to these traumas has made me fierce, and fun, and mad, and I’m mad proud of that. Psychiatry itself has been part of what I’ve had to fight against, with its compounding traumas of forced medication and hospitalizations on top of the childhood traumas that brought me like a fledgling to its door.
So of course I’m suspicious of the DSM and any of its attempts to “get” me. Psychiatry has gotten at me in some really violent ways. So I won’t be looking up that “bipolar” diagnosis today, no thank you.
I am less afraid to see what the DSM’s entry on “Gender Dysphoria” says. Still nervous, though. I’ve had the triggering experience of gender dysphoria, and I’ve experienced microaggressions and discrimination for being non-binary. So I’m okay, but not great. But I want to answer my friend’s question.
When I finally read the entry on Gender Dysphoria, a curious thing happened. When I started to read the entry, I was all IT ME.
“People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body.
People with gender dysphoria may allow themselves to express their true selves and may openly want to be affirmed in their gender identity.”
Yes, thank you. THANK YOU! Thank you….DSM?!
What do I, a gender non-binary radical mental health advocate do with that?Well I kept reading. It wasn’t great. But it wasn’t trash fire. When I kept reading the entry on Gender Dysphoria in the DSM-5 I discovered two other major flaws, other than the disease model itself:
1) They use the term “opposite” gender.
Gender is a spectrum, a multi-faceted glass prism of light. There are no opposites within a prism. At first, I felt seen, and not in a creepy way — I felt genuinely witnessed by the opening language, which was surprising. But then they reveal they think in the binary — two opposing, distinct masculine/feminine poles — no room for complexity or nuance. FAIL.
And then I read further.
2) There’s this:
“Gender dysphoria is not the same as gender nonconformity, which refers to behaviors not matching the gender norms or stereotypes of the gender assigned at birth. […] Gender nonconformity is not a mental disorder. Gender dysphoria is also not the same as being gay/lesbian.”
Okay, so this is where I’m lost, and also where I think the two noted flaws in their typology intersect. Since they see gender as a binary situation, they are very firm that nonconformity is not the same as dysphoria. Huh. What exactly could this possibly mean?
They may not be the same, but at least for me, they are undeniably intersecting experiences. I am so befuddled by these people! The way the first part was written, it expressed all this empathy and compassion for those “suffering” with dysphoria. But if you’re “nonconforming” that’s fine, you must not be suffering, really, and good on you.
I might be “read” as gender non-conforming when I walk around in the world because I am not on testosterone, I have not had any gender affirming surgeries, and yet I still suffer from dysphoria. My flesh feels wrong. I am uncomfortable in my skin. Where does that leave me, DSM entry?
The feeling of gender dysphoria is so rarely discussed in our culture that it feels like a welcome salve to read someone acknowledging it with compassion, and a powerful medical body no less. And dysphoria has made me suffer, so I like the compassion the DSM offers in its opening. I have grown weary of hanging bags of flesh that remind me that I’d rather be as sleek and svelte naked as I am dressed and wearing a binder.
Reading the first part of the DSM entry I felt seen, acknowledged, and it didn’t feel like condemnation. It felt like a ticket out of suffering. Get this box checked, we’ll get you out of that “female” box.
Yes, please! Thank you!
Maybe even write me a prescription for a medication called “Boob Be Gone!” I’d take that over surgery any day, and I wouldn’t feel the ambivalence I feel taking my psych drugs.
But then they continue on into knots of twisted logic in a vain attempt to make sense of something as fantastic and boundless as gender in one page.
The DSM is so good at not seeing all of me.
It honestly did surprise me that they offered such kind language when discussing the real pain of dysphoria, and not in a way that felt stigmatizing.
Yet its very presence in that goddamn brick of a book is a problem.
The National LGBTQ+ Task Force has this to say about the Gender Dysphoria entry in the DSM 5:
“We must understand that as long as transgender identities are understood through a “disease” framework, transgender people will suffer from unnecessary abuse and discrimination from both inside and outside the medical profession. As long as gender variance is characterized by the medical field as a mental condition, transgender people will find their identities invalidated by claims that they are “mentally ill,” and therefore not able to speak objectively about their own identities and lived experiences.”
First of all, thank you. Transgender and non-binary identities are not “mental illnesses.” But where does this leave me, Task Force? Are you going to throw me under the bus with my “legit mental illness” — and say that I am, by virtue of it, not able to speak objectively about my own identity and lived experience?
Robert Whitaker, author of Mad in America and who wrote the foreword to our book, helped give me language for this cruel phenomenon: “anosognosia.”
That’s what psychiatrists say when they don’t want to listen to their patients. The idea is that we can’t be trusted to know our own truth because we’re too damaged to know what’s good for us. Sounds remarkably like my perpetrator and those who stand by him. But in fact we with lived mental health experience are the ones who should be listened to the most.
Nothing about us without us.
As a radical mental health advocate, I have argued that every so-called “disease” in the DSM is a reaction to trauma. As a proud non-binary person, I do not believe trans or non-binary identity is connected to trauma other than the fact that trans and non-binary people endure the traumas of bigotry and institutional cis-supremacy.
Trans and non-binary identity is not borne of trauma, but we are certainly subject to it, and to say otherwise is itself bigoted. A non-binary friend of mine had to fire a therapist who tried to link their gender to their childhood trauma. That therapeutic rupture itself was traumatic for my friend.
My critique of the inclusion of Gender Dysphoria in the DSM does not come from the same place as my critique of other entries, such as “bipolar disorder.” My work as a mental health advocate has given me language to counter the biomedical model; there is “the recovery model” which claims that our wounds can be healed, and with the right trauma-informed care those who struggle with their moods or wellness won’t always be reliant on drugs and oppressive institutions.
But obviously, “recovery from trauma” is not the answer for what is described as “Gender Dysphoria.” Trans and non-binary are valid identities, not diseases.
But no one with mental health struggles has a disease. As a person marked as “mentally ill,” I also have a positive identity that I share with others marked in this way.
We are mad, we are neuorodivergent. We are not wrong. We represent a different kind of diversity — we share the sufferings of our traumas, the sensitivity and creativity of our beings, the shared struggle of seeking care from institutions that harm. We live in the margins of the mind.
The LGBTQ+ Task Force would probably say this is just another historical moment to fight the bigotry of the American Psychiatric Association on behalf of trans and non-binary people. Lesbian and gay identity were in the DSM-3. Social movements and pride wiped them out. But there is a crucial distinction here.
For lesbian, gay and bisexual folks, the DSM said the “condition” of homosexuality needed to be “cured” — which led to the horror that is conversion therapy. But for Gender Dysphoria, the DSM recommends a “cure” of gender affirming surgery and/or hormone treatment, which is often what the patients actually want. This makes a world of difference.
But what if we did more than take out the Gender Dysphoria entry from the DSM? What if we acknowledged the intersection of the oppressions of trans and non-binary people and neuroatypical people? That intersection certainly lives in me.
As Audre Lorde said of her intersections: “which me will survive all these liberations?”
What if we threw the brick of a book out of a window? What if we replaced it with as many explanations for our minds and identities and bodies as there are people? What if we honored and celebrated everyone’s individual story?
Some trans and non-binary folks might say of their experience: “My gender is on a spiritual journey” or “My trans body is part of nature’s biodiversity” or “My gender just is how it is and it’s only colonialism and/or monotheism which denies it.” And on and on, through the prism.
And here is the crucial intersection. This is similar to the rhetoric I and others use about our experience as people with diagnoses of “mental illness”:
“My mind isn’t breaking down, I’m experiencing a spiritual emergence because I have dangerous gifts.” “My mind is part of nature’s neurodiversity.” “My mind is on a shamanic quest.”
And on and on, through a different prism. But like double helixes, my non-binary gender and my identity and my body and my brilliance and my madness are all inextricably bound together, and unique. A psychiatrist would just pen down that I have two diagnoses. I would say I have multiple resiliences and brilliances. And my own story to tell.
As much as I want to throw the DSM through a window and call for a revolution in mental health care and gender, I also know those windows are shut pretty tight. Don’t get me wrong, I do want to overthrow cis-hetero-patriarchal white supremacist imperialist ableist sanist capitalism. I just think we need healing and whole people to do it, and a whole lot of us.
Here’s the revolution I want to call for in gender and mental health: let’s repurpose all those books (and lord, there are so many) into actual bricks and build community centers and hospitals that offer free surgery and hormones on demand without need of any permission slip, as well as mutual aid groups for anyone trying to survive this world and all its boxes — especially the ones with locks on them.
 We’ve Been Too Patient: Voices from Radical Mental Health — Stories and Research Challenging the Biomedical Model edited by LD Green and Kelechi Ubozoh, North Atlantic Books