Trans health care from a depathologization and human rights perspective

Amets Suess Schwend

doi:10.1186/s40985-020-0118-y

Abstract

Trans people are exposed to multiple human right violations in clinical practice and research. From 1975 on, gender transition processes have been classified as a mental disorder in diagnostic classification manuals, a classification that was removed recently from ICD, International Classification of Diseases, and continues in DSM, Diagnostic and Statistical Manual of Mental Disorders. Trans people in different world regions are forced to accept psychiatric diagnoses and assessment in order to get access to trans health care, subject to reparative therapies and exposed to transphobic institutional and social discrimination and violence. In many countries, gender identity laws include medical requirements, such as psychiatric diagnosis, hormone treatment, genital surgery, or sterilization. In the scientific literature, a frequent pathologization of trans experiences can be identified, by means of pathologizing conceptualizations, terminologies, visual representations, and practices, as well as ethnocentric biases.Trans activism and scholarship have questioned widely the pathologization of trans people in clinical practice and research. Over the last decade, an international trans depathologization movement emerged, demanding, among other claims, the removal of the diagnostic classification of transexuality as a mental disorder, as well as changes in the health care and legal context.International and regional bodies built up a human rights framework related to sexual, gender and bodily diversity that constitute a relevant reference point for trans depathologization activism. The Yogyakarta Principles, published in 2007 and extended in 2017 by means of the Yogyakarta Principles plus 10, establish an application of international human rights law in relation to sexual orientation, gender expression, gender identity, and sex characteristics. International and regional human rights bodies included demands related to depathologization in their agenda.More recently, advancements towards trans depathologization can be observed in the diagnostic classifications, as well as in the health care and legal context. At the same time, trans people continue being exposed to pathologization and transphobic violence.The Human Rights in Patient Care (HRPC) framework offers a human right-based approach on health care practices. The paper aims at analyzing the shared human rights focus and potential alliances between the trans depathologization perspective and the HRPC framework.

Highlights

All over the world, trans people1 are exposed to human rights violations, including social and labor discrimination, criminalization, pathologization, exposure to transphobic violence, and homicides [1–14]
The term is used taking into account its Western character that may not coincide with forms of gender transition or transgression in other cultural contexts [53]. These discourses identify the human rights framework as one of the most relevant foundations of the depathologization perspective. Taking into account this relevance, this paper aims at analyzing the relationship between trans depathologization discourses and the Human Rights in Patient Care (HRPC) framework [75, 76]
The review of the main principles and demands of the theoretical-activist trans depathologization perspective shows the relevant role of the international human rights framework, as established in the Yogyakarta Principles and reaffirmed in recent strategic documents

Summary

Introduction

Trans people are exposed to human rights violations, including social and labor discrimination, criminalization, pathologization, exposure to transphobic violence, and homicides [1–14]. In ICD-11, all trans-related diagnostic codes were removed from the chapter “Mental and Behavioural Disorders,” and the code “Gender incongruence” was included in a new chapter “Conditions related to sexual health” [38] In spite of this recent advancements, in different world regions, trans people continue receiving psychiatric diagnoses, are forced to reparative therapies aimed at modifying their gender expressions or identities, or have to undergo psychiatric assessment processes based on binary and heteronormative assumptions in order to get access to hormone treatment or trans-related surgeries [1, 2]. An emerging field of trans studies and allies identify a frequent pathologization of trans experiences in research, by means of discriminatory conceptualizations, terminologies and visual representations, the promotion of clinical practices that do not fulfill human rights standards, and ethnocentric biases [42–53] They observe a frequent lack of ethical practices in research processes with trans people, such as an absence of informed consent, violation of confidentiality, and lack of opportunities for active participation in research processes [42–44, 49, 51]. They criticize the exclusion of trans people from knowledge production processes, with a frequent reduction to a “testimony” role, without recognizing the theoretical contribution of trans scholarship [47]

Objectives

Conclusion