Friday, July 19, 2013

Charing Cross Team Echoes View On ICD Revision

GIC entrance

Earlier today I posted a short item reporting a statement by the heads of two English Gender Identity Clinics, Professor Kevan Wylie and Dr Walter Bouman, confirming their views about how the International Classification of Disease (ICD) should be updated for gender identity diagnoses.

For background see another recent blog.

The position of these two senior clinicians was not surprising, given their involvement in the global consensus-building process led by the World Professional Association for Transgender Health (WPATH). However, this was the first time that two clinical heads had stated the position so succinctly in writing.

Rapid response

No sooner had this morning's blog gone out than I heard from a senior clinician at the Charing Cross Gender Identity Clinic, England's largest.

Dr Stuart Lorimer lamented that it was a shame the letter had only had two signatories. He felt sure his colleagues would want to have had the opportunity to express the same to ILGA, who were gathering the information. They'd simply not been approached.

Another letter

I suggested that there was no reason they couldn't endorse the principles independently. I provided the contact details for ILGA's policy officer and the Charing Cross team went off to agree a suitable letter, to be signed by the chief clinician, Dr James Barrett.

And this is what James' message, addressed to ILGA, says:


Following the joint statement of Drs Bouman and Wylie, we would like to make our own position clear regarding gender related diagnoses in the forthcoming ICD-11. As the oldest and largest of the UK’s gender clinics, we find that dealing with the ongoing needs of our sizeable caseload (currently, around 4000 active attendees) keeps us occupied to the extent that we are often less directly involved than we would like to be in global matters such as the ICD-11 discussions in Geneva. This does not, however, mean that we are ignorant of or indifferent to those discussions.

As specialist clinicians dealing with the day-to-day realities of gender treatment, our own collective view is very similar to that of our professional colleagues. We support the renaming of the current F64.0 diagnosis, Transsexualism, to the less contentious Gender Dysphoria, Gender Incongruence or similar. Also, the diagnosis itself should, ideally, remain within the ICD-11 in a category aligned with gender identity, sexual or reproductive conditions rather than that section specifically designated mental health. This would help safeguard future provision of healthcare to gender variant people.

Again, a very clear endorsement of the direction being taken in the consensus process. And I don't doubt that the heads of the other English Gender Identity Services would agree too.



HenryHall said...

Such a contradiction.

Dysphoria is clearly a psychological condition and thereby MORE contentious than Transsexualism.

Not less contentious.

HenryHall said...

Oh, and by the way, the received English noun is Incongruity.

Incongruence is purely an Americanizm.

Christine Burns MBE said...

The letter is quite clearly stating that Charing Cross are not particularly bothered about the term. Within the context of the wider dialogue Barrett is simply expressing those terms as examples of options that have been mooted.

The ICD is an international publication, led by the World Health Organisation as an executive agency of the United Nations. Therefore there is no more reason to follow the grammar of British English than any other language. The term has not been decided yet. The current working term in the consensus group is "incongruence". However, discussions about the consensus forming are taking place in the open like this in order that people can voice their views.

I strongly doubt that any term will satisfy everyone. However, if the trans community spends all its time arguing with itself over pet preferences it will be somewhat missing the point.

grrlAlex said...

As a clinician I can clarify a linguistic point here: the term 'incongruence' is widely used within the psychology professions here in the UK- originating I suspect from the tenets of the humanistic movement. It's a term that is well understood within the clinical world albeit perhaps less so within the broader population. Agreeing with Christine, I'm disappointed to note that the leading UK clinic by far in the field was not consulted but am encouraged by the move which seems to balance the need to ensure continued access to healthcare and a move to steadily de-pathologise transgender
Alex Drummond MSc BA. MBACP(Snr.Accred) SGDT(Accred)

HenryHall said...

@> As a clinician I can clarify a linguistic point here: the term 'incongruence' is widely used within the psychology professions here in the UK.

You give an excellent reason to avoid using the word incongruence in a context of transsexualism.

Lucy Melford said...

Not only was the leading UK clinic not consulted. There is a small army out there of post-treatment transsexual people who could have given valuable evidence on how their condition developed as the years passed. The information gleaned from those among them who are willing to take part in properly designed and controlled ongoing monitoring would provide a solid basis for saying what type of condition we are really dealing with.

Obviously there would be many who would prefer not to be monitored, and there must be the possibility of a future opt-out, but I suspect a statistically significant number would agree to let themselves be quizzed from time to time on how their self-perception and socialisation in their correct gender had improved or deteriorated, and to give their own explanation for it. The evidence of post-treatment patients still seems to be stuck in a largely anecdotal stage, and its value underrated.

Lucy Melford

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