Sample Letters to the DSM-V Task Force of the American Psychiatric Association We feel it is essential that the APA open up the Sexual and Gender Identity Disorders Work Group to include professionals representing broader clinical and research perspectives. We ask trans-affirming professionals and clinicians to write the APA with specific recommendations for nomination to the work group and advisory panel. Here are some sample letters to the American Psychiatric Association DSM-V Task Force. Our Recommendation page contains biographical information and curriculum vitae for suggested nominees. Letters may be addressed to names listed on the Contact APA page. To my respected colleagues: For the past few months I have been engaged in a virtual maelstrom of email and phone conversations regarding the American Psychiatric Association's Work Group that has convened to address the Sexual and Gender Identity Disorders section in the long awaited DSM IV. It is my understanding that the APA is committed to maintaining an "open" process, and willing to hear feedback from the professional communities that are impacted by the outcome of the Sexual and Gender Identity Disorders Work Group and will be utilizing the next edition of the DSM in our clinical work. It is no secret to the Sexual and Gender Identity Disorders Work Group that there is impassioned debate regarding the Gender Identity diagnoses, and concern about the continued pathologization of transgender, transsexual, and gender non-conforming adults and children. We have all witnessed the enraged fury of trans-activists over the appointment of Drs. Zucker and Blanchard to the Committee, and the astonishing 9000 signatures on a poorly written and ill-informed petition requesting their removal. Although clinical decision-making should not be determined by political pressure (however well-intentioned), the fact that so many people who are impacted by the Sexual and Gender Identity Disorders Work Group's decisions believe that some members of the Work Group are hostile to their basic civil rights, should be of serious concern to the American Psychiatric Association. I enter these discussions trying to balance and address numerous clinical and scholarly concerns. I am a Social Worker and Family Therapist by training. For over twenty years, I have been teaching a graduate level course that on psychopathology, utilizing the DSM as our primary textbook. As an educator, I am conversant in the language of the DSM regarding the strengths, weaknesses, and complications of many diagnostic categories, not just GID. As a Family Therapist and Gender Specialist, I evaluate and assess transgender and transsexual people for medical referrals, and serve on the Standards of Care Committee of the World Professional Association of Transgender Health, focusing specifically on issues of assessment and medical referral - areas impacted greatly by diagnostic classifications. Additionally, I have spent the past thirty years of my life working for social justice, and it is this vision that guides my clinical work and scholarly pursuits, since - as research has shown - mental stability is greatly impacted by environmental pressures and societal bias. I am the author of two books that addresses transgender issues, including Transgender Emergence, a book which won the American Psychological Association's (Division 44) Book of the Year Award in 2006, and was noted as a Book of Special Merit by the Society for Sex Therapy and Research (SSTAR). I outline in my book a non-pathologizing treatment perspective that utilizes a developmental model of transgender identity formation and examines the particular role of social stigma in the lives of those with atypical gender expressions. I have authored an article that specifically examines these issues (Disordering Gender Identity: Gender Identity Disorder in the DSM-IV-TR, that is published in The Journal of Psychology and Human Sexuality, 17 (3/4), 2005), which will be sent to the attention of the Dr. Zucker and will hopefully be distributed to the Work Group members. Clinicians, scholars, and researchers from diverse fields are guided by the diagnostic criteria in the DSM. However, the DSM is not simply a diagnostic tool, but also influences socio-political and judicial decision-making, as well as impacts treatment considerations and insurance reimbursement for services. The issues the Sexual and Gender Identity Disorders Work Group are faced with are complex, and gender non-conforming people will be affected not only therapeutically, but medically and legally by the final resolutions determined by the Sexual and Gender Identity Disorders Work Group. Questions of civil rights and social justice are woven into clinical issues in this section of the DSM in a way that impacts no other APA Work Group. It is essential that all of those impacted by the Sexual and Gender Identity Disorders Work Group ultimate conclusions feel that the team represents the diversity and complexity of issues impacting the revision and reform of GID. However, many professionals are concerned that Sexual and Gender Identity Disorders Work Group, as it is currently convened, does not represent their clinical perspectives and treatment methods. Evidence-based practice depends not only on extant scientific research, but also the "best practices" of clinicians. In light of these concerns, I have been working with a number of other professionals, across diverse disciplines, that would like to see the Sexual and Gender Identity Disorders Work Group expanded to include a greater range of clinical and research perspectives. It is with this goal, that I am recommending that the following professionals be added to the Sexual and Gender Identity Disorders Work Group. They have all agreed to serve as Members of the Work Group or as Advisors. I am attaching small biographies of their skills and background, copies of the Curriculum Vitae's and their contact information. I strongly encourage the Sexual and Gender Identity Disorders Work Group to take seriously the criticisms that have been levied to the APA by both trans-activists and skilled and experienced clinicians, researchers, and scholars. Addressing the complex issues we are faced with regarding both diagnostic criterion for the therapeutic treatment of human beings experiencing distress related to gender issues and the equally important struggles of a burgeoning community's efforts towards self-determination and civil rights requires a balanced committee that represents the many perspectives and voices emanating at this seminal moment in history. My recommendations are listed below. Sincerely, Arlene Istar Lev LCSW, CASAC Edgardo Menvielle, M.D. Children's National Medical Center 111 Michigan Avenue, NW Washington, DC 20010 Michele Angello, Ph.D. 987 Old Eagle School Road, Ste. 719 Wayne, PA 19087 Dan Karasic, M.D. Clinical Professor of Psychiatry 1001 Potrero Ave., Suite 7M San Francisco, CA 94110 Herbert Schreier, M.D. Department of Psychiatry Children's Hospital Research Center Oakland California 94609 Diane Ehrensaft, Ph.D. 445 Bellevue Avenue Suite 302 Oakland, California 94610 Gail Knudson M.D., M.P.E., F.R.C.P.C. Clinical Assistant Professor of Psychiatry University of British Columbia Department of Sexual Medicine To Whom It May Concern: I am a psychotherapist and gender specialist who has been working with gender-variant clients for 10 years. I am also a member of a coalition of clinical psychologists, psychiatrists, academics, and independent scholars who are concerned about the limited breadth of perspective that the committees focusing on revisions to the DSM-IV in the areas of Gender Identity Disorder and Paraphilias have. In my clinical practice, I have witnessed a significant paradigm shift with regard to gender-variant individuals, including transsexual, transgender and cross-dressing people, which is particularly apparent when reflecting back on the experiences of these individuals at the time when the DSM-IV was published in 1994 and the DSM IV-TR in 2000. To a great degree, the clients I see do not feel as disenfranchised or socially isolated. The degree to which they feel shame and anxiety appears to have diminished substantially in comparison to what others may have been feeling when the diagnoses of Gender Identity Disorder and Transvestic Fetishism were created or elaborated upon. With this in mind, it stands to reason that the constructs reinforced by these diagnoses as they are currently written are not scientific or provable outside of a damaging and repressive social context. These social changes suggest that a different consciousness must be brought to bear on the analyses of these diagnostic criteria in order to avoid bias and prejudice. I respect the fact that the professionals currently appointed to the committees have significant experience and specific expertise, but I strongly believe that these topics deserve a broader base of more diverse experience that is represented on the committees. My practice primarily consists of transsexual individuals for whom medical treatment is beneficial, yet most of these individuals do not have any pathological impairment. I would like to make certain that committee members are aware that this is the experience of many people and that this experience will be taken into account as the diagnoses are reviewed and potentially revised. I would also like to trust that your committee members are consciously aware of the social and legal ramifications of any criteria they are considering. And finally, I would like to offer the following individuals as additional committee members and/or advisors to your current committees in the spirit of broadening the base of experience upon which to draw as the DSM-V takes shape: Edgardo Menvielle, M.D. Children's National Medical Center 111 Michigan Avenue, NW Washington, DC 20010 Dan Karasic, M.D. Clinical Professor of Psychiatry 1001 Potrero Ave., Suite 7M San Francisco, CA 94110 Herbert Schreier, M.D. Department of Psychiatry Children's Hospital Research Center Oakland California 94609 Diane Ehrensaft, Ph.D. 445 Bellevue Avenue Suite 302 Oakland, California 94610 Gail Knudson M.D., M.P.E., F.R.C.P.C. Clinical Assistant Professor of Psychiatry University of British Columbia Department of Sexual Medicine I hope you will contact any of these individuals and invite them to serve as advisors to your committees. Also, please feel free to contact me directly for further information. Thank you for your consideration and for the effort you are investing in organizing the revision. Warm Regards, Michele Angello, Ph.D. Wayne, PA To Whom It May Concern: I am a licensed clinical psychologist in the Atlanta area. I have been a gender specialist for 12 years and have worked with nearly 300 individuals of gender dissonant experience and their loved ones. I am a member of a coalition of clinical psychologists, psychiatrists, academics, and independent scholars who are concerned about the limited perspectives represented by the composition of the Committees focusing on revisions to the DSM-IV in the areas of Gender Identity Disorder and Paraphilias that are concerned with gender-variant behavior. I am aware that since the DSM-IV was published in 1994 and DSM-IV-TR in 2000, significant social change has occurred with respect to gender-variant individuals, including transsexual, transgender, and cross-dressing people. To a great degree, the people I see in my practice are no longer socially isolated or ostracized; shame and anxiety tend to be a less significantly issue than they were when the diagnoses of Gender Identity Disorder and Transvestic Fetishism were created or elaborated upon. Therefore, I believe that the constructs reinforced by these diagnoses as they are currently written are not scientific or provable outside of a damaging and repressive social context. With the social changes we have seen, and self-reports of my clients, my clinical experience suggests that significantly different consciousness must be brought to bear on the analyses of these diagnostic criteria in order to avoid bias and prejudice. I appreciate the significant experience and specific expertise that the extensively published professionals currently appointed to the committees have, yet I strongly believe that these topics deserve a broader base of more diverse experience than is currently represented on the committees. For example, I see clients for whom I know that transsexual medical treatment will be most beneficial, yet these individuals do not have any pathological impairment. I would like to know that this type of experience will be taken into account as the diagnoses are reviewed and potentially revised. I would like to know that the committee has members who are consciously aware of the social and legal ramifications of any criteria they are considering. To this end, I would like to offer the following suggestions for additional committee members and/or advisors to your committees in the spirit of broadening the base of experience upon which to draw as DSM-V takes shape: Edgardo Menvielle, M.D. Children's National Medical Center 111 Michigan Avenue, NW Washington, DC 20010 Michele Angello, Ph.D. 987 Old Eagle School Road, Ste. 719 Wayne, PA 19087 Dan Karasic, M.D. Clinical Professor of Psychiatry 1001 Potrero Ave., Suite 7M San Francisco, CA 94110 Herbert Schreier, M.D. Department of Psychiatry Children's Hospital Research Center Oakland California 94609 Diane Ehrensaft, Ph.D. 445 Bellevue Avenue Suite 302 Oakland, California 94610 Gail Knudson M.D., M.P.E., F.R.C.P.C. Clinical Assistant Professor of Psychiatry University of British Columbia Department of Sexual Medicine I hope that you will contact any of these individuals and invite them to serve on or as advisors to your committees. Also, please feel free to contact me for further information. Thank you for your consideration and for the effort you are investing in organizing the revision. Very Best Regards, Dr. Virginia Erhardt Decatur, Georgia www.virginiaerhardt.com To Whom It May Concern: We are a coalition of clinical psychologists, psychiatrists, academics, and independent scholars who are concerned about the composition of the Committees focusing on revisions to the DSM-IV in the areas of Gender Identity Disorder and Paraphilias that are concerned with gender-variant behavior. We would like to point out that since the DSM-IV was published in 1994 and DSM-IV-TR in 2000, significant social change has occurred with respect to gender-variant individuals, including transsexual, transgender, and cross-dressing people. No longer are these people (in large part) socially isolated or ostracized; no longer are they as filled with shame or anxiety as they were when the diagnoses of Gender Identity Disorder and Transvestic Fetishism were created or elaborated upon. We believe that the constructs reinforced by these diagnoses as they are currently written are not scientific or provable outside of a damaging and repressive social context. With the social changes we have seen, our clinical experience tells us that significantly different consciousness must be brought to bear on the analysis of these diagnostic criteria to weed out bias and prejudice. We have no doubt that the professionals currently appointed to the committees have significant experience and specific expertise, but we strongly feel that these topics deserve a broader base of diverse experience than is currently represented on the committees. For example, many of us see clients for whom we know that transsexual medical treatment will be most beneficial, yet these individuals do not have any pathological impairment, and we would like to know that this experience will be taken into account as the diagnoses are reviewed and potentially revised. We would like to know that your committee members are consciously aware of the social and legal ramifications of any criteria they are considering. To this end, we would like to offer the following suggestions for advisors to your committees in the spirit of broadening the base of experience upon which to draw as DSM-V takes shape: Edgardo Menvielle, M.D. Children's National Medical Center 111 Michigan Avenue, NW Washington, DC 20010 Michele Angello, Ph.D. 987 Old Eagle School Road, Ste. 719 Wayne, PA 19087 Dan Karasic, M.D. Clinical Professor of Psychiatry 1001 Potrero Ave., Suite 7M San Francisco, CA 94110 Herbert Schreier, M.D. Department of Psychiatry Children's Hospital Research Center Oakland California 94609 Diane Ehrensaft, Ph.D. 445 Bellevue Avenue Suite 302 Oakland, California 94610 Gail Knudson M.D., M.P.E., F.R.C.P.C. Clinical Assistant Professor of Psychiatry University of British Columbia Department of Sexual Medicine We hope that you will contact any of these individuals and invite them to serve as advisors to your committees. Also, please feel free to contact any of us who have signed below for further information. Thank you for your consideration. Very Best Regards, name of concerned professional