2022-02-01 16:58:18
Feeling like you are the other sex than that of your body, is it a psychiatric disorder or the expression of a personal experience that no one can dispute? The question is raised by a modification of the next edition of the DSM, for Diagnostic and Statistical manual of Mental disorders, published by the American Psychiatric Association, which refers to the global plan. This next version is planned for March.
The controversy arises from the modification that it should make to the terminology designating the distinction between the sexes, that between man and woman. The opposition “natural male/natural female” has until now expressed this opposition (but not without in passing reducing male or female bodily reality to an animalized presentation, which could indeed raise questions). In the new version of the DSM, this would become: “individual assigned male/female at birth.
A fundamental change
What are the consequences ? The modification introduced is fundamental. This involves ignoring the fact that the birth designation (“it’s a boy” or “it’s a girl”) comes from an objective observation of anatomical reality. The difference between the sexes would result from an “assignment”, in other words a subjective decision to which a baby would be subject: he could suffer from it later because it would be subject to error, or even arbitrariness.
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The baby having grown up should therefore have the right to correct this supposed initial violence which would have been done to him, according to this ideological discourse, his feelings should be considered as corresponding to an incontestable truth, even if it would be contrary to his bodily sex, his feelings defining one’s sexual identity without consideration for the reality of the body.
To conform to this vision, the new version of the DSM no longer speaks of the “desired gender” that the “body transition” would target, but of “experienced gender”, to be understood as the “true” sexual identity. Each person would then be the master in their bodily reality of deciding what defines their sexual identity (in English, their “gender”), making it necessary for society to help them “join” this sex upon simple request. Only he or she would be able to assess its relevance. The medical sex change procedure would suddenly become a “medical gender affirmation procedure”, with no one having anything to object to the request for “transition”, notably psychiatrists.
Cultural role of the DSM
Ideology? Yes, and American ideology. The proof is the inanity of his explanation: an “error of nature” would be at the origin of feeling like oneself of the other sex, it would have put a girl’s soul in a boy’s body or vice versa . American ideology, because this theorization is the parade of activists facing normative Anglo-Saxon society, which persecuted minorities, particularly sexual minorities. However, social injustice cannot validate a far-fetched explanation, especially if it leads to an error in the direction of aid.
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Furthermore, the drafting of the DSM is influenced by the fact that it plays a completely different role in the United States: not only statistical as in France, but an economic, even legal role (since it is the key to access to the reimbursement of care by insurance), and a cultural role. Thus, American child psychiatry massively resorts to drug treatments when faced with difficulties in the child’s psycho-affective development, whereas in France it is psychological help to resolve them that dominates.
Dismay
This is because French psychological culture is about understanding. Psychiatric classification remains a simple collection of information. The psychological approach does not remain on the surface of the manifestations, it deepens their causes in the interiority of the experience, from its family news if it is a child or an adolescent, or as reminiscences of its past. This is an adult. This understanding does not make any judgment based on an external and social criterion, it respects the diversity of everyone’s expressions but sheds light on them.
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Thus, French psychological culture detects a distress in the fact that a certain number of children and adolescents are demanding a “transition”: they are having difficulty taking ownership of their own body. Gender identity is the psychological process resulting in making chromosomal body sex (XX or XY) a coincidence, a necessity of oneself, as if it were obvious: “of course I am a boy/a girl”. This process involves the impregnation of the masculine for the boy, the feminine for the girl, which is established from the relationship of each child to his parent of the same sex: identification shapes the canvas of sexuation, implementing a transmission psychic.
Untimely medicalization
But this relationship is full of passions and pitfalls. They can embarrass this transmission and disrupt it. The question in France is not whether there is a psychiatric disorder or not; there is a dismay which can result in a mirage of belonging to the other sex. The belonging then claimed to be of the other sex is an understandable parade against an authentic malaise: such is the French explanation, argued by experience and opening up to respectful help for young people and families with a view to relieve the authentic discomfort at its emotional root. American society ignores this and therefore rushes into invasive and quickly irreversible medico-surgical protocols. The new wording of the DSM would reinforce this untimely medicalization.
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Whether American adults demand to be able to decide for themselves to change sex is their debate with American society. That this decision-making power applies to American children and adolescents is something that merits our making better known across the Atlantic the French understanding of the discomfort of these young people demanding the mirage of “transition”. For all this to be imported into French child psychiatry would be a betrayal of our psychological culture: it is attentive to the distress of all young people, without preconceptions, but by refusing any artificial response and excluding deceiving young people, fascinated at their age by a “transition” which seems to them to be an immediate relief without being able to measure its subsequent impacts.
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