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Tuesday, June 19, 2018

WHO excludes transsexuality as a mental illness

Por Rory

The World Health Organization (WHO) has excluded transsexuality as a mental illness and has incorporated the abusive use of video games as a behavioral disorder in the first update of its International Classification of Diseases in almost three decades published this Monday. After 11 years of work, the WHO has decided that transsexuality, which is a disorder of gender identity, leaves the category of mental illnesses -something that the LGTBI associations have been demanding for years- and enters into the category of sexual behaviors. It is maintained in this way within the classification so that when a person seeks medical help he/she obtains it since in many countries, if the diagnosis is not included in the list, the public or private health system does not reimburse the treatment.

"We want people who suffer from these conditions to get health care when they need it," Shekhar Saxena, director of the Department of Mental Health and Substance Abuse at WHO, told a news conference. But it is no longer considered a mental illness "because there is no evidence that a person with a gender identity disorder must automatically have a mental disorder at the same time, although it often happens that it is accompanied by anxiety or depression". Furthermore, "if people with a gender identity disorder are automatically identified as having a mental disorder, in many countries they are stigmatized and their opportunities to seek help may be reduced". Another of the most striking modifications of the classification is the inclusion of video games in a new disorder, that of the pernicious "game", which is incorporated into the same list where there is also the harmful action of betting. "We include the disorder of playing addictively after analyzing the few evidences we have and after listening to a Scientific Committee that suggested that this new phenomenon be included as a disease that can and should be treated," said Saxena.

This update (ICD-11) replaces the ICD-10, in force since May 1990, the year in which homosexuality was removed from the list. Since then, versions of this classification have been authorized every so often, but transsexuality has always been considered a disorder against the demands of the trans collective, which calls for the depathologization of their condition. It is one of the most ironclad LGTBI claims that ends the philosophy that underlies most of the world's legislations: transsexuality is a disease that must be diagnosed and needs treatment. The WHO has wanted to move away from this conception to recognize it as a situation that can come into contact with health services, for which it creates a new chapter.

ICD-11, which has been in development for more than ten years, incorporates what it calls "gender incongruence" in the chapter on "conditions related to sexual health" together with other concepts such as "sexual dysfunctions" or "related disorders" with sexual ailments." It not only changes the name and situation in the manual, but also the definition. Until now, the ICD-10 described transsexuality as "a desire to live and be accepted as a member of the opposite sex, usually accompanied by discomfort or disagreement with the anatomical sex, and desire to undergo surgical or hormonal treatment to make that the body itself matches as much as possible with the preferred sex."

Now the definition - for adults and adolescents - will be: "A marked and persistent incongruence between the experienced gender of the individual and the assigned sex, which often leads to a desire to 'transition' to live and be accepted as a person of the experienced gender through hormonal treatment, surgery or other health services to align the body, as much as desired and as far as possible, with the experienced gender.The diagnosis can not be assigned before the onset of puberty. Gender preferences alone are not a basis for assigning the diagnosis." The ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by the Member States, and will enter into force on January 1, 2022.

This presentation, specified by WHO in a communiqué, is an advance that will allow countries to plan how to use the new version, prepare translations and train health professionals across the country. The modification made by the organization is an achievement for the LGTBI collective, which asks to continue advancing in the total depathologization of transsexuality. This would imply that it was not denominated and defined as "an incongruity", but as an expression of human diversity.

The International Classification of Diseases is a standardized coding of all ailments, disorders, conditions and causes of death that helps countries obtain statistical and epidemiological data on their health situation and can plan programs and resources accordingly. The last revision of this standard was made 28 years ago, and for 11 years the most recent scientific information has been analyzed to create a new standard that is available for use by medical personnel from all over the world, although States have time to adapt until 2022. This process has served to update a classification that in many cases was outdated, did not reflect reality or did not include behaviors that are now considered diseases or disorders. The classification includes 55 thousand different codes.