On March 30, 2016, Raw Story ran
this article on a MN State Representative by the name of Glenn
Gruenhagen. Mr. Gruenhagen has introduced
a piece of legislation into the MN House of Representatives to identify LGBT
people as “mentally ill” and “in need of treatment.” The basis of his argument? The Diagnostic and Statistical Manual Fifth
Edition (DSM-V).
The DSM-V is the guidebook produced by the American
Psychiatric Association (APA) as a tool to help identify mental health issues
and deviations. I will admit that I’m
not well versed on the DSM-V; it was in the process of final approval and
publication when I made career changes.
But I know the DSM-IV and I know how to use the Manual in general. I also know that Mr. Gruenhagen’s
interpretation of this admittedly problematic diagnostic criteria for an
identity disorder is neither in keeping with the science nor the ethics behind
the DSM-V.
I’m not going to get into the ins and the outs of the actual
diagnostic criteria for Gender Dysphoria because sometimes nitpicking
psychological terms completely misses the point. Besides, it’s not like Mr. Gruenhagen has
released the actual reference or any literature in support of his position so
that the academic community can respond to specific misinterpretations and
misrepresentations. I guarantee it’s not a licensed psychologist
or psychiatrist that brought this to his attention.
The American public in general often misunderstands what the
DSM actually is. We’re so accustomed to
going to our doctors, laying out our symptoms, and having the doctor run
through the rolodex in his mind or his little pocket book or an app to help
identify our symptoms. Psychology is
different. We look at the symptoms but
we also consider how those symptoms may or may not affect one’s quality of life
or day to day functioning. We also
consider environmental influences which could trigger symptoms.
The whole point to the DSM is to give a framework for
treatment and not diagnosis. When you
look at a list of diagnostic criteria in the DSM, it may list five or seven
areas of behavior that are negatively influenced because a disruption or
disturbance in development or the environment or coping with the
environment. Depending on the diagnostic
category, to appropriately apply the diagnosis the patient/client must meet a
certain number of the criteria listed.
In short, it’s like a “check all that apply” list of maladaptive
behaviors and/or maladaptive coping. If
the patient/client falls short, the diagnosis doesn’t apply. The trick is, when doing this, is to look at
the right criteria for the right problem.
For example, “depression” is a diagnosis of its own but it’s also a
symptom in a variety of other diagnoses.
But again the idea with the DSM isn’t to find the right
label or labels for the patient/client.
The insurance companies like these labels because a lot of insurance
companies will look in their Big Books of Money Saving Policies and say, “Oh. Depression.
We’ll pay for six visits to a therapist for treatment because, on
average, it takes six therapeutic sessions to treat depression.” Which is a bunch of hogwash. But that’s our healthcare system.
Once the provider has determined what the struggle is,
however, an approach to treatment can begin.
One of the MANY things Mr. Gruenhagen fails to realize in
his hate-bill is that “disorder” is not “disease.” A disorder is not an illness. A disorder is what it says it is: Not order.
Something is out of whack, either in the person’s thought processes,
coping strategies, acceptance of reality, or environmental. Yes, environmental. A person can be diagnosed as 995.82 (Adult
psychological abuse by nonspouse or nonpartner, Suspected, Subsequent encounter). The damage caused by the abuse will need to
be dealt with, but the disorder is caused externally, environmentally. The disruption in the normal ordered
thinking/feeling/behaving pattern is DISordered because of the environment.
When the DSM-V was being developed, I remember quite a bit
of discussion among my peers about the gender and sexuality criteria and the diagnostic
labels. It’s problematic. Our understanding is constantly
changing. Science, particularly our
understanding of human psychology, is developing almost as quickly as computer
technology. The moment you buy a
computer it’s outdated. The moment the
DSM-V was finally approved by the APA and printed it was outdated in a lot of
respects. Mr. Gruenhagen is treating the
DSM-V like he treats his Bible—it says it, black and white, so that must be
what it means now and forever. And just
like his approach to the Bible, Mr. Gruenhagen is too ignorant and too lazy to
actually educate himself on what it is he’s reading. (I’d be willing to have a conversation about
Mr. Gruenhagen’s theology another time.)
I think a lot of psychiatrists and psychologists would agree
with me when I say: With Gender Identity
Disorder, there is a disruption in the order of thinking/feeling/behaving but
most of that disruption is aggravated by factors outside the person’s internal
struggle for identification.
Namely: Fear of judgment, fear of
rejection, fear of politicians who want to label them abnormal and force them
into behavioral conditioning camps where, perhaps, they can “pray the trans
away.” It doesn’t work that way.
I’ve posted recently two entries on my blog listing specific
statistics identified by scientists describing mental health and the LGBT
community. The crux of the problem is
not an internal one. It is
external. It’s about how individuals and
systems around the LGBT individual complicate coping and development. (You can read these posts here
and here.)
So, fine, if Mr. Gruenhagen wants to draw attention to the
disordering of LGBT people, I hope he’s ready to pass legislation to ease that
disordering. Equal protection, equal
access, anti-discrimination….basically all the things Mr. Gruenhagen has stood
against in his tenure in the Minnesota House of Representatives. Since his first key vote on January 27, 2011,
Mr. Gruenhagen has voted:
- To prohibit same sex marriage [SF1308]
- Increase requirements for Abortion Providers [SF1921]
- Voted against an authorization for same sex marriage [HF1054]
- Voted against requiring schools to establish antibullying policies (HF826]
- Voted against approving the MN HHS Biennium Budget [HF1233]
- Voted against the MN Health Insurance Exchange [HF5]
- Voted against expanding Medicaid [HF9]
- Voted against increasing equal pay and establishing workplace protections foe employees [HF2536]
It’s quite clear that, despite how he’s trying to portray himself
with this anti-LGBT bill, he’s not interested in mental health care, health
care, or services and policies that would change the environment and people’s
perceptions in order to mitigate the symptomology which is disrupting the order
of LGBT people’s lives.
Mr. Gruehagen’s agenda is clear and it’s one of barbaric,
religiously superstitious regression. I
mean, this is the guy who stood
on the floor of the MN House and advocated that in order to end bullying we
need to start beating our children.
Honestly, though, we shouldn’t be surprised by Mr.
Gruenhagen’s inability to understand how to interpret and apply the DSM-V. He’s an insurance agent. His professional reading is limited to an
understanding of black and white. I’m
not disrespecting insurance agents; I have a number who I consider close
friends. But that is how their brains
are wired. Psychology is never black and
white. I hope he figures this out sooner
rather than later. Not that I care how
badly he’s embarrassing himself; he’s making his bed and he can lie it. My concern is how backwards he is making the
State of Minnesota look by continuing to fight these old battles on which not
only the citizens have spoken but science made its determination nearly fifty
years ago. And my BIGGEST concern is the
continuing damage he is doing to LGBT individuals by prolonging a way of
thinking that has been demonstrated to be grievously harmful to LGBT people
time and time again.
Or, I suppose, Mr. Gruenhagen’s bill might have absolutely
nothing to do with actually helping people.
This might just be the Trump approach to politics: Say whatever, do whatever, and soak up the
attention. After all, it’s clear from
his anti-LGBT bill and his voting record he’s not about healing and
wholeness. To know what he’s really
about, you can check out his entire voting record here.
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