„Mi, neformalna grupa transrodnih* osoba iz Bosne i Hercegovine, Trans* BiH, koja djeluje u sklopu Sarajevskog otvorenog centra, vjerujemo da je tretiranje rodne raznolikosti kao mentalnog poremećaja pogrešno, neutemeljeno i pridodaje postojećoj stigmatizaciji transrodnih osoba. Kao takvo, ono nema mjesta u dijagnostici koja treba da se temelji na načelima naučnog istraživanja i univerzalnih ljudskih prava.
Mi govorimo, ne kao akademski stručnjaci ili kreatori rodnih ili zdravstvenih politika, već kao osobe koje žive stvarnost transrodnog postojanja. Naš glas je i glas onih koji su lično doživjeli predrasude, stigmatizaciju i uticaj loše pravne, zdravstvene i socijalne politike.
Označavanje rodne raznolikost kao mentalne bolesti potvrđuje pogrešnu pretpostavku da su cisrodni muškarac i cisrodna žena jedini rodni identiteti, i na taj način izravno ili neizravno označavaju rodne različitosti kao “neprirodne.” U zemljama u kojima je mentalna bolest kriminalizovana i gdje su mentalno oboljele osobe dehumanizovane i bez osnovnih ljudska prava, ta dijagnoza ima loše posljedice.
Djeca i mladi, koji su najviše obespravljena skupina, zbog njihovog društvenog i ekonomskog statusa, su u najvećoj opasnosti od tih strašnih zloupotreba.
Insistiranje na kategorizaciji ili dijagnosticiranju djece, u dobi kada tek počinju istraživati svoju društvenu okolinu, kad postaju svjesni svog tijela, pola i društvenih uloga, a prolaze kroz intenzivan rast i razvoj – je neodgovorno i štetno. Nametati naše pogrešne norme koje se odnose na izražavanje rodnog identiteta i seksualne orijentacije na djecu, znači oduzimanje djeci njihovog osnovnog prava da se razvijaju u sigurnom okruženju koje je poticajno za rast i razvoj.
Na taj način stavljamo sav teret na one koji nisu ni uzrok problema, niti imaju političku i društvenu moć da bilo šta mijenjaju, a u isto vrijeme oslobađamo odgovornosti one koji imaju moć i koji su često izvor problema.
Izraz “rodna nekongruentnost ili rodna kontradiktornost” temelji se na neodrživoj pretpostavci da postoji čvrsta, nepromjenjiva veza između roda i dodijeljenog fizičkog pola. Gomilajući naučni dokazi upućuju na to da rod i pripisani pol nisu jednostavni u svom obliku i prirodi, niti nerazdvojivi. Tako da „rodna kontradiktornost“ može da bude jedino kontradiktornost između onoga što mi mislimo da je rod sa pripisanim biološkim polom, kakvo god to značenje bilo.
Rodne uloge i pretpostavke koje se vežu za rod uveliko variraju među kulturama, religijama i u vremenu. Ova pravila koja su izmislili ljudi, nameću neprirodnu binarnu rodnu podjelu ljudi, čija je svrha prije svega socijalna i ekonomska, a jako malo veze ima sa sa stvarnim ljudskim rodnim identitetima.
Mi čvrsto vjerujemo da će Svjetska zdravstvena skupština pristupiti reviziji i pregledu Međunarode klasifikacije bolesti s istim žarom, stručnosti i predanosti, poštujući univerzalna ljudska prava i zaštitu djece. Psihijatrija, kao medicinska struka, također se također mora oslanjati se na naučne dokaze, a ne na različite kulturne norme.
Trans* BiH grupa, 18. oktobar, 2014. godine
Depathologisation of Trans* – call to stop treating gender diversity as a mental illness
With the support of the Sarajevo Open Center, Trans* BiH has released a statement regarding the upcoming revision of the International Classification of Diseases (ICD) diagnostic tool by the World Health Organization. The proposed new code (ICD-11), to be adopted in 2017, includes “Gender Incongruence of Adolescence and Adulthood” and “Gender Incongruence of Childhood” classified as disorders. Trans* BiH and the Sarajevo Open Center are joining international action to depathologise gender diversity. We find the classification of natural human gender diversity unscientific and damaging, especially to children and youth as the most disempowered population.
We are writing to you regarding the upcoming revisions of the ICD codes, namely the proposed declassification of “gender incongruence” in the ICD as a mental disorder. We believe that the treatment of natural gender diversity as a mental disorder is misinformed, unscientific and adds to the existing stigmatization of transgender people. As such, it has no place in a diagnostic tool of an organization based on the principles of scientific inquiry and universal human rights.
We are an informal group of transgender* people from Bosnia and Herzegovina, Trans* BiH, associated with the Sarajevo Open Center. We speak to you not as academic experts on gender or healthcare policy makers, but as people who live and breathe the reality of transgender existence. Our voices are the voice of those who experience on their own skin the prejudice, stigmatization and damaging legal, healthcare and social policies.
The World Health Organization describes mental health as “…a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”[i]
We find this statement practical where it applies to people facing normal stresses of life. However, transgender people worldwide face stresses that cannot be described as normal stresses of life. These include complete loss of family support, family violence, homelessness, peer violence, physical, mental and sexual abuse at the hands of authorities, bullying and abuse in schools, sexual exploitation, stigmatization, brutal “corrective treatments,” objectification, ostracism and murder. These stresses are far beyond any stresses that an average person should be able to effectively cope with.
Further, labelling gender diversity as a mental illness confirms the false assumption that cisgender male and cisgender female are the only normal gender identities, and thus directly or indirectly sanctions the violent suppression of natural gender diversity as “unnatural.” In countries where mental illness is criminalized and where mentally ill people are dehumanized and denied basic human rights, this diagnosis has dismal consequences.
Children and youth, who are the most disempowered group due to their social and economic status, are at the highest risk of these horrific abuses. Like adults, they are often subjected to “correctional treatments” resulting in severe trauma and frequently in death. These attempts to force individuals to adhere to cultural gender norms use physical and mental torture, “correctional” rape and starvation – to name just a few.
Insistence that we categorize or diagnose children at an age when they are just beginning to explore their social environment, when they are becoming aware of their bodies, gender, social roles, and are undergoing intensive growth and development – is irresponsible and damaging. To impose our misinformed norms relating to gender identity and expression and sexual orientation on children is to rob these children of their basic right to develop in a safe, accepting and positively stimulating environment, free of coercion.
The mental disorders that result from the aforementioned abuses by family, peers, authorities and the society at large and the failure of responsible authorities to support and protect transgender individuals, are left untreated. Trauma suffered and injuries received are sidelined, because of the insistence that gender identity – not savage abuse – is the problem. We thus place all the burden on those who are neither the cause of the problem nor have the political and social power to fix it, and excuse those whose behavior is the source of the problem.
Inability to exist in a state of well-being, realize one’s own potential, work productively and fruitfully, and contribute to one’s community while homeless, denied healthcare, exposed to physical, sexual and emotional violence and death cannot be described as a mental disorder. It is a natural human reaction to extreme hardship.
We ask that you very carefully consider the words “incongruence” and “assigned.” The term “gender incongruence” is based on an unsupported assumption that there is a solid, invariant connection between gender and assigned physical sex. Mounting scientific evidence indicates that gender and psychical sex are neither simple in their formation and nature, nor inextricable. Thus gender incongruence is an incongruence between what we imagine rather than know gender to be, with whatever meaning we assign to anatomy whose formation we do not fully understand. This approach fails to live up to the standards of scientific excellence that the WHO applies in other health-related areas.
Gender has, and always had, a significant cultural component. As such, gender roles and underlying assumptions vary widely between cultures, religions, and in time. These man-made rules impose an unnatural binary gender division on humans, whose purpose is above all social and economic, and bears little relation to actual human gender identities. Thus, what the ICD is actually labelling as a mental disorder is the failure to adhere to narrow, culturally defined, binary, unscientific assumptions subject to change with geography, time, and economic and social conditions.
As cultural gender rules are so strictly and brutally enforced in many places around the globe, it can be said that no “mentally healthy” person would venture to defy them. As we so often see from murder statistics of people who do not conform to cultural gender norms, such defiance is in effect, though not in intent, suicidal. This must change.
Through their dedication to bringing the best possible healthcare to all human beings around the world, the WHO has saved countless lives. Through strict adherence to science-based medicine and evidence-based interventions, and driven by a belief that all human beings deserve the best possible health care that the modern science can provide, the WHO staff and volunteers constantly put their lives on the line to reach those in need.
We are confident that the World Health Assembly will approach the review of the ICD with the same passion and excellence, and dedication to universal human rights and protection of children it applies to other areas of healthcare. Psychiatry, as a branch of healthcare, must also be science-based and rely on scientific evidence rather than varying cultural norms.