are you suffering enough?
if i could rewrite the dsm
i think about the dsm sometimes, which is funny because most people never do. but itβs shaped so much of my life. itβs this invisible book that decides whatβs βrealβ and whatβs βjust in your head,β and if youβre trans it can decide if you get hormones or surgery or if the insurance person gets to laugh and hang up.
once, a therapist told me, very gently, that she had to βfindβ enough gender dysphoria in my file so insurance would approve my treatment plan. she said it like she was doing me a favor. i sat there wondering if i should make it sound worse than it was, if i should cry more in that moment, if i should pretend i hated my body every second of the day. the truth was complicated, but the dsm doesnβt do complicated. it just wants the right words to check the right box.
and the thing is, the dsm doesnβt understand us. not really. it pretends to, but it still makes us pass through this little gate that says βare you suffering enough to matter.β
so if i got to write the gender and sexuality section for a dsm-6, iβd start with:
being trans is not a disorder.
not in the book. gone. deleted. the only thing left is something called βgender incongruence,β but even that is just paperwork so you can get your doctor to sign the form that says βyes, this is medically necessary.β
the problem isnβt you.
minority stress would be its own thing. not as a moral statement but as a real, documented source of mental health issues. because yeah, the depression or anxiety is there, but itβs not because you were born wrong. itβs because you were born into a system that makes being you exhausting.
stop making us small with your words.
no βdisorder.β no βdeficit.β no language that makes our existence sound like a typo. we deserve criteria that can hold trans, nonbinary, intersex, ace, and queer lives without shrinking them to fit a cishet shape.
affirming care is not optional.
right there in the manual: use their pronouns. donβt gatekeep. know that gender diversity exists everywhere, in every culture, and itβs not a crisis to be solved.
sexuality without the puritan hangover.
asexuality is fine. kinks are fine if theyβre consensual. and an actual full page that says conversion therapy is dangerous and unethical and should never have existed in the first place.
what i want is simple: a manual that doesnβt pathologize survival. one that understands our joy. one that starts from the assumption that we belong here.
until then, weβll keep writing our own manuals, and honestly, ours will be better