what's in a label?

A recent proposal to remove transgender identity from the ICD, the World Health Organization’s manual of medical conditions, has reignited the debate over what should and shouldn’t be a mental health diagnosis.

Many feel that classifying transgender identity as a disorder is unnecessarily stigmatizing. Others argue that leaving it as a recognized medical diagnosis has practical benefits. For example, as a New York Times article on the controversy points out, classifying transgender identity as a disorder has allowed inmates like Chelsea Manning to undergo hormone therapy.

Transgender identity aside, there’s no doubt that a label can be more than just a label when it comes to mental health.

Having a recognized condition with a name can make all the difference when you need your insurance to cover something or you want to seek accommodations you have a legal right to. It establishes your mental health diagnosis as something that deserves treatment as much as any other medical condition.

That’s one of the main benefits of tools like the Diagnostic and Statistical Manual of Mental Disorders (DSM), the book many mental health professionals in the United States use to diagnose and talk about mental health problems in a standardized way.

There are some potential drawbacks as well, though, which is why the DSM seems to be constantly surrounded by debate. Many of these drawbacks have to do with the fact that while the DSM breaks down mental health conditions in terms of different labels, the process of coming up with those labels isn’t inherently scientific.

So you end up, for example, with homosexuality being classified as a mental disorder in early versions of the DSM. Although homosexuality was later removed from the manual, the process for deciding what is and isn’t a disorder remains pretty much the same.

More recently, you have the controversy over transgender identity, which remains in both the ICD and the DSM. Like any other debate over what should be a mental health diagnosis, it’s one that will ultimately be resolved by a committee.

Given the complexities and murkiness around what ends up as an official mental health condition, it’s worth knowing how the DSM is put together and what some of the pros and cons of the manual are.

In this series of Ask the Therapist Videos, Marie Hartwell-Walker and Daniel J. Tomasulo give an overview of why the DSM was created, how it has ended up so much bigger than it used to be, and what some of its main advantages and disadvantages are. Watch the videos below, and see the Psych Central YouTube channel for more videos about psychology and mental health:

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