LAUSR

The current proposal for the World Health Organization’s Eleventh Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) is to retain the Gender Incongruence in Childhood (GIC) diagnosis in the ICD11 though to remove it from ICD-11’s chapter on Mental and Behavioral Disorders. While proponents of removing the GIC diagnosis argue that a mental health diagnosis for transgenderidentified children is stigmatizing and clinically irrelevant, the current proposal is based on the perspective that omitting GIC from ICD-11 will lead to greater negligence of these children’s needs and lead to greater harm (Drescher, Cohen-Kettenis, & Reed,2016).Asmembersofaninterdisciplinaryprofessionalcommittee for transgender health in a non-Western culture, we believe that exclusion of the GIC diagnosis would seriously impair access of our juvenile clients to appropriate services. Firstofall, thepresenceofaGICdiagnosisintheICD-11,asthe most widely used health diagnostic manual, helps to shed light on a tabooin traditional societies suchasours. Inoursociety,abinary understanding of gender and sexuality is culturally hegemonic, and there is great intolerance toward gender-nonconforming behaviors. For instance, consider the ‘‘clinical’’ arguments provided by Winter, De Cuypere, Green, Kane, and Knudson (2016) against theGICpresence inICD-11:‘‘pre-pubertalchildrendonot need substantial medical support, but instead need the psychological space, support, and information to explore who they are, become comfortable with their gender identity and its expression, and learn how to handle hostility in others.’’The critical question, however, that remains unanswered in their argument is how we canpersuadeparents toacknowledge the real, substantialneedsof their children while at the same time inform them that their children are completely ‘‘normal’’? And this is not just about parents; teachers, relatives, school staff and, even more importantly, authorities who make decisions about supporting financially the organizations that help these children, need to know that the child’s wishes are not whims. Interestingly, almost all adults with gender incongruence who visit our clinic with their families for psychoeducation ask us to tell their families there is‘‘something definitelywrongwith them’’and that they are‘‘patients’’whoneed to be cured with hormonal and/or surgical treatments. For these people, this is theonlywaytoobtain their family’sacceptanceand support. Otherwise, in our culture, their condition would be consideredaperversionordebaucherytobeeradicated; if itwouldnot be eradicated, they would be ostracized by their families. This wouldcertainlyalsooccurwithchildren,whoare, less thanadults, unable to takecareof themselves.Therefore,webelieve that ICD11,byrecognizingGICasadiagnosis,providesgreaterprotection for these children from the risk they face of abuse and neglect. In addition to parents and authorities, keeping the GIC diagnosis in ICD-11 is also critical for augmenting the knowledge of mental health professionals whose clients are not only children & Behzad S. Khorashad [email protected]