Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
Department of Ethics, Law and Humanities, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Sociol Health Illn. 2024 May;46(4):644-663. doi: 10.1111/1467-9566.13727. Epub 2023 Oct 28.
A formal Gender Dysphoria classification- as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders- is a prerequisite for the reimbursement of both gender-affirming medical care and transgender mental health care in the Netherlands. Gender Dysphoria and its conceptual precursors have always been moving targets: moving due to research, policy, care practices and activism both within and outside of medicine. This raises the question of what Gender Dysphoria is exactly. To elucidate this question, we turn to the people who use the concept in clinical practice to come to a diagnosis and treatment indication: mental health professionals working in gender-affirming medical care and transgender mental health care. Using a material semiotics approach, we reflect upon how Gender Dysphoria is done in clinical practice. Based on an analysis of seventeen practice-based interviews with clinicians as well as an examination of clinical guidelines and texts, we describe four modes in which Gender Dysphoria is ordered. These modes of ordering illustrate that Gender Dysphoria is not one, but multiple. We illustrate how in the mode of isolating, Gender Dysphoria is something which is carefully isolated from mental disorders, while in the modes doing the future and narrating, Gender Dysphoria is done as a continuous and predictable object of care. Such orderings of Gender Dysphoria potentially conflict with a fourth mode of ordering: the doing of diversity in transgender health care. The study's findings provide empirical insights into how transgender health care is currently done in The Netherlands and provide a foundation on which ethical debates on what good transgender health care should entail.
正式的性别焦虑症分类——如《精神障碍诊断与统计手册》第五版所概述的——是在荷兰报销性别肯定医疗和跨性别心理健康护理的前提条件。性别焦虑症及其概念先驱一直是移动的目标：由于研究、政策、护理实践以及医学内外的激进主义而不断变化。这就提出了一个问题，即性别焦虑症究竟是什么。为了解决这个问题，我们求助于在临床实践中使用该概念进行诊断和治疗指示的人：从事性别肯定医疗和跨性别心理健康护理的心理健康专业人员。我们使用物质符号学方法，反思性别焦虑症在临床实践中的表现。基于对 17 名临床医生的基于实践的访谈的分析，以及对临床指南和文本的检查，我们描述了性别焦虑症被排序的四种模式。这些排序模式表明，性别焦虑症不是一种，而是多种。我们说明了在隔离模式中，性别焦虑症是如何从精神障碍中仔细隔离出来的，而在未来和叙述模式中，性别焦虑症是作为一种连续且可预测的护理对象来进行的。这种性别焦虑症的排序方式可能与跨性别保健中多样性的排序方式相冲突。该研究的结果提供了对荷兰当前跨性别保健方式的经验性见解，并为关于良好的跨性别保健应包含哪些内容的伦理辩论提供了基础。
