Trans depathologisation and gender identity disorder in Japan: A critical discourse analysis of medical literature, 2010-2022.

Since the depathologisation movement in 2007 to challenge the pathologisation of trans identities in Western psychiatry, significant developments have occurred, including revisions to Standards of Care and diagnostic criteria such as ICD-11's gender incongruence and DSM-5's gender dysphoria, acknowledging gender diversity as an expected part of human development. This paper argues that Japanese medical models reflect global issues but also have unique aspects shaped by cultural and linguistic nuances. Using critical discourse analysis, this paper examines how depathologisation discourses are perceived in the Japanese medical community, focusing on the term seidouitsusei-syogai (gender identity disorder), presenting three ways in which seidouitsusei-syogai is used: psychiatric disorder, syogai/sikkan (impairment/disability/disorder), and diagnostic category. These uses are influenced by legal and social reforms, healthcare access and alignment with international classifications, while the medical profession's authority remains unexamined. Reflecting the structural challenges of diagnostic models in trans medicine, the interpretation of seidouitsusei-syogai differs from the English phrase 'gender identity disorder' due to the specific connotations of syogai in the Japanese context. By examining Japan's approach to depathologisation and medicalisation, this paper enriches the understanding of trans medicine and the impact of depathologisation discourse in Japan.

After the trans brain: a critique of the neurobiological accounts of embodied trans* identities.

This paper critically analyses three main neurobiological hypotheses on trans* identities: the neurobiological theory about the origin of gender dysphoria, the neurodevelopmental cortical hypothesis, and the alternative hypothesis of self-referential thinking and body perception. In this study I focus then the attention on three elements: the issue of (de)pathologisation, the idea of the trans brain, and the aetiology of trans* identities. While the neurobiological theory about the origin of gender dysphoria and the neurodevelopmental cortical hypothesis claim the existence of the trans brain, each offering its own neurobiological depiction, the hypothesis of self-referential thinking and body perception doesn't postulate a distinctive neurobiological trait for all trans* people. I problematize both portrayals of the trans brain departing from the findings and conceptualizations of the paradigm shifting brain mosaicism. Unlike the hypothesis of self-referential thinking and body perception that keeps the question of causation open, both the neurobiological theory about the origin of gender dysphoria and the neurodevelopmental cortical hypothesis situate the origin of trans* identities in the neurobiological domain. I challenge the biological deterministic framework in which this aetiology is inscribed from a dynamic processual entanglement perspective. Finally, concerning the issue of (de)pathologisation of trans* identities, an evolution can be seen in each of the hypothesis and among them, from the least to the most depathologising. However, I question their complete departure from a pathologising framework.

From self-management to depathologisation: the evolution of transgender health care and rights in Spain between 1970 and 2020.

Even though transgender people continue to experience violence and discrimination in many aspects of life, there has been progressive recognition of their experiences and demands in recent decades. This article analyses the process of claiming civil rights and the evolution of health care for transgender people in Spain, from the mid-1970s to the present day, paying particular attention to the narratives of key actors involved. To this end, three socio-historical periods are identified: (1) the travesti period (the mid-1970s to the early 1990s), characterised by strong social and institutional transphobia and resulting self-care practices; (2) the transexual period (mid-1990s to the 2000s), when demands for health care were institutionalised under a pathological medical model; and (3) the transgénero or trans period (2010s until the present) when identity and bodily autonomy have been re-claimed through a socio-cultural prism that has denounced pathologisation. At each stage, political, social and economic factors intervened at both national and international levels to trigger an ongoing negotiation between transgender movements and dominant social institutions, all within a changing universe of social values.

'A little bubble of utopia': constructions of a primary care-based pilot clinic providing gender affirming hormone therapy.

The provision of gender affirming hormone therapy for transgender and non-binary people is a rapidly developing area of gender affirming healthcare. While research indicates the benefits of providing gender affirming hormone therapy through interdisciplinary primary care-based models, less is known about how service users and providers construct their understandings of affirmative approaches. In this paper, we present findings from a discourse analysis of four service users' and four healthcare professionals' talk about a primary care-based pilot clinic providing gender affirming hormone therapy in Aotearoa New Zealand. Participants employed notions of pathologisation, time, and agency in their talk to construct the clinic as a personal setting which gave service users time to make their own health decisions, while constructing hospitals as impersonal with lengthy wait times. The assessment-driven nature of best practice guidelines that governed clinicians' decision-making was constructed as constraining users' agency. Findings highlight the ongoing importance of aligning gender affirming hormone therapy with other non-disease types of healthcare, and suggest new ways for achieving this through affirmative approaches to healthcare.

E se nós fossemos Jacques Rivière? / What if we were Jacques Rivière? / ¿Y si fuésemos Jacques Rivière?

A relação epistolar entre Antonin Artaud e seu editor, Jacques Rivière, sugere neste artigo a possibilidade de uma outra maneira de se relacionar com a chamada loucura. Propõe uma visão que permite um freio para a patologização constante das identidades sociais no campo da saúde mental. Para Rivière, Artaud era antes poeta do que louco; escritor antes que sujeito da loucura, e a partir daí o interpela, o acompanha. O editor aparece, então, como um tipo de gentil provocador, um hipocrático literário, um gerador de novos contextos de possibilidades, de canais para o fluir criativo de Artaud. E foi precisamente esse fluir acompanhado, o que mais tarde permitiria ao poeta francés, conseguir uma relativa recuperação. O artigo é apresentado como um breve ensaio teórico a partir do qual propõe a possível exploração de outras formas de se relacionar com a questão do sofrimento psíquico e da saúde mental. (AU)

We posit in this article that the epistolary relationship between Antonin Artaud and his publisher, Jacques Rivière, suggests the possibility of another way of relating to so-called madness. It proposes a view that enables a halt to the ceaseless pathologization of social identities in the field of mental health. For Rivière, Artaud was a poet rather than a madman, a writer rather than a subject of madness, and with that outlook he challenges him and attends to him. The publisher emerges as a gentle provocateur, a literary Hippocrates, an instigator of new contexts of possibilities for Artaud's creative flow. And it is precisely this ministered attention to flow which would later allow the poet to effectuate a certain recovery. The article is a brief theoretical essay which seeks to propose the possibilities of exploring other ways of linking with and relating to the question of psychic suffering and mental health. (AU)

La relación epistolar entre Antonin Artaud y quien fuera su editor, Jacques Rivière, nos sugiere en este artículo la posibilidad de una otra manera de vincularse con la denominada locura. Nos propone una mirada que habilita un freno a la constante patologización de las identidades sociales en el campo de la salud mental. Para Rivière, Artaud era antes poeta que loco; escritor que sujeto del trastorno, y desde allí lo interpela, lo acompaña. El editor aparece como una suerte de amable provocador, un hipocrático literario, generador de nuevos contextos de posibilidades para el fluir creativo de Artaud. Y fue precisamente ese fluir acompañado lo que le permitiría más tarde al poeta alcanzar una cierta recuperación. El artículo se presenta como un breve ensayo teórico desde donde proponer la exploración posible de otras maneras de relacionarse con la cuestión del sufrimiento psíquico y la salud mental. (AU)

Depathologising gender diversity in childhood in the process of ICD revision and reform.

From 2007 on, the World Health Organisation (WHO) has been revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD), with approval of ICD-11 due in 2018. The ICD revision has prompted debates on diagnostic classifications related to gender diversity and gender development processes, and specifically on the 'Gender incongruence of childhood' (GIC) code. These debates have taken place at a time an emergent trans depathologisation movement is becoming increasingly international, and regional and international human rights bodies are recognising gender identity as a source of discrimination. With reference to the history of diagnostic classification of gender diversity in childhood, this paper conducts a literature review of academic, activist and institutional documents related to the current discussion on the merits of retaining or abandoning the GIC code. Within this broader discussion, the paper reviews in more detail recent publications arguing for the abandonment of this diagnostic code drawing upon clinical, bioethical and human rights perspectives. The review indicates that gender diverse children engaged in exploring their gender identity and expression do not benefit from diagnosis. Instead they benefit from support from their families, their schools and from society more broadly.

Curar-se da "cura das homossexualidades": um manifesto à despatologização / Se soigner de la "cure des homosexualités": un manifeste à la dépathologisation / Healing from the "healing of homosexuality": a manifesto to depathologization

Para a psicanálise o desejo é o equivalente da falta e advém da constituição sexual do sujeito, esta de natureza infantil e inconsciente. É na complexidade da travessia edipiana que o sujeito constitui sua posição sexuada inconsciente. Masculino e feminino serão, assim, posicionamentos do sujeito quanto ao seu desejo. Com base nisso, o presente artigo, ao expor os princípios da sexualidade inconsciente do sujeito, pretendeu contribuir para a desconstrução da patologização das homossexualidades, concebida muitas vezes, no campo das inadequações psíquicas entre o eu e o corpo. Concluímos,com a psicanálise, que não há sintonia possível entre o eu desejante ­que percorre o desejo de ser homem ou o de ser mulher ­e a realidade anatômica dos genitais.

Pour la psychanalyse, le désir équivaut au manque et résulte de la constitution sexuelle du sujet, constitution infantile et inconsciente. C'est dans la complexité de la traversée de l' Oedipe que le sujet forme sa position sexuée inconsciente. Masculin ou féminin seront, ainsi, des positionnements du sujet quant à son sésir. Partant de cette base, le présent article prétend, en exposant les principes de la sexualité inconsciente du sujet, contribuer à la dépathologisation des homosexualités, souvent conçue, dans le champs des inadéquations psychiques entre le sujet et le corps. Nous concluons par le biais de la psychanalyse, qu ́ il n ́y a pas de syntonie possible entre lemoidésirant-qui parcours l'envie d ́ être un homme ou d ́ être une femme-et la réalité anatomique des organes génitaux

For psychoanalysis, the desire is the equivalent of lack and it originates from the sexual constitution of the subject, which has childlike and unconscious nature. The subject constitutes his unconscious sexual position in the complexity of the Oedipal crossing. Then masculine and feminine will be positions of the subject according to her or his desire. Based on this, this article, when exposing the principles of the unconscious sexuality of the subject, intended to contribute to the deconstruction of the pathologization of homosexuality, often conceived in the field of psychic inadequacies between the selfand the body. We conclude with psychoanalysis, that there is no possible tuning between the desiring self-which runs the desire to be a man or to be a woman -and the anatomical reality of the genitals.