Another thing is, something being listed in the DSM does not ipso facto make it a "mental illness." Case in point: When my psychiatrist was trying (unsuccessfully) to get me approved by the insurance company for Provigil, the diagnosis he put down was for "shift work circadian rhythm disorder," IOW, not being able to stay awake overnight like 99% of people. Not a "mental illness." But it's in there to get insurance companies to cover stuff. Which I guess sometimes works. (Fortunately, I could tolerate dextroamphetamine, which they had no trouble approving, go fig.)
Of course, "shift work circadian rhythm disorder" doesn't carry anywhere near the stigma of being diagnosed with "gender dysmorphia," so I can understand why it's a problem. It's tough, because if you want insurance companies (or whatever governing body pays for health care where you are) to cover a certain treatment, there has to be a code for it. Sure, you can move the code out of the DSM and just use the ICD codes, but you still have to call them something if you want treatment covered. Obviously, like you said, what they're doing now does not seem to be working for trans people.
This is also an issue with autism/Asperger's/PDD-NOS, for which the current diagnostic criteria are a swirly mess (people think ruling in for Asperger's Disorder rules you out for Autistic Disorder and vice versa, but that's not true according to the DSM-IV-TR), and which aren't "mental illnesses" either, as such. They are neurological issues rather than psychiatric ones, in and of themselves, but given the extremely high rate of depression and suicidal ideation among aspies (nobody really knows what it is with auties, because communication skills vary so widely in that group), and that our depression can present very differently from a non-autistic person's, it's something psychiatrists do need to be made aware of.
I'm not certain there's any colorable difference between neurological issues and psychological issues. If there is, that line cuts a jagged path through Axis I and Axis II of the DSM.
The neurological bases of, for instance, developmental disorders, Korsakoff's Psychosis, and obsessive compulsive disorder are well-understood. Similarly, there's likely some sort of underlying neurological basis for schizophrenia and bipolar disorder, even though we don't know what it is.
Even the personality disorders, which are likely created by extrinsic rather than intrinsic factors, have some sort of reflection in a person's neurology. Drawing a line between the two is not only arbitrary, it causes people with neurological differences to attempt to ignore the difficulties with their mind in favor of the difficulties they have with their brain.
I am my brain. You too. But neurology is still a blunt instrument. It knows processes without understanding how those processes affect our subjective understanding of the world, and when it can intervene and manipulate the physical or chemical structure of the brain, it does so only crudely.
When there are crude things wrong with you (a mass; a lesion; a missing neurotransmitter), that crude intervention can help But there certain problems, like autism, where examining the brain itself shows the difference without showing the reason or consequences.
In a sense, psychiatry treats the consequence without knowing the cause. Until we have the medical knowledge to join the two (and we might never), I think treating disorders that span the gap as both, rather than one or the other, is best.
Commenting by HaloScan
