Transnormativity in the psy disciplines: Constructing pathology in the diagnostic and statistical manual and standards of care

The psy disciplines (i.e., psychiatry, psychology, psychoanalysis, and psychotherapy) have played a significant role in shaping understandings of trans people's lives in ways that are transnormative (i.e., by emphasizing one particular account of what it means to be trans). This chapter documents (1) how the rise of the psy disciplines created opportunities for trans people to access treatment (but that such access often required tacit acceptance of transnormativity), and (2) how trans people have resisted transnormative accounts within the psy disciplines. More specifically, this chapter explores how both the American Psychiatric Association's Diagnostic and Statistical Manual, and what is now the World Professional Association for Transgender Health's Standards of Care, have often enshrined highly regulatory accounts of trans people's lives, while also changing over time, in part due to the contributions of trans people. The chapter concludes by considering recent contributions by trans people in terms of the use of informed consent models of care and clinical research and highlights the ongoing marginalization of trans people in terms of access to ethical, transcompetent care.