Chelsea (formerly Bradley) Manning said she leaked classified documents in an effort to “spark a domestic debate on the role of the military and our foreign policy in general as it related to Iraq and Afghanistan.”  A debate did ensue - but not necessarily about foreign policy; it was more a debate on whether Manning was a traitor or a hero. And Manning’s most recent statement is sure to stir up just as much controversy. On Thursday, August 22, 2013, Manning released a statement, through her lawyer, to NBC’s Today show, stating that she plans to live as a woman - Chelsea Manning - and begin hormone therapy as soon as possible.
According to Manning’s statement, “I am Chelsea Manning. I am a female. Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible...I also request that, starting today, you refer to me by my new name and use the feminine pronoun…”  Mannings gender dysphoria was brought up in his trial as a cause of severe stress and “to give context to what was going on at the time,”  not as an excuse for what transpired.
What is Gender Dysphoria?
In the most recent edition of the Diagnostic and Statistical Manual (DMS-5) , released in May 2013, the term gender identity disorder was removed and gender dysphoria was inserted. According to Dr. Jack Drescher, who was a member of the Sexual and Gender Identity Disorders Work Group for the DSM-5, this change was made to maintain access to care and help reduce the stigma surrounding the diagnosis.
The new criteria emphasizes, “the individual’s felt sense of ‘incongruence’ with natal gender, rather than cross-gender behavior.”  Characteristics of this condition include:
- Strong desire to be treated as the other gender and be rid of one’s sex characteristic or a strong conviction that one has feelings and reactions typical of the other gender
- A marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her
- Difference must be present for at least six months
- For children, the desire must be present and verbalized
The change from the word “disorder” to “dysphoria” recognizes that not everyone who identifies with the opposite gender is distressed. The diagnosis is meant to recognize those that have significant emotional distress because of their gender identity without saying everyone who identifies with the opposite gender has a “disorder.”
Treatment for Gender Dysphoria
Each person’s needs may be different; some may require more treatment than others. For example, some may require individual/group therapy and treatment to aid in ways to dress/behave/speak as the opposite gender. Most treatments will include hormone treatment and can include surgery to transition from one sex to the other. Treatments can include:
- Mental health support and treatment
- Hormone treatment
- Language and speech therapy
- Hair removal
Additional supports may be added as needed.
Chelsea’s Mannings Chances of Treatment While in Prison
Chelsea Manning was sentenced to 35 years in military prison for leaking classified documents. With good behavior, she may be released in as little as 7 years. In her statement to NBC Today Show, she indicated she would seek hormone therapy as soon as possible. However, the U.S. Army stated it “Does not provide hormone therapy or sex-reassignment surgery for gender identity disorder.”  Manning’s lawyer, David Coombs, hopes that the prison will work with Manning in providing hormone therapy and will “do everything in my power to make sure they are forced to do so.” 
The issue isn’t quite so clear cut. As of now, no inmates in U.S. prisons have received sex-reassignment surgery, although Manning is not requesting surgery at this time. Hormone therapy, however, may be a different story.
In Wisconsin, a federal appeals court ruled a ban on hormone therapy for inmates unconstitutional and in Massachusetts, Michelle Kosilek, formerly Robert Kosilek, began receiving hormone treatments after she sued Massachusetts Department of Correction and won. A federal court also ruled that sex-reassignment surgery was the only adequate treatment after she tried to castrate herself and attempted suicide. This decision is still pending on appeal.
Advocates for transgender people believe that inmates with gender dysphoria are entitled to medical treatment, just as those with diabetes, cancer or any other condition would receive medical care. Taxpayers, however, would ultimately foot the bill for any treatment. According to NBC News, hormone therapy can cost up to $200.00 per month, every month for the rest of the person’s life, psychotherapy may be expensive and, if surgery is performed, the cost can be anywhere from $12,000 to $30,000. 
Whether Manning receives treatment, and what treatment she receives is still unknown. What is known is that it is probably going to involve a fight.
 “Beginning Gender Change in Prison is a Long Shot,” 2013, Aug 22, JoNel Aleccia, NBC News
 “Bradley Manning: I Want to Live as a Woman,” 2013, Aug 22, Scott Stump, NBC Today News
  “Bradley Manning: I Want to Live as a Woman Named Chelsea,” 2013, Aug 22, Staff Writer, CBS News
 “Bradley Manning’s Father Says Son Was ‘Grandstanding’” 2013, Aug. 7, Dana Ford, CNN
“Gender Dysphoria,” 2013, Staff Writer, American Psychiatric Association
 “‘I am Chelsea’: Read Manning’s Full Statement,” 2013, Aug 22, Staff Writer, NBC Today News
 “New Gender Dysphoria Criteria Replace GID,” 2013, April 5, Mark Moran, Psychiatric News
“Reduction of Stigma Key to Changes to DSM-5 Gender Dysphoria Diagnosis,” 2013, May 20, Staff Writer, Psychiatric Annals
“Treating Gender Dysphoria,” Reviewed 2012, May 21, Staff Writer, NHS, United Kingdom
Published On: August 22, 2013