transvestite fetishism and oregon administrative rules and mental health parity

I only have space in this essay to lay out the first three categories of excluded coverages under the Oregon Mental Health Parity Act. The first consists of the diagnostic codes centering around Mental Retardation (317; 318.0, 318.1, 318.2; 319). More specifically, these are numbered as follows:

317 is Mild Mental Retardation (IQ 50-70)
318.0 is Moderate Mental Retardation (IQ 35-49)
318.1 is Severe Mental Retardation (IQ 20-34)
318.2 is Profound Mental Retardation (IQ under 20)
319 is Unspecified Mental Retardation.

I suppose that because no therapy or drugs or services are perceived to be able to "make things improve" or make severe mental disability even be more bearable, this category of disorders was excluded from mental health parity benefit coverage.

The second consists of various learning disorders (315.00, 315.1, 315.2, 315.9). These are:

315.00 Reading Disorder
315.1 Mathemathics Disorder
315.2 Disorder of Written Expression
315.9 Learning Disorder Not Otherwise Specified

Though lots could be written about all of these topics, let's just say a word about one of them: 315.1--Mathematics Disorder. Its technical name is "dyscalculia," and is defined as a specific neurological disorder affecting a person's ability to understand and/or manipulate numbers. Such a disorder may be caused by a visual perceptual deficit or other causes. I wonder if all those people who decided that they just can't "do math" felt that they had some kind of "disorder." Well, even if they admitted it as a disorder, they wouldn't be able to get mental health benefits to cover them under the Oregon Mental Health Parity Act.

The Paraphilias

The Third major category of excluded areas are the so-called "paraphilias." A paraphilia can be defined as "preference for or addiction to unusual sexual practices." This definition, from Webster's Third New International (Unabridged) Dictionary, betrays a subjective and culture-bound character, for what might be considered "unusual" in the United States could be seen as a normal practice in France, for example. In any case, the list of excluded paraphilia's under the Oregon rule is as follows:

302.4 Exhibitionism
302.81 Fetishism
302.89 Frotteurism
302.2 Pedophilia
302.83 Sexual Masochism
302.84 Sexual Sadism
302.82 Voyeurism
302.9 Paraphilia/Sexual Disorder Not Otherwise Specified

I have no idea why these are not listed in numerical order, either in the Administrative Rule or in the DSM-IV, but here they are. It is also interesting to me that many of these practices, which might have been considered a bit outre even in 1994, when the DSM-IV was adopted are now "mainstream." When Justin Timberlake can use words of sexual masochism in a 2006 song of his, we have just about come to mainstream acceptance of it, don't you think? Lots could be said about each one of these "disorders." Indeed, I would like to write about them at some time, but I am afraid it will take me a while...

Well, everything was just fine about this list until I recalled reading that the DSM-IV lists nine and not just eight paraphilias. The one in the DSM-IV that is not listed as excluded in the Adminstrative rule is 302.3--"transvestic fetishism." It must be an oversight, I thought, since there is no reason to "cover" transvestic fetishism. Ah, you are probably asking yourself at this very moment what exactly is transvestic fetishism, since we don't go around using this phrase even against our worse enemies. Well, it is used to describe heterosexual males who have sexually arousing fantasies, urges or behaviors involving cross-dressing. According to the DSM-IV, in order to be considered diagnosable, the fantasies, urges or behavior must cause significant distress in the individual. Hm. Most of the transvestites I have known aren't distressed by their cross-dressing. Does that mean they don't have the disorder?

Well, it seems that the Oregon Administrative Rule has made an obvious mistake. Perhaps there is a transcriptionist error, for there is no reason why transvestites who feel bad about dressing up like women should get parity in mental health benefits while voyeurs or exhibitionists shouldn't. How weird are these, anyway? Well, that question is out of line here..

Not a Mistake After All

Well, I thought that coverage for transvestites who feel bad about it was out of the question (because of likely error) until I ran across the Insurance Division's training briefing to providers on August 17/18, 2006. This multi-slide power-point presentation listed several questions raised by those interested in the implementation of the statute. Here is question # 2:

"OAR 836-053-1401(1)(a)(iii) lists diagnostic codes that are excluded for paraphilias. DSM code 302.3 (Transvestite Fetishism) is not listed as one of the excluded codes for Paraphilias. Was this an oversight? Or is this disorder meant to be covered?"

You have to go to the next slide to get the answer from the Oregon Insurance Division:

"This disorder is meant to be covered."

Conclusion

Wow. Can you believe it? Isn't this a riot? All other paraphilias are excluded from parity in coverage except transvestite fetishism. Maybe the women's clothing designers got to the committee, for we certainly will see our borders assaulted now with transvestites. Rather than just being the Rose City or the "Green State," Oregon will now be known as "Transvestite Central." Better go check out the clothes in my closet...

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