Diagnosis from the past

Russia refused to accept a new international classification of diseases. MKB-11 would prevent officials from fighting for "traditional values"

On February 2, the Ministry of Health of the Russian Federation said that he suspended the implementation of an updated version of the International Classification of Diseases (ICD-11). In one of its sections, State Duma deputies saw an attempt to legalize LGBT, pedophilia and transgender.

Although the “plan of events” from the government was accepted for 2021–2024, now the adoption of the document was postponed until 2025. Novyevropa says that it frightened the officials and how critical this transfer is for patients.

Why doctors need ICD

International classification of diseases is a kind of doctor’s board book, a standardized basic medical reference book, which contains and classified all known diseases into groups. Any pathological condition, disease or injury has their own code - this allows specialists from different countries to speak the same language and operate with the same terms.

ICD - a universal language for state bodies. The classifier helps to conduct international statistics of diseases and plan health costs, analyze the state of health of the population, organize the monitoring of incidence and develop classification of diseases and health disorders recorded in medical and civil documentary sources.

The World Health Organization (WHO) is developing a classification, it periodically reviews the document and makes adjustments to it. The previous ICD, the 10th review, has operated since 1994-that is, since the last century. Since that time, the whole world, and with it, medicine has changed rapidly, new diseases and conditions have appeared. At the beginning of the 21st century, WHO began work on the new version of the classifier - not only to update medical knowledge and make new information about diseases, but also to adapt data specifically for electronic medicine.

What changes appeared in the new version?

The creation of the MKB-11 has gone the debate hours with the participation of doctors and other health specialists from countries around the world, Lancet reports . As a result, the classifier was replenished with new terms, diagnoses and entire sections.

Different types of chronic pain and genetic diseases have a classification. For diseases of the immune system, including allergies, a separate section was distinguished. A special chapter was devoted to folk medicine.

Neurologists now classify a stroke as a brain disease. Resistance to antibiotics can be associated with individual diseases, and HIV - with specific infections such as tuberculosis and malaria. Separate chapters were awarded sleep disturbances and side effects of treatment.

Most changes occurred in the most sensitive sphere of medicine - psychiatry. The new edition no longer divides the personality disorders into different types, but unites into one group.

New diagnoses have appeared, for example, the syndrome of attention deficiency and hyperactivity, the prolonged reaction of grief, game and dysmorphic ( pathological discontent with its appearance. - Ed. ) Disorders.

A number of concepts have been reviewed. For example, pathological accumulation (when a person is not able to get rid of unnecessary things), from the type of obsessive-compulsive disorder, became a diagnosis. And increased sexual desire was transferred to the category of compulsive disorder of sexual behavior.

But the most significant change (at least for Russia) was the removal of sexual motto from psychiatry (section 06) and the creation of a separate chapter “Status related to sexual health”.

It was this chapter that caused such a storm of emotions among some psychiatrists, State Duma deputies and representatives of the Russian Orthodox Church that the government decided to postpone the introduction of the ICD-11 for a year.

What does the new section offer?

Since the ideas about sexuality and gender identity over the past quarter centuries have changed a lot, these categories had to be brought into line with reality.

So, the concept of “transgender disorder” is renamed “gender inconsistency” and is no longer included in the list of mental illness. Instead of the terms “opposite sex” and “anatomical floor”, more modern and binary “associate gender” and “prescribed floor” are used. The same group of “gender inconsistencies” transferred the concepts of hermaphroditism and transsexualism.

So, the classification of sexual dysfunctions is revised. Pedophilia - sexual perversion and sexual craving for children - has become a pedophile disorder. This diagnosis is proposed not to make children, but among adolescents - to use with particular caution, since sexual experiments are characterized by this age. In addition, it is necessary to take into account the cultural characteristics of countries. So, for example, if the parent kisses the child on the lips, this can sometimes be a sign of attachment, and not inappropriate sexual activity.

Nevertheless, pedophile disorder still refers to paraphilia (all types of atypical sexual interest) and takes place in the encoding "mental and behavioral disorders and disorders of neuropsychic development."

What caused disagreement?

Disputes among psychiatrists about the new version of the ICD arose at the stage of discussion. For example, in 2017, a scientific article was published that reproached the authors of the section on sexual disorders that they focus on the social consequences of these conditions and legal considerations and ignore aspects of clinical psychopathology.

But a year ago, when in Russia, preparations were in full swing for the introduction of the new edition of the ICD, the discussion went beyond the scope of the scientific community. At the consideration in the State Duma, the bill on the “sex change” criticized the ICD for the values ​​allegedly alien to the country, including the declaration of transgender and homosexuality by the norm, as well as, as deputies think, the legalization of perversions, in particular, pedophilia.

The discussion was essentially reduced to the main question: whether the “gender inconsistencies” be considered mental illness or the norm. Some of the specialists did not agree that transgender people want to withdraw from the category of mental illness.

This would mean the lack of differentiated diagnostics and the possibility of requesting a floor change to distinguish people with mental disorders from people with the congenital anomaly of the psyche. The latter from birth feel like people of the other sex and are just transsexuals who are entitled to surgery to change the gender marker.

All other cases are a consequence of either mental disorders or propaganda manipulations of transgender communities, the participants in the discussion said.

“The gender theory of the diversity of sex, orientations and sexual identity, the variety of types of sexual relations destroys traditional ideas about relationships between people, within families”,

-said Bukhanovskaya, psychiatrist, associate professor of the law faculty of the Southern Federal University, a member of the Russian Society of Psychiatrists.

Supporters of the new version of the ICD adhere to the position of WHO, offering to distinguish the conditions that relate to public health and need correction by healthcare authorities, from the characteristics of the behavior of an individual individual who do not affect public health and do not require intervention by health authorities. This position reflects modern ideas in matters of gender correspondence and inconsistency and, ultimately, provides a person with the right to sexual self -determination.

“Sexual disorders relate to psychiatry about the same as tropical fever,” the psychiatrist explains the situation on anonymity. - But zealots of domestic traditions, including in science, this is very worried ... "

According to Alexei Perekhov, associate professor of the Department of Psychiatry and Narcology of the Rostov State Medical University (RSMU), a member of the Russian Society of Psychiatrists, the Vice-President of the Independent Psychiatric Association of Russia, if a person is sane and wants to change gender, he has the right to do so. Even if he has a mental illness that affects his behavior.

And what's wrong with the section about pedophilia?

Officials falsely considered pedophilia the description of the symptoms for making a diagnosis "pedophile disorder". There is a phrase: "A person must act in accordance with these thoughts, fantasies or motives or to be noticeably upset by them." The chairman of the Patriarchal Commission on Family, Protection of Motherhood and Childhood, Priest Fedor Lukyanov, interpreted this phrase so that pedophilia is a deviation only if the pedophile feels discomfort from this. For the same reason, Irina Filatova, deputy of the State Duma from the Communist Party of the Communist Party, also called for the MOT of the ICD-11.

However, many psychiatrists do not see any attempts to decriminalize and legalize pedophilia in this. According to the associate professor of the department of psychiatry Rudn Roman Suleimanov, the diagnosis of pedophilia is not a synonym for insanity and does not exempt from criminal liability in case of sexual violence against children.

At the same time, timely identification and treatment of people with pedophilic disorder helps to prevent and reduce the number of sexual crimes against children.

Nevertheless, in August 2023, the head of the State Duma Committee on Health Protection Badma Bashankaev complained that transvestism, transsexualism and pedophilia migrated from conditions and diseases into disorders, and this is incorrect, as it expands the overton window. “There are things that contradict our traditional values. We ask that the Ministry of Health does not accept the ICD-11 in these positions, ”he remarked.

As a result, at the beginning of this year, the government suspended the implementation of the plan of measures to switch to a new classification, as explained in the Ministry of Health of the Russian Federation, “in connection with a large number of appeals of citizens, public organizations, senators and deputies in terms of possible contradictions of the ICD-11 traditional moral and spiritual and moral values, the protection of which is provided for by the legislation of the Russian Federation”.

How critical is this abolition according to the government?

The Ministry of Health of the Russian Federation believes that nothing terrible due to the cancellation will happen and such a decision will not affect the quality of medical care. Officials assure that time appears in order to additionally study the experience of other countries on the introduction and transition to the ICB of the 11th revision in the conditions of annual refinement of Classification of WHOs.

According to Larisa Popovich, the director of the Higher School of High Service Institute of Health, the transmission of the transition is necessary for re-training of doctors and to create a transition table from ICD-10 to ICD-11 with another language of coding of diseases and conditions. There are also other countries, not only Russia, which have not yet adopted the new edition of the ICD and use the previous one.

Will the doctors, including psychiatrists, become more difficult to do their job? How will this affect the diagnoses that they make, and the drugs that prescribe?

Doctors in Russia will have to be guided by diagnoses from the former ICD-10, but from a practical point of view, nothing will change directly now: coding is needed more to collect statistics, on the basis of which medical recommendations are produced, treatment protocols are developed, and so on.

For example, doctors of the old formation like to diagnose “vegetovascular dystonia”, which is not even in the ICD-10. Therefore, in words the patient will be voiced by this diagnosis, but the document will be made in the document, which is most consistent with him.

Perhaps, in the end, the Russian Ministry of Health will decide to create its own classification of psychiatric diseases, as is done in the United States. Then the ICB-11, most likely, will be accepted, and the section on psychiatry will use their own.

In the future, this is a bad solution, because while the whole world is moving forward, we continue to stomp in the spot. Doctors - including psychiatrists - will make outdated diagnoses and prescribe ineffective treatment.