Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual

Abstract

The American Psychiatric Association (APA) is in the process of revising its Diagnostic and Statistical Manual (DSM), with the DSM-V having an anticipated publication date of 2012. As part of that ongoing process, in May 2008, APA announced its appointment of the Work Group on Sexual and Gender Identity Disorders (WGSGID). The announcement generated a flurry of concerned and anxious responses in the lesbian, gay, bisexual, and transgender (LGBT) community, mostly focused on the status of the diagnostic categories of Gender Identity Disorder (GID) (for both children and adolescents and adults). Activists argued, as in the case of homosexuality in the 1970s, that it is wrong to label expressions of gender variance as symptoms of a mental disorder and that perpetuating DSM-IV-TR's GID diagnoses in the DSM-V would further stigmatize and cause harm to transgender individuals. Other advocates in the trans community expressed concern that deleting GID would lead to denying medical and surgical care for transgender adults. This review explores how criticisms of the existing GID diagnoses parallel and contrast with earlier historical events that led APA to remove homosexuality from the DSM in 1973. It begins with a brief introduction to binary formulations that lead not only to linkages of sexual orientation and gender identity, but also to scientific and clinical etiological theories that implicitly moralize about matters of sexuality and gender. Next is a review of the history of how homosexuality came to be removed from the DSM-II in 1973 and how, not long thereafter, the GID diagnoses found their way into DSM-III in 1980. Similarities and differences in the relationships of homosexuality and gender identity to psychiatric and medical thinking are elucidated. Following a discussion of these issues, the author recommends changes in the DSM-V and some internal and public actions that the American Psychiatric Association should take.

The pathologisation of sexual diversity – a critical scrutiny of the DSM

“…Furthermore, arguments for removal of the 'trans diagnoses' included societal intolerance of difference, the human cost of diagnostic stigmatization, using the language of psychopathology to describe what some consider to be normal behaviours and feelings and, finally, inappropriately focusing psychiatric attention on individual diversity rather than opposing the social forces that oppress sexual and gender nonconformity (Drescher, 2010).…”

The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults

“…As in the case of homosexuality, a high prevalence of gender dysphoria in the general population would raise more questions on whether the condition should be considered a mental disorder (Drescher, 2009).…”

What is the DSM? Diagnostic manual, cultural icon, political battleground: an overview with suggestions for a critical research agenda

“…It should be understood that there is always a value judgment in deciding that a particular area of functioning is 'important ' (1981, p. 212). xi More recent debates in connection with expressions of gender variance and the DSM-IV category of Gender Identity Disorder, in anticipation of the category's revision for DSM-5, have been compared to the controversy over homosexuality (Drescher, 2010). While there are many points of resemblance between the two controversies -including important parallels in arguments for diagnostic removalthe more recent debates complicate the picture, by illustrating that acceptance of gender variance and the promotion of civil rights for transgender persons is not invariably or necessarily predicated on the removal of the relevant diagnostic categories.…”