In 1973, after years of prolonged social agitation and professional conflict, the nomenclature committee of the American Psychiatric Association decided to remove the diagnosis of homosexuality from the Diagnostic and Statistical Manual- II. Until then it had been considered a mental disorder. Sigmund Freud had often touched the topic of homosexuality in his writings, concluding that paranoia and homosexuality were inseparable. The entire community of psychologist referred to homosexuality as something that needed treatment. Without ever contextualizing the situation, homosexuality was deemed as mental illness. In the 1970s
gay activists came out on the streets and started protesting against the APA convention. The same happened in 1971 this encouraged more and more people, gay men all over felt empowered and came out of the closet (Lamberg, L. 1998). And the APA directorate was getting uncomfortable with this level of awareness. The social and political struggles and protests along with their visibility forced APA to get this reform. But one cannot assume that sexual prejudice is a thing of past. In the west homophobia and homohysteria peaked in the ’80s with the spread of AIDS. The infectious nature of the disease further stigmatised homosexual men.
What role does Sexual Prejudice have to play?
Until the amendment in 1973, and for some even after that, many psychologists and psychiatrist believed that homosexuality was a psychopathology that must invariably cause distress. Some were sensible enough to realize that the distress or impairment visible was probably and after product if the stigma and social repression of the community. The only factor that backed the 1973 decision for APA was the results of recent studies that had shown that homosexuals were extremely content in their same-sex relationships.
Various theories of pathology regard homosexuality as a disease, as a condition deviating from normal heterosexual development. The feelings associated with atypical gender behaviour is something that has to be “Cured “by mental health professionals. For the longest time. In the ’60s, homosexual men were electrocuted and drugged heavily to deter them from negating in “homosexual behaviour”. it was assumed that an internal problem or an external pathogenic agent caused homosexuality and that it could occur in people pre-or postnatally- for example, hormonal exposure, excessive mothering, sexual abuse etc. it was considered as social evil the church labelled it as a “sin” (Kite, M. E., & Bryant-Lees, K. B. 2016).
Another strong notion was the theory of immaturity in which psychologists associated homosexuality with stunted growth, or “developmental arrest”. According to them, ideally, everybody goes through a “homosexual phase” which they must eventually outgrow. This is how adult homosexuals were stigmatised as deviants because they were regarded as individuals who indulged their immature fantasies instead of fully developing as heterosexual adults (Drescher, J. 2015). Some of these theories for psychopathology also based their opinion on existing gender beliefs. These gender beliefs were based upon gender binaries that usually emphasised on implicit ideas about what are essential qualities of a man or a woman. Any deviation from the same brought upon scrutiny and was shunned and shamed publicly. This made the connotations even more toxic and harmful for homosexual men (Green, R. 1972).
The most astounding factor in this whole situation is the fact that the APA did not remove homosexuality from the manual as a disorder, not as a result of any scientific breakthrough. It the community of homosexual men who took it upon themselves to create some noise around the injustice they had been subjected to. They gained momentum and voice and made sure they were heard. And the APA and various other organisation worldwide had to take notice and make amends to forestall any radical scrutiny of the DSM system.
For the longest time, what is known as gender dysphoria today was referred to as gender disorder. The World Professional Association for Transgender Health (WPATH) decided to change the name of the diagnosis of gender identity disorder to the less pathologizing gender dysphoria. It describes the condition of stress without making it all about the attributed gender identity of the subject (Wilson, et al 2002).
Gender dysphoria involves a conflict between the gender assigned to a person at their birth and the gender they identify with. In this situation, they can feel extremely uncomfortable in their body and also be uncomfortable with the gender roles expected of them (Hartung et al 1998). Here, we have an example of Sam, the fourth child of his parents’ who was assigned the gender of female at birth due to their biological body. For the longest time, all psychologists labelled Sam’s situation as “gender non-conforming” but Sam was very clear about how he felt. At the age of 4, he knew he identified as a male.
Sam had refused to potty train unless he was brought boxers, he refused to conform to his gender roles even as the third grader. When in fourth grade Sam parents announced his social transition into male pronouns and bathrooms, Sam responded in a much better manner. The medical intervention for the physical transition took some time as Sam’s parents did not have the access to that kind of healthcare back in 2011. But their empathy in recognising the need to understand their son’s situation, and their efforts in trying to alleviate the clinically significant distress or impairment in social relationships, school or home life helped Sam immensely.
There is a lot of scepticism around the inclusion of gender identity disorder in the DSM- V. this is mainly because GID is not able to capture the whole spectrum of gender variance phenomena. There are certain characteristics of transsexualism and GID that are similar and confusing. Until recently the entire emphasis was on the diagnosis only applying to individuals who have had medical treatments (Lev, A. I. 2006). This can be stigmatising for the individuals who do not identify with their gender they were assigned at birth and they do not have access to such advanced medical treatment yet.
As per doctrines of standard care, as soon as the child starts feeling persistent dissatisfaction with their gender identity, no matter what age, their therapy treatment should start- whether it is hormonal psychological or surgical all treatments should begin. Sam knew it at the age of 2. His identification with the gender of his choice was insistent, consistent and persistent and he could only actualize the same because instead of diminishing it to a mental disorder, Sam was given proper care and attention. He was fortunate enough to get a safe space that provided him with adequate support for his transition without ever having to go through the trauma of intense stigmatization.
The intense stigma and hate associated with anything that is not cis-gendered hetero normative behaviour go against the objective standards of care that the medical community. A psychologist should take all care in understanding the situation and providing adequate solution and treatment instead of pressurizing individuals to conform to heteronormative gender roles or penalizing them for not doing the same. Psychological treatment must create developmental pathways of treatment that do not label any anything different as pathological or deviant simply because they are not too familiar with it. gender and sexuality have a huge spectrum that lots of adequate research, empathy and most of all a supportive environment that does not discriminate people for their individual choices.
Drescher, J. (2015). Out of DSM: Depathologizing homosexuality. Behavioral Sciences, 5(4), 565-575.
Kite, M. E., & Bryant-Lees, K. B. (2016). Historical and contemporary attitudes toward homosexuality. Teaching of Psychology, 43(2), 164-170.
Drescher, J. (2015). Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD. International Review of Psychiatry, 27(5), 386-395.
Wilson, I., Griffin, C., & Wren, B. (2002). The validity of the diagnosis of gender identity disorder (child and adolescent criteria). Clinical Child Psychology and Psychiatry, 7(3), 335-351.
Lev, A. I. (2006). Disordering gender identity: Gender identity disorder in the DSM-IV-TR. Journal of Psychology & Human Sexuality, 17(3-4), 35-69
Hartung, C. M., & Widiger, T. A. (1998). Gender differences in the diagnosis of mental disorders: Conclusions and controversies of the DSM–IV. Psychological bulletin, 123(3), 260.
Green, R. (1972). Homosexuality as a mental illness. International Journal of Psychiatry.
Lamberg, L. (1998). Gay is okay with APA—forum honors landmark 1973 events. JAMA, 280(6), 497-499.
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