When Homosexuality Came Out
(of the DSM)

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41 years ago this month, homosexuality ceased to be a mental illness. Amid growing opposition from gay activists, and dissent within its own ranks, the American Psychiatric Association was begrudgingly forced to expunge homosexuality from the DSM-II. Paradigmatic of the social nature of psychiatric diagnosis, the purging of homosexuality from the psychiatric nomenclature highlights the instability of the psychiatric sign: once signifying disease and perversion, homosexuality came to be recognized by the establishment as a normal variant of human sexuality. The ‘coming out’ of homosexuality from the DSM-II allows us to reflect on the following: (1) change in the concept of mental disorder is slow; (2) diagnosis-making is a social act; (3) the construct of illness and disorder, ‘mental’ or otherwise is a social one; (4) the construct of illness has social consequences; and (5) shifts in the concept and nature of disorder reflect wider social, political and economic forces more than scientific advancement.

The slow demise of homosexuality as disease

Although the removal of homosexuality from the DSM is often heralded as a radical and rapid sea-change in how sexual orientation was viewed, the reality is more sobering. Homosexuality was not actually removed from the diagnostic nomenclature of the revised DSM-II. Instead, it was shifted into parentheses of the new diagnosis of sexual orientation disturbance. The change in diagnosis was supposed to create as little disruption to psychiatric practice as possible, and the position statement about this change notes that ‘hardly anyone can disagree’ that ‘Modern methods of treatment enable a significant proportion of homosexuals who wish to change their sexual orientation to do so.’ While noting that homosexuality does not fulfill criteria for a psychiatric disorder, the same position statement goes on to note “no doubt, homosexual activists will claim that psychiatry has at last recognized that homosexuality is as “normal” as heterosexuality. They will be wrong.” The same year, 1973, a number of publications discuss diagnostic and treatment aspects of homosexuality, including aversive conditioning, use of electric shocks and even lobotomy. Further, the diagnosis of ‘sexual orientation disturbance’, later to become ‘ego-dystonic sexual orientation’ was only applicable to same-sex attraction. The implicit assumption is that it is not possible for those with opposite-sex attraction to feel negatively about this. Whether true or not, the assumption goes unchallenged.

It was not until 1987 that homosexuality completely disappeared from the DSM, but the concept of ego-dystonic sexual orientation persists in the World Health Organization’s International Classification of Diseases. More recently we have seen a similar shift with transgendered individuals. It is interesting to note as homosexuality came out of the DSM, transsexualism was making its debut. This transformed into gender identity disorder, and most recently, to gender dysphoria in DSM-5.

Diagnosis making as a social act

The ritual of making a diagnosis is a performance that occurs within the social space. Making a diagnosis, as Arthur Kleinman has pointed out, is a semiotic act. It involves transforming experiences into ‘symptoms’ and ‘signs’ that signify disease or disorder. These diagnoses confer social meaning not just for those labeled so, but also come to signify what it means to be without disease or disorder. Taking the example of homosexuality, its appearance as a social and medical concept at the end of the 19th century, also coincided with the invention of heterosexuality. Psychiatry was thus instrumental in creating and polarizing sexual identities in a way that persists today despite the demedicalization of sexual orientation. Diagnoses thus convey not only information about the treatability and prognosis of particular states, they also create identities, confer recognition, or conversely erode personhood, and our ability to construct meaningful narratives beyond the medico-psychological discourse. Schizophrenia is not just a diagnosis, but signifies a particular identity that shifts with cultural convenience — once capturing the attractive delicate white woman who has been trampled by society, to the imposing, aggressive black man who poses a threat to social order.

The social construction of ‘mental illness’

Whilst the concept of the sodomite dates back to biblical times, the concept of the homosexual did not emerge until the late 19th century. At once, sexual behaviors were transformed into a diagnosis and a sexual identity. That this transformation occurred when it did is no accident, but accompanied the tacit acceptance that sex was not simply procreative but pleasurable, the increasing prominence of the physician-as-expert, and the need for physicians to ‘prescribe a healthy sexuality.’ Similarly, the demise of homosexuality as disorder came at a time when pleasure could be celebrated over duty, with the rise of anti-authoritarianism, and psychiatry’s grand venture into solving the social ills of our time. Whether homosexuality or psychosis have some biological basis does not detract from the role of psychiatrists as agents of social control. For example, in 1972, just a year before the DSM expunged homosexuality, John Feighner and colleagues proposed diagnostic criteria for various mental disorders to be used in research. Among the ’14 psychiatric illnesses’ was homosexuality, defined so:

  1. This diagnosis is made when there are persistent homosexual experiences beyond 18 (equivalent of Kinsey 3 to 6)
  2. Patients who fulfill the criteria for transsexualism are excluded
  3. Patients who perform homosexual activity only when incarcerated for a period of at least one year without access to members of the opposite sex are excluded

Here we see a psychiatric definition of homosexuality that is operational and wholly arbitrary, with the long-term incarcerated given a free ticket to buggery, unencumbered by psychiatric labeling. All medical diagnoses psychiatric or otherwise are socially constructed, but psychiatric illnesses also confer identities — wanted or unwanted — that other medical illnesses seldom do.

The social consequences of illness

Illnesses can be stigmatizing, and although such diseases including leprosy, TB, cancer, and AIDS have carried stigma for sufferers at some point in history, they rarely alter the experience of the self in the way that psychiatric diagnoses do. The pathologization of homosexuality convinced some individuals that they were sick, and that in itself may have made them (feel) sick! The removal of homosexuality from the psychiatric canon has undoubtedly facilitated the rights of those who identify as lesbian, gay, or bisexual. Adoption rights, same-sex marriage, the repeal of Don’t Ask Don’t Tell would never have occurred if homosexuality continued to be seen as the developmental end-point of deep psychopathology. In the same way, diagnoses of mental illness confer individuals with a sense of otherness, that they are somehow different than other people, perhaps less important, less deserving, or of less worth. With a diagnosis of schizophrenia, if internalized, comes the erosion of personhood, lowered self-esteem, shattered dreams, and a sense of disenchantment. The psychiatrist Richard Warner has even suggested that those who reject the diagnosis of severe mental illness may have better outcomes as they retain the right to construct their own narrative of personhood and define what really matters for them. Despite public education campaigns (or perhaps because of them), the stigma of mental illness is as enduring as it was 50 years ago.

The rise of illness: scientific advancement or commercial cash cow?

As discussed above, the removal of homosexuality from the DSM was the result of sociopolitical forces, and not a reflection of scientific advancement. Even within psychiatry, the mass proliferation of psychiatric diagnoses is viewed as something commercial. Up until the 1970s psychiatric diagnoses were not necessary to treat individuals with a wide range of problems, and psychiatrists had little competition from other mental health professionals. With the growth of clinical psychology and other mental health professions who could provide psychotherapy more cheaply, psychiatrists needed to maintain their moral authority over the mental life that had come under their purview. What psychiatrists, as physicians, could do that others could not was make diagnoses. Thus the medical profession created new diagnoses for the range of mental life that psychiatrists were already seeing in their offices; and these became the signifiers that these patients had a medical illness that required treatment. The growth of psychopharmacology allowed the boundaries for these new diagnoses to expand, creating new markets, not only for the pharmaceutical industry but also for the mental health field. There was no problem too small to warrant pharmaceutical relief.

But what of the social and political forces that facilitated the growth of mental illness? At the same time that homosexuality was losing its status as mental disorder, the US was in the midst of a deepening economic crisis. By 1980, the year of publication of DSM-III, a new republican government headed by Ronald Regan entered the White House. Rather than draw attention to the psychiatric casualties that would amass under neoliberal policies, it became convenient to locate mental illness within the self — in brain, cell, and molecule — rather than as a product of community, society, and state. It is for this reason that psychiatrist Joanna Moncrieff has suggested that a “marriage of convenience” exists between biopsychiatry and the politics of neoliberalism. A biological model that was gaining ascendance was fortified by the political expedience of supporting a paradigm of psychic discontent that obfuscated the wider social, economic and political forces at play. In the same way the removal of homosexuality from the DSM was not the result of scientific advancement but political will, the solidifying of disease status of minor psychiatric diagnoses and their biological basis are more the result of these same forces than scientific triumphalism.

 

Further Reading

  1. Disturbance: Proposed Change in DSM-II, 6th Printing Page 44 Position Statement. http://dsm.psychiatryonline.org/data/PDFS/dsm-ii_homosexuality_revision.pdf (accessed 12/24/13)
  2. Freund K, Langevin R, Cibiri S, Zajac Y. Heterosexual Aversion in homosexual males. Br J Psychiatry 1973; 122:163-169
  3. McConaghy N, Barr RF. Classical, avoidance and backward conditioning treatments of homosexuality. Br J Psychiatry 1973; 122:151-162
  4. Rhodes RJ. Homosexual aversion therapy. Electric shock technique. J Kans Med Soc 1973; 74:103-105
  5. Freeman W. Sexual behavior and fertility after frontal lobotomy. Biol Psychiatry 1973; 6:97-104
  6. MacDonal AP Jr., Huggins J, Young S, Swanson RA. Attitudes towards homosexuality: preservation of sex morality or the double standard? J Consult Clin Psychol 1973; 40:161
  7. Lesse S. The current confusion over homosexuality. American Journal of psychotherapy 1973; 27:151-154
  8. Stoller RJ, Marmor J, Bieber I, Gold R, Socarides CW, Green R, Spitzer RL. A Symposium: should homosexuality be in the APA nomenclature. Am J Psychiatry 1973; 130:1207-1216
  9. Maletzky BM, George FS. The treatment of homosexuality by ‘assisted’ covert sensitization. Behav Res Therapy 1973; 11:655-657
  10. American Psychiatric Association. Homosexuality and Sexual Orientation
  11. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic Criteria for Psychiatric Research. Arch Gen Psychiatry 1972; 26:57-62
  12. Ch.3 The Fall and Rise of Homosexuality. pp55-99 In: Kutchins H, Kirk SA. Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: The Free Press, 1997
  13. Katz JN. Ch.7 the invention of heterosexuality. Pp83-98 In: Privilege: a reader.
  14. Tanner BA. Shock intensity and fear of shock in the modification of homosexual behavior in males by avoidance learning. Behav Res Therapy 1973; 11:213-218
  15. Skene RA. Construct shift in the treatment of a case of homosexuality. Br J Med Psychol 1973; 46:287-292
  16. Moncrieff J. Neoliberalism and biopsychiatry: a marriage of convenience. In: Cohen C, Timimi S. (Eds.) Liberatory Psychiatry. p235-257 Cambridge: Cambridge University Press, 2008

 

 

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42 COMMENTS

  1. Really horrified to see comments expressing this level of hatred and homophobia on MIA. I truly hope they will not be tolerated. At the end of the day, this type of attack is targeting all of us.

    “The removal of homosexuality from the psychiatric canon has undoubtedly facilitated the rights of those who identify as lesbian, gay, or bisexual.” Completely, completely agree. Something to think about for all of us. Excellent article, Dr. Datta.

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    • I am disgusted that you would stand up for a clear mental illness that was only taken out of the DSM due to the protesting of the LGBT community and nothing else.

      Homophobe is only used by those that decide if you are disgusted by a certain group you must be afraid of them.
      No fear at all here. Just a disgust with them serving and weakening our military as well as tearing down the moral fabric of our country.
      It was taken out of the DSM by vote not discovery.
      I don’t want them around my children and won’t allow it in my home PERIOD.

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  3. Hi folks. Just a heads up from the moderator that there will be zero tolerance for homophobia here — all such comments will be removed and their authors placed on moderation. Attempting to shame or denigrate people for their sexual orientation is oppressive and we are not interested in providing a platform for that. I encourage our regular readers to report any homophobic comments you see. Thank you.

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    • Thank you, Emmeline. Please feel free to remove my sparse comments as well. The bigoted comments are taking up so much real estate that perhaps it might be in order to wipe out all their threads entirely if that’s possible, leaving no trace of them.

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    • Thanks Emmeline.

      I was shocked and saddened to see how certain people had managed to twist what I had written as support for their own anti-gay sentiments. I hope it is clear that this blog post explores how all diagnosis making is a sociopolitical act and both the inclusion and expunging of homosexuality from the DSM are sociopolitical in nature.

      v

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    • Emmeline,

      I very much appreciate your moderating of any and all moral-ethical sentiments against homosexuality with respect to this article and on this site. As you politely reminded us, this is certainly not the place for any kind of moral-ethical comments, or value judgments, regarding sexual practice or sexual orientation.

      However, or just as a (kind and gentle) note of caution, the word “homophobia” can, potentially, be perceived as just as denigrating (or “oppressive”) a “mental-illness” (or “disease”) diagnosis as “homosexuality” once was. This, I believe, is what Dr. Datta implies when he, graciously, corrected Cataract’s belief that the DSM “did one thing right when they left homophobia in there”. That is, it would tend to be just as equally detrimental to label those of an opposing sexual moral construct as having “homophobia”:

      (Quote): “Vivek Datta, M.D., M.P.H. (MIA Author) on December 2, 2014 at 3:10 am said: homophobia is actually one of the few things that is not in the DSM! don’t give them any ideas!”

      As such, and with all kindness, you may (possibly) want to amend your value judgment that “attempting to shame or denigrate people for their sexual orientation is oppressive”. The reason being, or given the open-ended trajectory (or logical conclusion) of that statement, is that there are, in fact, individuals (or groups) within society whose sexual orientation is, presently, against the law (e.g. pedophilia); but who feel that their orientation is, actually, being unjustly discriminated against, or “oppressed”, by an unenlightened society (e.g. NAMBLA http://www.nambla.org/).

      Moreover, society does not just attempt “to shame or denigrate” these particular groups of “people for their sexual orientation” but in fact does so; especially through legislation. In other words, both society and the law clearly “discriminates” against this kind of sexual orientation both adhered to and practice by either groups or individuals.

      Lastly, I could not agree (or resonate) more with Dr. Datta’s shock and sadness over those inappropriate comments that distracted us from such an excellent article that simply sought to explore “how all diagnosis making is a sociopolitical act and both the inclusion and expunging of homosexuality from the DSM are sociopolitical in nature.”

      Kind regards,
      Reverend Haynes

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      • I think Emmeline’s statement is perfect as it is.

        Pedophilia in action is child rape. I think it goes without saying that “discrimination” against child rapists is just fine. It is not oppressive to protect children from rape. Rape is oppressive. No one has a right to be a rapist.

        You may not have realized it, but it can be upsetting to people when the subject of pedophilia comes up in the context of conversations about LGBTQ issues. This is because bigots often, either for rhetorical reasons or just out of ignorance, like to conflate non-heterosexual orientations with other orientations and behaviors that have absolutely nothing to do with them.

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        • Uprising,

          Thank you for your comments. I, sincerely, appreciate the feed back!

          I totally (and wholly) agree with your statement that: “Pedophilia in action is child rape. I think it goes without saying that ‘discrimination’ against child rapists is just fine. It is not oppressive to protect children from rape. Rape is oppressive. No one has a right to be a rapist.”

          Also, I am very much aware (and absolutely agree) that: “it can be upsetting to people when the subject of pedophilia comes up in the context of conversations about LGBTQ issues. This is because bigots often, either for rhetorical reasons or just out of ignorance, like to conflate non-heterosexual orientations with other orientations and behaviors that have absolutely nothing to do with them.”

          As such, I would concur with you that any and all sexual “orientations” (i.e. “orientations” in the broad and not narrow sense of the term – as any possible intrinsic or extrinsic inclination within the capacity or range of human sexuality) should be considered separately and not conflated.

          And so, my point was not to confuse (or equate) homosexuality, in any way, with pedophilia but, simply, to draw attention to the reality (i.e. as an example) that peoples, laws, and cultures, whether past or present, do in fact “discriminate” with respect to human sexuality in some form or another.

          My sincere apologies for any confusion I may have caused!

          Kind regards,
          Reverend Haynes

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      • Pedophilia is not a sexual orientation anymore than klismaphilia (enema fetish) is. Pedophiles typically engage in sexual activity and have sexual attraction to adults. I really am not quite sure what you are getting at. Children do not have the ability to consent to sex, and this is why sexual activity with children is legislated against and quite rightly so. Pedophilia is also not a mental disorder and does not meet even the DSM requirements for being so despite being included.

        I do think there is a difference between those individuals who have sexual phantasies through no choice of their own involving in children and those who willfully act on these phantasies. I sympathize with the former, but certainly not with the latter who are quite rightly criminalized.

        v

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        • Vivek,

          Thank you for your response. I much appreciate it.

          Just to, kindly, let you know, it was not my intention to move the discussion in this direction of human sexuality. Nor, do I believe that it was your intention as well. As such, I think we are agreed that MIA is not the proper place for this kind of moral-ethical discussion; nor should it be.

          Moreover, I would like to emphasize that this was, in fact, the main thrust of my response. However, this particular trajectory would appear to be an unfortunate (and somewhat unforeseeable) consequence; given the sensitive nature of the socio-medical history of the topic under discussion.

          Notwithstanding this distraction, please allow me to clarify where I was coming from. And then, hopefully, we can move into a more productive discussion regarding the real issues in this article; which was my intention to begin with.

          As a Christian minister, and theologian, I hold to a worldview that would, quite naturally, adhere to Christian boundaries for expressing human sexuality. And so likewise, or together with yourself, I would whole-heartedly concur that “there is a difference between those individuals who have sexual phantasies through no choice of their own involving children and those who willfully act on these phantasies. I sympathize with the former, but certainly not with the latter who are quite rightly criminalized.”

          As such, my point regarding sexual “orientation” (Lit. to face the East) was, simply, that human sexuality has no intrinsic (or innate) socio-cultural established boundaries. In other words, human sexuality, in and of itself alone is, quite naturally, extremely fluid or plastic in its innate capacity for a vast range of internal and external (or intrinsic and extrinsic) experiences, movements, inclinations, directionality, attractions etc).

          And so, or in view of this, I thought it might be advisable for our MIA Moderator to, kindly, refrain from making any value judgments against ANY sexual discrimination; as though ALL sexual discrimination is denigrating and “oppressive”. This is, simply, not the case. For example, various cultures and laws, both present and past, have not only varied, as I am sure you know, with respect to age of consent (or perceived boundaries of childhood to adulthood) but are clearly discriminatory in nature.

          Accordingly, I felt drawn to, gently, remind everyone, reading this post, that respectful restraint, and mutual understanding, on all sides of this sensitive issue, is the best way forward here at MIA; considering the wide range of liberal and conservative positions on human sexuality and behaviour.

          As such, it was out of this goal toward mutual understanding and respect that I wished to, kindly, let our MIA moderator know that the use of the term “homophobic” or “homophobia” is, in fact, offensive to many people who hold to a moral construct that excludes homosexuality (though not homosexuals as persons, per say) from their religious worldview and life practice.

          Respectfully,
          Reverend Haynes

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          • Hi Reverend. I hear what you’re saying, but I think we’ll have to agree to disagree on this. A person’s religious worldview is not really my concern — the words on the screen are, and my job is to make decisions (judgments, you could say) about whether those words are in accordance with our posting guidelines, which explicitly prohibit hate speech and discrimination based on identity. I can’t get into extended debates here about moderation decisions, their wording or the values they’re based on. It’s derailing to the conversations and to my work.

            That said, your comments have led me to think about how “phobia” has connotations of diagnostic terminology, which is problematic in its own right. Maybe “anti-gay” would be better.

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          • Emmeline, I must take issue with this.

            Personally, I believe homophobia is an accurate term, as this is based in ‘fear,’ to my mind. Calling it ‘anti-gay’ feels very demeaning to me, as a gay man. It seems these respective terms highlight ‘the other’ as ‘the one with the problem.’

            Either way, semantics aside, more than anything, I’d like to reiterate that at the core, this is about how people are regarded, above and beyond stigma. To me, this is about stigma. We could just as easily say, “Anti-straight” vs. “heterophobia,” which does apply to some people, that’s how some people feel, just like some heterosexuals fear gay people. Many roots to these, based on social trauma and programming, of course.

            In either direction, are we not trying to find our commonalties more than our differences? Especially when noting our difference leads to fearing or shunning or in some way ‘othering,’ if even simply by deconstructing analytically a population of people simply because they/we are outside some illusory notion of what is ‘normal?’

            Please let’s not say anti-gay. That feels dehumanizing to me.

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          • Alex, very good point about highlighting ‘the other’ as ‘the one with the problem.’ I hadn’t thought about it that way, but I think you’re right, it could have that effect.

            It seems that the element of fear suggested by the term homophobia is precisely why some object to it, because they feel that their aversion or discrimination is rational and justifiable, and they do not want to be highlighted as ‘the one with the problem.’ If there’s a value judgment contained in the term I think it’s a positive one — it conveys that the lives and well-being of LGBTQ people are valued.

            I do think this conversation thread has drifted from Vivek’s blog post, but I also see how it ties in, because the terms we use are social constructs that convey social meaning much like diagnoses do, with real consequences for people’s lives.

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          • Thanks, Emmeline. I do appreciate that my posts on this thread were a bit askew from the main point of the blog, but as an activist-minded member of the LGBT community, when this issue is discussed in relationship to mental illness, even as an example of ‘social control,’ I feel compelled to address nuance, in any capacity. Stigma run bones deep, and can be extremely insidious and subtle.

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    • You mean anything you disagree with or anyone that disagree’s with you sounds like to me.
      If I am wrong and my previous comment or this current one is not deleted then I applaud your ‘ahem’ tolerance.

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  4. Homosexuality – once a disease, now it’s not.
    And psychiatry wonders why it is seen to have no credibility.

    I hope I’m not off-topic here; but I’ve never understood the hatred some people have towards homosexuals. Since I was a kid, it has never made sense.

    It still doesn’t. I just don’t get it.

    The first 15 years of of our marriage, we lived in a largely gay/lesbian area in Dallas. We had a gay couple across the street; a lesbian couple next door. They were great neighbors. We watched out for each other.

    I hear the term “homophobia” and it also makes no sense.
    It sounds like psychobabble.

    A person is afraid of homosexuals; or is it homosexuality; what exactly?
    And I think to myself that it must be a pretty big fear, for them to strike out with such rage. And the rage makes me wonder if it has anything at all to do with fear. It seems more like hate…. and around and around my head goes, trying to figure it out….

    I studied some of this stuff in graduate school. It still makes no sense. All I know is that I can’t stand it. As a Catholic, I appreciate some of the comments Pope Francis has recently made; his reaching out to the gay community. Maybe one day we will all learn to love one-another more perfectly; more unconditionally.

    Duane

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  5. I no longer post here, for personal reasons, but reading this blog and comments, I cannot help myself at present.

    My partner of 30 years (and now-husband) and I survived the catastrophe our life had become due to my particular story of psychiatric and social service abuse, coming off tons of meds, and my legal battle with the system. I was in despair and paranoia, and he was enraged at life and scared to death he had lost me to ‘mental illness.’ We had no effective support, of which to speak, so we were basically alone together, each of us in crisis and with me suddenly disabled.

    As I healed and ‘woke up,’ he was forced into doing his own healing, were we to survive as a couple. He did, and dedicated himself to healing, as did I, and we have since moved to the country together and are living a very happy and well-balanced, fulfilled life together. We feel we are living our dream, finally, the way we had planned, but which got derailed temporarily thanks to my debilitating encounters with the ‘mental health world.’ I’ve since shifted out of that world, eschewing it altogether.

    Personally, I don’t know of couples of any sexual orientation who weathered the storm like we did, both of us coming out of the dark and our own respective crises, growing and evolving together–once at odds as we each wrestled with our own demons, but now deeper in love and more committed to each other than ever.

    I just wanted to give a vivid example of how couples can heal together and create a really profound and meaningful partnership commitment, as a result. It just so happens that I’m part of a same-sex couple. So what?

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    • Just as a final comment, I’ve always attributed the substance behind why ‘homosexuality’ was finally stricken from the DSM as having no basis whatsoever for being in there, to Dr. Evelyn Hooker.

      http://en.wikipedia.org/wiki/Evelyn_Hooker

      Here’s a 5 minute clip from an excellent and enlightening documentary I saw a couple of years ago about Dr. Hooker and her work in this area, called Changing Our Minds: The Story of Dr. Evelyn Hooker.

      http://www.youtube.com/watch?v=oWOfyD5qvSQ

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    • Alex:

      Thanks for sharing! Your life is proof that my daughter can have a good life and need not be crushed by the psychiatric label that was imposed on her by an inhumane mental health system or that her brain will be permanently damaged by five years of forced medication. With people like you coming out of the closet in more ways than one, our family has a right to hope for better days to come!

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      • I’m so glad my story lights up your hope, madmom. That’s the only reason I share. I had to bust through a lot of mythology and illusion (blatant stigma) I was being fed in order to find my clarity and true voice.

        Indeed, one vital truth I learned along my journey is that EVERYTHING heals, if we *allow* it to. Healing is natural and inevitable, although we can sabotage it with cynicism, pessimism, and negative beliefs, in general. Environments which stigmatize are, in no way, healing environments. Quite the opposite.

        I had to find and manifest environments where my full and complete healing was 1) believed in, and 2) supported. I certainly had to believe in that, myself, for it to occur. I learned that what we believe–deep in our hearts, when we are really being honest with ourselves–is what matters most when it comes to healing.

        (Apologies for veering off topic, but I felt strongly compelled to follow through, here).

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  6. I’m not quite certain what to make of the prior comments, since they were removed prior to my reading and comment. But it strikes me that Vivek’s blog is really more about the reality that psychiatric “diagnosis” in it’s true purpose is about social control, not actual medical illnesses.

    And this, I believe, is an important comment on the reality of what psychiatry really is. Especially since the psychiatrists are defrauding society, via their claims their social control system of so called “mental illnesses” are based upon medical science, when there is actually zero scientific / medical validity to the DSM “bible” whatsoever.

    And, this is especially disconcerting since their DSM “bible” of so called “mental illnesses” seems to accurately describe the ADRs and withdrawal effects of the psychiatric drugs quite accurately (iatrogenic illnesses). But the psychiatric industry can’t find any actual genetic markers of their so called “life long, incurable, genetic mental illnesses.”

    It strikes me psychiatry is a fraudulent system intended to divide society into “us’s” and “them’s,” and divide and conquer is a long known strategy to destroy civilizations.

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    • I don’t think psychiatry is intended to divide and conquer though it has certainly been used in this way, especially in the US. This coincides with the professionalization of medicine in general, and the rise of psychiatry in particular in the early 20th century in the era of late capitalism where governments saw the potential for psychiatry and psychoanalysis to oppress and repress and displace the causes of misery onto the individual rather than the structure of society itself. In contrast to the US in some countries such as France and Italy psychiatric thinking in the 20th century was often more subversive and many within the profession had the goals of liberation rather than oppression.

      v

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  7. Vivek, your posts are more incisive and more impactful every time. What an impressive deconstruction of the DSM and the forces behind it! This melds very well with Sera’s comments on the connection of this movement with other human rights movements, as social oppression appears to be the centerpiece of the DSM and all of its various institutional offspring. I’m glad to hear that France and Italy may have preserved some different energy in the psychiatric profession.

    Thanks for sharing your knowledge and passion!

    —- Steve

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  8. Twice the rate of psychosis amongst the LGBT community – or so Mr Richard Bentall said when I asked him and he is the big expert in these things.

    Thus the Pinko Commie Queer from Reading speaks – and that’s me folks.

    So homophobia drives people mad, but I don’t suppose you get that in DSM.

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    • The Dutch are the ones who have looked at this. NEMESIS (The Netherlands Mental Health Survey and Incidence Studies) was a population based study that suggested psychotic symptoms in LBG individuals was twice that found in heterosexuals. They suggested most of this was mediated by childhood trauma, bullying and experience of discrimination in the main. The problem with these sorts of surveys is they use lay interviewers to try and tease out psychotic experiences which vastly overinflates the number of cases identified as psychotic. So they are not looking a psychosis (i.e. people who might seek help or find themselves in the mental health system as a result of these experiences) but people who are endorsing unusual experiences or who didn’t understand the question. If you ask people “do you hear voices?” A lot of people say “yes” because they don’t understand what you’re asking. To my knowledge no one has actually looked at differences in the incidences of cases diagnosed with psychotic disorders between LGB and heterosexual individuals.

      In my experience clinically (50% of my patients are MSM) I have not seen twice the rate of “psychosis”, not that couldn’t be explained by meth or other substance use. Difficulties with attachment, trusting other, re-experiencing trauma, anxiety, self-loathing, phobic behavior, maladaptive behaviors used to regulate powerful emotions are however much more common.

      v

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        • MSM = men who have sex with men. it is the term used as a catch all including people who do not identify as gay/bisexual/queer and also includes male sex workers. Most of my patients in this bracket are gay or queer identifying, but I also have patients who have sex with men for money and identify as heterosexual.

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          • thanks for getting back to me. I am familiar with this term but I had forgotten it. I do not think it is not common outside health and social research circles.

            Nice to see these issues bought up, no matter how fleetingly, in MIA.

            I ran a Queer Group at a mental health day centre for a short period. We were bitchy, gossipy and fun. They did not have psychotic diagnosis (not that I’m keen on diagnosis) but mainly BPD (which I’m definitly not keen on). My guess is that we all had experienced large childhood traumas but that the homophobia and transphobia added to the stresses of our lives.

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  9. If you look in my book, They Say You’re Crazy, and in the chapter on sexual orientation by William Metcalfe and me inmo the book Bias in Psychiatric Diagnosis, you will see that it is a huge myth created by DSM-III head Robert Spitzer that he REMOVED homosexuality from DSM-III. Here are the facts: They CHANGED it to “ego dystonic homosexuality” but announced very publicly that they had decided that homosexuality was no longer a mental illness (because they voted that it was not — a vote — that is how “scientific” it all was). What is “ego dystonic homosexuality”? It is being homosexual but not being totally comfortable with that, not feeling like it is fully consistent with who you are. In the very homophobic society at the time DSM-III was published, it was extremely rare for anyone who was homosexual NOT to have “ego dystonic homosexuality.” So Spitzer and his cronies had it both ways — they continued to pathologize being lesbian or gay, AND they got all the acclaim from lesbians and gays who mistakenly believed the lie that homosexuality itself had been removed from DSM-III. Right now, it is not in the current DSM, but there are still ways to diagnose homosexuality as a mental illness, such as by classifying a homosexual with a DSM category like Sexual Perversion. Be aware, too, that, as Jeremy Caplan and I document in the chapter on sexual orientation in our book, Thinking Critically about Research on Sex and Gender, after claiming to have removed homosexuality from the manual, Spitzer announced that he did “research” in which he “proved” that people could be converted from homosexuality to heterosexuality! But even later than that, after many of us pointed out how horrifically poor was his research — it was like a made-up research design in which as many methodological errors as possible had been included! — he acknowledged that his study had been appallingly bad.

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    • Brilliantly said!

      Have you followed the new age attack now on gender dysphoia in the form of a new classification of autogynnephila, promoted by the likes of Dr. Drescher.

      Where they are marrying the concept of ego dystonic autogynophilia with the confusing debate to convoluted morphology by stating it must be ego syntonic?

      This entire attack was to exploit the sexually abused transsexuals, whom suffered mostly in prison to make a new criteria.

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  10. Dr. Datta,

    I admire your ruthless exploration of the subversive underpinnings that have flourished into the malodorous weed psychiatry has become. Though this weed grows in the swamp of our health care system, it is uniquely troublesome, as you have pointed out:

    <<"… psychiatrists needed to maintain their moral authority over the mental life that had come under their purview. What psychiatrists, as physicians, could do that others could not was make diagnoses. Thus the medical profession created new diagnoses for the range of mental life that psychiatrists were already seeing in their offices; and these became the signifiers that these patients had a medical illness that required treatment."<<

    Whether it is their perceived "moral" authority, or simply their right to *diagnose*, the fact that *new diagnoses* were created to fill the needs and line the pockets of a small percentage of our society, while harming, destroying lives– even killing the unwitting public who is being funneled into psychiatry at an alarming rate, is actually, by strict definition, a criminal act. Is it not?

    I find an unsettling inference in your revelations that doctors, psychiatrists, politicians and other members of a [formerly] highly esteemed group of professional authorities have been enacting rules, guidelines and even laws that reflect the will of the "culture"; that the feelings and beliefs of the masses take root in the hearts and minds of our *leaders* and we become a society that will demand psychotropic drugs, for instance, despite the publicizing of the evidence of their nefarious origin and their destructive adverse effects. This is unsettling because, by virtue of their attainment of higher education; of their association with or proximity to academic minded intellectuals and all that elevates them in status above the *common citizen* there remains– at least in my mind, a duty– call it simple responsibility, but, I do not discount the expectation that the spoils of privilege accompany the capacity to know right from wrong.

    I think that this installment, more so than any of your previous discourses on the *method* employed by psychiatry to lead society astray from our basic nature as human beings, has summarized the fundamental flaw within psychiatrist's themselves. Granted, this topic has inherent emotional powder kegs embedded beneath the professional lexicon that continues to condemn homosexuality, but it also simply illuminates the height of arrogance that continues to deny the only aspect of the human psyche we share in common; each of our *souls* is a unique, never duplicated expression of life itself. Doctors of the *soul* who failed the first pop quiz, use their status and authority to exploit suffering people for obscene profits. Nowhere do you mention that education itself holds the key to understanding the roots of all discrimination; that these hideous misperceptions you outline in detail are spewed from the minds of our own elite highly educated, authority figures and elected public servants.

    I think accountability, not forensic rationalizing, is the most pressing order of business for all of us in the medical profession.

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  11. “homophobia is actually one of the few things that is not in the DSM!”

    I’m no fan of the DSM but I have to say, this is the irony of the century. Talk about an indicator of indoctrinated social values!

    Homophobia is, specifically, to my mind, a social ill that causes a lot of harm to people–from grossly distorted self-perception, to death, including, of course, suicide. It is based on ‘fear,’ and breeds stigma, discrimination, and marginalization, and is, therefore, accurate in language.

    This is merely my opinion, based on not only being a gay man, but also having lived, worked, and played in the Castro District of San Francisco for almost 20 years. This was after growing up, out and open, in Texas. So it was incredibly interesting to be part of ‘the norm’ for a while, there. It’s an entirely different experience in life, I felt like a totally different person. There’s a lot to learn and integrate when you experience life on both sides of the fence.

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  12. Thank you Dr. Datta for such a comprehensive article, I personally found it brilliant.

    As we have seen in the removal of homosexuality as an ego dystonic orientation, we have seen a growing attack on transsexualism in the emergence of autogynephilia, by such people as Dr. blanachard.

    I am glade you mentioned Maletzky BM, George FS. The treatment of homosexuality by ‘assisted’ covert sensitization. Behav Res Therapy 1973; 11:655-657, as we see many involved with pushing for conversion treatment of transsexualism.

    Whilst Dr.Drescher vehemently opposes conversion therapies such as all the aversion techniques you mentioned; he and his colleagues have been enlisting ‘assisted’ covert sensitization, involving many actors for political motives.

    In promoting his has served as a member of the World Health Organization’s Working Group on the Classification of Sexual Disorders and Sexual Health which will address sex and gender diagnoses in WHO’s forthcoming (2017) revisions of the International Classification of Diseases (ICD-11), populating a cognitive genius pathology of ego syntonic autogynephilia.

    As you had mentioned the lack of inclusion of homophobia as a mental disorder, this new emergence of of transphobia seeks to visit the same type os horror to a complete commercialization of transgender by forced perspective.

    This begs the question, should transphobia be put into a revised addition of the DSM 5, as the obvious rise of transgender experts build their careers off the social acceptance of homosexual and attempt to create new criteria of confusion between ego dystonic and ego syntonic allowing a treatment protocol to be populated.

    Some serious work has to be done before the WHO International Classification of Diseases (ICD-11) comes out in 2017 which has re-imagined criteria in conflict with the exclusion criteria of transsexualism, when transexuals have suffered prolonged incarcerated or have been subjects of near captive sexual abuses.

    As my research suggests, transsexuals have and are being exploited, and being intentionally subjected to “exclusionary” covert abuses, and reclassified to fill this market. This market is and has been known to populate the artifact gay transvestite or drag queen, and this familiar persona is highly marketable for political motive, even as a benefit to the gay community.

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