Friday, October 24, 2008

LGBT HISTORY: APA's Strange Relationship with LGBT People

Alfred Kinsey publishes Sexual Behavior in the Human Male, the first major sexological research scientific study. Its results challenged the growing conservatism that would define the next 10 years.

Homosexuality is listed in the first DSM as a Sociopathic Personality Disturbance. (I actually didn't know this; the Catholics told me.)

Alfred Kinsey publishes Sexual Behavior in the Human Female, the follow up to his popular 1948 piece. Less successful, and with fewer "wow's." The conservatism had set in, and people were no longer interested in listening.

Evelyn Hooker's paper, "The Adjustment of Male Overt Homosexuals," was published which put psychological tests to both "healthy" homosexuals and heterosexuals. When the results were presented to professionals, they were unable to distinguish between the two groups. The lesson: you can't tell a homo by the psychological profile alone. Bigger message: gays aren't that different.

Homosexuality is moved from sociopathy to "other sexual deviations."

Homosexuality is removed from the Diagnostic and Statistical Manual (DSM) by the American Psychological Association. It is replaced, instead, by sexual orientation disturbance. The move was credited as the result of three things: 1) Alfred Kinsey, 2) Evelyn Hooker, and 3) the gay rights movement.

Sexual orientation disturbance is replaced in the DSM by "ego-dystonic homosexuality." This is defined (to this day in the ICD-10 by the World Health Organization) as:
The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.

The ICD-10 (universal medical diagnosis coding system) has a whole section on sexuality, the F66 section. Egodystonic sexual orientation is F66.1. They also have relational and maturational diagnoses.

The argument against this is that homosexuality is egosyntonic -- that is, aligning with the values or beliefs necessary to a person's ego or person's self-image. Seems very personality-based, so I would think it's difficult to make a universal statement there. Especially since anorexia nervosa is considered egosyntonic.

Ego-dystonic homosexuality is removed from the revised DSM, but "sexual disturbance not otherwise specified" persists which is defined as "persistant and marked distress about one's sexual orientation."

The American Psychological Association comes out against reparative/conversion therapy. They find, though there is little evidence either way, that conversion therapy is potentially harmful. From their statement:

In the current social climate, claiming homosexuality is a mental disorder stems from efforts to discredit the growing social acceptance of homosexuality as a normal variant of human sexuality. Consequently, the issue of changing sexual orientation has become highly politicized. The integration of gays and lesbians into the mainstream of American society is opposed by those who fear that such an integration is morally wrong and harmful to the social fabric. The political and moral debates surrounding this issue have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue... Psychotherapeutic modalities to convert or "repair" homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to First, do no harm.

The DSM-V, the latest manual, is due out. They are currently analyzing current diagnoses. There are two that are being challenged this time around:
  • Gender Identity Disorder -- actually listed under a couple of categories. GID is the psychological "disease" necessary to have before undergoing sexual reassignment surgery. It is the only psychological condition that has a surgical cure. Think about that one for a moment.
  • Transvestic Fetishism -- listed as a "paraphilia." This specifically revolves around people who cross -dress and may, in fact, gain sexual arousal out of cross-dressing. People diagnosed with TF would be what we would call "transvestites" or "cross-dressers."
GID Reform Advocates is seeking to either delete or significantly alter both of these diagnoses to "affirm that difference is not disease, nonconformity is not pathology, and uniqueness is not illness...[and] serve a clear therapeutic purpose, are appropriately inclusive, and define disorder on the basis of distress or impairment and not upon social nonconformity."

And that's the whole purpose of this blog... we are gearing up for this one. So, um, yea.

There you go.

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