Enough to Make You Sick

May 2003

Gay people rightly celebrate that thirty years ago, activists successfully pressured the American Psychiatric Association (APA) to revise its attitude towards homosexuality.

Prior to 1973, the APA’s “Bible” (the Diagnostic and Statistical Manual) labeled homosexuality an unambiguous mental disorder; any and all gay people were– by definition– sick. This “expert” diagnosis endangered gay people’s jobs, housing, and equal treatment before the law. Custody hearings, immigration proceedings, and civil service exams were all tainted by professionally sanctioned anti-gay bigotry.

But lost in many of the stories about the APA’s change of heart are two key points. First, the APA did not initially completely remove homosexuality from its list of mental disorders. As a compromise, they created a category for “ego-dystonic homosexuality” wherein a person has “the feeling of extreme distress over [his or her] homosexual preferences.” Thus, those doctors who continued to see homosexuality as inherently disordered retained a diagnosis (and insurance billing code!), while more liberal sorts could assert that the patient’s distress originated from a world hostile to homosexuality– homophobia, not homosexuality, was seen as the illness. Although the APA later dropped this diagnostic purgatory, for a time it allowed anti-gay psychiatrists to continue practicing, with explicit professional approval, their frequently torturous and uniformly ineffectual “cures.”

The second point overlooked in stories about the APA’s history is that many sexual behaviors and desires that any non-uptight person would simply call kinky are still branded mental disorders, or in psych-speak, “paraphilias.” Get off on boots? Like to wear women’s panties? Fantasize about being wrapped in rubber? Watersports get you hard? Enjoy peaking behind other guys’ shower curtains at the gym? If so, the APA says you’re half way to being mentally disordered. To complete the diagnosis, the “fantasies, sexual urges, or behaviors” must cause “significant distress or impairment in social, occupational, or other important areas of functioning.”

Presumably, this requirement for “distress or impairment” protects patients from over-zealous, sexually-straitlaced doctors who might be eager to affect a cure in a patient untroubled by his or her sexual peculiarities. But a grave problem nonetheless arises from the APA’s retention of diagnostic categories for routine sexual kinks: a growing number of laws seek to incarcerate, punish, and “treat” those suffering from “mental abnormalities” or “personality disorders.”

It used to be guys jerking off in the woods at highway rest stops risked arrest and charges of “indecent exposure.” New legislation now means they face being diagnosed with the paraphilia of “exhibitionism,” deemed sexually dangerous, and locked away in a state mental hospital until they are cured, a process the law says could take “one day to life.” Circular reasoning uses the fact of arrest and prosecution as proof of the required “significant distress or impairment.”

Of course, prosecutors have tested these new laws first on so-called pedophiles, knowing that virtually no one objects to the crassest abuse of accused “child molesters.” But, predictably, they are expanding their crusade, now looking to diagnose and commit those suffering from “ephebophilia” (a newly coined paraphilia covering those attracted to youthful– but sexually mature– beauty). And those charged with real crimes increasingly face having their fully consensual, but admittedly kinky, sex life prejudice legal proceedings about unrelated matters.

Clearly, the psychiatric profession needs further reform if it is to avoid being used by unscrupulous prosecutors for unjust ends. As gay people, we have a special appreciation of how dangerous it is to label sexual diversity as pathological deviance. Let us celebrate our success in 1973 by dedicating ourselves to removing all consensual kinkiness from the realm of both doctors and policemen.

Pasted from <http://guidemag.com/magcontent/invokemagcontent.cfm?ID=10DED2F3-3EB4-452B-AD960B56F2E68A1E>