The Gay Brain

By Emily Dzurak

I was raised as a Lutheran in an ELCA church. I was taught that good Christians were compassionate, forgiving, accepting, and loving; not self-righteous or hateful. Yet I have met many members of the latter group of Christians–most of whom subscribe to the Christian Bible literally. I have always found these Bible literalists to be an interesting, yet misguided group. Specifically, I mean those who pick the couple of Bible verses that condemn homosexuality as a basis for persecuting the LGBTQA community. This seems incredibly hypocritical: how could these so-called Christians overlook the hundreds of verses about compassion and acceptance just to focus on less than ten verses that vaguely disapprove of homosexuality? If they were Bible literalists, didn’t they then also believe that women were inferior to men (according to the dozens of passages stating so) and that marriage ought to be between a man, a woman, and a couple of concubines? I guess you cannot rationalize irrational thinking.

I was confronted with some of these literalists early in my high school career. They were two of my friends, actually. Both of them believed that being gay was a sin and a choice. I was appalled. A choice? Really? Not quite yet tactful in my argumentative tactics, I simply responded that that was “the dumbest thing I have ever heard.” We aren’t friends anymore. But while my argument rested on my personal experience (I did not choose my own sexuality, so others surely could not choose theirs), I lacked scientific evidence to strengthen my point.

There has been a lot of evidence in recent years, however, that being gay is, indeed, not a choice. In 2008, the National Academy of Sciences journal published a study from the Karolinska Institute in Stockholm, Sweden comparing 90 adults’ brain sizes in order to garner evidence that sexual orientation originates in the brain during fetal development. The research team focused on measuring brain parameters that were fixed at birth, and couldn’t be altered by learning or cognitive processes. The study was based on the relationship between hemispheric dominance in the brain and whether a person is gay or straight. Hemispheric dominance refers to an individual showing preference towards using one hemisphere, since the two hemispheres of the brain are specialized to perform certain tasks. In this Swedish study, a group consisting of healthy gay and heterosexual men and women underwent brain scans to measure the volume of their right and left hemispheres. The results of the study showed that heterosexual men and lesbians share a “particular asymmetry” in their hemisphere size, with the right hemisphere being slightly larger than the left. Heterosexual women and gay men had no significant difference in size between their hemispheres. This suggests that the brain structure of gay men are more similar to heterosexual women, and gay women’s brain structure are more similar to heterosexual men. Scientists, however, are still trying to find out what this data means.

Furthermore, studies of the amygdala show other significant differences in gender and the brain. In heterosexual men and gay women, the right side of the amygdala has more nerve connections than the left. The reverse was true in gay men and heterosexual women, with more neural connection in the left amygdala. The amygdala, known as the emotional center of the brain, plays a primary role in processing memory, decision-making, and emotional reactions. The findings that gay men share connectivity patterns with heterosexual women and heterosexual men with lesbians could lead to a better understanding of how that brain is connected to sexuality and gender.

Time magazine reflected on the Karolinska Institute study in an article called “What Makes People Gay?” In the article, Dr. Eric Vilain, a professor of human genetics at UCLA, asks “if the brains of gay men are different, or feminized, are there regions other than those connected to sexual preference that are gender atypical in gay males?” Vilain hypothesizes that the brains of gay men “possess only some ‘feminized’ structures, while retaining some masculine ones,” which is “reflected in how they act in their sexuality.” He further explains that men, regardless of their sexual orientation, manifest “masculine” characteristics in their sexual behavior. For example, both straight and gay men tend to prefer younger partners, while women tend to prefer older partners. Vilain supports this example by saying that he expects “some regions of the brain [to] remain masculine even in gay men.” Well, duh. To summarize, scientists have found that an individual’s brain structure may determine and explain their gender and sexual preferences.

But why does that matter? Would this evidence really convince my Christian ex-friends that being gay wasn’t a choice, when they also rejected other scientific findings in lieu of their religion? Would the LGBTQA community feel empowered that the connection between their innate brain structures and their sexuality was legitimized or saddened that it needed to be legitimized in the first place while heterosexuality is fully accepted?

John Lauritsen has ridiculed scientific research trying to prove the relationship between the brain and homosexuality, writing that:

“Attempts have been made, at least since the beginnings of ‘sexology’ in the 19th century, to explain ‘homosexuality.’ Almost as soon as ‘homosexuality’ was coined in 1869, the term acquired a clinical character based on the false assumption that only a tiny minority of human males are erotically attracted to each other. Male love (comprising sex, love and friendship) does not need to be explained. When males have sex with each other, they are expressing an ordinary, healthy component of male sexuality — something phylogenetically inherent in the sexual repertoire of the human male, and thus a product of evolution.”

Lauritsen’s article reminds me of the argument I had with my friends many years ago. I remember trying so hard to come up with a counterargument to the claim that being gay was a choice. But maybe I didn’t need to. This does not mean that the findings of the studies previously mentioned are irrelevant. Simply that scientific evidence is less important than the human compassion and decency needed to understand that sexuality is not a choice. If the Christian community does not need scientific evidence to legitimize their beliefs in creationism and a talking snake, the LGBT community certainly doesn’t need scientific evidence to legitimize their sexual preferences. Sexuality doesn’t need to be explained. What does need to be explained, as Lauritsen notes, is sexuality’s condemnation.

Mental Health in the LGBT Community

By Michaela Banz

As a student who is extremely interested in issues regarding mental health, I have chosen to explore the accuracy behind the claim that LGBT young adults have a greater incidence of mental health issues. Up until 1973, homosexuality was considered a diagnosable mental illness in accordance with the guidelines of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Prior to the elimination of homosexuality as a disorder, homosexual people around the world were diagnosed as mentally ill, which resulted in thousands of prescriptions for conversion therapy to change their sexual orientation to heterosexual. As soon as empirical data could demonstrate that homosexuality was not a disease, the board of the American Psychiatric Association removed it from the DSM. However, it is important to acknowledge that gender dysphoria, or the feeling that one’s gender does not match one’s biological sex, is still considered a mental disorder according to the current DSM. Therefore, people who are transgender would technically qualify for a diagnosis of mental disorder.

Why do people suspect that people within the LGBT community have greater instances of mental health problems? One answer may be that homosexuals and transgender people have historically been considered mentally ill for simply existing. Another possibility is that because homosexuality is stigmatized around the world, people assume that homosexuals should have higher incidences of mental illness because of the discrimination they face. Theoretically, these claims make a lot of sense. It seems logical that young LGBT adults who are ostracized by their peers would have higher rates of anxiety and depression than their heterosexual peers. However, in the early 2000s, the American Psychological Association released new data on lesbian, gay, and bisexual mental health that complicated these assumptions. Their findings suggest that while gay men, lesbians, and bisexuals appear to have higher rates of certain mental disorders than heterosexuals, these rates are not to a level of a serious pathology or a statistically significant difference.

A recent study at San Francisco State University surveyed a group of 245 Hispanic and white LGBT young adults, ranging from 21 to 25 years old. The researchers used data from the Family Acceptance Project’s survey and were particularly interested in the findings of questions about disclosure of LGBT status at school, self-reported past LGBT school victimization, young adult depression, and overall adult life satisfaction. The goal of this study was to uncover whether the benefits of coming out at a young age outweighed potential health risks resulting from discrimination. This study found that coming out while attending school is strongly and positively correlated with life satisfaction and negatively associated with depression. Conversely, hiding one’s sexual orientation is correlated with a greater likelihood of mental health problems as a young adult. Interestingly enough, there were no significant differences in responses found between males, females, and transgender participants. As you would probably assume, the researchers did find that being out is positively associated with victimization, but the positive psychosocial effects of being out typically outweighed the negative effects of victimization.

The findings of this study challenge the notion that the perceived consequences of coming out, such as increased discrimination and victimization, lead to higher rates of mental health issues. Stephen Russell, the study’s principal investigator and the director of the Frances McClelland Institute for Children, Youth, and Families at the University of Arizona, asserts that the findings of this study should not be too surprising. According to Russell, “This is clearly aligned with everything we know about identity. Being able to be who we are is crucial to mental health.” The changing attitudes of Americans regarding LGBT issues over the past couple decades likely contributed to the results of this study. These changing attitudes have had profound and positive effects on the lives of LGBT youth.

There is a fairly large body of research that would contradict the findings of the San Francisco State University study. For example, in 2001, the National Survey of Midlife Development found that perceived discrimination of the LGBT population in the United States was positively associated with harmful effects on the quality of life and psychological problems. The National Alliance on Mental Illness (NAMI) reports that LGBTQ individuals are three times more likely to qualify for a diagnosis of a mental illness such as depression and anxiety disorder. Furthermore, a literature review of studies about mental health and the LGBT community found that gay men and lesbians were more likely to receive a diagnosis of depression, anxiety, or develop a substance abuse disorder. Almost all of the studies cited in this review suggested that social stigma and victimization were likely the leading risk factor for a diagnosis.

The question remains whether or not being LGBT puts one at a higher risk for the development of a mental health disorder. After looking at a multitude of studies that have examined this question, I’ve come to the conclusion that the answer is simply conditional on people’s experiences after coming out. People whose families and friends would not be receptive to the news and would instead disown, abuse, and torment them, would most likely be more at risk of developing a mental disorder if they came out. However, the development of a disorder would be based largely on circumstances. People who have a good support network of people around them would definitely benefit from coming out because they will be supported by these people. A supporting piece of evidence for the former claim is the finding that individuals who faced rejection after coming out to their friends and family were more than eight times more likely to attempt suicide than someone who received positive affirmations. Assuming that all members of the LGBT community are at a higher risk of developing a mental disorder is too simple an answer to a question that requires complexity.

The Politics of Blood Donation

By Natalie Mironov

Every two seconds someone in the U.S. needs blood.

More than 41,000 blood donations are needed every day.

A total of 30 million blood components are transfused each year in the U.S.

These are the first three facts about blood needs on the American Red Cross website. And yet the site goes on to explain that although an estimated 38% of the U.S. population is eligible to donate blood, less than 10% actually do each year.

Given the clear need for blood donations, shouldn’t we be taking every donation we possibly can?

Despite these staggering statistics, the Food and Drug Administration (FDA) still imposes strict limitations on men who have had sex with other men (MSM) from donating human cells, tissues, and cellular and tissue-based products, which include blood and bone marrow donations. These policies began in 1983 when HIV and AIDS started to gain a reputation as a “gay disease,” because they were more prevalent within the category of men who have had sex with men. The FDA claimed that due to the possibility of missing an HIV diagnosis during the screening of these cells and tissues, it was safer to impose a lifetime donation ban on any man who had had sex with another man after 1977, when the AIDS epidemic hit the United States. At that time, little was known about HIV/AIDS and there were many limitations surrounding the ability to test blood for infection. Given the limitations of testing at that time, maybe this policy made sense at one point, but with the technological development and the advances in scientific ability to screen for HIV and other infectious diseases, why is it still in place now?

Dr. Steven Kleinman, the senior medical adviser to the American Association of Blood Banks, believes the issue is related to the social stigma surrounding homosexuality. In a 2010 article in the New York Times he was quoted as saying: “You wonder, if this wasn’t about gay men, would the rules be applied in the same way?” The FDA claims that it is not an issue of discrimination, but what else can it be attributed to?

Merriam-Webster defines discrimination as the practice of unfairly treating a person or group of people differently from other people or groups of people. If current HIV and infectious disease screening practices, which are mandatory for every single blood donation received, are good enough for heterosexual blood, why are they not good enough for homosexual blood?

I understand and agree with the importance of patient safety and the need to protect from transmitting infection. The last thing anybody wants is for a patient to become infected with HIV through a blood transfusion. But if the blood testing protocol presents this much risk, maybe we should start being more cautious rather than less. There are many other categorizations that can be correlated to an increased risk of HIV that are not currently used as reason for deferral, so maybe the FDA should start investigating these further. (I am being intentionally provocative here.)

According to the 2010 statistics from the Centers for Disease Control and Prevention, in terms of racial divides, the category of Black/African American, both specific to males and as a whole, was most affected by HIV. So should we start banning black people from donating blood? No, because that would be considered racist. Why, then, is it still okay to discriminate based on sexual preference? If anything, donation should be decided based on the level of risk and exposure of an individual. Maybe a higher prevalence of infection in certain sexual preference groups factors into that on some level, but more important would be safe sex practices and number of partners. Why should two men in a long-term monogamous relationship practicing safe sex be banned from donation, while a promiscuous heterosexual person who does not engage in safe sex is not even questioned about if he or she should be able to donate?

A letter written by John Kerry in 2012 pointed out that, “healthy gay and bisexual men continue to be banned for life, while the FDA allows a man who has had sex with an HIV-positive woman to give blood after waiting only one year.” While the FDA recently removed its lifetime ban on men who fall within the MSM category, reducing it to a one-year deferral since the prospective donor last engaged in sexual contact with another man, it still seems unreasonable to say that every man who falls under the MSM category presents a comparable risk to a confirmed, HIV-positive, heterosexual woman. This still prevents men in long-term monogamous homosexual relationships who would carry low risk of infection from ever donating blood or bone marrow, unless they choose to abstain from sex for an entire year.

They can take the #celibacychallenge — it can’t be that hard, right?

The celibacy challenge is a campaign that was created by organizations including GLAAD and the Gay Men’s Health Crisis with the aim of changing the FDA’s regulations surrounding MSM donations. The use of satire by Alan Cumming presents the challenge still faced by men in the MSM category today who wish to donate blood or bone marrow. The campaign is effective because it speaks to the very human nature of sexual desire and appeals to people on a more personal level, rather than coming off as a lecture about human rights. The humorous video allows the viewer to put themselves in the shoes of an MSM individual, and try to imagine what it would be like to remain celibate for an entire year in order to donate blood. The celibacy challenge’s aim is to pressure the FDA to further reconsider the one-year deferral for MSM and to base donation qualifications on level of risk rather than sexual preference.

Isn’t it time for blood and bone marrow donation requirements to be based on the risks of individual behaviors rather than stereotypes?

The Right to Intimacy

By Bridget Novak

In the article “Privacy, Dependency, Discegenation: Toward a Sexual Culture for People with Intellectual Disabilities,” Rachel Adams concisely states, “While desire may be instinctual, the rules governing its appropriate expression are cultural.” For non-heterosexual couples and for individuals with disabilities, social and legal institutions limit sexual expression. It is by society that these identities are constructed and their sexual expression restricted.

Robert McRuer, in his introduction to Crip Theory: Cultural Signs of Queerness and Disability, discusses the constructed nature of heterosexuality and able-bodiedness. The construction of these categories is evidenced in their definitions, which incorporate the “opposite” identity–for an identity cannot occur socially without an opposing one. “The OED [Oxford English Dictionary] defines able-bodied redundantly and negatively as “having an able body, i.e. one free from physical disability, and capable of the physical exertions required of it; in bodily health; robust.’” The “physical exertions required” of the body are culturally determined and used to distinguish the “able-bodied” from the “disabled.” The OED Supplement definition of heterosexuality includes a normative evaluation: ““pertaining to or characterized by the normal relations of the sexes; opp. to homosexual.”” Again, the incorporation of the opposite identity in the definition emphasizes the constructed nature of the identity category. These constructions and their social reification must be acknowledged in order to understand how the labels “disabled” and sexually “abnormal” determine how people’s livelihoods are dictated by society.

People with disabilities are often desexualized or assumed to be asexual. “American Able,” a photo series by Holly Norris, draws attention to this assumption. The photos imitate American Apparel ads, but incorporate a model with disabilities. Norris describes her inspiration for the project: “I chose American Apparel not just for their notable style, but also for their claims that many of their models are just ‘every day’ women… Women with disabilities go unrepresented…in most of popular culture,” The model, Jes, is posed in the same positions and outfits as the able-bodied models in American Apparel ads, drawing attention to how rarely images like this include people with disabilities. The photo series may result in many questions for the viewer. Is it shocking? Why? Is this an effective method to challenge stereotypes? What are the concerns people have in regards to people with disabilities participating in sexual acts?

There are systems and organizations in some countries that successfully provide sexual services to the physically disabled. In the Netherlands, an article in VICE notes, the national health system provides “a grant scheme for people with disabilities to receive public money to pay for sexual services up to 12 times a year.” In Taiwan, the NGO Hand Angel provides opportunities for sexual experiences, namely handjobs, for the physically disabled. To determine the eligibility of clients, Hand Angel assesses the client’s level of disability: “The person has to be recognized by the government as having a serious physical impairment, but can’t be mentally disabled. Once they’re cleared, the service is totally free, but each applicant can only receive three bouts of sexual stimulation.” Hand Angel provides a safe, comfortable environment for their clients to experience sexual pleasure. One client reported, “I didn’t feel I was the target of pity. The whole process was full of respect and equality. This might be deemed as controversial by society, but as long as you’re willing to look into it, what we desire is no different from others.” Organizations can provide safe, consensual environments for the physically disabled to act on their right to sexual expression.

The sexual rights of people with intellectual disabilities are restricted with this classification. Sex education and privacy are regulated, limiting opportunities for safe sexual experiences. These limitations prevent the fulfillment of what Rachel Adams calls “fundamental needs for companionship, intimacy, and the right to self-determination.”

Sex education for people with intellectual disabilities is often inadequate, which prevents them from fully consenting to participation in sexual acts. Again, in Adams’ words, “the differences of people with intellectual disabilities are cognitive, as well as physical, and claims about their sexual rights will need to account for atypical ways of perceiving, understanding, and navigation the world,” Improving sex education for people with intellectual disabilities is an important precursor to their giving of consent. Otherwise, Adams points out, “a vicious cycle arises when inadequate sex education leaves people with intellectual disabilities ignorant of the mechanics and repercussions of sexual activity, rendering them unable to establish their competency to consent,”  There is no rule to determine suitability for sexual experiences that applies to every individual with intellectual disabilities. Currently, however, deprivation of sexual experiences is the norm.

Opportunities for people with disabilities to engage in sexual acts are practically nonexistent due to a lack of privacy. For people with intellectual disabilities, Adams notes, there is “the possibility of lifelong dependence,” This often places them in the care of someone (typically a group home or a relative) who may not grant them privacy. This lack of privacy prevents people with disabilities from encountering the circumstances in which it is socially acceptable to perform sexual acts. Ultimately, Adams concludes, “sexual experience rests on political determinations about who has the right to enjoy intimacy in private.” In order to fully satisfy the basic human right to intimacy, something must change in the way people with disabilities are categorized and treated. Like other sexual minorities, Adams suggests, “the sexuality of people with disabilities is queer in that it confounds bourgeois notions about the appropriate settings and circumstances in which intimacy may occur.”

The Truvada Debate

By Heidi Beckman

There may be a one-word solution to the HIV/AIDS epidemic: Truvada. What is Truvada, exactly? It’s a pill that is highly effective at preventing HIV infection. If taken daily, this FDA-approved pill can be up to 99 percent effective. The Centers for Disease Control and Prevention (CDC) endorses Truvada, also called PrEP (pre-exposure prophylaxis), as an efficient way to prevent infection in those who don’t have HIV but are at risk. Essentially, the answer to the HIV/AIDS crisis may be close at hand, and its name is Truvada.

In terms of affordability, Truvada can be quite expensive. Most private health insurance companies will cover PrEP; however, these companies often charge a high co-pay for Truvada. Without private health insurance, Truvada costs approximately $13,000 per year at $40 per pill. However, Gilead, the company that manufactures Truvada, offers two different programs that help cover the cost of the drug. Despite Truvada’s expensive price tag, Gilead aims to make their product more affordable and accessible to its users.

A drug as revolutionary as Truvada, however, is bound to cause commotion. While Truvada is available to heterosexual couples, its main target is gay men. Certainly, there are mixed reactions from gay men in regards to the development of a successful HIV-prevention drug. That is to say, the availability of Truvada has changed perceptions of risk, as well as sparked gay men’s opposing attitudes towards PrEP.

According to Truvada’s website, there’s a strong recommendation to follow the comprehensive HIV prevention strategy, which includes the following: getting tested regularly for HIV and STDs; practicing safer sex; knowing partner(s)’ HIV status; not sharing needles; and using condoms all the time. This last recommendation–always using a condom–has sparked quite a controversy within the gay community, and it’s worth exploring.

Some gay men who are on Truvada refuse to use condoms, as the pill protects them from HIV. Does this philosophy encourage a change in sexual behavior? Yes, it can. In fact, some Truvada users embrace the bolder, unapologetic sex that the drug has to offer. Truvada has been called an accessory to promiscuity.  In November 2012, David Duran coined the term Truvada Whore in an article written for the Huffington Post. Duran believes that “a good number of those running to get the prescription are gay men who prefer to engage in unsafe practices.” Duran’s use of the term “whore” isn’t a direct reference to sex work; instead, it’s a negative term describing those who abuse or misuse Truvada. In March 2014, Adam Zeboski’s reclaimed the term with a hashtag that took the gay blogosphere by storm: #TruvadaWhore. In this case, #TruvadaWhore illustrates support for Truvada, as it allows men to have risk-free sex. These “#TruvadaWhores”–proudly wearing their slogan on t-shirts–view the drug as their liberation, their ability to have condom-less sex with whomever they please. Zeboski and his counterparts argue that sex without condoms is “old school, natural, [and] kind of amazing.” The TruvadaWhore movement emphasizes the appeal of promiscuity; however, this opinion isn’t shared by all gay men.

Certain opponents of Truvada believe this medicine’s sole goal is to promote promiscuous sexual behavior. While Truvada may grant sexual freedom, this is not the medicine’s main purpose. Truvada isn’t the end-all and be-all. It can’t cure STDs or HIV. However, Truvada’s capabilities are still significant: it’s a medicine that prevents HIV infection. What a great stride in the fight against HIV/AIDS! Also, Truvada encourages the use of condoms during sex; in fact, a link is available on Truvada’s website to “order condoms discreetly by mail.” If anything, Truvada aims to both prevent and contain HIV/AIDS.

Interestingly enough, the dispute regarding Truvada varies between generations of gay men. As already noted, some young men embrace Truvada to the fullest, becoming full-fledged #TruvadaWhores. Other younger men, however, refute the of idea of promiscuity: Truvada simply assures a peace of mind, as there’s one less factor to consider before having sex. Older gay men–most of whom experienced the AIDS outbreak in the 1980s–offer an intriguing stance on Truvada’s availability. Larry Kramer, now 79 years old and HIV-positive, wrote the influential play The Normal Heart in 1985. Kramer’s play, now an HBO film, documents the initial moments of the HIV/AIDS crisis. Kramer strongly opposes Truvada: “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads. There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.” Not all older gay men share Kramer’s opinion; others believe that the gay community has suffered enough already. Why should such suffering continue?

All in all, there are many drawbacks and benefits associated with Truvada. As Truvada becomes more and more prominent, the conversation surrounding this medicine will evolve. Nonetheless, it’s important to acknowledge the main advantage of Truvada: it prevents HIV infection, which in and of itself is a bit miraculous.

Gender and the DSM

By Amanda McKelvey

Gender identity and psychology have historical, intricate relationships with each other. The medicalization of homosexuality created individual, societal, and global effects that persist even today. These effects extend into physical, emotional, and political realms, and many of these effects stem from official medical statements concerning homosexuality.  One source of such statements is the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the official manual that North American clinicians and researchers reference when discussing mental disorders. Clinicians outside of North America usually reference other diagnostic systems—particularly the International Classification of Diseases (IOS; Johnson, 2013). While some countries may utilize alternative diagnostic systems, the IOS and the DSM are the most widely used diagnostic systems of mental disorders. This post focuses on the DSM. Jack Drescher and John Merlino, influential psychiatrists who witnessed the evolution of the DSM, explain that in the 1950s, psychiatry had indescribable influence over homosexuality (Drescher, 2010). According to these psychiatrists, homosexuality was viewed as a dangerous force that needed to be corrected in order to protect individuals and society. Cures for homosexuality included forced stays in mental hospitals, lobotomies, and aversion therapy (Drescher & Merlino, 2007). By today’s standards, official medical claims about homosexuality as a sickness were shamefully unscientific, based not on facts but on opinions.

In order to understand the source behind the DSM‘s first description of homosexuality as pathology, one must first understand Freud’s ideas concerning sexuality. Freud believed that both heterosexuality and homosexuality are products of individuals’ environments. That is, Freud argued that people are born with both heterosexual and homosexual tendencies; as the individual lives his or her life, one type of sexuality becomes the dominant form of sexuality (Clarke, Ellis, Peel & Riggs, 2010). Interestingly, both allies and opponents of LGBTQ identities used—and continue to use—Freud’s work to reach their own goals (Clarke et al., 2010). Freud’s ideas concerning homosexuality were widespread by the time the DSM-I was published in 1952. The DSM-I defined homosexuality as “a sociopathic personality disturbance” (Drescher, 2010). This description of homosexuality stays close to Freud’s description; the diagnosis implies that homosexual individuals developed an illness due to some aspect of their upbringing.

The American Psychological Association (APA) made slight modifications to the homosexuality diagnosis in the DSM-II, published in 1968. This version of the DSM defined homosexuality as “a sexual deviation” (Drescher, 2010). The year that the APA published the new manual, gay activists began conducting research on homosexuality with the goal of removing homosexuality from the DSM (Clarke et al., 2010). Finally, on December 15, 1973, the APA voted against the inclusion of homosexuality in the DSM, and the diagnosis no longer appeared in the DSM (Clarke et al., 2010). However, a new disorder—ego dystonic homosexuality—was introduced to the list. Ego dystonic homosexuality was defined as “[failure] to accept [one’s] homosexuality, [the] experience [of] persistent distress and [the desire] to become heterosexual” (Clarke et al., 2010). Ego dystonic homosexuality remained in the DSM until 1987. However, throughout the time that ego dystonic homosexuality appeared in the DSM, the APA stated that “homosexuality, per se, implies no impairment in judgment, stability, reliability, or general social or vocational capabilities” and instructed “all mental health professionals…[to] take the lead in removing the stigma of mental illness that has long been associated with homosexual orientations” (Clarke et al., 2010).

In 1980, the APA published the DSM-III. This version of the manual did not include ego dystonic homosexuality, but the manual did introduce two new diagnoses including gender identity disorder of childhood (GIDC) and transsexualism (Drescher, 2010). These diagnoses were the first to concern gender in children. A revision to the DSM-III—the DSM-III-R—came into being in 1987. This edition of the manual introduced a disorder called gender identity disorder of adolescence and adulthood, nontranssexual type (Drescher, 2010). The APA published the DSM-IV and DSM-IV-TR in 1994 and 2000, respectively. These two editions of the manual eliminated gender identity disorder of adolescence and adulthood, nontranssexual type from the list of disorders. In addition, GIDC and transsexualism became a single diagnosis called gender identity disorder (GID). Criteria for the new diagnosis differentiated between gender identity disorder in children, adolescents, and adults (Drescher, 2010).

Finally, the APA published the most recent version of the DSM—the DSM-V—in 2013.  Much debate surrounded the inclusion of a gender disorder in the newest diagnostic manual.  There was concern that individuals who could be described by the disorder would be discriminated against in several areas of life.  In response to these concerns, the APA set a goal to use terminology that would protect these individuals from discrimination.  The DSM-V eliminated all previous gender disorders and introduced the present diagnoses called gender dysphoria.  Individuals may be diagnosed with gender dysphoria if their “gender at birth is contrary to the one they identify with” (American Psychiatric Association, 2013).  It is also important to note that gender dysphoria has its own chapter in the DSM-V, separating the diagnoses from Sexual Dysfunctions and Paraphilic Disorders (American Psychiatric Association, 2013).  In addition, the new manual includes wording that ensures—with as much power as it can—that individuals who desire medical or psychotherapeutic interventions in the course of a gender transition will be able to receive these services.

While the evolution of the DSM has moved in a positive direction in general, the discussion of how to treat LGBTQ identities in the medical field continues. Certainly, there are several issues associated with modern-day psychology, especially in relation to gender concerns  For one thing, most research in psychology ignores the experiences of LGBTQ individuals. Instead, psychological research focuses almost exclusively on non-LGBTQ individuals (Clarke et al., 2010). The field of LGBTQ psychology was created in order to combat this hole in psychological research. In addition, the LGBT Casebook was published in 2012 to help clinicians better understand and interact with LGBT individuals (Levounis, Drescher & Barber, 2012).

Numerous people were affected by the medicalization of homosexuality, and this effect persists into the present day.  Clearly, the psychiatric view of LGBTQ individuals has changed much since its introduction into the DSM-I in 1952. Hopefully, clinicians, the APA, and all other sorts of global citizens will continue to shape the presentation of gender disorders within the DSM to meet the best interests of LGBTQA individuals throughout the United States.

References

American Psychiatric Association. (2013). Gender dysphoria. American Psychiatric Publishing.

Clarke, V., Ellis, S. J., Peel, E., & Riggs, D. W. (2010). Lesbian, gay, bisexual, trans and queer psychology: An introduction. Cambridge University Press.

Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of Sexual Behavior, 39, 427-460.

Drescher, J., & Merlino, J. P. (Eds.). (2007). American psychiatry and homosexuality: An oral history. Routledge.

Eyler, A. E., & Levin, S. (2014). Interview with Saul Levin, MD, MPA, CEO/Medical Director of the American Psychiatric Association on the 40th anniversary of the decision to remove homosexuality from the DSM. LGBT Health, 1, 70-74.

Johnson, S.B. (2013). What is the ICD and why should psychologists care? American Psychological Association.

Levounis, P., Drescher, J., & Barber, M. E. (Eds.). (2012). The LGBT Casebook. American Psychiatric Publishing.