While all other mainstream medical bodies recognize that homosexuality does not in and of itself cause mental health problems, the World Health Organization still implies that it does, and that needs to change.
The American Psychiatric Association (APA) declassified homosexuality in 1973, a move that most other medical bodies followed. This would eventually help end the stigma that had reigned up until that point that classified homosexuality as a form of psychological illness or weakness, thus helping to shift the debate toward one about equal rights.
At the time the APA changed the classification to one known as “sexual orientation disturbance,” with gay rights supporters calling the change a political compromise that was significant but still problematic. That same classification was later changed to ego-dystonic homosexuality/sexual orientation, which attempted to capture and treat anxiety in people who are struggling to cope with their sexuality.
That classification was removed in 1987 (in DSM-III-R), with “persistent and marked distress about sexuality” shifted to the section ”sexual disorder not otherwise specified,” thus largely removing the pathological stigma that could have been attached to homosexuality or bisexuality. However, this is where the World Health Organization and the APA parted ways.
While WHO has formally depathologized homosexuality in the sense that it declassified it as a mental health problem and actually does stress that homosexuality or bisexuality should not be treated as a mental health problem, it retains in its International Classification of Diseases (ICD) a section that lists a number of sexual orientation-related problems in problematic terms. For example, “ego-dystonic sexual orientation” suggests an anxiety and depression disorder that reads:
“The gender identity or sexual preference is not in doubt, but the individual wishes it were different. ” (F66.1)
This is just one out of about five named pathologies which, while not pathologizing homosexuality directly, means WHO’s diagnostic criteria manages to swipe at homosexuality and imply that it can cause health worries. Others include FF60.2, which implies sexual orientation can be a reason why someone would be unable to maintain a relationship with a partner, as well as others that are more generalized yet still problematic.
The American Psychological Association has long opposed any such classification entering into the text of the DSM because it is clearly open to abuse and could lend itself to the cause of those who push sexual orientation change efforts. Indeed, it might even be seen to legitimize such efforts.
Sadly, this isn’t a baseless fear, either. Currently, India incorporates the ICD’s criteria into its own literature, with medical professionals using it as a justification for trying to combat homosexuality. Those opposed to legalizing homosexuality have also cited it as a reason why the country should retain its penal code provision (377) that, essentially, makes homosexuality a crime.
China also bases its diagnostic criteria on the ICD and as such those opposed to homosexuality are empowered to offer the unscientific and unsupported notion that changing sexuality is possible and healthy.
Encouragingly, there is now a push to have the ICD’s sexual orientation classifications amended. Science reports a panel of medical experts have reviewed several decades of studies on sexual orientation and mental health and are recommending that the WHO strike these criteria because, essentially, the classifications are baseless and have no scientific or medical underpinning. They say that anxiety and depression occur regardless of sexual orientation and thus it should not be implied that these are somehow attributable to homosexuality or bisexuality in itself.
In its report, the panel reserves special condemnation for the notion of “sexual maturation disorder” (F66.0), which is based on the Freudian theory that homosexuality is, essentially, a stunted phase in our growth, and that normal, well adjusted people should always arrive at heterosexuality. (I should note that this is a simplified version of what Freud actually said, and that Freud’s theories, though they lacked emperical research, were for the time quite kind to people who dared express homosexual feelings.)
“It is not justifiable from a clinical, public health or research perspective for a diagnostic classification to be based on sexual orientation,” the group wrote in a report released last month. All such classifications need to be eliminated from the ICD not only because they lack scientific basis or clinical utility, but also as a ‘human rights issue,’” says Cochran, who led the working group.
I urge readers to read the full Science report because it covers ground we won’t have time for here. Instead, we’ll focus on the fact that unfortunately the WHO faces an uphill battle to strike these provisions. The criteria change will have to undergo several more reviews and will ultimately face a vote from health ministers from WHO’s member states. As that involves a number of countries which outright oppose homosexuality and its decriminalization, including states from North Africa and more conservative parts of Europe as well as the Arab Emirates, it will be very difficult to make this change — yet, that’s precisely why the change should be made.
With countries like Uganda and Nigeria further criminalizing homosexuality, and Russia using propaganda laws to hound its LGBT community, the World Health Organization cannot be seen to lend legitimacy to their cause in any way, and sadly the retaining of this criteria, however infrequently used or well-meant, does that.
It will be a hard fight but, for the sake of LGBTs around the world, it is a necessary one.
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