Classification of homosexuality and gender identity have come under scrutiny ever since 1974 when the American Psychiatric Association declared that homosexuality would no longer be considered a mental illness; however, as a political compromise, the association created a new disorder, ego-dystonic homosexuality. The latest classification issue occurred when a working group, affiliated with the World Health Organization (WHO) addressed sexual orientation-related disorders listed in the WHO publication, the International Classification of Diseases (ICD). The group recommended that the disorders be deleted from the ICD. If the recommendation becomes a reality, it will facilitate healthcare access for gays and others who may have gender atypicality.
The WHO is a global organization that determines what is and what is not a disease. More than 170 nations, including the United States, follow the WHO recommendations, At present, the WHO is revising the 10th edition of the ICD for release of the 11th edition in 2017. Susan D. Cochran, PhD, MS, a professor at the UCLA Fielding School of Public Health and a member of the WHO working group, noted that the recommendation, if adopted, clarifies “a human rights issue.”
Dr. Cochran explained, “In California, gay people may have the right to marry, but in most of the world, being gay can be dangerous. There are at least six countries that criminalize homosexuality with a possible death sentence. This recommendation, to remove diagnoses that have no scientific basis, is a way of cleansing our public health apparatus of the social animus directed at a group of people for reasons that have no health justification.”
Although WHO recommendations are often heeded, the new recommendation must survive several approval processes, and then finally being subjected to a vote by the member nations. Dr. Cochran noted that in 1990, the ICD made the same declaration; however, it, but retained several unsupported disorders. For example, if a person was married and woke one day and declared that he or she was gay and wanted a divorce, the current ICD considers that to be a mental disorder. Or if a teen was unsure whether he or she was gay, straight or bisexual and was distressed about that issue, that also is considered mental disorder. Or if a person were gay, and for whatever reason wished not to be, that also is considered a disorder.
In reference to the foregoing, Dr. Cochran said, “It doesn’t make any sense. If a person were short and wished they weren’t, that is not a disorder. Or if someone was a lousy singer and wished they weren’t, that is not a disorder. In other words, the ICD takes content that is sexual orientation–related and attaches a diagnosis to it in ways that it does not do for other aspects of people.” She explained that, if the recommendation is adopted, it will have an instantaneous and significant impact on healthcare access. Every healthcare event and every physician visit has an ICD code attached to it. These codes that are used for insurance billing, for public health surveillance, and for medical records. Thus, the removal of these codes related to sexual orientation will improve healthcare for gays. For example, if a gay man is depressed and seeks care he is vulnerable to being mistreated by the healthcare system. At present, he could be diagnosed with ego-dystonic homosexuality if he says he is upset about how he is being treated as a gay man and wishes he were straight. Furthermore, discredited treatments, such as conversion therapy, have been performed. These treatments have been deemed unethical but sometimes are justified by this diagnosis. If the codes are removed, it will be more likely that his complaints will result in an appropriated diagnosis of depression and treatments for that depression.
An article published in the June issue of the Bulletin of World Health Organization defined the scientific basis for the recommendation to delete the sexual orientation-related disorders from the ICD. In regard to removal of the codes, Dr. Cochrain explained, “This means that gay people can feel free to seek care, to share their concerns and not fear that they will diagnosed with a mental illness simply because the content is about homosexuality or gender atypicality. It would mean an end to the medicalization of homosexuality.”