Decoding the DSM

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In 2020, I gave a presentation at my alma mater, the University of Arizona. The presentation was part of a speaker series with the university’s Institute for LGBT Studies.

I began the presentation by playing George Michael’s song “Faith.” The group was about half students and half faculty and guests, so I asked whether they had ever heard of the song. Most of the audience raised their hands.

I then challenged them to tell me what year the song came out. No one raised their hand, so I gave them a few hints: it was the same year the shows "21 Jump Street," "Married With Children," and "Full House" (the original season) first aired, as well as the year both Kesha and Kendrick Lamar were born, two people popular among a lot of the youth I used to teach.

Someone from the front row raised a hand and yelled “1987!” I said, “Yes!”

Then I continued, “Which was also the same year homosexuality (a sometimes offensive term because of its clinical history used to denigrate gay and lesbian people) completely fell out of the DSM.”

Diagnostic and Statistical Manual of Mental Disorders

For those not familiar, the DSM (Diagnostic and Statistical Manual of Mental Disorders) is a book used by health care professionals in the United States to diagnose mental disorders.

While most people familiar with the DSM and its history of misdiagnosing gay and lesbian people recognize 1973 as the year the American Psychiatric Association (APA) voted to have it removed, homosexuality wasn’t completely taken out of the DSM until 1987.

Between 1973 and 1987, it was still considered an ego-dystonic sexual orientation, or a sexual orientation disturbance. In both instances, according to the DSM, being gay or lesbian was a malformity of the person.

Timeline of Homosexuality in the DSM

Following is a detailed timeline of the history of homosexuality in the DSM, organized by esteemed psychiatrist and psychoanalyst Jack Drescher, MD, a well-known LGBTQ advocate and spokesperson:

• DSM-I (1952): Sociopathic Personality Disturbance
• DSM-II (1968): Sexual Deviation
• 1973: Homosexuality per se removed from the DSM-II and replaced by “Sexual Orientation Disturbance” (a vote that included almost 10,000 psychiatrists, 5,854 voting to remove homosexuality from the DSM and 3,810 to retain it)
• DSM-III (1980): Ego-dystonic homosexuality (EDH)
• DSM-III-R (Revised) (1987): EDH removed
• DSM-IV (1994) and DSM-IV-TR (Text Revision; 2000): Sexual Disorder NOS (NOS is an abbreviation for “not otherwise specified.” When something isn’t easy to diagnose, it’s a term used by professionals that allows them to show that a person has a treatable illness.)
• DSM-5 (2013): none

In addition, the ICD-10 (International Classification of Diseases), which is maintained by the World Health Organization (WHO) and is like a globalized version of the DSM, didn’t remove homosexuality from its ICD classification until 1992. Today, it still carries with it the construct of ego-dystonic sexual orientation.

Although significant and more LGBTQ-affirming changes have been proposed to ICD classifications of mental and behavioral disorders related to sexuality and gender identity, the ICD-11 has only been in effect since January 2022.

Modern psychology originated in the late 1800s with the work of Dr. Sigmund Freud. In the grand scheme of things, that isn’t a very long time. During an Introduction to Psychology class, the instructor made a point to share with us how little is actually known about the human brain and how outdated many of the theories are that have influenced the mental health field.

What’s more, the first edition of the DSM wasn’t published until 1952 and has since been revised five times. The most current version, the DSM-5, was published in 2013. For 35 years of its almost-70-year existence, the DSM considered being gay or lesbian an actual diagnosable mental illness.

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During a recent interview I heard, the late director John Singleton ("Boyz n the Hood") said, “I'm a product of the last decade, and now I'm out for change.” He was speaking about how it’s not possible to grow up during a certain time period and not be touched by systemic and dominant cultural belief systems, no matter who we are.

What’s so important about the history of the DSM today is that while the standards of psychotherapy have made advancements, it wasn’t that long ago that LGBTQ people were considered mentally unwell. Remnants of misguided beliefs around the mental health of LGBTQ people still exist in the collective consciousness and are connected to many of the stigmas LGBTQ people face today.

Until we live in a world where the message to young people that being gay or lesbian isn’t something to fear, LGBTQ youth may experience increased challenges accepting themselves.

Most of the parents I know who have a child who is LGBTQ initially questioned why their child is lesbian, gay, bisexual, transgender, or queer. Even the most accepting parents I know once thought there must be a reason or cause for their child’s gender or sexuality. Some still question whether it was something they did or didn’t do. I don’t think I’ve ever heard a parent question why their child is straight or cisgender (when a person’s gender identity matches the sex they were assigned at birth).

If we explore what’s behind the curiosity about why a child is LGBTQ, we often find misguided beliefs about gender and sexual minorities, which include the DSM’s history of diagnosing LGBTQ people. By digging deep, naming, and cleaning out our consciousness of harmful stigmas, we take their power away.

The point I made during my presentation at the University of Arizona was that if lyrics to a popular song from the 1980s, which is still played on the radio today, and hit shows from 30 years ago are alive in our memories and are only as old as cultural figures like Kesha and Kendrick Lamar, then it’s possible that remnants of misguided beliefs about gender and sexuality can still negatively affect modern belief systems, thereby influencing how we parent and subconsciously perceive LGBTQ youth.

Recently, while I was at a lecture with people in their mid-20s to late 60s (most of whom were parents), the teacher mentioned going to a Bon Jovi concert as something fun to do. I thought, “That’s kind of an outdated reference.” But then the next morning, during my spin class, before playing “Living on a Prayer,” the instructor said, “From 1986, ladies and gentlemen, Bon Jovi—everyone’s guilty pleasure!”

I thought about what John Singleton said and how it’s not possible to compartmentalize what influences society and culture. We are touched by our history—which includes everything from pop culture, food, and trends to language, religion, and psychology.