In the beginning…. homosexuality was a mental illness.

It was in the ’70s when I first met Bill. Since his LDS Mission he had been “acting out” his homosexual thoughts and got AIDS. He was the first AIDS case in our community mental health clinic where I worked. The director assigned Bill to me. I recall the first meeting with Bill. In someways I felt honored – actually meeting someone with AIDS. It was a hot summer day and I opened my office window  (so now you know for sure this happened years ago-no air conditioning.)  I listened to his story.  I assisted him with the admission paperwork to become a client and to get insurance to pay for the counseling. We didn’t know much about AIDS back then- just that it was deadly. We weren’t sure how AIDS was even transmitted. As a result of my limited knowledge, after Bill left I remember getting a Kleenex, picking up the pen he signed his paperwork with and throwing it in the garbage can.

Using DSM-II, Bill’s mental disorder was: Diagnosis “Homosexuality-302.0” – Sexual Deviancy
Page 44 from DSM-II reads:

“This category is for individuals whose sexual interests are directed primarily toward objects other than people of the opposite sex…”

The Diagnostic and Statistical Manual of Mental Disorders (DSM)
DSM is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It’s used in the courts, research, billing insurance etc. etc. A single document that “defines” mental illnesses. It’s kind of like our “Bible of Mental Illness.”

1974 – In the DSM-II 6th printing Homosexuality was eliminated. Bill would be diagnosed as having a mental disorder referred to as: Sexual Orientation Disturbance.

1980 – Using the next version of the DSM-III Bill would have been diagnosed with Ego-dystonic Homosexuality.” Ego-dystonic meaning individuals who identified themselves as having homosexual tendencies but wished to change those tendencies to heterosexual.

Up until this point- all of these diagnoses in some form or another defined homosexuality as a “mental illness” or “mental disorder” and would allow us as mental health providers to collect insurance and perform what is now called “reparative therapy”. (Reparative Therapy is a term used to describe treatment attempts to change a person from a homosexual or bisexual orientation to a “normal” or heterosexual orientation.) To learn more about Reparative Therapy see: National Association for Research and Therapy of Homosexuality (NARTH).

For a more detailed discussion on homosexuality in the early years see “The DSM I and DSM II.”

1987 –  The diagnosis was removed entirely from the DSM-III-R. The only remnant of “ego-dystonic homosexuality” occurred under “Sexual Disorders Not Otherwise Specified,” which included persistent and marked distress about one’s sexual orientation.

2009 –  A few years ago “American Psychological Association (APA)” reiterated that homosexuality is not a mental disorder and warned mental health professionals against trying to help those wishing to change:

In some places – Against the law.
And of course by now we all have heard about the “ban” on mental health professionals – like me – providing, “reparative therapy” (also known as conversion therapy) to like minors in California etc etc. Here are some sample articles about it being illegal to provide such therapy: Court Hears Gay ‘Conversion Therapy’ Arguments” and “The End of “Ex-Gay.”

2013 – I JUST RECEIVED MY NEW  DSM-V THIS WEEK
Yes there is a new DSM. Using the DSM-V Bill can be diagnosed for his medical condition “AIDS” or rather now we call it “Major or Mild Neurocognitive Disorder Due to HIV Infection.” Of course Homosexuality is now long gone as a mental disorder in the DSM.

But I did find a new focus being placed on Cultural Influence in understanding and dealing with a mental disorder in the DSM-V.  Culture is defined to include “…religion and spirituality, family structures…” (Pg. 749)  In the Cultural Formulation Section III of the DSM-V, we as mental health clinicians are now instructed to say to the client, I quote:

“Sometimes, aspects of people’s background or identity can make [your] problem … worse. By background or identity, I mean for example, the communities you belong to,… your gender or sexual orientation, or your faith or religion.”  (pg. 753)

The message appears to be twofold: 1) your family, faith or religion can make your condition worse and 2) if you have a behavior that is not accepted by your culture (e.g. family, faith or religion) then give up your culture  – not the behavior.

AND furthermore,  my interpretation – a good clinician would follow the “DSV-V Script” and help the client to identify and to turn away from the aspects of “family, faith or religion” which  “make the problem worse” . Specifically, if your faith or religion increases your “guilt”  – makes the problem worse – turn away from them.

Back to Bill
Well its been over 30 years now. In 2013 as a psychologist, it would now be professionally unethical and under some circumstances illegal, for me to provide Bill with counseling to change his sexual orientation-even if HE wanted. Homosexuality is no longer a “mental illness.”

As I recall – the reparative counseling was effective. Bill, married a beautiful young lady in the temple and died from AIDS HIV at a young age.

NOW FOR AN OPPOSING VIEW

Oh yea, About your son or grandson with “Asperger’s Disorder”…

You’ll be glad to know he doesn’t have Asperger’s anymore.
That’s right!
DSM-V did away with “Asperger’s Disorder” diagnosis.
(See APA Autism Spectrum Disorder.)

CHALLENGE
Identify one value important to you.
Hold on to it.
Tight.

dr rick
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