The diagnostic status of homosexuality in DSM-III: a reformulation of the issues

In this passage, Spitzer justifies his reasoning behind removing homosexuality from the DSM in 1973. He first begins by specifying how to define a “disorder”. He explains that in the process of determining disorders, it is less of a “Is condition X a disorder?” and more of a “Is it useful for condition X to be a disorder?” and “What are the consequences in society of an individual with condition X?” More specifically, a disorder can be defined as a condition that causes distress to the individual and general impairment in social effectiveness or functioning. Regarding homosexuality, it is obvious that these individuals are not distressed by their homosexual arousal or suffering major social impairments (unless it is due to negative societal attitudes).

Other sexual “conditions” such as pedophilia, fetishism or voyeurism are listed as a disorder because of the impairment in sexual functioning. These individuals differentiate from the “human norm” by becoming aroused at atypical objects/images. Although these individuals may not necessarily be distressed, the consequences in society are on a much larger scale. Homosexuality differentiates from this in the fact that there is no norm, because heterosexuality cannot be morally designated as the norm. Spitzer states that disorder must be defined by facts- not value judgment. He also states that there is no heterosexual “sexual disorder” category that implies that there is no distress or consequences in the heterosexuality community, which is obviously untrue.

One argument that advocates homosexuality being a disorder is that because as humans we have “built-in genetic mechanisms” for heterosexual reproduction, homosexuality obviously is an atypical disorder. Spitzer counters this argument by providing the example that as humans we possessed a gene for aggression that has since been repressed by society and the decrease of instinct to compete against others and hunt for food. Also, he states that the presence of homosexuals is not a recent occurrence and if they were truly a threat to human reproduction, we would have suffered by now.

Spitzer’s next argument is that if homosexuality had an effective treatment, more people might consider it as a true disorder. However, there is also the possibility of misdiagnosis. For example, if a person is depressed because of their homosexual arousal, why not diagnose only depression?

In conclusion, Spitzer presents many different arguments and counter arguments to his claim that homosexuality is not a disorder and does not belong to the DSM.