Why is Homosexuality Still Classified as a Disease?

While the American Psychiatric Association declassified homosexuality as a psychiatric disorder in 1973,  a coalition of professional groups are calling on the World Health Organization (WHO) to do the same with its own list of medical conditions.   Used as a reference to track diseases around the world, the International Statistical Classification of Diseases and Related Health Problems (ICD), is now in its 10th edition.  Among the more than 14,ooo different codes for diagnosis are five that relate specifically to homosexuality.   While the ICD-10 specifically states that "sexual orientation by itself is not to be considered a disorder,"  existing diagnoses can still be selectively applied to sexual minorities.  These diagnoses  include "sexual relationship disorder" (relationship problems due to gender identity or sexual orientation issues" and "ego-dystonic homosexuality" (inability to accept one's sexual orientation). 

In a recently released article in the Bulletin of the World Health Organization,  the members of a working group helping to develop the 11th version of the ICD are asking the WHO  to remove all references to sexual orientation.   According to lead author Susan Cochran, a professor of epidemiology at the Fielding School of Public Health, there is no justification for any any diagnosis to be based on sexual orientation.    She also added that dropping the codes would mean ""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."

While many countries continue to discriminate against sexual minorities, the United Nations High Commissioner for Human Rights has publicly stated that"“All people, including lesbian, gay, bisexual and transgender people (LGBT) are entitled to enjoy the protections of human rights law, including in respect to rights to life, security of person and property, the right to be free from torture, arbitrary arrest and  detention, the right to be free from discrimination, and the right to freedom of expression, association and peaceful assembly."  

Despite these assurances,  activists have warned that the continuing existence of these behavioural labels  can be used to stigmatize patients based on sexual orientation or gender identity in order to harass or silence people deemed to violate social norms.   As well, retaining diagnoses linked to sexual minority status can also be used to justify various types of treatment programs aimed at "converting" patients to heterosexuality as well as cause critical delays in treatment for other conditions.  

In calling for the removal of all sexual orientation-related diagnoses from the next version of the ICD, Susan Cochran and her fellow researchers argue that they serve no real value for treatment or research.   As well, the potential for harm is too great, especially for patients in countries where sexual orientation is treated as a criminal offense.  

Cochran also points out that sexual orientation is needlessly targeted and can be regarded as a form of special treatment.  "If a person were short and wished they weren't, that is not a disorder,"  she said in an interview.  "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."

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