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The Gay & Lesbian Review

A bimonthly magazine of history, culture, and politics.
The G&LR <em>talks with an eminent LGBT psychiatrist, Jack Drescher</em>

How Psychiatrists Came Around
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Published in: November-December 2022 issue.

 

AS PART OF OUR RECOGNITION of the fiftieth anniversary of the declassification of homosexuality as a mental illness in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), we interviewed one of the foremost authorities on this event and on LGBT psychiatric issues and APA history in general. Jack Drescher, MD, is clinical professor of psychiatry at Columbia University and a faculty member at Columbia’s Division of Gender, Sexuality, and Health. He is a past president of GAP—the Group for the Advancement of Psychiatry—and remains very active in this organization.

            Dr. Drescher is the author of Psychoanalytic Therapy and the Gay Man (2001) and (with Joseph P. Merlino) editor of American Psychiatry and Homosexuality: An Oral History (2012), among many other books and papers. He is emeritus editor of the Journal of Gay and Lesbian Mental Health. He’s an expert media spokesperson on issues related to gender and sexuality who has appeared on major news networks and in mainstream publications.

            This interview was conducted via Zoom in late August.

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Robert Spitzer holding DSM-III. Courtesy: Columbia University.

G&LR: After the events of 1972 and ’73, homosexuality was effectively delisted from the DSM, and it seems that gender then rose to the fore. I think it was in 1980 that APA listed “gender identity disorder” as an official diagnosis. It almost seems that this was kind of a sop to conservatives who were still disgruntled about the ’73 change.

            In creating the DSM-III, Spitzer wanted to solve the problem that, depending on where you lived and practiced, patients might get very different diagnoses. We know, for example, that if you come from a community of color and you have psychotic symptoms, you’re more likely to get a schizophrenia diagnosis, which has more stigma and perhaps a worse outcome than, say, a mood disorder with psychotic features. So Spitzer wanted to create standards of diagnosis such that every diagnosis would have criteria, and you couldn’t make a diagnosis unless you were trained on how to use these criteria and fit them to the clinical situation you were observing.

JD: Eve Sedgwick wrote a paper, “How to bring your kids up gay,” arguing that the introduction of gender identity disorder of childhood was a backdoor way to put homosexuality back into the DSM. Bob Spitzer, the father of the modern DSM starting with DSM-III, and Ken Zucker wrote a paper in which they disagreed with that. They pointed out that DSM-III was markedly different from the DSM-I and -II, which were basically just a list of diagnoses. They didn’t talk about how you make a diagnosis. It just was a way to code things. If you saw a patient, you could put a code down for what their diagnosis was.
In creating the DSM-III, Spitzer wanted to solve the problem that, depending on where you lived and practiced, patients might get very different diagnoses. We know, for example, that if you come from a community of color and you have psychotic symptoms, you’re more likely to get a schizophrenia diagnosis, which has more stigma and perhaps a worse outcome than, say, a mood disorder with psychotic features. So Spitzer wanted to create standards of diagnosis such that every diagnosis would have criteria, and you couldn’t make a diagnosis unless you were trained on how to use these criteria and fit them to the clinical situation you were observing.

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