Psychiatry and Sexuality vs. Psychiatry and Gender

In “We Are Certain of Our Own Insanity,” Lewis documents the history of the struggle between gay liberation activists and psychiatrists in relation to the psychological status of homosexuality. By means of sustained protest and professional discourse, not only did the gay liberation movement redefine sexual identities and preferences by de-pathologizing them, but contributed to the restructuring of psychiatry as a field and created more nuanced views of sex, sexuality, gender, etc.

For gender identities, the fight has been more arduous and long-winded. An article from the APA (https://www.psychiatry.org/psychiatrists/cultural-competency/education/transgender-and-gender-nonconforming-patients/gender-dysphoria-diagnosis/) documents gender’s relationship with psychiatry throughout the years. In 1980, the diagnosis “transsexualism” appeared in the DSM-III. In this framing, the psychiatric topos of gender became that people who are not comfortable with the gender that they were assigned at birth were mentally ill. There was no nuance as to what causes people to become distressed over their appearance and self-image in relation to gender.

In the DSM-IV published in 1994, the term was changed to “gender identity disorder.” This was done to destigmatize it, but still didn’t get to the root of the issue. Trans people and their identities were still being pathologized and treated as the disorder. Not until 2013 did the term change to “gender dysphoria.” “The presence of gender variance is not the pathology but dysphoria is from the distress caused by the body and mind not aligning and/or societal marginalization of gender-variant people” (APA).

Despite this shift in topos on an institutional level in psychiatry, the forces of anti-intellectualism and corporatism prove difficult to push back. The nuance of gender identity cannot permeate the fear and emotions being evoked by far-right populists nor the one-dimensional identifiers and marketing ploys of companies that employ the cheap method of rainbow capitalism to appeal to a customer base that’s now allowed to exist out in the open, much to the rage of the aforementioned politicians and pundits.