Countries where homosexuality is outlawed, such as Saudi Arabia, are stridently against making the change to global medical terminology.
In 1961, the police department in Inglewood, Calif., put out a scare film titled “Boys Beware” as a warning to teen boys about older predatory homosexuals. In the knowing voice-over, the officer warns that men like the character Ralph, who offer hitchiking teens rides and compliments, could have ulterior motives–and an ailment.
“Ralph was sick, a sickness that was not visible like smallpox but no less dangerous and contagious. A sickness of the mind. You see, Ralph was a homosexual,” the narrator says.
With the classification of homosexuality as a mental disease struck from the official Diagnostic and Statistical Manual of Mental Disorders in 1973, and more recently, with conversion therapy outlawed in California, it would seem that the era of gayness being considered an ailment to be treated in padded cells was long over.
However, the classification of “homosexuality-related psychological disorders” is alive and well in the World Health Organization’s directory of standard medical reporting, known as the International Classification of Diseases. That’s something American doctors are fighting to change.
WHO’s disease directory is the standard diagnostic tool used by doctors and hospitals in countries around the world to systematically track health conditions and their mortality rates, and it gets sporadic updates to include new and emerging illnesses.
Susan Cochran, a psychologist and epidemiologist at the University of California, Los Angeles, is part of a panel created by WHO to review the classification of “psychological and behavioural disorders associated with sexual orientation and development.”
These experts released a report this week saying there’s no scientific evidence to support sexual orientation–related illnesses, and that they should be struck from the books.
“[It] doesn’t make sense to put something in a book and say, ‘This is a disease,’ when there’s no proof that it is a disease,” Cochran said.
Although being gay or lesbian is no longer classified as a disorder—references to homosexuality as a mental illness were removed from the WHO directory in 1990—in its place emerged new categories of “gay-related” diseases. For example, if a homosexual teenager is confused about his sexual identity, he could be classified as mentally ill under current WHO guidelines, Cochran said. Or if a married man wakes up one day and realizes he’s gay and wants to leave his wife, he could be diagnosed with having sexual relationship disorder.
WHO aims to keep the ICD relevant and useful for clinicians, but the inclusion of some of these outdated disorders could be downright dangerous. Under the current code, a doctor may be able to justify the use of “reparative therapy” in treating a gay person who suffers from depression or anxiety. These conversion treatments are widely understood to be unethical and harmful to the individual and wholly ineffective at changing the person’s sexual orientation.
The report is intended to inform an international dialogue about these issues and will likely lead to debate, because the WHO deals with the cultural beliefs and broadly varying scientific findings of many countries.
In Saudi Arabia and Iran, homosexuality is a crime, and these countries, among others, will likely exhibit “tremendous pushback” to the proposed changes, epidemiologist Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health told Science magazine. In addition, the recent antigay laws passed in Uganda and Russia make this “precisely the right time for the WHO to stand up, take an evidence-based approach, and say [homosexuality] is not a pathology,” Beyrer said.
Ugandan president Yoweri Museveni is already vowing to assemble his own working group to counter Cochran’s findings, GLAAD reports.
Even more than highlighting a disconnect between different countries’ political and cultural standards, the classification of homosexuality-related mental disorders is a human rights issue, said Cochran. The existence of these “diseases” in the disease directory exposes a historically stigmatized group to further vulnerability. The United Nations high commissioner for human rights says LGBT individuals are entitled to the same protections as everyone else, including shelter from “torture, arbitrary arrest and detention,” according to the WHO report.
“International professional organizations, such as the World Association for Sexual Health and the International Planned Parenthood Federation, have also asserted that sexual rights, including rights pertaining to sexual orientation expression, are integral to human rights,” the WHO report says.
Even in the U.S., many health care professionals use the Diagnostic and Statistical Manual of Mental Disorders when treating patients but also subscribe to and rely on the WHO classifications, said Cochran.
Cochran’s team’s recommendations will have to be voted on by health representatives from 170 countries and then field tested against real health scenarios. The new version of the ICD is scheduled to be released in 2017, and it will have been the longest WHO has gone without making revisions to the diagnostic book.