Guest Blogger

Blinded Me with Science: Devolution of the DSM

Filed By Guest Blogger | August 25, 2008 2:00 PM | comments

Filed in: Gay Icons and History, Living, Marriage Equality, The Movement, Transgender & Intersex
Tags: Charles Socarides, DSM V, NARTH, Robert Spitzer, sexual orientation, transgender

Editors' note: Kelley Winters, Ph.D. is a writer on issues of transgender medical policy, founder of GID Reform Advocates and an Advisory Board Member for the Matthew Shepard Foundation and TransYouth Family Advocates. She has presented papers on the psychiatric classification of gender diversity at the annual conventions of the American Psychiatric Association, the American Counseling Association and the Association of Women in Psychology.

kelley winters.jpgAt the 2003 Annual Meeting of the American Psychiatric Association, Dr. Robert Spitzer, Chair of the DSM-III and DSM-IIIR Task Forces, defended the categories of Gender Identity Disorder (GID) and paraphilias such as Transvestic Fetishism (TF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). He declared the inherent pathology of gender identities that vary from assigned birth sex.

He based this premise not on empirical data but upon a theory of evolutionary essentialism, "the view that some 'things' (like being human) have properties or qualities that are invariable and represent the true essence of the 'thing.' In this context, Spitzer defined a medical disorder as "some biological function that is expected--that is part of being a human being - that is not working." He disparaged gender variant identities and expressions as pathological, because they do not serve what is "expected," because they are incongruent to biological function of the born body. But who gets to decide what is "expected?"

From whose perch of social privilege is American psychiatry to pass judgment upon the evolutionary worthiness of a class of people who have survived since human antiquity?

Dr. Spitzer stated,

Children normally develop a sense of gender identity. It is not taught--it just happens. I would argue that by itself, the failure to develop a gender identity that is congruent with biological gender is a dysfunction.

Dr. Spitzer's reasoning is very reminiscent of essentialist theories that upheld the classification of same-sex orientation as mental illness in previous editions of the DSM. In the early 1960s, psychoanalyst Dr. Sandor Rado stated that "every individual is either male or female" based on reproductive anatomy, that the only healthy sexual adaptation is male-female pair bonding. Dr. Charles Socarides, co-founder of the anti-gay National Association for Research and Therapy of Homosexuality (NARTH), asserted, "heterosexual object choice is determined by two and a half billion years of human evolution." Psychoanalyst Dr. Irving Bieber echoed these views of biological heteronormativity. Arguing to retain homosexuality as a diagnosis in the DSM, he stated, "Humans born with normal gonads and genitals are biologically programmed for heterosexual development."

Ironically, Dr. Spitzer was himself instrumental in removing the diagnosis of homosexuality from the DSM between 1973 and 1987 and was strongly opposed by Socarides and his NARTH cohorts. Spitzer refuted essentialist arguments for homosexual pathology, noting that the purpose of the DSM is to list disorders, not human functioning that is judged "less than optimal." He explained,

"if failure to function optimally in some important area of life, as judged by either society or the profession, is sufficient to indicate the presence of a psychiatric disorder, then we will have to add to our nomenclature the following conditions: celibacy (failure to function optimally sexually), revolutionary behavior (irrational defiance of social norms), religious fanaticism (dogmatic and rigid adherence to religious doctrine), racism (irrational hatred of certain groups), vegetarianism (unnatural avoidance of carnivorous behavior), and male chauvinism (irrational belief in the inferiority of women).

Stanford evolutionary biologist Dr. Joan Roughgarden challenged assumptions of adaptive unfitness for gender diversity in her 2004 book, Evolution's Rainbow: Diversity, Gender, and Sexuality in Nature and People. She concluded, "Diversity allows a species to survive and prosper in continually changing conditions," emphasizing that the occurrence of sexual and gender diversity across species and its prevalence among human beings across many cultures are inconsistent with stereotypes of pathology.

Roughgarden cited many examples of animal and plant species with more than two distinct genders and others with abilities to change sex from female to male and vice versa. A tropical ginger plant can change sex mid-day, making pollen in the morning and receiving pollen in the afternoon. A coral reef fish, the bluehead wrasse, has three genders, including large and small types of males. The larger type begins life as female and is aggressive toward the smaller males born male. A male clown fish can turn into a female, and hamlets, producing both sperm and eggs, switch roles several times as they mate. Gobies can crisscross sexes several times in their lives to relieve shortages of males or females. Forty-two species of hummingbirds exhibit "transgender expression," with females having masculine coloration and characteristics and vice-versa.

Regarding sexual orientation, Roughgarden cited ninety-four bird species known to mate in same-sex pairs. Geese can mate for life in male-male pairs, with some couples documented together over fifteen years. (A span that most American heterosexual marriages might envy.) Male and female homosexual behavior has been found in over 100 mammalian species, including wild and domestic sheep, hyenas, kangaroos, squirrels, seals, sea lions, dolphins and whales. Among primates, bonobos (along with chimpanzees) are our closest genetic relatives. Male and female same-sex encounters are very common for bonobos, and they even use a set of hand signals to communicate the kind of sex they wish.

Among humans, Dr. Roughgarden proposed that transsexualism occurs too frequently to be explained by random mutation pruned by natural selection alone and therefore does not imply significant adaptive disadvantage. As cited in an earlier essay, Olyslager and Conway estimated the lower bound on prevalence of transsexualism at around 1:500, based on mathematical correction of prior studies and survey of surgical data, nearly 100 times greater than figures cited in the DSM. Roughgarden noted this is consistent with estimates from the U.K and the Hijra in India of around 1:1000. She compared the prevalence of transsexualism to a 99.9 percentile score on a college entrance exam or an IQ of 130, stating that such relatively common traits "can only be consistent with a tiny and undetectable loss of fitness."

Is social Darwinism in American psychiatry rooted in science or social bias? At the 2003 APA meeting, Dr. Spitzer echoed evolutionary psychologists who seemed to project rigid contemporary sex stereotypes (dominant, hunting males vs. passive, nurturing, gathering females) upon ancestral cultures. He speculated:

In all cultures, young boys want to play with boys, Young girls want to play with girls... If you are interested in evolutionary psychology, you ask yourself could that have some survival value? The answer is yes. Thousands of years ago when men were more likely to be in hunting and women were more likely to be in the nurturing role, if you were a young boy you would do better if you spent your time with other boys with whom, when you were older, you would go to the hunt.

He went on, "...in all cultures, gender is recognized as a dichotomy."

All cultures? Anthropological research has revealed a long list of non-European cultures with more than two recognized sex and gender roles. Traditions of social gender role transition independent of birth sex include the Tahitian and Hawaiian Mahu, The Madagascar Sekrata, Hindu Tantric and Hijra Sects, Islamic Xanith, Khawal, and Sufi Traditions and others. Native American scholars now use the term Two Spirit to describe sex and gender traditions, common among First Nations, that are beyond dichotomy.

Here in Colorado where I write today, Two-Spirit (male-to-female) women, such as the Navajo Nadle, the Lakota Winkte and the Cheyenne He man eh, held respected roles in healing and spiritual leadership. Gender transcendence was not only a normal variation of human life but sacred, a sign of a person especially close to the spirits. As a young boy, the great Chief Crazy Horse of the Lakota Sioux was blessed by a Winkte shaman in a secret naming ceremony. Possessing a secret Winkte name marked social status and conferred spiritual protection, good health and long life. Later, he married at least one Winkte wife, in addition to his wives born female.

Like the coral reef fish, these proud Native American nations thrived for millennia, apparently unaware of any "adaptive disadvantage." That was, perhaps, until European intolerance appeared on the plains in the form of the Seventh Cavalry and compulsory missionary and reservation schools, which drove these ancient traditions into the closet. Among human societies, the anomaly is not the existence of gender diversity but the repression of it, isolated to relatively few cultures, including our own. It seems astonishing that such a large, relevant body of social science has been ignored by previous authors of the Diagnostic and Statistical Manual of Mental Disorders.

In our modern global economy, as among the native nations of the Colorado plains, humans live and compete in communities. Adaptation and survival mean success of the tribe, perhaps more than individual breeding. Economist Richard Florida stated that in today's world, "Human creativity is the ultimate economic resource." In his book, The Rise of the Creative Class, he tracked the growth of the "creative class," those doing creative work for a living, from less than 10 percent in 1900 to nearly a third in the year 2000 - a class generating as much wage and salary income as the manufacturing and service sectors combined. Surprising to many, he found strong correlations between the most diverse US communities and those with the highest creative class share. Five of the top ten metropolitan regions ranked for diversity, Seattle, Boston, Minneapolis, San Francisco, Austin, and Denver, also ranked in the top ten of creative class share. Four of these, San Francisco, Austin, Seattle and Boston, were in the top five regions for gay and lesbian population share, a component of the diversity ranking. And three of these, San Francisco, Boston and Seattle respectively, were the top three regions for high-technology industry. Dr. Florida concluded that lowering barriers to inclusion fosters creative ecosystems -

Habitats open to new people and ideas, where people network easily and offbeat ideas are not stifled but are turned into new projects, companies and growth. Regions and nations that have such ecosystems are likely to do the best job of tapping the diverse creative talents of the most people, and thus gain competitive advantage.

Although Florida's analysis utilized gay and lesbian census data, where gender variant populations are not counted, gender transcendent people are a vibrant and increasingly visible component of lesbian, gay, bisexual, transgender (GLBT) and straight communities - especially in urban centers. For example, of the top ten large metropolitan regions for creative class share in Florida's survey, seven prohibit employment discrimination based on gender identity -- according to the Human Rights Campaign. These include Washington, D.C., Boston, Austin, San Francisco, Minneapolis, Denver, and Seattle. Nine of the top ten high-technology communities, all but Phoenix, have trans-inclusive civil rights ordinances. Lowering barriers to gender diversity in these communities is associated with creative human capital and economic potential.

While correlation does not imply causality, there is growing evidence that gender diversity is far from a "dysfunction" in human communities. Diversity of gender identity and expression can contribute adaptive advantages in unique breadth of perspective and creative viewpoint to the cultural and economic success of communities, ancestral and modern.

Derogatory stereotypes that equate gender diversity with evolutionary unfitness and psychiatric pathology, like those of same-sex orientation that preceded them, are contradicted by the pervasive reality of gender diversity throughout nature and human culture. As Dr. Joan Roughgarden observed,

When scientific theory says something's wrong with so many people, perhaps the theory is wrong, not the people.

I hope that the Sexual and Gender Identity Disorders work group of the DSM-V Task Force will reexamine the evidence that difference in itself is not disease.

For full citations, please check out the original version of this blog post at Kelley's site. For more information about her project, visit GID Reform Advocates.


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Most diagnoses in the DSM have nothing at all to do with psychiatric illness or even much with impairment of function. Most have a heck of a lot to do with how society views certain behaviors and all have to do with doctors and therapists getting paid by insurance companies.

If Dr. Sptizer and others would simply tell that one truth a lot of the DSM problems would disappear over night.

The other major truth that needs telling is that DSM in all of its incarnations has been predominated in its making by Neo-Freudians and their desire to make the world conform to their theories about the world.

Observation and discussion have almost no efficacy in regard to terminologies, existing prejudice and its protection have a tremendous amount of efficcay within the DSM models.

I don't know why we continue to look at fitness through the lens of the individual. There are many species with individuals that aren't fit at all - like ants - but work as a group to reproduce. Perhaps European Enlightenment had more of an effect on our collective imagination than we thought....

And while Spitzer may have been instrumental in removing homosexuality from the DSM, he did conduct a "study" about a decade ago that has been used by ex-gay organizations in promoting the idea that people can will their sexuality away. While it contained a lot of wording about how limited it was, and while he spoke out against its use later, the absolute lack of science in it and his certainty that it proved that changing sexuality was at least "possible" doesn't leave a good taste in my mouth when it comes to him.

Thanks for the passages from Dr. Roughgarden. I had never thought about the constant occurrence of both transsexuality and homosexuality as proof that they neither are related to fitness. I think a lot of those studies about the origins of (male) homosexuality simply take it for granted that it has to be an anomaly.

Brynn Craffey Brynn Craffey | August 25, 2008 8:43 PM

Excellent post, Dr. Winters!

As for the basic premise of "fitness" and "biological function," given the state of the world--human overpopulation leading to severe depletion of resources, starvation on a mass scale in some regions, and global climate change that may lead to the end of civilization--you would think that thoughtful researchers would see the adaptive value of homosexual and transgender people if our existence even minimally limits the creation of yet more human beings.

Maybe we should classify heterosexuality as a dysfunction.

Dr. Spitzer's evolutionary essentialism, "the view that some 'things' (like being human) have properties or qualities that are invariable and represent the true essence of the 'thing' sounds remarkably similar to the Catholic Church's natural law theory.

The Catholic (and apparently Spitzer's) contention that biological function of the body determines appropriateness undergirds its opposition transgender expression, as well as its opposition to homosexuality. I wonder if the doctor isn't reconsidering his support for the declassification of homosexuality as a mental illness.

Thank you Dr.Winters and to Alex,Brynn and Dale for taking the time to not only read this article but to comment on it as well.There is so much going on with the dsm debate between those who think we should be removed and those who think we should stay in it.If we're actually still listed in it as potentially needing treatment I would like to see it as not for dealing with our Ts issue but for the impact of societys negative view of us.I think there is a lot to be gained by having a strong medical treatment protocol and research into the biological aspect of transsexualism.By strong medical treatment protocol I don't mean a system that fleeces those who don't have insurance and who are financially marginalized but requires reasonable steps to ensure somebody doesn't make an irreversible mistake.

battybattybats battybattybats | August 27, 2008 6:37 AM

Clearly Dr Spitzer has no notion whatsoever of evolution.

As already mentioned most ants don't reproduce but they help their relatives suceed. Because of this ants are one of the most successful species on the planet and almost all people are mere feet away from an ant at any one time. Didn't someone give Dr Spitzer an ant farm as a child? Maybe someone should now.

I love my Antquarium (translucent gel replaces the dirt and food and water for the ants to tunnel in based off the ones made for a NASA shuttle mission!). Dr Spitzer should get one. Then he can observe how the vast majority of Ants are not mate-then-die males or birthing-factory females but instead infertile-varient-females. And depending on the species even those infertile varient females may come in a wide variety of sizes, anatomical variations and castes to suit their social role as child-raisers, hunters, gatherers, farmers, defensive soldiers, slavers etc.

And kin selection as it's called doesn't just operate in Ants. There's wasps, bees, termites... and Grandmothers! For the survival of humans beyond fertility has been suggested by evolutionary psychologists as one of the reasons for humanities success by enabling us to grow larger brains by having longer maturity because the grandparents could help with the child rearing. So we already have suggestions for kin selection operating in humans in the form of grandparents as well as suggestions of it playing a part in GLBT folk.

Has anyone pointed out to him that schizophrenia runs in families with more creative members? Sickle cell aenemia and it's connection to (iirc) maleria resistance?

It's a known fact that many traits that cause substantial advantages in a family line might cause disadvantages for some individuals in that line in a way that might prove as much as fatal to the individual insufficient to prevent it being an evolutionary advantage to siblings and becoming a widespread trait. Most with the gene get the advantage and the trade off is a minority with a disadvantage.

And if that disadvantage proves helpful like siblings who help the family hunt, gather raise young etc without competing for mates... well then it's really an advantage to the gene. Thats how kin selection works for social insects for starters.

And now theres talk that autism might be caused by excess foetal testosterone. Excessive maleness some have called it.

There's another thing not considered by Dr Spitzer and it's tellingly the most vital one.

ETHICS.

In that these gender diverse people are engaging in ethical behaviour! What they do to themselves is plainly ethical as body modification (tattoos, piercings etc) including ones resulting in infertility (vasectomies etc) are already considered so. What they may do sexually involves consenting adults as much as vanilla hetero cis sex does (or more so!).

A distinction needs to be made between ethical behaviour that is different from generally accepted cultural 'norms' and that which is unethical. The former is little more than eccentrism at most. Harmless. The latter however is very harmful.

Dr Spitzer needs to take another peek at anthropology, evolutionary psychology, plain old evolution and ethics!