BMJ  2004;328:E286 (17 April), doi:10.1136/bmj.328.7445.E286

BMJ USA: Editor's choice

Editor's choice

Labels

Recently, huge amounts of ink and videotape have been used to document, applaud, and assail attempts by gay male and lesbian couples to get married in the United States. Front-page photos and articles are common, often featuring protestors demonstrating next to the newlyweds. Why has this become such a volatile issue?

Part of it is because marriage is, as opponents to homosexual unions say, a bedrock institution of society. Many believe that the institution is debased if same-sex couples are allowed in. But I suspect an even more important factor is the deeply ingrained negative feeling many hold towards homosexuals. Until recently, sexual relations between consenting adults of the same gender were illegal in most states. It wasn't so long ago that homosexuality itself was considered a disease, a diagnosable condition. As Marshall Forstein points out (p 143), this diagnosis was based on psychoanalytic theories that had no empirical evidence behind them, reinforced by religious doctrines. In fact, the best evidence supports the conclusion that homosexuality is a (minority) behavioral variation found in almost all animal populations, through time and across species.

In Western medicine, we pathologized homosexuality. Two disturbing British qualitative studies in this issue confirm that various treatments for the condition were administered without evidence that they "worked." Gay men and lesbians who came to their general practitioner for help were often referred for behavioral conversion therapy, generally with electric shocks. Glenn Smith and colleagues (p 155) interviewed 31 former patients or their family members and found that the various treatments administered had negative long-term effects. A companion study, by Michael King and others (p 158), reports interviews with 30 clinicians who treated homosexuals. Most now consider their treatments to have been baseless and the diagnosis to have been a social rather than a medical one.

What can we learn from this work? First, rigor is crucial in diagnostic criteria, with precedence given to empirical evidence over theory. Judd Marmor (p 192) campaigned aggressively to have homosexuality removed as a disease because there was no evidence that it was a valid diagnosis. Second, mental disorder diagnoses merit special attention, because "gold standards" are harder to establish, and social and moral norms can easily cloud judgment. Third, diagnostic criteria inevitably will change over time. As Joanne Roberts documents in her Personal View (p 191), a diagnostic label has great power. When the label changes, so do self-perception, external validation, and even the ability to access needed care.

Labels matter.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Rapid Responses:

Read all Rapid Responses

Is homosexuality "normal"?

William Craig Cook MD
bmj.com, 20 Apr 2004 [Full text]