Medicalizing SEX-Gender Deviance James J. Hughes Deviance UConn – October 26, 2009 Medicalizing SEX-Gender Deviance

Medicalization of Deviance Thomas Szasz: Mental illness is just deviance Defining deviant behavior as a medical condition Medical-industrial complex defining us as sick to sell us cures Doctors claiming social “problems” Peter Conrad: ADD is just deviance

(Dis)Advantages Medicalized deviance Alleviates guilt and shame Opens possibility of medical treatment, covered by insurance But Defines person as “sick”

Conrad’s Complaint “The process of medicalization, often seen as humanitarian reform, has another side: (1) expert control; (2) medical social control; (3) the individualization of social problems; and (4) the depoliticization of deviant behavior.

ICD: What is a Disease? World Health Organization’s International Statistical Classification of Diseases and Related Health Problems ICD-9 (WHO 1977) – 17,000 codes ICD-10 (WHO 1992) – 155,000 codes ICD-11 (WHO 2014) 569.42 = rectal pain

DSM: Diagnostic and Statistical Manual Manual of official diagnoses of the American Psychiatric Association DSM-I (1952) DSM-II (1968) DSM-III (1980) DSM-III-R (1987) DSM-IV (1994) DSM-IV-TR (2000) DSM-V (2012)

Medicalization Controversies Childbirth Shyness Aging Depression Addiction ADD/ADHD Aspergers Syndrome Unusual Bodies Height, unusual genitals Sexual Behavior

Sex-Gender System Biological Sex Gender Identity Sexual Preference Gender Role Behavior Conformity Sex-Gender Basics (19min)

Intersexuals Female (XX, female genitals) Adrenal Hyperplasia (XX, male genitals) Hermaphrodite (XX, XY, or mosaic) Androgen Insensitivity (XY, female genitals) Hypospadias (XY, incomp. male genitals) Male (XY, male testes and genitals)

Intersex Rights Movement Are “ambiguous genitals” a medical condition? ICD-10 codes for “endocrine disorders” “hypospadias” “hermaphroditism” Side-effects of hasty surgical sex assignment Should there only be boys and girls? Anne Fausto-Sterling 1993 “The Five Sexes: Why Male and Female Are Not Enough”

Body vs. Gender Identity David Reimer - Surgically made a girl after penis destroyed during circumcision Raised as Brenda, but never identified as a girl Began living as a male at 14

Transgender Trans-Women: Male to Female Transsexuals Kelly Shore’s Story (5min) Trans-Men: Female to Male Transsexuals Genderqueers ICD and DSM: “Gender identity disorders” Thomas Beattie, the pregnant trans-man

Kim Petras Pre-Pubertal Diagnosis and Treatment: A German trans-girl who started hormones at 12 and is now a pop singer

Resisting Medicalized Gender Should sex reassignment be a medical deduction? Is it cosmetic surgery or elective surgery? If it is an illness why not fix the brain instead of adapt the body to the brain? What if it is just a form of radical body modification, like piercing and tattoos?

Bisexuality/Homosexuality Demedicalization Used to be a medical/psychiatric diagnosis. But since 1974 has been excluded from DSM, since 1980 from ICD: F65 Disorders of sexual preference F65.1 Fetishistic transvestism F65.2 Exhibitionism F65.3 Voyeurism F65.4 Paedophilia F65.5 Sadomasochism Iran still sees homosexuality as both a medical and (terminal) moral problem, and “treats” with sex change surgery Iran performs 2nd most sex changes per capita after Thailand

Genetics of Sexual Preference If sexual preference is partly determined by genetics and intra-uterine hormones, why isn’t it a medical condition like intersex or gender dysphoria? Brain imaging Pheromone response Physiological differences

Biology is not Destinty Younger people, especially women, today are far more likely to report some homosexual behavior, identity and feelings Gays and lesbians are more likely to have university educations

“Restorative” Therapy Only a small minority of psychologists “treat” homosexuality in the West Little research supports psychoanalytic “cures”

Neurobiological “Cures” But, brain research is identifying the basis of sexual preference Might sexual preference be re-medicalized once effective “treatments” are developed? Army researchers considered creating a “gay bomb”

Dangerous Gay Sheep Many animals exhibit homosexual behavior Some worry research on gay animals might lead to “cures” for gay humans People for the Ethical Treatment of Animals also objected to any effort to “cure” gay sheep

Transvestism Most “transvestites” are heterosexual men ICD/DSM lists transvestism as a psychiatric condition: Fetishistic transvestism The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines.

Review Advantages and disadvantages of medicalization ICD-9/10 and DSM-4/5 Four components of sex gender system An example of demedicalization