Sex and gender

Bill (KWM) Fulford, Katherine Morris, John Z Sadler and Giovanni Stanghellini

in Values and Psychiatric Diagnosis

Published on behalf of Oxford University Press

Published in print October 2004 | ISBN: 9780198526377
Published online March 2013 | e-ISBN: 9780191754357 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Sex and gender

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No topic related to values in the DSMs has generated more attention, press, acrimony, and activist intervention than the issues involving sex and gender. Indeed, I believe a credible historical argument could be made that the debate surrounding the American Psychiatric Association’s declassifying of homosexuality by membership vote in 1974 signaled the popular arrival of the idea that psychiatric diagnosis and categories were value-laden, a trend that was consolidated in the mid 1980s when the diagnoses of Late Luteal Phase Dysphoric Disorder and Self-Defeating Personality Disorder drew fire. Reconsidering the homosexuality diagnosis was not the first time that the value-ladenness of classification was recognized; it was, however, a landmark from the standpoint of the public attention given to this awareness. The following two decades were characterized by vigorous, even angry, debate among DSM architects and a relatively diverse group of APA members, other mental health professionals, feminists, gay and lesbian activists, and others who were quite critical of sex- and gender-related disorders as described or proposed. This chapter cannot do justice to all, or even most, of the evaluative facets of this debate; indeed, such a project would require its own book-length treatment just to appraise the literature! Rather, I hope to add a measure of focus and depth to this discussion at the cost of breadth. After this brief introductory note, I will very briefly review the homosexuality and related issues mentioned above; I’ll frame some of the evaluative issues there, and defer the discussion of some aspects to Chapter 10 (Politics). In the following section, I’ll struggle with the question of gender-specific psychopathology. Throughout I’ll apply my ideas to particular diagnostic categories that have been a focus of concern, particularly for women.

Gender and sexual disorders are not the only categories in the DSMs and ICDs that raise the issue of normativity, values, and disorder status, but they are historically important, and indeed provide excellent case studies from which to consider the full range of mental disorder categories. As shall be seen, my treatment of this group of categories is intended to be provocative in the best sense of the word, that is, to generate interest in considering ‘what is normal?’ and to address some of the fundamental sources of disagreement and debate in the DSM literature.

Chapter.  22493 words. 

Subjects: Psychiatry

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