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The 1990s: World Health Organisation Declassifies Same-sex Attraction As A Mental Illness

By Kat Batchelor, Senior Digital Marketing Manager at Close Brothers Asset Management & Rachel Dance, Model Risk Analyst at Winterflood

Same-sex attraction is no longer classified as a mental illness.

While it might be difficult to accept now, the declassification of homosexuality as a pathology or disease only happened completely in the nineties.

Psychologists and psychiatrists rely primarily on two classification systems and handbooks as their diagnostic and statistical tools – the DSM (the Diagnostic and Statistical Manual of Mental Disorders) is the primary American tome, while the ICD (International Classification of Diseases) is maintained by the World Health Organisation (WHO).

The second edition of the DSM was published in 1968, listing homosexuality as a mental disorder. At the same time, the ICD classified it similarly. By 1973, a vote put to the members of the American Psychiatric Association resulted in homosexuality being removed from the DSM (although nearly 40% of voting members still chose to retain the classification). It took until the 43rd World Health Assembly to endorse the decision to remove it from the ICD, with the publication of the tenth edition in 1992 (the last major version to be published).

To put the American declassification into historical context, the Stonewall riots in New York City took place in 1969. The riots were driven, in part, by the activists’ belief that psychiatric theories were a major contributor to the social stigma around homosexuality. Hence, LGBTQ+ activism was a huge and effective catalyst for change in the system.

Thankfully, by the 1990s, the work that had begun in 1973 to declassify homosexuality in the international mental health community was continued with an amend to the ICD. While this would have had an immediate positive impact for some who might otherwise have been subjected to cruel aversion/conversion therapies, it had the greater impact of depriving all those who rationalised their discrimination using medical or scientific reasoning of their evidence.

This took even longer for the transgender community. It was only in 2019 that a WHO expert said that they now understand that being transgender is "not actually a mental health condition". As a result, transgender health issues will no longer be classified as mental and behavioural disorders. Dr Lale Say, a reproductive health expert at WHO, said: "It was taken out from mental health disorders because we had a better understanding that this was not actually a mental health condition, and leaving it there was causing stigma”.

An important benefit of these declassifications is to reduce stigma and shift thinking from how to ‘treat’ or ‘cure’ same-sex attraction or trans or non-binary gender, to how to meet the physical and mental health needs of LGBTQ+ patients.

What are the impacts of LGBTQ+ stigma? Why is it important that you use inclusive language? Why is it important that you spend time learning about the problems LGBTQ+ people face?

The study below conducted by the Center for American Progress outlines some interesting, and perhaps surprising, ways LGBTQ+ people change their behaviour to avoid discrimination: