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

2. 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

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

4. 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.

5. 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)
= rectal pain

6. 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)

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

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

9. 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)

10. 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”

11. 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

12. 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

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

14. 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?

15. 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

16. 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

17. 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

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

19. 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”

20. 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

21. 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.

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