Contesting Affliction: Demedicalization Frames and the Removal of Homosexuality from the DSM

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 1. (De)Medicalization Processes

Abstract

Researchers and activists have criticized medicalization in many ways. However, existing research has not investigated which kinds of critiques of medicalization, or demedicalization frames, are most effective at persuading others to support demedicalization. This paper revisits a famous case of demedicalization: the removal of “homosexuality” as a category from the American Psychiatric Association’s classification of mental illnesses (DSM-II) in 1973. Using archival sources, I analyze which demedicalization frames were key to the success of lesbian and gay activists in persuading both APA leadership and the rank-and-file to accept a compromise resolution removing “homosexuality” from DSM-II. I identify two key demedicalization frames: a “psychiatric oppression” frame and a “social functioning” frame. The psychiatric oppression frame argued for demedicalization by asserting that psychiatry’s influence had upheld the systematic political and cultural marginalization of gay people. The social functioning frame argued for demedicalization by asserting that lesbians and gay men were just as capable of being effective and productive members of society. Ultimately, I show that lesbian and gay activists were successful in part because they used frames that attacked medical jurisdiction over homosexuality at its weakest points. This led to a surprising outcome: psychiatrists accepted demedicalization despite most continuing to view same-sex sexuality as pathological. In other words, the APA shifted from portraying same-sex sexuality as a medical problem to portraying it as a medical non-problem. I conclude that demedicalization frames contesting the core of medical expertise (e.g., medical explanations and treatments) may be less effective than frames that contest medicalization by highlighting its social consequences or attacking the portrayal of something as a problem altogether. Medical sociologists have identified many cases where under- or overmedicalization have produced injustice. Yet if we wish to intervene effectively, medical sociologists must also study which (de)medicalization frames are persuasive across various contexts and audiences.

Author

• Rowan Hildebrand-Chupp, University of California-San Diego