Gender Dysphoria and the Medicalisation of Distress

Abstract

This article investigates the controversial psychiatric diagnosis of gender dysphoria and the sociohistorical context that has led to its inclusion in the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5). An outlining of the lineage of the diagnosis demonstrates psychiatry’s continuation of nineteenth-century theories pertaining to sexuality and gender. The development of the psychiatric discipline and its offshoot, sexology, produced a theory of the ‘third sex’. While creating legitimacy and protection for persons outside the heterosexual matrix, its unintended consequence has been to further entrench absolute differences between men and women. In an attempt to establish itself as a branch of medicine and give scientific credence to the profession, it is argued that psychiatry continues to promote the third sex theory through diagnoses that pathologise homosexuality and gender variance. As critically interrogated in the article, significant academic psychiatrists, including Robert L. Spitzer and Kenneth J. Zucker, have deployed a biomedical conception of sexuality and gender. It is proposed that their work conflates these two concepts, which stems from the cisnormative and heterosexist assumption that gender diversity should be ‘corrected’.