50 years ago, the American Psychiatric Association removed the Diagnostic Code 302.0, homosexuality,

from the DSM. Almost. Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003. I'm Chris Aiken, the editor-in-chief of the Carlet's Psychiatry podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Last week, we left our unlikely hero, Robert Spitzer, in a Honolulu hotel room,

where he drafted the APA position statement on the removal of Diagnostic Code 302.0 homosexuality. I was born a few months after that

1973 decision, and 25 years later, I started my career as a psychiatric intern at the Wheel Cornell Psychiatric Program.

One of the first patients I admitted was a young woman with mood symptoms and suicidality.

She was a lesbian and had recently broken up with her girlfriend.

My attending physician was a psychoanalyst and believed that her homosexuality was part of

her disorder. I didn't agree, and I thought I had the backing of the APA to challenge him. You see,

six months before this, in December 1998, the APA had published a position statement against reparative or conversion

therapy, quote, any therapy, which is based upon the assumption that homosexuality per se

is a mental disorder or based upon the a priori assumption that a patient should change his or her sexual, homosexual orientation.

I was grateful that the attending allowed me this momentary rebellion, but when I came back to the

ward the next day, I found him smiling wryly at the nurse's station, DSM-4 in hand.

Look, he said, it's still here. As he opened to the diagnostic code 302.9, sexual disorder not

otherwise specified. Here's what the text said. This category is included for coding

a sexual disturbance that does not meet the criteria for any specific sexual disorder. Examples

include persistent and marked distress about sexual orientation. This young woman was distressed about losing her romantic partner,

not about her sexual orientation, but I knew enough not to argue with a psychoanalyst about

the unconscious roots of human motivation and distress. That APA meeting, the one that supposedly

...