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Medicalizing SEX-Gender Deviance

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

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Medicalizing SEX-Gender Deviance

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  1. James J. Hughes Deviance UConn – October 26, 2009 MedicalizingSEX-GenderDeviance

  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) 569.42 = 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. ResistingMedicalized 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 transvestismas a psychiatric condition:Fetishistic transvestismThe wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of aperson 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

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