GLR November-December 2022

down for what their diagnosis was. In creating the DSM-III , Spitzer wanted to solve the problem that, depending on where you lived and practiced, patients might get very different diagnoses. We know, for example, that if you come from a community of color and you have psychotic symptoms, you’re more likely to get a schizophrenia diagnosis, which has more stigma and perhaps a worse outcome than, say, a mood disorder with psychotic features. So Spitzer wanted to create standards of diagnosis such that every diagnosis would have criteria, and you couldn’t make a diagnosis unless you were trained on how to use these criteria and fit them to the clin ical situation you were observing. G&LR: The “gender disorder” diagnosis remained in place for quite a few years. You were deeply involved in producing DSM 5 , which ultimately threw out that diagnosis and replaced it with “gender dysphoria.” What was going on during those interven ing years that led to this shift? JD: There was lots of media attention and interest among the general public about the DSM-5 development process—not just the gender diagnosis, but other diagnoses as well. Some advo cates within the transgender community began calling on APA to remove the diagnosis of what was then called “gender iden tity disorder of adolescence and adulthood” from the DSM the way homosexuality had been removed in 1973. I became very interested in the question of the parallels and contrasts between the two diagnoses and wrote a paper in 2010 called “The Queer Diagnoses.” One parallel is that both psychiatric diagnoses are highly stigmatizing. One of the differences is that people who have what we now call gender dysphoria require a diagnosis in order to access the treatment they need, so the problem that I saw was that removal of the gender diagnosis to reduce stigma created a problem of maintaining access to care. G&LR: Whereas people who were once diagnosed as homo sexuals just wanted to be left alone: Keep us out of the psychi atric rule book, thank you. JD: Well, gay people can have depression, anxiety, bipolar dis order, and other kinds of psychiatric problems. G&LR: But those are problems that anyone can have, no? JD: They’re problems that everybody has, but there’s no need for a psychiatric diagnosis called homosexuality, except if you want to treat the homosexuality, and there’s very little evidence to support the idea that treating homosexuality leads to any good outcomes. G&LR: Still, you wrote a book titled Psychoanalytic Therapy and the Gay Man , whose title implies that gay men are distinc tive in some way that calls for a separate approach. Is this a fair assessment? JD: I tried in my book to provide a cultural context, to think about gay identity within the cultural context of a heterosexist, homophobic society. I grew up in a Jewish, observant house hold—not super religious, but religious enough—in Brooklyn, in Bensonhurst, which was then a mixed Jewish-Italian neigh borhood. When my Italian neighbors and friends heard from their priest in their catechism classes in preparation for their first communion that Jews killed Christ, they would ask me:

“Why did the Jews kill Christ?” I didn’t know, so I asked my mom, and she said: “You go back and tell them that the Romans killed Christ.” From that cultural context, parents teach their children how to deal with the prejudices of the wider culture. What’s unique about being LGBTQ is that kids are born into the enemy camp. Often the parents share the prejudices of the wider world and lack the ability to teach their children how to deal with those prejudices. I saw a family of a child who had come out as a different gender than the one assigned at birth. The parents were terri fied, because they didn’t know what harm their child would face in the world. That was helpful for their child to hear, because they [the child] have the unfortunate task of trying to educate the parents about the dangers that they actually face as they learn to negotiate the wider world. G&LR: As you mentioned, gender is currently a major issue that we’re trying to resolve as a society. There’s a lot of terrible legislative activity going on, of course. There’s a lot of discus sion about age: at what age do you recognize someone as hav ing gender dysphoria? There’s now discussion about the use of hormones to delay puberty while decisions are being made. Do you have a viewpoint on this issue? JD: So, here’s the interesting thing that I’m discovering. When the DSM-5 was being put together in the beginning, among the various attacks on APA and the manual were attacks on the work of Ken Zucker, who chaired our Workgroup on Sexual and Gender Identity Disorders, because his clinic in Toronto

November–December 2022

31