This week’s podcast for This American Life is the story of how homosexuality was declassified as a mental illness by the American Psychiatric Association in 1973, and what it took to get it out of the DSM. It’s 60 minutes, but it’s a good listen for anyone interested.
It felt apropos since psychiatrists are now talking about adding “obesity” to the DSM as a “brain disorder.” (That’s right, classifying fat as a mental illness. No, not binge eating disorder, not compulsive eating, just being fat.)
And its also a good reminder how very bigoted and oppressive the “vast medical consensus” can be, and how important activism is to keep it honest.
fat fu 
May 17, 2007 at 8:05 pm
I think this could directly be related to the requirements of getting bypass or stomach stapling surgery. Most states (I’m not sure if all) require a psychological evaluation as well as the medical diagnosis to ‘recommend’ the surgery for insurance purposes (of course!), not to actually make sure the individual is ‘sound’. So, my thought is, if obesity is added to the DSM IV it will make approving this easier for doctors, and then insurance pays for it. My personal opinion?: how horrid this is to any individual. Where is the fat acceptance? the support to work through the emotional reasons why someone wants to do something so drastic to themself? where is the love we should be offering other human beings instead of another way to make a buck easily? This makes me want to cry because we could use all our resources to do good instead of this.
May 17, 2007 at 8:26 pm
You’re so right. I think this has a lot to do with insurance compensation – and not just for WLS but for drugs, diets and probably psychiatric appointmens for “therapeutic treatment.”
You’re right about how tragic the missing “acceptance” part is. It was so interesting in the podcast how psychiatry went from trying to “cure” homosexuality (and convinced that it was a disease to be treated with drastic means if necessary)…to virtually overnight turn around and recommend psychiatrists to find ways to help their patients accept it. Not to say it was “overnight” in terms of the activism needed to make the change…but in terms of how quickly the “official” line on it changed medical attitudes and treatments.
May 17, 2007 at 8:28 pm
That is astounding and yet somehow I’m not entirely surprised. In creating hysteria about the “obesity epidemic” labeling fat a mental illness is just fuel for the fire. I see in the future if this comes to pass yet more billions passing into the diet industry because then, any “diet aid” money can be funneled into the medical industry which means $$.
It’s sad.
May 17, 2007 at 9:15 pm
Yes. What a cruel irony that we can actually provide well planned, researched, and documented data to indicate that ‘obesity’ is not the evil it is made out to be; whereas, scientists are still trying to prove a ‘gay’ gene (which is another topic within itself).
May 18, 2007 at 1:05 am
I look at the nature vs. nurture issue on homosexuality and weight about the same way: okay, maybe it’s biologically destined or maybe it’s entirely controllable (or with either condition, I think there are a variety of ways to arrive at them), but morally it doesn’t matter. It is okay for a person to be fat. It is okay for a person to be gay. A person’s size or who they have sex with is entirely their business, and it is immoral to deny someone the basic respect and human dignity every person us due on the basis of entirely amoral factors.
And fat fu – this is a great comparison. I assure you that the blog crush is mutual!
May 18, 2007 at 4:33 am
earthencircle – yeah I think the “gene search” is another interesting issue. Why is the scads of data on the genetics of fat not “relevant” to the way that fat is socially constructed the way it is for sexuality?
May 18, 2007 at 4:36 am
sara – thanks 🙂 that means a lot from you. I emphatically agree that the overarching issue here is individual autonomy and respect. In the end the greatest abuse is that basic rights and dignity aren’t being respected and people’s own observations and decisions about their own bodies are dismissed and even ridiculed. They’re told they’re wrong; their bodies are wrong; their “lifestyles” (lives?) are WRONG. And this is such a profound violation.
But I can’t quite bring myself to wave my hands and say “oh this may or not may not be a choice; it doesn’t matter.” (Nature/nurture is a little bit a different issue, I think). Just for me part of the unutterable tragedy about the current construction of fat is how HARD fat people work to “be normal.” How they crucify themselves for “lacking will” and don’t understand “what’s wrong with them.” And I think it does them (us) an injustice to say…”oh all this biology is so complicated…who knows? but let’s not judge.” (I know you’re not saying that, but a lot of people do say that).
Because I feel comfortable enough with the research for myself to say that most of the popular messages we’re told about why we’re fat aren’t based in science, they’re based in cultural mythology, and the more that’s learned, the more they look like pure fiction. And that matters. Even if of course thre are conflicts and complexities and areas of raging debate, and even though the research is always a work in progress.
May 18, 2007 at 12:58 pm
ff, I kind of am saying that, because I think it’s a huge mistake to take our cues about how to judge and value people from biology. I’m certainly waving away the science of fat because it’s not something I know a lot about (so in other words, it’s not really the issue I’m discussing), but I feel like it’s a sort of lazy way out of discussing the moral issues, which are what drive the way people are treated. The physiological cause of any factor that differentiates people can just as easily be considered a pathology as an exhonoration (sp?).
May 18, 2007 at 1:39 pm
I can’t help but being reminded here of what Susan Faludi wrote in Backlash (1991) about the attempts to add “sadomasochism” and “paraphiliac rapism disorder” to the DSM. The idea behind both, of course, was that women got into abusive relationships or got raped because they were Asking for It. As I recall, the sadomasochism diagnosis became a reality, while the “rapism disorder” was “tabled pending further discussion.”
Anyway, as someone who didn’t become “obese” until she was psychopharmacologically treated for major depression, I fart in their general direction.
May 18, 2007 at 7:58 pm
Meowzer – their mother smelled of elderberries and their father was a hamster! haha
Fatfu – ahmen on what you are saying. If people really understood that all of our fat-fobia and fat-fears are based on one actuary’s ideal. (I looked up the definition of actuary = one who calculates insurance and annuity premiums.) As I said before (sorry, but feel I MUST state it again) ‘If people really understood’ the very first height/weight chart came from an insurance company and was calculated by a guy who was a number cruncher with NO OTHER qualifications? Well, what else need be said? *sigh*
May 19, 2007 at 4:47 am
Sara – yep I get you on that. But my feeling is it isn’t an either/or. I think it’s a both. I think it’s *both* unacceptable to moralize against something that is essentially amoral AND unacceptable to oversimplify and misrepresent fat as just a “lifestyle choice” in the service of that same bigoted argument.
Meowzer – re: the psychopharmacology. Holy God. This must be an especially sick irony for you. I always wonder how much of the increase in average weight in the U.S. population is the result of people trying to do what their doctors tell them: dieting leading to yo-yoing; quitting smoking (ex smokers have higher BMIs than either smokers or nonsmokers); and of course all the psychopharmacology – most drugs that impact weight, afaik, cause weight gain.
I’m not going to even think about rapism disorder because it makes me want to kick a puppy. Or a psychiatrists’s puppy.
Earthen – yeah I’ve heard that about the actuarial tables. I think now most epidemiologists would argue that they have real data now backing this up, but all that data was collected and interpreted with those tables firmly entrenched in the minds of the researchers, and I think they’ve just never been able to see past it, or seriously consider that the whole construct they were working under might be flawed.
May 22, 2007 at 10:43 am
Hi! First time commenter. This blog is great.
I listened to that “This American Life” as well, and noticed something else–at one point, they said the Kinsey study concluded that about 30% of adult males had had same-sex sexual contact. So one argument for removing homosexuality from the DSM was that committing homosexual acts *couldn’t* be considered a disease because it was too common.
Isn’t about 30% of the population supposedly obese?
June 4, 2007 at 12:30 pm
Psychiatrists and psychologists constantly need to justify a “scientific discipline” which is not very scientific. Some of the drugs do wonders for some people (and some do horrors to other people) but the inventing of “conditions” which therapists of all stripes can be paid to treat is the main business of psychiatry/psychology. I remember being sent to a therapist for discussion of “lack of adjustment to motherhood,” because I had concerns about the strange way my new baby behaved (and continued to behave as he entered the toddler years). Turned out my son was (and is) severely autistic. He has acquired many skills and more than deserves respect for the effort invovled in learning those skills; as to the therapists — I’m not sure they have any skills, except a certain oily talent for selling cr-p.
June 19, 2007 at 5:58 pm
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