Mostly Normal: American Psychiatric Taxonomy, Sexuality, and Neoliberal Mechanisms of Exclusion

Abstract

Accounts of how homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders in 1974 treat it as a moment of liberation and scientific progress. Economic imperatives in the 1980s, including the rise of drug companies and competition from related professions, led American psychiatrists to redefine and consolidate the profession’s status as distinct and with a unique domain. This was achieved by inducing a paradigm shift in taxonomy that was partly enabled by the struggles that led to depathologization. This paper calls into question this progress narrative of scientific knowledge production to focus instead on the power dynamics, exclusions, and processes of homogenization that have also characterized the relationship of sexuality to the DSM after depathologization. While the USA has seen the rise of much needed research into sexuality, it has also seen a tendency to flatten “LGBT” categories, understand distress in predominantly individualistic frameworks, absorb dissent within a context of increasing professionalization and bureaucratization, and create the impression of comparability across disparate frames of understanding. This paper advances a theory of how depathologization and the paradigm shift in taxonomy operated on certain neoliberal logics that have affected the understanding and management of sexual minorities in the USA.