Tuesday, August 15, 2006

Cooties

Whether homosexuality is a disease or not doesn't matter to me for the typical reasons. But it's interesting to think about, and I do have a few opinions.

There are good reasons not to call it a disease separate from all the political and activist posturing. Historically diseases carry stigma (they shouldn't, but they do). A couple hundred years ago diseases were thought to have not a single etiological cause, but to result from any of several sufficient causes that were associated with character or moral weaknesses. Even now physicians get lots of training on not making value judgments about patient behaviors. If they're 500 pounds because they have no self control, you don't treat them any differently. If they come in every 2 weeks with a new STD, you just give them antibiotics and some advice on how to avoid a future problem. But, this clinical detachment doesn't always work, and even for diseases with etiologies completely outside the person's control, people sometimes judge. To the extent that homosexuality has long been characterized as a disease as indicative of moral deficiency and weak character, it has rightly been removed from the DSM as a psychiatric illness.

However, I think there are still good reasons to call homosexuality a disease too. Sure, I'm willing to concede that there's no necessary psychopathology, but what about just plain old physiologic pathology? It's rare to find professionals who connect the reproductive system with reproduction, for some reason, but you can't reproduce with a gay reproductive drive without some conscious intervention. I'd say that qualifies it for most definitions of disease I've seen. And mitigating a disease doesn't change it's status as a disease, it just changes its status to "controlled" or "cured". For those (like me) who would prefer to be sexually attracted to women for purposes of procreation, having righteously dissociated homosexuality from disease status or pathology of any kind effectively eliminates my access to relevant medical or psychiatric care, a crime all on its own.

Professional medical organizations spend a lot of time lobbying for or against CMS (Centers for Medicare & Medicaid Services) designation of something as a disease because it always translates into reimbursement for medical services provided. For example, if obesity is a disease, you get reimbursed for someone coming in to your doctor's office and working out a treatment plan. If it's not a disease, you either don't get paid or you have to put down an associated diagnosis that is a disease (like diabetes, or high blood pressure, or sleep apnea). In the case of homosexuality, if I want professional help (rather than having a do-it-yourself and safety-be-damned attitude) I have to pony up the cash myself because everyone's so afraid I'll be stigmatized by being labeled as "diseased". For crying freaking out loud, label me and let me pay my $20 copay!!!

But, oh yeah. It's not about what's best for me. It's about pushing for civil rights. I'll just be a martyr then. Since I have no choice.

15 comments:

Samantha said...

But didn't you know...it's all about Darwinism, natural selection, and keeping the earth from becoming overpopulated. You weren't MEANT to reproduce, which is why you feel the natural urges within you. Obviously, in Mother Nature's eyes, your gene pool is inferior...(this is the latest theory posed to me in e-mail--not that I hadn't heard it before)

Just for the record, it's only been recently that insurance companies began covering treatment for obesity--it wasn't viewed as a disease until people started dropping dead from it, and you could supposedly "get over" it with determination and self-control...hmmm...sounds familiar, somehow...maybe there's hope...yeah, don't count on it...

Still, you should read this: Why Isn't Homosexuality Considered A Disorder On The Basis Of Its Medical Consequences?
http://www.narth.com/docs/consequences.html

It's interesting, and might help you in your case to get insurance coverage. It made me cry--if you ask me sometime, I'll tell you why.

-L- said...

I barely got through a couple paragraphs of that article before being quite annoyed. Not that there aren't a few good points there.

Dr. Satinover brilliantly laid out in his book, Homosexuality and the Politics of Truth the solid, irrefutable evidence that there are lethal consequences of engaging in the defining features of male homosexuality--that is, promiscuity and anal intercourse.

Neither promiscuity nor anal intercourse are necessary or "defining" for gay sex. I'm surprised a healthcare professional would say or quote otherwise. Anyway... back to reading the rest.

-L- said...

While I agree with a few of the points made in the article, I disagree with the overall premise--that something can be designated as a disorder or disease based on its medical consequences. If that were true, stupidity would be a disease. As would poor sanitation. And recklessness.

Obesity is still not considered a disease by many precisely because of this. It is thought by some merely to be a risk factor for other diseases while it is, of itself, a completely physiologically adapted and appropriate response to excess calories.

Anyway, I think sexuality is somewhat unique in that its reproductive effectiveness is contingent on both psychiatric and organic components. If you consider reproduction to be a "consequence" of sex you might consider it differently than someone like me who sees reproduction as the essence.

Chris (hurricane) said...

That article is little more than anti-gay polemics.

Samantha said...

YAY!! I knew you'd get it--now you know why it made me cry...truly biased and full of stereotyping--based on a bigotted (sorry, but I think she is) nurse's experience in an emergency room.

And just for the record, none of the opinions in the first comment were mine--just passing on the CRAP that's been given to me--must share...

And Chris, I have to agree with you. I find it upsetting that this article was written by a health professional who uses it to represent the global gay community, when, in reality, it represents such a tiny segment. And truthfully, I know from experience that heterosexual sex, used inappropriately, can cause at least as much physical, mental and emotional trauma. So yes, in my mind this type of article is prejudicial to anyone who experiences homosexuality.

So as to the sex/reproduction theories...well, considering that not one of my children was planned, I've decided they're just happy surprises that occur when you least expect it--how's that for a scientific method????

Scot said...

“irrefutable evidence that there are lethal consequences of engaging in the defining features of male homosexuality--that is, promiscuity and anal intercourse.”

Once again, I’ve been cured of homosexuality by definition.

Now can I get my homemaker a claim to my Social Security? :-)

Chris (hurricane) said...

Phew. I'm glad we're on the same page on this samantha. Sometimes I feel quite alienated from my gay brothers and sisters who are seeking to stay in heterosexual relationships/marriages and so I always get a bit uneasy when others don't see what seems to me to be blatantly obvious.

I really hate it when bigots hide behind their credentials. Just because they have captial letters after their names (RN, MA, PhD, MD) doesn't mean their opinions, ideas, and research are above careful examination. If it looks like B.S. and smells like B.S., it probably is, regardless of how educated the person who wrote it is.

santorio said...

taking l's comment on recklessness on step further:
risk-taking behavior has genetic roots (cf matt ridley's somewhat dated but excellent discussion in "genome: history of a species" or something like that). there are evolutionary advantages to risk-taking, but not if everyone is a risk-taker. while joe is climbing a mountain to see if there are better lands on the other side, fred needs to stay behind tending the fields so joe doesn't starve. i like to think my gay gene is linked to some more adaptive (in reproductive terms) behavior. my sperm may not be cast as wide, but my selection of a mate may better insure the success of my progeny.

Scot said...

L, you certainly have a point regarding the barrier to procreation. I know I mourned at the realization of what I though being gay meant in the long run for all the dreams I had for my life. I was gratefully greatly wrong, but, we did need a good deal of help to get to where we are.

The trouble with homosexuality is, as you indicate, that it’s an issue of both mind and body. Change either, and there’s no problem. And worse, both the attraction and the anatomy of gays are very common, and no one would call either, on their own, a disease. It’s when *that* attraction (e.g. an attraction to men) appears in *that* body (a male body) that people get upset and want to cure the mental aspects, not typically when an attraction is towards someone that would cause an infertile coupling.

What’s the reasoning to pick the mental aspect for treatment in this case, over the physical? Seems, because “disease” is greatly defined by what symptoms people don’t want, we consistently subvert the physical barriers in such instances. But here there are social consequences to the mental aspects too. A man who knowingly marries an infertile woman is not considered mentally diseased by anyone, or in need of treatment; the problem for the couple is the anatomy. The same goes for anyone who knowingly marries a hermaphrodite. But a man who marries a man, will face many more problems than infertile coupling.

To be clear, I see why you’d want to treat the mental aspect instead, and I’m not saying you’re wrong for that. If it makes you feel any better, what you’ve spent in time and money addressing the mental aspects because homosexuality is not being defined as a disease, may be comparable to what other gays spend addressing the physical aspects for the lives they’re allowed for the same reason. Having children is costly for all couples that can’t physically do it alone.

Maybe, when the heat dissipates, those who see their homosexuality as a blessing and those who see it as a curse could both be satisfied. Maybe in a couple months ;-)…

Samantha said...

Actually, although I agree that the article is B.S., the thing that made me cringe the most was that this nurse was so ready to plunge the entire gay populace into the same pigeon hole, label them, and "treat" them. Sorry, but there's more to "us" than how we have sex--and even that part of our natures is varied and unique.

But I brought up the article because, even though it would be nice to have some insurance coverage as we seek counsel on how to live healthy emotional lives, it seems that (even if one uses the premise of physiologic pathology) something is lost when we lump everyone together on the basis of sexual preference. Your point is well-taken, however, and perhaps by using this article as an extreme example, my logic is flawed--I admit to being a fan of the satirical writings of Jonathan Swift and I blame him.

-L- said...

In a couple months, Scot? :-)

I admit I don't have this fleshed out adequately in my mind, but sexual attraction to an infertile woman does not seem to be reproductively inappropriate in quite the same way attraction to the same gender is. Sexual attraction (indeed, probably all instinct) is visceral and it is amazing for me to consider how biochemistry can result in such nuanced and complex behavior. The attraction to women itself is normal even if some particular woman is not reproductively capable. Determining the exceptions requires higher brain funcion. But being attracted to men is always an exception.

Scot said...

“The attraction to women itself is normal even if some particular woman is not reproductively capable.”

Agreed (for men).

Then it is the combination of being attracted to an infertile pairing, and the rarity of that attraction showing up in a person with your anatomy that gives homosexuality characteristics similar to a disease, with regards to reproduction?

If a mental disorder is defined by the extent to which the person experiencing it does not want it, then I could see that bringing homosexuality nearer to “disease” for some gays. But I think the desire for a coupling that, though you may not want it to be, is biologically infertile, is not, alone, a problem of the mind to most folks. Most in a coupling that is infertile will just work around the material barriers, and no one would give them a hassle (if they’re straight... and date for a respectable amount of time... after a mission :) ).

“But being attracted to men is always an exception.”

No way! For more than half the human population, it’s the rule ;-).

-L- said...

Then it is the combination of being attracted to an infertile pairing, and the rarity of that attraction showing up in a person with your anatomy that gives homosexuality characteristics similar to a disease, with regards to reproduction?

I'm thinking more it's the never being attracted to a fertile pairing that's a problem. And I don't think the prevalence of some problem has much to do with whether or not it's a problem (although it seems to be brought up a lot... I don't really see why).

Dave Walter said...

If it's not a disease, you either don't get paid or you have to put down an associated diagnosis that is a disease (like diabetes, or high blood pressure, or sleep apnea). In the case of homosexuality, if I want professional help (rather than having a do-it-yourself and safety-be-damned attitude) I have to pony up the cash myself because everyone's so afraid I'll be stigmatized by being labeled as "diseased".

Tell your doc to code the claim 302.0, ego-dystonic homosexuality, or 302.7, psychosexual dysfunction, and you'll be all set.

-L- said...

Except for the commiting fraud part...

I don't quite fulfill the criteria for those... and the treatment is entirely different than what I'm looking for.