Blinded Me with Science: Devolution of the DSM

Kelley Winters, Ph.D.

GID Reform Advocates


At the 2003 Annual Meeting of the American Psychiatric Association, Dr. Robert Spitzer, Chair of the DSM-III and DSM-IIIR Task Forces, defended the categories of Gender Identity Disorder (GID) and paraphilias such as Transvestic Fetishism (TF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) [1].  He declared the inherent pathology of gender identities that vary from assigned birth sex,


“Children normally develop a sense of gender identity.  It is not taught—it just happens.  I would argue that by itself, the failure to develop a gender identity that is congruent with biological gender is a dysfunction.” [2, p.116]


He based this premise not on empirical data but upon a theory of evolutionary essentialism, “the view that some ‘things’ (like being human) have properties or qualities that are invariable and represent the true essence of the ‘thing.’ In this context, Spitzer defined a medical disorder as “some biological function that is expected—that is part of being a human being – that is not working.” [p. 113].  He disparaged gender variant identities and expressions as pathological, because they do not serve what is “expected,” because they are incongruent to biological function of the born body.  But who gets to decide what is “expected?”  From whose perch of social privilege is American psychiatry to pass judgment upon the evolutionary worthiness of a class of people who have survived since human antiquity?


Dr. Spitzer’s reasoning is very reminiscent of essentialist theories that upheld the classification of same-sex orientation as mental illness in previous editions of the DSM [3].   In the early 1960s, psychoanalyst Dr. Sandor Rado stated that “every individual is either male or female” based on reproductive anatomy, that the only healthy sexual adaptation is male-female pair bonding [4].  Dr. Charles Socarides, co-founder of the anti-gay National Association for Research and Therapy of Homosexuality (NARTH), asserted, “heterosexual object choice is determined by two and a half billion years of human evolution” [5]. Psychoanalyst Dr. Irving Bieber echoed these views of biological heteronormativity. Arguing to retain homosexuality as a diagnosis in the DSM, he stated, “humans born with normal gonads and genitals are biologically programmed for heterosexual development” [6, p.1209].


Ironically, Dr. Spitzer was himself instrumental in removing the diagnosis of homosexuality from the DSM between 1973 and 1987 and was strongly opposed by Socarides and his NARTH cohorts.  Spitzer refuted essentialist arguments for homosexual pathology, noting that the purpose of the DSM is to list disorders, not human functioning that is judged “less than optimal.”  He explained,


“ if failure to function optimally in some important area of life, as judged by either society or the profession, is sufficient to indicate the presence of a psychiatric disorder, then we will have to add to our nomenclature the following conditions: celibacy (failure to function optimally sexually), revolutionary behavior (irrational defiance of social norms), religious fanaticism (dogmatic and rigid adherence to religious doctrine), racism (irrational hatred of certain groups), vegetarianism (unnatural avoidance of carnivorous behavior), and male chauvinism (irrational belief in the inferiority of women). [6, p1215]


Stanford evolutionary biologist Dr. Joan Roughgarden challenged assumptions of adaptive unfitness for gender diversity in her 2004 book, Evolution’s Rainbow: Diversity, Gender, and Sexuality in Nature and People [7]. She concluded,


“Diversity allows a species to survive and prosper in continually changing conditions,”  [p.21]


emphasizing that the occurrence of sexual and gender diversity across species and its prevalence among human beings across many cultures are inconsistent with stereotypes of pathology.


Roughgarden cited many examples of animal and plant species with more than two distinct genders and others with abilities to change sex from female to male and vice versa. A tropical ginger plant can change sex mid-day, making pollen in the morning and receiving pollen in the afternoon. A coral reef fish, the bluehead wrasse, has three genders, including large and small types of males.  The larger type begins life as female and is aggressive toward the smaller males born male.  A male clown fish can turn into a female, and hamlets, producing both sperm and eggs, switch roles several times as they mate. Gobies can crisscross sexes several times in their lives to relieve shortages of males or females.  Forty-two species of hummingbirds exhibit “transgender expression,” with females having masculine coloration and characteristics and vice-versa [pp. 32-35,102].


Regarding sexual orientation, Roughgarden cited ninety-four bird species known to mate in same-sex pairs.  Geese can mate for life in male-male pairs, with some couples documented together over fifteen years. (A span that most American heterosexual marriages might envy.)  Male and female homosexual behavior has been found in over 100 mammalian species, including wild and domestic sheep, hyenas, kangaroos, squirrels, seals, sea lions, dolphins and whales.  Among primates, bonobos (along with chimpanzees) are our closest genetic relatives. Male and female same-sex encounters are very common for bonobos, and they even use a set of hand signals to communicate the kind of sex they wish [pp. 136-149].


Among humans, Dr. Roughgarden proposed that transsexualism occurs too frequently to be explained by random mutation pruned by natural selection alone and therefore does not imply significant adaptive disadvantage [p. 287]. As cited in an earlier essay, Olyslager and Conway estimated the lower bound on prevalence of transsexualism at around 1:500, based on mathematical correction of prior studies and survey of surgical data [8], nearly 100 times greater than figures cited in the DSM [1, p.579].  Roughgarden noted this is consistent with estimates from the U.K and the Hijra in India of around 1:1000 [7, p. 286].  She compared the prevalence of transsexualism to a 99.9 percentile score on a college entrance exam or an IQ of 130, stating that such relatively common traits “can only be consistent with a tiny and undetectable loss of fitness.” [p. 282] 


Is social Darwinism in American psychiatry rooted in science or social bias? At the 2003 APA meeting, Dr. Spitzer echoed evolutionary psychologists who seemed to project rigid contemporary sex stereotypes (dominant, hunting males vs. passive, nurturing, gathering females) upon ancestral cultures [9,10]. He speculated:


“In all cultures, young boys want to play with boys, Young girls want to play with girls… If you are interested in evolutionary psychology, you ask yourself could that have some survival value?  The answer is yes. Thousands of years ago when men were more likely to be in hunting and women were more likely to be in the nurturing role, if you were a young boy you would do better if you spent your time with other boys with whom, when you were older, you would go to the hunt.” [2, p115]


He went on, “…in all cultures, gender is recognized as a dichotomy.” 


All cultures? Anthropological research has revealed a long list of non-European cultures with more than two recognized sex and gender roles. Traditions of social gender role transition independent of birth sex include the Tahitian and Hawaiian Mahu, The Madagascar Sekrata, Hindu Tantric and Hijra Sects, Islamic Xanith, Khawal, and Sufi Traditions and others. [11, 12, 13, 14].   Native American scholars now use the term Two Spirit to describe sex and gender traditions, common among First Nations, that are beyond dichotomy[15].


Here in Colorado where I write today, Two-Spirit (male-to-female) women, such as the Navajo Nadle, the Lakota Winkte and the Cheyenne He man eh [16], held respected roles in healing and spiritual leadership. Gender transcendence was not only a normal variation of human life but sacred, a sign of a person especially close to the spirits.  As a young boy, the great Chief Crazy Horse of the Lakota Sioux was blessed by a Winkte shaman in a secret naming ceremony. Possessing a secret Winkte name marked social status and conferred spiritual protection, good health and long life [14, p.37].  Later, he married at least one Winkte wife, in addition to his wives born female [p. 112].


Like the coral reef fish, these proud Native American nations thrived for millennia, apparently unaware of any “adaptive disadvantage.”  That was, perhaps, until European intolerance appeared on the plains in the form of the Seventh Cavalry and compulsory missionary and reservation schools, which drove these ancient traditions into the closet [14, pp.177-196]. Among human societies, the anomaly is not the existence of gender diversity but the repression of it, isolated to relatively few cultures, including our own. It seems astonishing that such a large, relevant body of social science has been ignored by previous authors of the Diagnostic and Statistical Manual of Mental Disorders.


In our modern global economy, as among the native nations of the Colorado plains, humans live and compete in communities.  Adaptation and survival mean success of the tribe, perhaps more than individual breeding. Economist Richard Florida stated that in today’s world, “Human creativity is the ultimate economic resource.” [17, p. xiii].  In his book, The Rise of the Creative Class, he tracked the growth of the “creative class,” those doing creative work for a living, from less than 10 percent in 1900 to nearly a third in the year 2000 – a class generating as much wage and salary income as the manufacturing and service sectors combined [p. xiv].  Surprising to many, he found strong correlations between the most diverse US communities and those with the highest creative class share.  Five of the top ten metropolitan regions ranked for diversity, Seattle, Boston, Minneapolis, San Francisco, Austin, and Denver, also ranked in the top ten of creative class share [pp. xxi, 244]. Four of these, San Francisco, Austin, Seattle and Boston, were in the top five regions for gay and lesbian population share, a component of the diversity ranking.  And three of these, San Francisco, Boston and Seattle respectively, were the top three regions for high-technology industry.  Dr. Florida concluded that lowering barriers to inclusion fosters creative ecosystems –


“Habitats open to new people and ideas, where people network easily and offbeat ideas are not stifled but are turned into new projects, companies and growth. Regions and nations that have such ecosystems are likely to do the best job of tapping the diverse creative talents of the most people, and thus gain competitive advantage.”  [p. xx]


Although Florida’s analysis utilized gay and lesbian census data, where gender variant populations are not counted, gender transcendent people are a vibrant and increasingly visible component of lesbian, gay, bisexual, transgender (GLBT) and straight communities – especially in urban centers.  For example, of the top ten large metropolitan regions for creative class share in Florida’s survey, seven prohibit employment discrimination based on gender identity — according to the Human Rights Campaign. These include Washington, D.C., Boston, Austin, San Francisco, Minneapolis, Denver, and Seattle. Nine of the top ten high-technology communities, all but Phoenix, have trans-inclusive civil rights ordinances. [17 pp .244, 251; 18]  Lowering barriers to gender diversity in these communities is associated with creative human capital and economic potential.


While correlation does not imply causality, there is growing evidence that gender diversity is far from a “dysfunction” in human communities. Diversity of gender identity and expression can contribute adaptive advantages in unique breadth of perspective and creative viewpoint to the cultural and economic success of communities, ancestral and modern. 


Derogatory stereotypes that equate gender diversity with evolutionary unfitness and psychiatric pathology, like those of same-sex orientation that preceded them, are contradicted by the pervasive reality of gender diversity throughout nature and human culture.  As Dr. Joan Roughgarden observed,


“When scientific theory says something’s wrong with so many people, perhaps the theory is wrong, not the people.”  [7, p.1]


I hope that the Sexual and Gender Identity Disorders work group of the DSM-V Task Force will reexamine the evidence that difference in itself is not disease. [16]



[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, D.C., 2000.


[2] R. Spitzer, “Sexual and Gender Identity Disorders: Discussion of Questions for DSM-V,” Journal of Psychology & Human Sexuality, Vol. 17, Nos. 3-4, February2006, pp. 111-116,


[3] K. Winters (published under pen name Katherine Wilson), “The Disparate Classification of Gender and Sexual Orientation in American Psychiatry,” 1998 annual meeting of the American Psychiatric Association, Workshop IW57, Transgender Issues, Toronto Canada, June 1998.


[4] S. Rado, Psychoanalysis of Behavior II. New York: Grune and Stratton, 1962.


[5] C. Socarides, The Overt Homosexual. New York: Basic Books, 1962.


[6] R. Stoller, J. Marmor, I. Beiber, et al.,”A Symposium: Should Homosexuality be in the APA Nomenclature?” American Journal of Psychiatry, vol. 130, pp. 1208-1215, 1973.


[7] J. Roughgarden, Evolution’s Rainbow: Diversity, Gender, and Sexuality in Nature and People, Univ. of CA Press, 2004.


[8] F.  Olyslager and L.Conway, “On the Calculation of the Prevalence of Transsexualism,” WPATH 20th International Symposium, Chicago, Illinois, 2007. , Submitted for publication in the International Journal of Transgenderism (IJT).


[9] G. Alexander, “An Evolutionary Perspective of Sex-Typed Toy Preferences: Pink, Blue, and the Brain,” Archives of Sexual Behavior, Vol. 32, 2003, 1991, pp. 7-17.


[10] J. Benenson, “Sex Differences in Children’s Investment in Peers,” Human Nature, vol 9 no 4, 1998, pp. 369-390.


[11] C. Ford and F. Beach, F., Patterns of Sexual Behavior. New York, Harper and Brothers, 1951.


[12] A. Bolin, In Search of Eve, Bergin & Garvey, 1988.


[13] V. Bullough and B. Bollough, Cross Dressing, Sex, and Gender, University of Pennsylvania Press, 1983.


[14] W. Williams, The Spirit and the Flesh: Sexual Diversity in American Indian Culture. Boston, Beacon Press, 1986.


[15] S. Jacobs, W. Thomas, S. Lang, Two-Spirit People, Univ of Illinois Press, 1997.


[16] K. Winters (published under pen-name Katherine Wilson) and B. Hammond, “Myth, Stereotype, and Cross-Gender Identity in the DSM-IV,” Association for Women in Psychology 21st Annual Feminist Psychology Conference, Portland OR, 1996,


[17] R. Florida, The Rise of the Creative Class: And How It’s Transforming Work, Leisure, Community and Everyday Life, Basic Books, 2003.


[18] Human Rights Campaign, “Cities and Counties with Non-Discrimination Ordinances that Include Gender Identity” April 2008,


Copyright © 2008 Kelley Winters, GID Reform Advocates

About Kelley
Dr. Kelley Winters is a writer and consultant on issues of gender diversity in medical and public policy. She is the author of Gender Madness in American Psychiatry: Essays from the Struggle for Dignity (2008) and a past member of the International Advisory Panel for the World Professional Association for Transgender Health (WPATH) Standards of Care, the Global Action for Trans* Equality (GATE) Expert Working Group, and the Advisory Boards for TransYouth Family Allies (TYFA). She was recognized in the 2013 Trans 100 Inaugural List for work supporting the transgender community in the US. Kelley has presented papers and presentations on gender policy issues at annual conventions of the American Psychiatric Association, the American Psychological Association, the American Counseling Association and the Association of Women in Psychology. Kelley wanders the highways of America in an old Mazda, ever in search of comfort food.

2 Responses to Blinded Me with Science: Devolution of the DSM

  1. Kim says:

    For me it seems that in western cultures there’s a main problem: To say that a penis is more important as the human brain and everyone who doesn’t fit in the penis=male-definition is mentally ill… but the real acceptance for transsexual people will begin, when people recognize that girls can be born with a penis too.

  2. Marcus says:

    The DSM is an acrahic approach to culture that seeks to oppress the non hetronormative minorities by classifying them as mentally ill.

    when we as individuals and the health care providers who support us have the opporunity to overcome this oppression society will change.

    at the moment i would like to go to a conference in melbourne australia on the issues of minorities in mainstream mental health.

    i would like to put a motion that transseuxualism be removed from the dsm , but alas it costs more money than i have in the bank to go.

    I urge people to act and write to the conference organisers seeking the issue of recongnition of gender identity as not being a mental illness.

    and supporting the removal of GID from the DSM IVTR

    “From Margins to Mainstream: 5th World Conference on the Promotion of Mental Health and the Prevention of Mental and Behavioral Disorderswill explore new ways that individuals and organisations from a range of sectors can promote mental health and prevent mental illness.

    Mental health promotion and prevention are concepts which are no longer discussed only within health, but are now being integrated into many conversations including those within education, physical activity, justice, planning, the arts, technology and human rights – to name just a few. The evidence that mental health is determined by a range of socioeconomic factors is also building.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: