Way back in the mists of time, circa 1973, gay liberationists, as queer activists were then known, successfully lobbied and agitated to have homosexuality removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association citing empirical evidence that homosexuality was no more a dysfunctional state of being than heterosexuality.  This was in opposition to the traditional Freudian view that homosexuality was a pathology that could be controlled, if not cured, with therapy and counseling.

Psychiatrists opposed to the removal of homosexuality from the DSM, in turn, lobbied for a vote by the membership of the American Psychiatric Association with a view to re-instate homosexuality as a pathological disorder.  The vote was held in 1974 and the decision to amend the DSM was ratified by the membership.  But that was not the end of it.

In 1980, in the third edition of the DSM, a new diagnosis, ego-dystonic homosexuality, was created.  Ego-dystonic homosexuality, according to the new diagnosis, was indicated when an individual experienced a total lack of heterosexual arousal and a perception on the individual’s part that such lack of arousal towards the opposite sex interfered with their desire to form romantic and sexual relationships with the opposite sex.  The second part of the equation involved the individual displaying a "persistent distress from a sustained pattern of unwanted homosexual arousal."

The new diagnosis was seen by many as trying to placate those psychiatrists - mainly psychoanalysts - who still considered homosexuality a pathology.  Also, as awareness of homophobia increased, many within the Association recognized that, due to societal disapproval of homosexuality and social and religious condemnation of it, it would follow that many homosexuals, both gay and lesbian, would experience a period of difficulty in acceptance of their orientation that could be ‘ego-dystonic’ but eventually moved out of that phase to acceptance and even celebration.

In 1986, the diagnosis was removed from the DSM. The only vestige of ego-dystonic homosexuality in the revised DSM-III occurred under Sexual Disorders Not Otherwise Specified, which included persistent and marked distress about one’s sexual orientation.  One assumes it would be the distress that would be viewed as a disorder, not the orientation itself.

And this is pretty much how things stayed for 20-odd years.  While the above overview is American, the Canadian Psychiatric Association followed much the same line and also uses the DSM.  Homosexuality and bisexuality have gained significant acceptance since the 1970’s and 1980’s and, in Canada at least, highly significant advances in legal and political areas has resulted in a fuller equality for gay, lesbian and bisexual individuals with transfolk still lagging somewhat behind but benefitting to a certain degree, although not a huge degree, from the advances in GLB rights.

However, it has come to light that here in Alberta, doctors continue to bill the province for the treatment of homosexuality as a mental disorder...right up there with bestiality and pedophilia.  This despite assurances from the then-Minister of Health Gene Zwozdesky the "incorrect and unacceptable classification" would be removed immediately.

Liberal MLA Laurie Blakeman (Edmonton Centre) raised the issue in the legislature, stating despite Zwozdesky’s acknowledgement of the unacceptability of classifying homosexuality and bisexuality as mental disorders in 2010, and the provincial government being aware of the outdated classification for over a decade and promising to change it in 1998, the billing codes remain in use.

Edmonton gay activist Rob Wells and the Edmonton Journal’s provincial affairs writer, Karen Kleiss, released government records which revealed doctors billed the province for "treatments" under this code more than 1,750 times between 1995 and 2004.

Although Zwozdesky did, in fact, remove the classification from the on-line version, as promised, in 2010 the code remained in use as confirmed by senior Public Affairs Officer and Alberta Health spokesperson Kathleen Range.

Range attempted to explain the situation by stating "[I]t’s diagnostic code, it’s not a billing code; they’re two different things," she said, adding "...[D]octors bill (the province) according to the schedule of medical benefits and they use the international diagnostic codes with that billing information."

Alberta uses the World Health Organization’s International Classification of Diseases (ICD-9).  ICD-9 was written in 1975.  WHO updated the code in 1990 (ICD-10) which does not list homosexuality as a mental disorder.

Range went on to say the province uses a version of ICD-9 known as the Alberta Health and Wellness Diagnostic Codes and insisted these codes did not include "language which is obviously outdated and offensive" in regards to homosexuality and that the code has been removed.  However, she continued by stating, "Alberta can’t, on its own, change what other jurisdictions are using, so we still use that coding system" and that Alberta won’t adopt ICD-10 until other provinces do so.  Why?  For the sake of administrative efficiency, according to Range.

So we have a grossly outdated and prejudicial code remaining on the books despite a former Minister of Health’s assurances it was removed, but it was only removed from the website, not from the actual manual.  The version used by Alberta Health is 37 years out of date despite a revised version, the ICD-10, being released twelve years ago, but Alberta won’t use the updated version until other provinces do.  Will somebody go first, please?  Given the state of our health care in this province, I’m all for ‘administrative efficiency’ but -- really -- at what personal cost?

1,750 people, perhaps more if the code was used in the eight years since 2004 - and I can assume with some confidence it probably was - seeking assistance from their medical professional for relief in dealing with being gay, lesbian or bisexual.  That’s a lot of pain. Pain and distress and even despair because these folks had internalized the homophobia and heterosexism which surrounds all of us and having that reinforced by their medical professional who, instead of channeling these individuals to supportive and affirming sources both within and outside the GLBT community, chose instead to respond as if being gay, lesbian or bisexual was the problem.

When I coordinated what was then Gay Lines Calgary, an information and peer-counselling service for gay and bisexual men which worked closely with the Womyn’s Collective’s Lesbian Information Line, we frequently received calls from individuals struggling to come to terms with their sexual orientation.  Many came from a conservative Christian background and were in turmoil and in conflict between their religious beliefs and their dawning realization they were that which their church condemned.

Others were struggling with the societal messages, not always clearly articulated within themselves, that being a homosexual or bisexual was ‘abnormal’ or ‘wrong’, and they desperately  - desperately - wanted relief from the anguish.  To them, more often than not, that meant being straight.  It was heartbreaking to hear the stories of struggle and self-recrimination and self-loathing.  To have one of us on the other end of the line tell them that being gay or bisexual was part of normal human sexual expression and that the issue was not they were gay or bisexual or lesbian but that the issue was their church’s/society’s/family’s reaction to it was a revelation.

For some, having their orientation affirmed was the beginning of healing and eventually moving to a level of acceptance and involvement in ‘their’ community and a relatively happy life.  But not for all.  Some could never get past the ‘but it says in the Bible...’ or ‘but my family would disown me...’ stage.  These were the heartbreakers, our lost sisters and brothers, condemned to a life filled with self-hate and despair because they wanted - needed - to be with another man or another woman and just could not accept that.

If such individuals, desperate for resolution to their despair, seek professional help, I can understand that.  What I find outrageous and unacceptable and even inhumane is for the professional to whom they turn exploiting that pain, most likely out of ignorance themselves rather than malice, and couching the issue not in terms of the individual’s reaction/response to who they are, but in terms of attempting to treat their gayness or bisexuality as the problem rather than the person’s reaction as being the problem.

We no longer force children to write with their right hand when they are left-handed.  And we certainly don’t tie the left hand behind their backs or swat it when used as was once the case.  We now recognize that being left-handed in a right-handed world is just another point on the spectrum of being human; not a deviance but a variance.  With all the political and legal advances we have made in GLB equality rights, it seems we still confuse a possibly pathological response to a normal condition with the condition itself.  What needs to be treated is the negativity to being homosexual or bisexual, and help move the person suffering that to accepting and being comfortable with who they are, not trying to treat who they are as if that were the problem.