Why Does My Health Portal List “LGBTQ” as a Medical Condition?

An abridged history of queer medicalization and its implications for Needham High School students.

As we return to school, we are accosted by the usual resurgence of routine documents, syllabi, and forms to complete. On August 31st, my family and I were doing a brief examination of my SNAP portal, in which medical conditions, allergies, and certain accommodations which have been declared to the school or otherwise documented by the school are listed. Upon arrival at the “Allergy/Condition” menu for medical information, I had two light gray boxes (indicating that I could not edit them from my profile; rather, they could be edited from the nurse profile) with the input diagnosis of “*LGBTQ” which had a listed onset date of May 12th, 2020. Pictured below.

For the purpose of relative brevity, the fundamental issue with this labeling will be divided into two categories: Implications for students, and the invocation of harmful narratives about queer people.

Implication for Students

As a brief caveat -- in ongoing communication with the Needham Public Schools Director of Health Services, a comprehensive acknowledgement of harm was offered, and additional context was provided.

The Director of Services suggested that “*LGBTQ” appeared on my profile as a condition, but on the nursing profile would appear as a note for referential purposes. While this is itself concerning in that it begs the question of who is responsible for labeling students as such, it is entirely plausible that this was an honest mistake, and one which has been addressed (at least for me). The primary concerns raised are: How is the school designating students as queer, and what are the possible consequences of parents being able to view this designation?

The designation begs the question of profiling; it is reasonable to assume that I would be a likely candidate for being identified as queer. I co-lead the Queer Student Union, I’ve been interviewed by the superintendent on trans issues, I co-led last years’ student walkout against anti-queer bills. I am visibly queer. Despite this, I feel deep unease that someone, or something, should it be computerized, went out of their way to mark me as such. This move discloses information that, though I have made public, is incredibly personal, and remains my information to disclose when and if I choose to do so. The documentation of “LGBTQ” raises the issue of family safety--only parents can easily view the SNAP portal, which means my parents were notified that I was on record LGBTQ before I was. While for me, this is not particularly compromising, it is negligent to assume that this is universally the case. Queer people are at an elevated risk of parental rejection. A study done by Brian E. J. Richter, Kristin M. Lindahl, and Neena M. Malik find that upwards of 70% of LGB+ teenagers have experienced, in varying degrees, parental rejection or dismissal. This number increases exponentially for transgender and genderqueer youth. Schools violate the entitlement to safety and privacy their students have when they unilaterally decide to disclose a students’s identity, a sentiment we have seen expressed through opposition to bills such as the so-called Parental Bill of Rights, which would force school personnel to “out” queer students to their families under the guise of parental involvement in education.

Historical Narratives

The presence of LGBTQ specifically under medical conditions begs the question-- what is the historical precedence for LGBTQ+ as a medical condition, and why should this upset students?

As a precursor to any discussion of medicalization, a few definitions should be supplied: Medicalization, according to biologist and Stanford fellow Erik Eckhert, who studies the intersection of oncology and LGBTQ patients, is the “(often unconscious) process by which organisms, tangible objects, or social constructions are rendered into biomedical terms” (2016). In simplified language, medicalization is the process of describing a phenomenon using scientific (biological) language. In this case, it is the social phenomenon of gender and sexuality being described as a biological occurrence, either through psychology or genetics. A product of medicalization is the ability to describe phenomena apolitically, though this can create a hierarchy of social phenomena as either “natural” or “unnatural.” One example of this hierarchy would be the apparent consensus that same-sex attraction occurs biologically, as we can observe inter-species same-sex coupling. Conversely, we see no same “proof” of transgender animals, as gender as we understand it is a uniquely human construct. In this way, we see a limitation of the biomedical model of understanding social constructs. (more on sexuality as a social construct). The aforementioned example of “LGBTQ” being labled as a condition is an example of medicalization in which being queer, a social phenomenon, is described as a condition, something expressed biologically.

Philosopher and historian Michel Foucault in his seminal work on human sexuality, The History of Sexuality Volume 1, describes an evolutionary relationship between “sodomite” (someone who engages in so-called homosexual acts) as a criminal and amoral class and the medicalized homosexual (homosexual here encompasses people we would contemporarily consider any varity of queer, but most often gay or bisexual men). The turn of the 18th century saw a shift towards secularism, and with it an emphasis on the individual and the scientific. Now, being queer wasn’t an action, à la sodomy, but an identity, homosexuality (or, rather, homophilia).

Karl Heinrich Ulrichs was a mid-1800s human rights advocate and was among numerous early theorists who suggested homosexuality was not just a social identity, but an innate biological reality. He held the belief that the homosexual man became such because of a “woman’s spirit” trapped in their body, and that the inverse was true for lesbian women. His theories informed the work of Károli Mária Kertbeny, who was the originator the label “homosexual.”

The term “homosexual” was later appropriated by the psychiatrist Krafft-Ebing, who held the conviction that homosexuality was a “degenerative congenital disorder,” a theory adopted by his protégés, which inspired research into both cause (often believed to be parthenogenic, by disease or bacteria) and cure (which inspired the modern day conversion therapy movement).

Another term to originate in the same era was the “invert,” a person (usually male or intersex) who develops a desire to embody the opposite sex. Using “invert” as a reference, we can see the bimodal way in which medicine and human identity inform one another. “Inversion” posits that a protypical homosexual man eventually might develop the urge to transition to a woman, in which she becomes a prototyical heterosexual woman. Thusly, the “invert” theory of gender encouraged transsexuals and transgender people to perform as heterosexual and binarily feminine or masculine. This in turn reinforces the foundational assumption that trans people exist in a definite binary, and validates the assumptions the label entails (that transgender people are all straight and gender-conforming).

These theories of queerness eventually inspired the psychiatric model of describing identity. Studies emerging in the early to mid-1900s alleged that homosexual individuals (again, primarily men attracted to men) experienced elevated psychological disturbances. These studies were foundational in securing queerness a spot in the American Psychiatric Association’s (APA) first edition of the Diagnostic and Statistical Manual (DSM-I, 1952), listed as one of the “sociopathic personality disturbance[s].” In the 1968 DSM-II, homosexuality was reclassified as a “sexual deviation.” In the wake of Stonewall, the 1969 uprising of queer people of color against police who were harassing them, and the increased visibility of gay liberation movements, gay and lesbian communities were able to seek redress for the stigma medicalization had caused. By 1971, the APA’s annual conference had featured a panel titled “Gay is Good,” which featured prominent gay activists who advocated for a depathologization, or a removal of medical language, for homosexuality. In 1973, homosexuality was removed as a categorical mental disorder, to be replaced with “Sexual Orientation Disturbance,” which conditionally labeled homosexuality as a disorder insofar as the homosexual person experienced distress related to being gay. In 1980, “Sexual Orientation Disturbance” was substituted with “Ego Dystonic Homosexuality” (something still in the WHO’s listings of medical conditions). Homosexuality, in some capacity, remained in the DSM until DSM-V in 2013.

Transgender people have seen a similar medicalization, with two disorders currently existing to pathologize gender non-conforming and transgender individuals. Due to the sexualized nature of these disorders, descriptions will be concise. DSM-V replaced “Gender Identity Disorder” with “Gender Dysphoria” and “Transvestic Fetishism” with “Transvestic Disorder.” The latter directly contributes to the harmful stereotype suggested by media figures like Buffalo Bill, or a person who transitions out of fetishistic and/or violent urges, rather than out of a “true desire” to embody a different gender. All of these disorders neglect that gender variance is not a psychiatric disorder, but instead a product of human diversity, which fluctuates cross- and inter-culturally. When queer people are prescribed psychiatric labels, their identity is inextricably tied to mental illness, which fuels stigma, and suggests “treatment” or “cures.”

Medicalizing queerness necessarily restricts queer people to a population solely valid on the basis of biology, rather than humanity. It enables institutions to promote “cures” and abusive so-called “reparative” treatments. Altogether, it creates and reinforces stigmas which materially harm LGBTQ+ people.

Though Needham High’s health portal was one incident in which we see medicalizing language being applied to queer and transgender students, it is symptomatic of a culture which has understood queerness through this lens. It is critical that we examine medicalized beliefs about queer and LGBTQ+ people and work towards a radical acceptance model which doesn’t stipulate “proof” for people merely living authentically in our community.