Draft DSM-IIIs, including a handheld version called the “Mini-D”, is published. Noted sexologist, Dr. Spitzer, who initially supported the removal of homosexuality from the DSM, but who, in 2003, published a (now retracted, but originally published by Dr. Zucker) paper claiming that homosexuality could be cured, was the chair of the DSM editing board. Spitzer initially criticized his detractors as being politically correct saying that the study, “questions the politically correct view that once you’re gay, that’s it and suggests that there is more flexibility than many people have assumed.” In 2006, Spitzer asserted:

Granted that hormone therapy or surgery may now be the only treatment that we can now offer the adult with GID… But surely something remains profoundly wrong psychologically with individuals who are uncomfortable with their biological sex and insist that their biological sex is of the opposite sex. The only diagnosis that is appropriate for such cases is GID.

The DSM-III draft replaced the diagnosis of “homosexuality” with “ego-dystonic homosexuality;” “transsexualism” and “gender identity disorder of childhood” were added as subclasses of “gender identity disorders,” which itself was a subclass of “psychosexual disorders.” Early versions of this GID entry were modeled after the transsexual ontology presented by Dr. Green in his 1974 book, Sexual Identity Conflict in Children and Adults in which he asserts that transsexuals are primarily concerned with achieving “sex roles” of the “opposite sex.” Consider the following takeaway from a review of Green’s book:

The second major section of Green’s book deals with young children who show extreme cross-sex identity and behavior… In this section, Green also reveals his own point of view, or theory, which is largely experientially, learning-oriented. He lists 10 variables relevant to the development of typical femininity in boys, and he observes that the most necessary variable is that, as any feminine behavior begins to emerge, there is no discouragement of that behavior by the child’s significant caretakers.

Green’s interest in studying boys, of course, stems rather naturally from his earlier work with adult TSs. It is indeed true that many of these children present a picture that is completely consistent with the one that adult TSs paint of their own childhood. The data are consistent with the hypothesis that many extremely feminine boys will grow up to become, in the absence of favorable environmental actions, adult transsexuals, effeminate homosexuals, or transvestites… Green acts on these data and provides treatment for feminine boys. A chapter discusses the treatment rationale and methods.

It was stated above that the TS wants to act in accordance with the traditional sex role.

While Dr. Green was involved with early work on the DSM-III, he was fighting bitterly with Dr. Spitzer. Green was later removed from the DSM-III workgroup and a more feminist understanding of the difference between gender role and gender dysphoria became evident in the post-Green draft. This draft version largely equates “gender identity disorder” with a transsexual experience of dysphoria with one’s physical sexed attributes, whether in children or adults. For children, merely rejecting cultural gender roles and stereotypes was not enough to diagnose a child with GID: “Differential diagnosis. Children whose behavior does not fit the cultural stereotype of childhood masculinity or femininity but do not have the full syndrome.”

While this distinction between being transsexual and being gender nonconforming was later very deliberately removed when CAMH sexologists became more involved in the GID Workgroup, feminists worked hard to ensure that Dr. Spitzer would make this distinction more clear in the DSM-III. Consider the following excerpt from The Making of DSM-III: A Diagnostic Manual’s Conquest of American Psychiatry:

[T]he largest group of documents in the Archives are letters to and from Ann Laycock Chappell, M.D., a member of the APA Committee on Women. Chappell had apparently been sent a copy of the DSM-III draft, and she, in turn, had duplicated sections about which she was troubled and sent them to various professional women for comment… The Archives also contains an exchange of letters between Chappell and Spitzer that chronicle a winning exchange in the making of DSM-III. Much attention in the opening letters was focused on the diagnosis of “Gender Identity or Role Disorder of Childhood”…

Chappell sent all the replies she had received to Spitzer, who appeared both bemused and taken aback by the large volume of material and chose to deal with the situation humorously. “I have decided to become famous by editing a book on the correspondence regarding Gender Disorders of Childhood. Since you are largely responsible for engineering this literature, would you like to be co-editor? On a more serious note, I am, to say the least, a little overwhelmed by all of the input from your female network. Can I expect to get from you a summary of what you think we should do with specific rewriting of the offending section?” This being the early days of the feminist movement, Spitzer was obviously unfamiliar with the seriousness with which some women viewed the unequal status of women… We should also note that with the women’s objection to the Gender Identity descriptions we see another favorite tactic of Spitzer when he faced complaints about material in DSM-III. He turned to the objector and asked her or him to provide specific changes and rewritten text for himself and the Task Force to consider, thus placing the burden on the critic, who many times withdrew.

But that did not happen this time. Chappell replied in a week with a three-page letter, which unfortunately is missing page 2 in the Archives. But on the first page there is a long discussion of the “Gender identity Disorder of Childhood” repeating twice the “potential for harm” that was contained in the category as written. Moreover, Chappell declared:

A major concern is that the category tries, but fails, to differentiate true identity confusion with failure to follow sex stereotyped roles… Such a failure is unforgivable and unacceptable. There is a real philosophic argument on how to impart gender identity without imparting sexual stereotypes [but] it does become imperative … that in these criteria we must remove all sex-stereotyped material.

[…]

Soon after his letter to Chappell, Spitzer made serious efforts to carry out the women’s proposals and objectives. He informed the “Advisory Committee on Gender Identity” of Chappell’s positions, enclosed the correspondence that Chappell had earlier forwarded to him, and asked the Committee how the category could be “defined without reliance on stereotyped sex behavior, which most of Dr. Chappell’s respondents found objectionable.” Within two months, Spitzer and Jon Meyer of the Psychosexual Disorders Committee rewrote the Gender Identity Disorder of Childhood section and sent it out for comments from the people who had originally written the section and from Chappell.

If one compares the Gender Identity Disorder of Childhood section in the April 15, 1977 draft of DSM-III with the section in the revised draft of January 15, 1978, it is readily apparent that almost the entire category had been reworked with an attempt to meet the concerns of Chappell and the other critics. In the later draft, under “Essential Features” and “Diagnostic Criteria:’ the discussions of boys and girls were done separately. The new descriptions were written so as to stress the significant pathology of the disorder, and they explicitly declared, “There is not merely the rejection of stereotypical sex role behavior as, for example, in ‘tomboyishness’ in girls or ‘sissyish’ behavior in boys.”

Again, it should be noted that after CAMH sexologists became part of the Gender Identity Disorder Workgroup, the distinction between the transsexual and gender non-conforming experience was purposefully removed. Studies that later claimed that most children grow out of being trans were based upon later criteria wherein a child could be diagnosed with GID without having ever experienced gender dysphoria.

While the incorporation of the feminist perspective of not pathologizing gender nonconforming children was a positive step, the DSM-III, nonetheless, conceptualized heterosexual trans women as homosexual gay men. This (mis)understanding of the sexuality of trans people would be carried forward, forming the ontological basis of Dr. Blanchard’s trans typology of so-called “autogynephilia” in 1989.

For an account of the way GID was used to lock up and institutionalize trans youth, giving rise to anti-trans reparative therapy, read The Last Time I Wore A Dress. See also first-hand accounts of the way the psychiatric community failed to grasp the way their pathologization of the trans experience would stigmatize trans people.