Nosology is a branch of medical science dealing with the classification of diseases, not to be confused with rhinology, a subspecialty within the field of otolaryngology (ENT) focused on the treatment of diseases and disorders affecting the nose.

The International Classification of Diseases (ICD) is the international standard diagnostic tool for epidemiology, health management and clinical purposes.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association, is sometimes flippantly called “the psychiatrist’s bible” by journalists.

Classification of gay, lesbian, and bisexual sexual orientations underwent major changes in different editions. DSM I (1952) classified these orientations under “paraphilia”, and DSM II (1974) under “sexual orientation disturbance”. DSM III (1980) further modified this to “ego-dystonic homosexuality”, before finally dropping the subject from DSM-III-R (1987) and subsequent editions.

These changes were brought about primarily by pressure from APA members who formed a political group (caucus) of gay and lesbian psychiatrists within the organization to lobby for changes in the nomenclature reflecting current scientific understanding of sexual orientation variations.

The final stage of deleting “ego-dystonic homosexuality” was proposed in a paper of that name by this writer in 1980 and discussed at the annual meeting of the APA in a packed session mischievously titled “Ego-dystonic Nosology” . I recall one colleague suggesting that removing the diagnosis from the DSM would constitute “a step backwards”,and responded with, “A step backwards would be a step in the right direction if one were initially facing the wrong way!” This repartee provoked laughter and applause.

Though the editor of the DSM at the time objected, he was overruled, the diagnosis was deleted and was no longer is listed as a mental disorder.

The ICD retained the diagnosis for a while until an “International Advisory Group” was established to review the section associated with sexual development and orientation. It concluded by explicitly stating that “sexual orientation by itself is not to be considered a disorder,” in line with the DSM and other classifications that recognize homosexuality as a normal variation in human sexuality. The Working Group reported “there is no evidence that [these classifications] are clinically useful” and recommended that it be deleted from ICD.

in Moscow in 1991 I met a Freudian psychoanalyst who said he was pleased to once again engage in “scientific psychiatry” following the collapse of the USSR. Elsewhere in the world this view would have been considered outdated. Not surprisingly, opposition to the nomenclature change described here was strongest among psychoanalytically trained psychiatrists.

June 11, 2018