Throwback to the 1970s

Members of bc’s queer community are appalled that their provincial government continued to list homosexuality as a mental illness more than three decades after psychiatric professionals stopped doing just that.

A list removed from the Ministry of Health’s website last week included homosexuality as a neurotic illness under the general heading of mental disorders.

The list contains billing codes for the provincial Medical Services Plan. These are the numbers doctors use when billing the province’s health plan for treatment they’ve administered for various ailments or procedures.

On the BC list, under a subheading of sexual deviations and disorders, were “homosexuality, bestiality, paedophilia, transvestism, exhibitionism, trans-sexualism, disorders of psychosexual identity and frigidity and impotence.”

Homosexuality was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) more than 30 years ago.

Ministry of Health spokesperson Michelle Stewart says the BC listing would have been based on the World Health Organization’s (WHO) disorder listings.

The WHO removed homosexuality from its International Classification of Diseases (ICD) in 1992 when the ICD 9 was updated to the ICD 10.

The ICD 10 does list transsexualism, dual-role transvestism, fetishism, fetishistic transvestism, exhibitionism, voyeurism, paedophilia and sadomasochism under the subheading of gender identity disorders.

The BC list was apparently based on the old ICD 9.

“These codes are not a ministry invention; they are something used around the world,” Stewart points out. The WHO’s ICD 9, on which BC seems to have modelled its own code, was implemented around 1979.

The BC government removed homosexuality from its billing chart late last week, after an uproar in the media.

Before its removal, doctors used the billing code more than 7,700 times in the past five years, the ministry says.

Figures indicate that in 2003-2004, doctors made 1,794 billings under the code to the Medical Services Plan. The billings totaled $67,359 for 173 patients.

But Stewart says the doctors may not have been treating homosexuality per se. They might have used that code if they were providing a counselling service to someone coming out of the closet and dealing with depression or anxiety, she suggests.

“That code would go on not because they’re treating them for mental illness but because [homosexuality] was part of the discussion.”

But, she adds, the fact homosexuality was still on the code list was “completely inappropriate.

“Physicians have been informed that billings by that code will not be honoured,” she says. “We will move to the new code.”

Queer human rights lawyer barbara findlay finds the government’s explanation a little hard to swallow.

She asks how the government could know what exactly doctors were treating a patient for when it’s only the billing code number that appears when doctors submit their billings; no treatment explanations are given.

Still, she says, the fact it’s gone now is a good sign.

“I’m hopeful this will signal their intention to change some of their obsolete attitudes,” she says. “I think they held these attitudes, regardless of whether they say they were out of date.”

As for the presence of transsexualism on the mental disorder list, findlay says that’s a bit of a Catch-22.

She says transsexuals are forced to accept its being there in order to receive sex re-assignment treatment.

“We don’t dare to call for the elimination of it because if we do, this government will undoubtedly de-list sexual re-assignment surgery,” she explains. So transsexuals “are forced, as a condition of being able to address their condition, to agree that they’re ‘sick’-which they’re not,” she adds.

Vancouver-Burrard Liberal MLA Lorne Mayencourt was unavailable to comment on the disorder list due to commitments in the legislature in Victoria.

Running against Mayencourt in the May 17 provincial election is former NDP government member and current Vancouver city councillor Tim Stevenson. He first heard about the list on Feb 9.

“I think it’s appalling, absolutely appalling,” he says of the fact that it remained in use so many years later. “I don’t know why there aren’t regular checks done.”

The list was in use while Stevenson was still in cabinet.

“Yes, it should have been [checked] by the previous government as well,” he says.

Stevenson says someone in the ministry should be delegated to examine such issues on an ongoing basis to ensure it does not happen again.

“If this slipped through the cracks, what else is slipping through the cracks?” he asks.

Curiously, psychopathy did not appear on BC’s now-revoked, 1979-based list, even though the American Psychiatric Association removed that term from its diagnostic manual seven years after it removed homosexuality.

The American Psychiatric Association replaced psychopathy in 1980 with the term antisocial personality disorder. BC’s old list apparently kept up with that change, since it included personality disorders in its billing codes, along with the code for homosexuality.

The fact that psychopathy was changed while homosexuality remained on the BC list “reflects the fact that, to this government, queers don’t matter,” says findlay.