Bri: Hello everyone and welcome back to another episode of Queer Science! I’m Bri, one of your cohosts for this podcast and a recent college graduate who studied biology and international studies.

R: And I’m R, your other cohost. I’m a current college student and the resident artist for this podcast.

Bri: Queer Science! explores the intersection of science, society, and queerness in order to think critically about the ways in which science is done. In this episode, we look at the history of psychology and sexuality with special guest Sam Simon, a bisexual clinical mental health counselor, and PhD student studying counselor wellness. Our conversation topics include Freud, a massive diagnostic manual known as the DSM, and a group of Swedes who called in gay to work.

R: Before we dive in, let’s explain some terminology. The “T” of LGBTQ stands for transgender, which is when a person’s gender doesn’t align with their gender assigned at birth. When you’re born, a doctor gives you a label called sex – and this word shapes your identity throughout life. If you were assigned a female sex at birth, and still mentally, socially, and physically perceive yourself as female later on, you are cisgender. Cis- meaning on the same side. If not, you are trans – an umbrella term for binary trans people and agender, non binary folks like me. Both terms are adjectives, not nouns. A common part of being trans is gender dysphoria, which is defined by the American psychiatric association as conflict between a person’s physical or assigned gender and the gender with which they identify. It’s important to understand that gender dysphoria is diagnostic and required to begin medically transitioning.

Bri: That brings us to another term, medicalization. This is the process by which human experiences or identities are treated as medical conditions. This can be a good thing – and a bad thing, especially when medicalization stigmatizes marginalized groups. Now that we’ve covered some necessary lingo, let’s get started with our interview with Sam. She’s a great friend of ours and has experience working in various counseling settings, adding professional, as well as personal, insight on these topics.

Sam: My name is Sam Simon, and I am a licensed clinical mental health counseling associate of North Carolina… it’s always a mouthful. And so that means I have my master’s in counseling and I’ve been counseling since 2017. And since then I have been working for NC State at the counseling center there. And I also am currently working at an agency practice as well – seeing people in the community – and I’m getting my PhD in counselor education and supervision. So my goal is to teach counselors, cause I feel like we need to be doing a better job at it to prepare them after they graduate. So my dissertation is interviewing those counselors who are graduating and talking about their wellness practices and if we, as counselor, educators need to do a better job at teaching counselors how to take care of themselves, which I know we do, but it’s all about having the numbers and the evidence to show that.

R: Sigmund Freud is an old name with many modern connections – like it or not. He’s a huge pillar of psychology and was one of the first in the Western world of science to really study sexuality. But what does that mean today?

Sam: Freud, he is the father of psychoanalysis. That’s what he’s known as. So anybody who is going into psychology or counseling, psychiatry, whatever you’re going to – learn from Freud, because he was kind of the first person that was like, “Hey, let’s like, look at this a little bit deeper.” And so I feel like he has a lot of validity there of just being that outlier person that wants to look at human behavior and sexuality in a time where it was not accepted to do that. However, what he also did was say that homosexuality and heterosexuality, there has to be a difference. There has to be something underlying someone who identifies as queer, or homosexual – as he would say, versus someone who’s heterosexual and almost, you know, demonizing homosexuality.

Sam:

And he’s kind of flip, floppy. He goes back and forth in a lot of his work and sometimes he’ll say, “Oh, it’s, there’s nothing wrong with it. It’s just a natural occurrence.” But then he stigmatizes it in other parts of his work. And so when you have him as this big figure who is not taking a stance on this, of course, that’s going to influence the field. People have psychology lineage, like who studied under who, who studied under who. So if you think of everyone who studied under him or learned from him, which is almost the entire psychological community, you have that as the underpinning. And so, yeah, he, there was a lot of studies that he did where honestly, he, he was just curious, he was just a scientist. He’s like, “I’m going to sit down and talk with you. I want to figure out why are you attracted to this woman?” You know, as a female identifying person, “why are you attracted to this woman? I want to know” “Is it some type of pathology?” Is what he was thinking. And he came to a conclusion at some point where he said, well, if there has to be a reason for homosexuality, there has to be a reason for heterosexuality. So he, it was almost like he was first weaponizing and demonizing homosexuality, but also saying if there’s a reason for one, there has to be a reason for another, which is very interesting because you don’t hear that these days, it’s always, homosexuality is the thing that’s not normal. And he was just, at some point was saying, it’s kind of on a spectrum. And that’s what he said very early on, but he negates himself so much in everything. He always goes back and forth and he never took a clear stance. And so that is a problem because what it does is it left researchers to say, “Oh, I believe in that, I, Oh, I believe in that” and try and do their own research based off that. So there was never a clear understanding of what he truly believed.

R:Sounds sort of similar to other scientific studies where people cherry pick what they want to believe out of things that they say, this is exactly what I believe. So I’m going to support that and ignore everything else or say that it’s a very binary, he did support it, or he did support it. So having that acknowledgement of the flip floppiness, as you said, yeah, that sounds very similar to other things that are happening currently about the, “We’re just going to pick this part of it and everything else we’re going to ignore.”

Bri:So let’s dive a little deeper into this idea of medical intervention with sexuality and gender identity – or this idea that sexuality needs to be fixed. So if you’ve ever seen the second season of American horror story, which is titled “Asylum” – and warning, these next 10 seconds will definitely contain some spoilers -You’ll know that the character Lana winters, a lesbian journalist played by the actress Sarah Paulson, was committed to a mental institution because she was a homosexual. And although this is fictional, I think it’s a great example because this character was forced to go into a medical institution because of her sexual identity. So we just were talking about Freud and psychoanalysis, but now we’re going to talk a little bit more about psychiatry and how psychiatry played a key role in the discrimination of queer individuals. So if you were not heterosexual or cisgender, you were deemed sexually inverse or deviant and required psychiatric care. And up until 1973, homosexuality was actually listed as a mental disorder in the diagnostic and statistical manual of mental disorders, otherwise known as the DSM.

Sam:When it was first created – I think the first DSM, um, was – it’s kind of in its infancy, to be honest, um, after World Wars that they were coming back, soldiers were coming back with PTSD, psychiatrists and psychologists were thinking a lot about, “Okay, there’s something going on here. We’re, we’re noticing there’s hypervigilance. We’re noticing a lot of other behavioral factors that we need to adjust and, you know, recognize.” And so well before the DSM was in place, there wasn’t a high emphasis on diagnosis – that was never the emphasis for psychiatrists, psychologists and things of that sort. It was well actually more psychiatrists then… What it was was just kind of like an understanding, like I want, it was more of a behavioral tactic of, I want to know what’s going on with you. Um, I want to sit with you and share space – and it was kind of fore-scientific thought processes. And then the psychiatrist realized, “Hey, in order to do more research and make sure this is valid, we need to have a manual. So that we’re all going off of so that, you know, we can cure this, we can cure specific disorders, we can label them a certain way. So that psychiatrist A is also doing the same thing as psychiatrist B” and you know, doing a lot of tests and a lot of experiments to refine everything. And so the first DSM, it was kind of like, okay, this is what we’ve been seeing. Let’s throw it in here. And it was a meetup of a lot of people, um, from psychiatrists to pharmaceutical companies and all of these high name people. And to put it that way, um, that are, have high societal status that were, hopefully, – I hope this was in the back of their mind – wanting to come up with a criteria for people, uh, for psychiatric disorders.

Sam: But it was also a lot of red tape, a lot of bureaucracy. It is like, “Oh, well, you know, if I give you this and you’ll give me this.” As far as the pharmaceutical companies, and as far as like, high-trust, how can we come together to help everyone here? And so that was developed and they realized that, you know, the DSM in itself, every DSM and every DSM after the first one, you have to look at the psychosocial components around it. So if they’re in the society at that point, what was not normal… What was not normal and what was not accepted by white heteronormative, religious culture was homosexuality. And so, yes, it was, it was in there for that reason. Um, and then, so after this group came together and developed this, they said, this is, what’s not normal right now. They did a lot more tests. And they came out with the next DSM. They were like, okay, well, we were wrong with that one. Cause they did a lot of tests. So it’s pretty much this historical book of seeing how our society was normalized and what was normal and what was not normal and what was demonized.

R:So did they explicitly say that homosexuality was abnormal or was it just kind of assumed through context?

Sam: Yeah. So there was – from Freud and language, there is instances where you can infer that what’s being said that there is a, I don’t really remember the exact terminology, but there is a, um, like a disconnect between, you know, Oh, deviant stuff. That’s the word. It was like before there was a deviance in the human, like to be a homosexual person. And so you were deviant from normal culture. That’s essentially what was portrayed.

R: In April, 2015, Mental Floss published an article called “The time Swedes called in gay to work.” Part of a larger national protest over the classification of homosexuality as a disease, several people claimed they were unable to work due to being gay. One woman even got sick benefits due to these protests. Sweden was the first country to declassify sexual orientation as a medical condition.

Sam: Those are the, I would say small moments that create huge social change – because what the government then sees is “I’m losing money.” And that’s pretty much the only way that the government’s going to take anything seriously, especially in our country. Um, is if there is, you know, some type of loss of capital,

Bri: They withheld that labor… They said no!

R: Like all legal rules, they were following, like they’re following the letter of the law – in the sense that they had a condition that was considered unacceptable in the workplace. So they stayed home just like the flu or something else. Like I think that was a really interesting way to bring up something like having a diagnostic manual that says “This thing is a treatable, curable condition” – to bring that up in a way that makes sense to people and to bring up sort of the hypocrisy of that. Um, and it was part of a larger movement in Sweden to get LGBTQ rights, but it was in 1979, there was a group of people that called in gay to work.

Sam: I love that actually – that’s, that’s, like reclaiming power and it’s a beautiful thing to hear stories like that.

Bri: Homosexuality was taken – uh, it was removed from the DSM in 1973. And so I was interested in knowing a little bit more of how that came about. Was it just a new volume that was released? Was there a lot of pushback – do you think is very much so reflective of what was going on? I mean, we had Stonewall that happened in 69 and all sorts of stuff…

Sam: A hundred percent. For any DSM, what happens is they have a committee for a DSM and, you know, honestly, I could probably show you, there’s a whole list of people who are on this committee and what they discuss is, you know, the political climate at the time. The social, cultural climate at the time and, and all of the tests and experiments and research, right? So they do exhaustive research. And I think the last DSM, I want to say it took nine years to come out or something of that. Like, it takes a long time to develop all of this information. It’s kind of like, um, grand meta analysis of all the research that’s been done. And so I hundred percent would agree that, yes, there’s political context to it. Just like with anything – but also the movements, of course, there’s going to be people that say, you know, this is what’s in the best interest of this group of people – and people who we might not even know the names of that were fighting to get that removed from the DSM. And, and all, all, all of those minds together – I think it really shaped the DSM. I hope from the research that people are doing in academia and all these people that gender dysphoria does get out of the DSM at some point, or there’s a better understanding from the community.

R: So the medicalization continues today, especially in terms of gender identity. Formerly called gender identity disorder – now it’s referred to as gender dysphoria, which encapsulates the same thing, but it’s a little bit different either way. It’s putting the trans experience into medical terms, which you would think would be a good thing. But in actuality, it’s saying that this is a condition that needs to be corrected and fixed, and there needs to be some sort of medical intervention to make this person that is clearly quote unquote “sick” better. So the idea that being diagnosed with gender dysphoria is the only way to be trans is that the qualification to have medical intervention – in this case, being given hormones, having gender affirming surgeries, um, even to having access to insurance and counseling and basic primary care – that you have to have this state of being at odds with your own body. Saying that’s the only way to be trans is super, super harmful, mainly because the idea of the ultimate goal of being trans is to be in an environment in which you don’t have that kind of disconnect between your mental state and your body. That gender dysphoria is a symptom of a larger society that doesn’t accept trans people. So the end result is to get rid of that entirely and just have a trans person be a trans person, and be able to say like, Hey, my gender that I was given at birth, when a doctor looked at my infant genitalia, doesn’t quite match how I feel about myself now. So like putting the trans experience into just one pathway limits people, especially when the pathway is faulty within itself.

Bri:Insurance, mental health, and queerness, I think especially gender queerness and being trans, I think is an interesting relationship there too, of having to get a diagnosis in order to receive the medical treatment that you need. And then have to go through insurance claims for that… is another, yeah. Another layer.

Sam: A lot of messy layers. And I could get on that soapbox for like an hour of how infuriating that is. Yeah. It it’s, it’s messy because, well, it’s, it’s saying that you have to have a professional to say that you’re not like invalid like that you are a valid human being. This is a valid experience. And when that’s not the case in so many other realms, you know, you don’t have to have four doctors telling you that you broke your arm. It’s just like, it’s this disconnect – it’s a stigma with mental health. And, and the fact that like, okay, I have to sometimes go to a lot of therapy before some therapists will write even a letter sometimes, you know, I mean, it’s all interconnected. The name change process, the hormones process, every single process that you go through, someone has to make sure that that’s what should be best for you in your body. And that’s what the U S has done for a lot of things. Unfortunately for people’s body is that they are saying, we have to agree with it. And that’s based on white cisgender heteronormative systems.

R: It removes a lot of power from the person as well. But the, like I know my body, I know myself, I know my identity. Why do I have to explain it in a way to you that you approve of it? And you know, that I’m whatever enough that I’m trans enough, I’m queer enough to get this process, to do this thing that will obviously improve my wellbeing. Like it removes a lot of, uh, autonomy by saying that I no longer can make a decision about myself. I have to rely on other people and to have someone else say, “no, no, no, no, no – you don’t know what’s going on” or “no, it’s not quite. It’s not, it doesn’t meet our standards. You only meet four of the five criteria. So you’re not technically this.” Like that removes a whole lot of control and choice. And that can be its own fear too.

Sam: Yeah. And I think it also comes with the notion that we think that trans looks like one thing. And even in that system, like thinking of trans in a binary system, um, it’s like, “This is what you have to do, you have to have gender dysphoria and then you have to do these steps.” And it’s like, no. Who, who said that? That’s your version of who you are that doesn’t make sense. Yeah. But unfortunately that’s, that’s what has to happen for some people to get insurance. And even, even then once we have a diagnosis for insurance purposes, insurance is like, “Nope, we’re only going to cover like 5%.” But yet when it’s with someone who is a cis male who needs testosterone because their hair is falling out, it’s completely covered.

R: Thinking of all those commercials that are like “hair loss” or like the low T thing where it’s like, “are you a man over 65? And you’re no longer having the energy” or whatever. Like those, you can, like, those are readily available. But for someone who arguably in my opinion, needs it more in terms of being able to have a better, more satisfying life. I would argue that a trans male or just someone who, uh, who’s trans masculine or someone that wants to use testosterone to get masculine features. Like that’s more important than some old guy who worries that he’s not like agile enough in the bedroom, like…

Sam: Right, exactly. Yeah. And it goes back to like cis white power that, that is deemed as more important than someone potentially losing their life to suicide because they can’t get the surgery that they want. They can’t get the hormones that they want or need. And that’s frustrating to me as a counselor, when you hear, you know, now that I’ve had hormones for this long, and I like myself, you know, and now I feel better, but it took me a hundred hoops to jump through. And that’s just so frustrating to me because people are talking about, Oh, how do we prevent suicide? Take care of someone. Be a human being, be decent. But yeah, unfortunately it’s not like that.

Bri: It’s almost like we’ve gone from the shift of, if you’re queer, you have a mental disorder to queer people today, very much so need mental health services, but distinguishing that. Because sometimes you could have people who are still saying your mental health, like issues and your queerness are the same thing. It’s like, you’re queer because you have mental health problems. You have mental health problems because you’re queer, but it’s like, no, like my mental health issues stem from the fact that I’m queer in a heteronormative society. Like, and I am trying to cope with that. And it has resulted in that – they aren’t connected. It’s not like all queer people have anxiety and depression –

Sam: We don’t have the power, right? Like, so in a heteronormative society, like of course there are going to be feeling things and being stressed and being anxious. And you know, all of these things that could be categorized as having a mental health concern, but we don’t have power. Of course we’re going to feel that way. We’re kind of the underdogs in a lot of situations. And so, yeah, I agree with you. It’s – one thing that I was taught in school that I really appreciated – was my teacher, I can remember we were studying in a multicultural class and so if you have, you know, this case scenario, queer person comes into your office, you know, like what questions are you going to ask? And, you know, he’s like “nothing different from anyone else.” Just because they are queer. It doesn’t mean they’re coming in because they’re queer. That that’s not the purpose. If they like, if they even tell you they’re queer on their first time. Cool. If they don’t, you know, it doesn’t matter unless they bring it up to you. Um, and so there is in training, the focus has shifted and being like, that’s just because that’s who they are doesn’t mean that that’s the problem. One thing that I hate is hearing instances where people who are, you know, of LGBTQ community will go into therapy and that’s the first thing that the, the counselor says like, “Oh, you know, you’re, you’re telling me about that. Or you’re trans and you must be in here because you’re – you have gender dysphoria.” I’m like, “no, I had issues with my mom.” You know, like it was nothing that was connected and, and we really need to get past that. So I feel personally in my training that there’s a shift, but there’s such a long way to go with that.

R: In that circumstance where you have an LGBTQ patient or someone who wants therapy, is there any benefit in the counselor or therapist being a member of that community, for instance, the same thing with racial or ethnic identities, they generally ask on forms “Do you want someone who is of the same demographic group as you?” Is there any benefit to that even though you’re supposed to treat people the same? Is there any benefit to having specifically queer counselors with specifically queer patients?

Sam: Yeah, for sure. Um, yeah, so, I mean, I hate giving this answer, but it’s a very counselor answer of: it depends. Right? So like, I can talk from my personal experience in seeing a counselor – that was something I wanted a counselor who is a social justice advocate and someone who was queer affirming and queer friendly, because I don’t want to have to explain myself to you. Right. And so if those weren’t two priorities, then I don’t want you as my counselor. But at the same time, I’ve also heard people saying, I want someone who doesn’t identify with me at all. Maybe because they are working through their queerness with their family members who don’t agree with them and they want a perspective from someone who’s not in the queer community. Um, so I think it really depends on what that person is wanting and needing. Are there benefits to it a hundred percent. And also, you know, I think every counselor should asterix be, you know, trained in how to work with any person. But I mean, personally, it just works whatever you’re comfortable with. I know for me, I feel a lot more comfortable around queer people and that’s just because I feel like there’s a mutual understanding there, but it just could depend. And I also think that representation is important too. So, you know, you mentioned like with people who are of a certain race requesting that person, it’s like representing that and seeing that as counselor, like that’s, so it’s such a beautiful thing when someone’s like, has not seen themselves represented in a healthcare profession or has maybe not been cared for by someone of a certain race or how they personally identify to have someone who just kind of gets you on that perspective.

R: But thinking to the – you had mentioned that there’s already an automatic mutual understanding when you go into a situation where you sort of have the same check boxes marked as the person that you’re talking with – and the, it takes that responsibility off of the marginalized person to explain their existence where in society, you’re pretty much told to justify why you’re here, why you feel this way constantly. So it’s like that, that relief that, Oh, thank you. I don’t have to explain all of this. And that can be really, really important. Like in my personal experience, it’s a lot easier to talk to someone who I can see, like they have the little rainbow flag, safe space thing in the corner. Um, just because I know that there’s not going to be that confrontation and that conflict specifically with your identity. And also as a mixed person, seeing someone who is – not like someone who having an environment in which there’s not just white doctors or white counselors – lets me know that they’re at least open to other perspectives and they understand that there are issues with race in medicine and treatment. So having that mutual understanding.

Sam: For sure. Yeah. And you know, if, and there’s also an availability issue as well and, and um, for mental health services for people. And so, you know, one thing I always tell people is you should never have to explain your identity to your therapist. If they don’t understand, they need to do research. So if you are at any point, you know, because of lack of availability, trying to find resources for people, and it’s not fitting – tell the therapist. Two puzzle pieces, they don’t fit, they don’t fit. And it’s their job to help find someone that does. And so, yeah, if you ever feel like you’re in a position where you’re just not understood for whatever reason, that’s okay, that’s not your job.

Bri: For more information regarding what we discussed in this episode, please be sure to check out our show notes. A transcript of this episode can be found on our website at queerscience.show. If you liked this episode, you can tell us why by tweeting at us at queer_science, you can also find us on Facebook as Queer Science or follow us on Instagram at queer_sci. We’re even on Tik-Tok too and you can find us at queerscience. The Queer Science! Team believes that educational content should be accessible to all – and we are a small team of 20 somethings working to bring this podcast to our audience for free. If you like our work, consider giving the cohosts a tip by supporting us at patrion.com/queer science. You can also donate to our GoFundMe, which allows for us to afford microphones, recording software and website upkeep. We also have merch featuring the Queer Science! logo and more original designs by our cohost R. Want to support us? You can find out more by checking out our website at queerscience.show.