Psychiatry has often claimed to be a medical discipline, and indeed psychiatrists (unlike psychologists) are usually MDs. However, we need to look critically at their tranfer of medical concepts to their discipline.
Until 1973 the American Psychiatric Association regarded homosexuality as a disorder. Then, after a vote was taken, the category was replaced--or rather modified, since for a time "ego-dystonic homosexuality" continued to rank as a disorder. Yet who ever heard of taking a vote to decide whether tuberculosis or cancer are disorders? Needless to say, I am glad that the denigration of same-sex behavior was modified, and later eliminated. Yet the way in which is was done seems strange. The fact that changes can be made so cavalierly, as it were, ought to elicit suspicion about the claims of the psychiatric establishment.
The results of this change and others were incorporated in the official APA volume, the Diagnostic and Statistical Manual (DSM). It was widely recognized that this compilation left a good deal to be desired, and a further revision was undertaken. Dr. Robert Spitzer labored intensely for seven years to make the work more comprehensive and precise. The result is known as DSM-IV (sometimes accompanied with other sufficxes to indicate the particular state).
Despite this effort many observers note that the DSM definitions are still lacking in transparency. That is to say, a patient who may be diagnosed by one clinician as bipolar may not be so regarded by another. As a rule such problems do not occur with disorders that are physiologically sited.
My learned friend on the Adriatic has said that ethnic self-hatred is a clinical entity. As I have shown, however, the category was invented by Theodor Lessing in 1930 and has since undergone various vicissitudes. It will not do simply to label ethnic self-hatred and gay self-hatred clinical entities without further discussion. By whose definition and under what criteria?
I do not doubt that there are some African Americans, for example, who suffer from a crippling sense of racial inadequacy. But is "self-hatred" the best way to characterize this condition? When one gets right down to it, how can one hate oneself in any fundamental fundamental sense? If one does, how can one stop? Yes, I am acquainted with the Freudian concept that depression is internalized aggression, and other such notions. But not one distinctively Freudian idea has survived the powerful acids of criticism that have been applied in the last few decades.
May I suggest that another way of addressing the matter of group low esteem in individuals who have this problem is the idea of false consciousness. In this concept, which arose in Marxist circles in the 1920s, the individual is seen as having come to entertain a distorted idea of his or her actual social situation owing to having assimilated ideas diffused by the power structure. These ideas have precisely the function of disabling those subaltern individuals who have accepted them. The remedy is to encourage the victim to acquire a more adequate understanding of his or her actual situation, setting aside the false beliefs that serve the interests of an alien authority, disempowering those who have been suborned to adopt them.
In the gay-liberation circles of the 1970s we formed many consciousness-raising groups. They functioned effectively, I believe, in throwing light on these disabling mechanisms--mechanisms that had been implanted in us in one way or another by the host society. We had not come, by some mysterious process to hate ourselves, but had been induced by various forms of propaganda and social cueing to embrace an inferior status. Through careful study the malign influence of such motifs can be exorcized. However, a diagnosis of self-hatred may persist, beyond hope of permanent cure. For if one has mysteriously fallen into such a state it may be that one can never get out of it. Or it may recur.