PSYCHOLOGY’S SHIFTING MODELS OF IDENTITY: CLASSIFICATION, REVISION, AND REMOVAL

Opening Scene: The Page That Disappeared

If you opened the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1972, you would have found homosexuality listed as a mental disorder. In 1973, if you opened the same, you wouldn’t find it. So, what changed?

Here’s the thing: nothing changed in those twelve months. Not biologically. There were no gene mutations, no new brain scans to reveal a hidden structure. There hadn’t been a pharmaceutical breakthrough rendering the category obsolete. No, the change came about because the American Psychiatric Association took a vote, which led to a page revision removing the diagnosis, retroactively rendering millions of people no longer sick.

In part, this moment can be seen as a triumph of science over prejudice. Unfortunately, there was also something more unsettling at play. This moment demonstrated how profoundly identity in the modern world is mediated by institutional classification.

If all it takes to change someone’s status from “mentally disordered” to “normal variation” is a simple committee vote, then the story we tell about psychology as a purely discovery-based enterprise becomes harder to sustain. It’s important to understand the DSM doesn’t simply describe human nature—it stabilizes it, drawing borders around behaviors to declare them medical. The DSM offers names that harden into identities.

We can’t look at the story of psychology over the last century as one of scientific refinement. We have to look at it for what it truly is: a story of classification, revision, and removal—a choreography between culture and clinic.

Classification: Turning Experience Into Condition

The DSM first came to be in 1952, part of a larger project within the psychiatry community, but quickly spread to broader society. The DSM was designed to bring coherence to psychiatry and standardization to post-war America. There needed to be a shared vocabulary among courts, hospitals, insurers, and researchers. Having a classification system solved that problem, creating the necessary language required for these systems to talk to each other.

When we name something as a disorder, we relocate it. Naming something that might previously have been described as eccentricity, sin, weakness, or temperament makes it medical. It acquires codes from the DSM. It becomes something a doctor can bill for. We name it so it can be studied, tracked, treated, and managed. But we can’t call this transformation trivial. Naming a disease or disorder changes how people see and understand themselves and others.

Beginning with Sigmund Freud’s influence, mid-century psychiatry framed sexuality, gender variance, and other behavior forms as developmental deviations. Over time, these theories became categories, leading to entries in the DSM, which filtered out to courts, schools, and families. Classification has a quiet force, making it feel explanatory rather than coercive.

Although it may change lives immeasurably, receiving a diagnosis can also bring a sense of relief. Having a concrete name for feelings can make it easier to figure out how not to feel that way. We have a name for what we are, what we have. In addition to legitimizing suffering, having the vocabulary for our feelings can help crystallize identity around pathology. The DSM isn’t merely a book. It is so much more—a cultural artifact with institutional backing. By naming something in the DSM, we help it enter broader society.

The Vote: When Categories Move

While it was voted on by APA members, removing homosexuality from the DSM didn’t come from anything happening in a lab. The decision to vote came from years of activism, internal debate, and shifting cultural norms. Psychiatrists were facing growing tension between the day’s research and moral assumptions made by broader society.

This is not to say there wasn’t significance to the vote made by the APA. There is no doubt about the significance of that vote, but it goes beyond what was removed from a book. This vote, and the years of research and debate that led to the vote, revealed that diagnostic categories are dynamic, rather than static. Yes, there needs to be data to back them up, but more importantly, there are cultural thresholds and institutional self-understanding.

By declassifying homosexuality as a disorder, psychiatry showed a capacity for correcting itself, while showing the boundary between illness and variation is moveable and ever-changing. By removing an entire category, the APA showed that identity categories are administrative, rather than geological formations.

Declassifying this didn’t dismantle the APA; it simply showed there was willingness to adjust their thought processes and beliefs.

Revision: Renaming Without Surrendering Structure

Transformation isn’t always dramatic. Transformation doesn’t always mean removing a category—there can be category refinement, too. Language is constantly changing. Emphasis shifts. But the key to it all is that the diagnosis remains.

In the fifth edition of the DSM, Gender Identity Disorder morphed to Gender Dysphoria, with the goal of focusing on distress rather than identity as a way of reducing stigma. This revision showed how and what words matter while preserving the ability to diagnose the disorder. Diagnostic language is important to maintain insurance coverage for medically necessary interventions.

While a diagnosis may be difficult to come to terms with, having one can open up resources that might not have been available prior to diagnosis. However, this is a double-edged sword of sorts: communities may want to resist pathologization while maintaining the practical necessity of having a concrete diagnosis in order to take advantage of available resources.

Thus, we need to be careful when making revisions. We have to adjust the language we use as we seek to maintain institutional access. We need to avoid ideology while preserving scientific credibility.

It is not just within gender where these patterns have been found. Autism expanded to be a spectrum, establishing new ways of supporting those on the spectrum. By renaming Multiple Personality Disorder to Dissociative Identity Disorder, hysteria dissipated to appear in other categories.

It should be noted that removal from the DSM is rare, while mutation is more common. The DSM isn’t getting smaller across the years; instead, we are revising how disorders and diagnoses are classified.

Removal: Erasure or Transformation?

When people speak of removing a diagnosis from the DSM, it’s never entirely erased—there will always be traces of that diagnosis. Hysteria, previously mostly applied to women, has simply been redistributed following its initial appearance in the DSM. The behaviors still exist; they just go by another name. The same applies to homosexuality. The stigma didn’t vanish overnight—it took years for cultural attitudes to change (and there will likely always be a stigma among some societal groups).

Removal can lead to liberation, but it can also lead to concealment in that it may be reclassified to a different category, changing, but not erasing, the stigma. Committees evaluate and re-evaluate criteria many times between editions of the DSM; revisions are made, decisions are recorded. To the APA, it is, simply, procedure.

The Loop: How Categories Create the People They Describe

The diagnostic categories within the DSM are not confined to psychiatrists’ offices or within clinics. The DSM is available to anyone who wishes to have access, but more than that, the diagnoses become mainstream. People see themselves in books, in films, in television shows. They meet people in real life and online who are like them, creating community where there previously wasn’t. Language develops around a diagnosis.

In doing this, a feedback loop is created: the condition is named, language is adopted, cases are generated, research develops based on those cases, refining the criteria, which in turn creates categoric stability.

Finding a list of symptoms or having a diagnosis can help cohere internal turmoil and shape perception. Getting a diagnosis makes temperament, stress, or confusion legible. Once we understand what’s happening, we can take steps to adjust or fix it. We no longer have to struggle—we can firmly say we have ADD or autism or whatever we have been diagnosed with. The language of disorder transforms into the language of self.

Institutional Neutrality and Cultural Drift

Today, psychology can be seen as empirical, data-driven, and neutral. Additionally, psychology and psychiatry are more methodically rigorous than before. This began with the DSM-III, which held greater diagnostic reliability and preferred observable criteria over theoretical speculation. However, reliability does not equal permanence.

We can’t ignore the boundary between disorder and difference. It is still porous, but there is more pressure for adjustment: cultural change, activism, insurance systems. Diagnostic language is referenced in courtrooms, schools use it to establish accommodations for their students. Classification is everywhere.

In modern society, stability is important. We want to know what counts as illness, what variation looks like, and what is considered normal. We can get that, albeit temporarily, stability from the DSM. However, the DSM’s revision history shows that stability is negotiated, not discovered. Diagnostic classification helps to manage ambiguity, while revision manages dissent and removal manages embarrassment.

The Present Tense

We live in a time when identity language proliferates faster than institutional consensus can consolidate it. Social media increases the spread of diagnostic terminology, making self-diagnosis more common. Communities form before professionals can render official judgments. Institutions lag behind culture. It is only once they catch up that they can respond and revise.

The deeper question is not whether any particular identity is real. We need to be asking how reality is filtered through institutional frameworks. When does difference morph into disorder? How does disorder become variation? Who gets to answer those questions, make those decisions?

The answers are never purely scientific. They are shaped by values, incentives, and historical context.

Psychology’s shifting models of identity do not prove that identity is fictitious. They demonstrate that identity in modern society is mediated—stabilized through classification, softened through revision, occasionally erased through removal.

If the last century has taught us anything, it is that the most stable feature of psychological identity is not the diagnoses themselves. It is the institutional impulse to name, manage, and reorganize them. The manual will be revised again. And with it, some of us.