Features | Society | East Asia

China Never Actually Removed Homosexuality From Its Official List of Mental Disorders

On the 25th anniversary of the Chinese Classification of Mental Disorders Version 3 (CCMD-3), we revisit the widely repeated claim that China “removed” homosexuality from its list of mental disorders in 2001 – and make the case for retiring it.

For decades, it has been conventional wisdom that homosexuality was “removed” from the Chinese Classification of Mental Disorders Version 3 (CCMD-3) in 2001. Media, scholars, NGOs, and international organizations have regularly cited the “removal” as a milestone in the history of China’s LGBTQ communities. In China, state media and government actors have also held up the “removal” to demonstrate progress on LGBTQ rights and even to deny the presence of the discredited practice of “conversion therapy” in China. Yet, since 2001, many healthcare providers, educational textbooks, and official actors in China have continued to treat homosexuality as if it were a mental disorder. The “removal” narrative puts the blame for this problem’s persistence squarely on insufficient implementation and public education. Through CCMD-3, the story goes, China achieved depathologization in policy but not in practice. However, the foundation of this story is a myth. CCMD-3 did not “remove” homosexuality. If one opens up CCMD-3 to the section on “psychosexual disorders” and then flips to the subsection on “sexual orientation disorders,” one will find there disorders simply named “homosexuality” and “bisexuality.” Now, this is where things get complicated. While CCMD-3 retained these diagnoses, it also described “sexual orientation disorders” as “not necessarily abnormal in terms of sexual behavior itself.” For comparison, its previous 1995 version categorized homosexuality as a “sexual perversion” and explicitly rejected the idea of treating homosexuality as “normal.” That CCMD-3 described homosexuality as “not necessarily abnormal” was a major milestone and would help bolster greater social acceptance. But why not just remove homosexuality altogether? CCMD-3 explained that the “main reason” for retaining homosexuality was that some individuals “may not wish to be this way or feel hesitant about it, and thus feel anxious, depressed, and distressed. Some people try to seek treatment to change.” The official English version rendered this last line as “change the sexual development and orientation.” CCMD-3’s lead drafter would later confirm that treatment for “homosexuality” indeed included conversion therapy. 

Far from “removing” “homosexuality” along with any rationale for conversion therapy, CCMD-3 retained “homosexuality” as a disorder and legitimized conversion therapy. This scrambled CCMD-3’s message and limited its impact in catalyzing social change. 

China is not alone in having taken an incrementalist approach. Psychiatric classification systems elsewhere also took halfway steps before completely depathologizing homosexuality. For example, in the decades before CCMD-3’s drafting, the American Psychiatric Association (APA) and the World Health Organization (WHO) had replaced “homosexuality” with diagnoses that only applied to people who were distressed by their homosexuality. These diagnoses distinguished between one’s homosexuality and distress about one’s homosexuality, considering the former as normal and the latter as pathological. According to the logic of these diagnoses, treatment could resolve distress either by helping one accept their sexual orientation or by helping one change their sexual orientation – i.e., pursue conversion therapy. CCMD-3 looked to these other systems as examples. Indeed, it explicitly sought to harmonize with the WHO’s classification system, including its position on homosexuality. However, CCMD-3’s principles stated that it had to balance international harmonization with China’s “national conditions.” Under these circumstances, CCMD-3’s position on homosexuality declined to do three key things that the other systems did. First, CCMD-3 did not make a firm statement that homosexuality itself is not a disorder. The WHO’s and APA’s classification systems had made such statements. Instead, CCMD-3 landed on the “not necessarily abnormal” language. All claims of homosexuality’s depathologization in CCMD-3 rest on this equivocal clause. Second, CCMD-3 did not make self-distress a clear diagnostic requirement of the disorder. APA and WHO clearly stated that only individuals distressed by their sexual orientation suffered from a disorder. While these diagnoses were still problematic, maintaining this distinction created a diagnostic threshold and........

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