In the September 1 issue I enjoyed reading Dr. Alfred M. Freedman’s recounting of APA’s historic depathologizing of homosexuality in 1973. He is accurate when he states: "In DSM-III-R [ego-dystonic homosexuality] was deleted, and homosexuality no longer appeared, remaining absent in DSM-IV."

Both DSM-III-R and DSM-IV, however, retain "persistent and marked distress about sexual orientation" as an example of a "sexual disorder NOS." It’s never been clear to me why (other than perhaps reasons of third-party coverage for therapy) this isn’t fully and more properly included under the nonmental disorder maladjustment section (i.e., "Other Conditions That May Be a Focus of Clinical Attention") of "identity problem," which includes sexual orientation as one aspect of identity. If, in contrast, the stress arising from the awareness of one’s homosexual feelings causes excessive and maladaptive symptoms, then arguably an "adjustment disorder" would be a more appropriate diagnosis.

C. Leon McGahee, M.D.

St. Louis, Mo.