The section on deviant desires, to take one example, is denounced by advocates for alternative sexuality as stigmatizing those whose lusts, no matter how unusual, are harmless, or those whose erotic play, no matter how unsettling, is consensual. Should a man with a foot fetish be branded as mentally ill? Should a woman who finds ecstasy in being elaborately bound and enduring denigration or pain? Should such people be labeled with psychiatric diseases, though the rest of their lives have no serious dysfunction? Until 1973, homosexuality was among the D.S.M.’s disorders, and critics of the present chapter point to the condemnation the volume once inflicted on gay men and lesbians — condemnation that both reflected and bolstered the prevailing cultural perspective — by way of arguing that the current manual, the D.S.M.-IV, is full of unfounded and damaging sexual judgments. Many on the panel, which probably won’t, in the end, do much in the way of deleting conditions, maintain that the chapter on sexuality and gender identity doesn’t brand people too readily with disease. They note that, aside from exceptions like patients with pedophilia, only those who are distressed meet the threshold for diagnosis. In turn, the critics respond that such distress stems not from within the individual but from the infliction of societal standards, from the culture’s disapproval and aversion and therefore, in part, from the D.S.M. itself. This, they emphasize, was why the A.P.A. finally removed a last remnant of the homosexuality diagnosis — what was known as “ego-dystonic” homosexuality — in 1987.