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You don't seem to acknowledge that different order preferences contradict one and other. I would define a psychological illness not in terms of social approval but subjective higher order preference: a psychological illness is a behavioral pattern or psychological trait that people who possess it would rather not possess. Would you acknowledge that someone can both be addicted to heroin, and thus have the impulse to do heroin, and also have the desire to not have said impulse?

By my definition, then, for a homosexual who wishes he could be cured of his homosexuality, his sexuality is a disease. Whether we classify a trait as a disease usually depends on whether those who have it would rather not have it (except in cases where the behavior harms others, but I think that's a minority of psychological illnesses). Sometimes, as in the case of homosexuality, that's culturally determined, but for some traits, like extreme addictions, or OCD or attention deficit disorder, these are behavioral patterns that few people in any society want to keep if they can help it. You can redefine them as preferences if you please, but this seems like a purely a semantic victory. Fine, then they're preferences that people would, at a higher level, prefer not to have. The only important question is whether psychiatry is effective at curing people of these adverse 'lower order preferences.' Unless Bryan is positing that most people don't actually want to be cured of them.

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