How Homosexuality Was Removed as a Mental Disorder by the American Psychiatric Association

Time for change

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Fri Jun-01-07 02:57 PM
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How Homosexuality Was Removed as a Mental Disorder by the American Psychiatric Association

Edited on Fri Jun-01-07 03:50 PM by Time for change

This past weekend I was discussing with my daughter and her boyfriend the causes of homosexuality (A long standing interest of mine), and my daughter just happened to have with her a DVD which discussed how homosexuality went from being classified as a mental illness prior to 1973 to being NOT classified as any illness whatsoever. It is a very interesting and informative story, narrated on NPR by Alix Spiegel, the granddaughter of Dr. John P. Spiegel, the President-Elect of the American Psychiatric Association in 1973 when he signed off on the historic and permanent change that gave official recognition to homosexuality being re-classified as �a normal variant of sexual behavior� rather than as a mental illness.

Initial classification of homosexuality as a mental illness by the psychiatric profession

The psychiatric profession in particular and most other people in general had long considered homosexuality to be a mental illness. As such, it was classified as a mental illness in the official bible of the psychiatric profession, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was first published in 1952.

Alix Spiegel in her NPR narrative, titled �81 Words�, discussed two psychiatrists in particular whose research did much to contribute to the widespread impression of homosexuality as a mental illness: Irving Bieber and Charles Socarides. Today their research is rightly recognized as fatally flawed. The most crucial flaw in their research was that it was conducted among patient populations � in other words, populations that had already been either self-identified or identified by others as having mental problems. If one studies a population of people identified as having mental problems, one is likely to find � mental problems. In retrospect, that flaw in their research appears so obvious that it seems incredible that scientists could have repeatedly made such a mistake or that so many people would have bought into it. But such is the power of ingrained stereotypes that they often cause objective scientific judgment to fly out the window.

Yet, Bieber and Socarides were not what I think of today as bigots, in that it appears that their work was motivated by real empathy towards the homosexuals whom they treated and conducted their research upon. In fact Bieber, as a military psychiatrist, spent much of his time defending homosexuals against punishments (for their homosexuality) meted out by the military, arguing that homosexuality was an illness rather than a crime, so homosexuals should receive treatment rather than punishment and dishonor for their homosexuality. That was actually a progressive view at the time � at least within the U.S. military. After all, classification as a mental illness is a step up from classification as immorality or a crime. Therefore, I feel that it is unfortunate that Dr. Bieber later became the target of such hatred for his views.

The movement to de-classify homosexuality as a mental illness

By the late 1960s, as the Civil Rights movement was gathering steam, gay activist groups were springing up and aggressively questioning the classification of homosexuality as a mental illness.

Probably the researcher who did the most to turn the tide on this issue was Evelyn Hooker, a Ph.D. psychologist who had many gay friends who urged her to conduct research on this subject. Hooker obtained a grant from the National Institutes of Mental Health (NIMH) in 1953 to conduct that research.

In 1956 she startled the psychiatric profession and the world by presenting her research findings. Using standard psychological tests of the time, and having the results of those tests interpreted by psychological experts, it was found that, on average, there was no difference in mental health status between the homosexuals and the heterosexuals who participated in the study.

These findings set off a revolutionary change in the way that homosexuality was viewed, although it took the psychiatric profession several years to come around and accept the revolutionized view. In 1967 Dr. Hooker was appointed to a NIMH national task force to study and make recommendations on homosexuality. In 1969 the task force presented its findings, but President Nixon shelved the report because of its (for the time) liberal recommendations. It did, however, see the light of day in 1972. Matthew Kennedy notes and comments on the recommendations:

The Task Force published its recommendations: Additional research and education, intensive research on prevention and treatment of homosexuality, repeal of laws against consensual adult homosexual acts, and the abolition of employment discrimination.

The clause regarding treatment remained controversial, but Hooker defended her efforts to foster masculinity in effeminate boys. For her, this was a humane solution to a society that demanded heterosexual normalcy. While adoring her gay male friends for their intelligence and creativity, she nonetheless believed that any teenagers who were "teetering on the fence" should be encouraged toward a life with less suffering.

I find it interesting that the hero of the movement to de-classify homosexuality as a mental disorder nevertheless believed that it should be �prevented� and �treated�, an opinion that many homosexuals today (and perhaps in her day as well) would find offensive. This goes to show how much our opinions are dependent upon the prevailing views of our time. In a similar vein, Abraham Lincoln, who did more to abolish slavery in our country than any other single person, made numerous statements while campaigning for the presidency that would today be considered racist, though in his day they were considered quite liberal (which is why the South seceded from the Union).

Dr. Hooker�s research has been criticized on many grounds, some which are valid criticisms. Most important, by selectively choosing apparently healthy homosexuals for her research she made a mistake that was somewhat similar � but in the opposite direction � to the mistake made by previous researchers who claimed to prove that homosexuality was a mental illness.

But most of her critics miss the main point. To show that a research study is �flawed� is not to say that it doesn�t demonstrate some important findings. I don�t believe that any objective analysis of her research could conclude that it proves that homosexuals, on average, don�t have more mental problems than heterosexuals. Indeed, given the degree of prejudice and discrimination that so many of them face throughout their lives, I would be very surprised if they didn�t face a greater risk of mental problems. But demonstrating that should not be construed as evidence to warrant calling homosexuality a mental illness.

The main value of Dr. Hooker�s research was that it showed that it is eminently possible to have homosexual preferences without exhibiting signs of mental illness based on standard psychological testing. In the 1950s and 60s, that was an astounding revelation to most people, in and out of the psychiatric profession. And a major reason that that fact was so widely unappreciated was that the good majority of homosexuals in those days would not dare publicly admit to it.

The final crucial events that led the American Psychiatric Association to de-classify homosexuality as a mental illness

For several years following Dr. Hooker�s groundbreaking research, gay activists continued to agitate for de-classifying homosexuality as a mental illness, while most of the psychiatric profession continued to hold steadfastly to the existing stereotypes. It was a confrontation between single individual members from each of these two groups that provided the proverbial straw that broke the camel�s back: Ronald Gold of the Gay Activist Alliance, and Dr. Robert Spitzer, who was a member of the Nomenclature Committee for the American Psychiatric Association (APA).

At a meeting of the Association for the Advancement of Behavioral Therapy in October 1972, Ronald Gold led a group from the Gay Activist Alliance in protest demonstrations, thus disrupting the meeting. Dr. Spitzer vigorously confronted Gold over the disruptions, but then they got to talking about the issues, and Spitzer invited Gold to a meeting of psychiatrists to speak and discuss the issues that concerned him. Gold accepted the invitation and attended the meeting, where he spoke of disease classification as a tool of oppression. Later he invited Dr. Spitzer to a party held by a closeted organization of gay psychiatrists (known as the Gay PA) at a gay bar in Hawaii, after Spitzer told Gold that he wasn�t aware that any gay psychiatrists existed.

The Gay PA party turned out to be a shocking revelation to Spitzer, as he was amazed to recognize numerous prominent psychiatrists there. His conversations with them about their secret lives provided more shocking revelations, and Gold believes that it was that night that Spitzer, as a member of the Nomenclature Committee for the APA, sat down and wrote the draft recommendations that deleted homosexuality as a disease from the DSM.

In his arguments before the committee, Spitzer�s main point was that in order for something to be classified as a disease it must cause �subjective distress� in the victim. In the case of homosexual preference, it isn�t the sexual orientation itself that causes the distress, but rather society�s reaction to it. Spitzer�s recommendations were forwarded to the �Reference Committee�, headed by Alix Siegel�s grandfather, John P. Siegel, whose committee endorsed the change and forwarded it on to the President of the APA, who signed it and made it official.

Today, the percentage of American psychiatrists who believe that homosexuality is a �normal variant of sexual behavior� rather than an illness is over 90%, up from well below 10% in the early 1950s. In 1992 the APA took another big step towards the normalization of homosexuality, with the following official statement:

Whereas homosexuality per se implies no impairment in judgement, stability, reliability, or general social or vocational capabilities, the American Psychiatric Association calls on all international health organizations and individual psychiatrists in other countries, to urge the repeal in their own country of legislation that penalized homosexual acts by consenting adults in private. And further the APA calls on these organizations and individuals to do all that is possible to decrease the stigma related to homosexuality wherever and whenever it may occur.

The official change in the classification of homosexuality by the APA from an illness to a �normal variant of sexual behavior� has been instrumental in greatly reducing the legality of discrimination against homosexual men and women in the United States � though there is still a long way to go.

A final word on Robert Spitzer�s argument to de-classify homosexuality as an illness

The argument that provided the final push to re-classify homosexuality from an illness (or disease) to a �normal variant of sexual behavior� was amazingly simple and straight forward: It shouldn�t be classified as an illness because many or most people who have it experience no distressful symptoms as a direct result of it � and what distressful symptoms they do experience can be largely if not entirely attributed to the prejudice and discrimination directed against them by society. Homosexuality should no more be classified as an illness than having black skin or orange eyes.

No complex scientific studies were even necessary to make that determination. All it would have taken would have been to question a large number of homosexuals about the �subjective distress� that they did or did not feel as a direct result of their sexual orientation. Dr. Spitzer may not have even needed to do that to reach the conclusion that revolutionized the way that we think about homosexuality in this country. All it took for him was the shock of seeing so many people that he had known as mentally healthy individuals at a gay party � and it hit him like a bolt of lightning.

It should make us think long and hard about the way that we make decisions in this country.

And incidentally it turned out after the dust settled that John P. Siegel (Alix Siegel�s grandfather) was a gay man (previously closeted), as was Charles Socaride�s son, Richard Socaride, who went on to become President Clinton�s Special Assistant and organizer of the first White House Conference on HIV/AIDS. Charles Socaride, who spent his whole career arguing that homosexuality should be classified as an illness, went to his grave believing that he had failed his son by allowing him to become a homosexual.