Today In History: APA Removes Homosexuality from List of Mental Disorders
December 15th, 2008
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-I) classified homosexuality as a mental illness beginning in 1952. Before then, psychiatrists and psychologists looked at homosexuality as a perversion and as a deviant behavior, but the idea that it was a mental illness was considerably more controversial. Sigmund Freud, the father of psychoanalysis, famously wrote to one American mother in 1935, “Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness.”
But by the early 1950’s American society’s view of homosexuality took a very sharp turn toward the dark side. This turn was partly sparked by the loud controversy stirred by Alfred Kinsey’s Sexual Behavior in the Human Male in 1948. Where before, homosexuality was little talked about; now it seemed suddenly to be everywhere. In the minds of Americans across the country, homosexuality now joined the other emerging threat, communism, as two great menaces to American order. By 1952, there had already been several purges of gays from federal employment. With the APA’s addition of homosexuality to its list of mental disorders, the fates of gays and lesbians would be sealed for the next two decades.
And as is always true in the medical and psychiatric fields, where there is an illness, there’s a quest for a cure. This was true for homosexuality long before 1952, and unfortunately it is still true today in some unenlightened circles. For the most part, the cure consisted of ordinary forms of talk therapy. But other, more abusive forms of therapy — namely electric shock therapy or therapies involving severe nausea-inducing drugs — weren’t exactly rare. And, of course, as long as gays and lesbians were labeled “mentally ill,” all manner of discrimination was made possible against those who officially declared to be operating under a mental impairment.
Thirty-five years ago today, on December 15, 1973, all of that began to change when the American Psychiatric Association’s Board of Trustees “cured” millions of gays and lesbians across America when they voted to pass this resolution (PDF: 464KB/5 pages):
For a mental or psychiatric condition to be considered a psychiatric disorder, it must either regularly cause subjective distress, or regularly be associated with some generalized impairment in social effectiveness or functioning. With the exception of homosexuality (and perhaps some of the other sexual deviations when in mild form, such as voyeurism), all of the other mental disorders in DSM-1 fulfill either of these two criteria. (While one may argue that the personality disorders are an exception, on reflection it is clear that it is inappropriate to make a diagnosis of a personality disorder merely because of the presence of certain typical personality traits which cause no subjective distress or impairment in social functioning. Clearly homosexuality, per se, does not meet the requirements for a psychiatric disorder since, as noted above, many homosexuals are quite satisfied with their sexual orientation and demonstrate no generalized impairment in social effectiveness or functioning.
The only way that homosexuality could therefore be considered a psychiatric disorder would be the criteria of failure to function heterosexually, which is considered optimal in our society and by many members of our profession. However, if failure to function optimally in some important area of life as judged by either society or the profession is sufficient to indicate the presence of a psychiatric disorder, then we will have to add to our nomenclature the following conditions: celibacy (failure to function optimally sexually), revolutionary behavior (irrational defiance of social norms), religious fanaticism (dogmatic and rigid adherence to religious doctrine), racism (irrational hatred of certain groups), vegetarianism (unnatural avoidance of carnivorous behavior), and male chauvinism (irrational belief in the inferiority of women).
The New York Times alerted the world with this Page One announcement:
The American Psychiatric Association, altering a position it has held for nearly a century, decided today that homosexuality is not a mental disorder. The board of trustees of the 20,000 member organization approved a resolution that said in part, “by itself, homosexuality does not meet the criteria for being a psychiatric disorder.” Persons who are troubled by their homosexuality, the trustees said, will be classified as having a “sexual orientation disturbance” should they come to a psychiatrist for help.
The full APA would go on to ratify the policy statement on April 9, 1974. But attempts to cure homosexuality would continue under a new illness inserted into the DSM as a compromise in 1974. Sexual Orientation Disturbance (SOD) defined homosexuality as an illness if an individual with same sex attractions found those attractions distressing and wanted to change. The new diagnosis served the purpose of legitimizing the practice of sexual conversion therapies, even if homosexuality per se was no longer considered an illness. The SOD diagnosis also allowed for the unlikely possibility that a person unhappy about a heterosexual orientation could seek treatment to become gay. Reflecting the realities of clinical practice, 1980’s DSM-III changed SOD to “Ego Dystonic Homosexuality” (EDH). That diagnosis was finally removed in 1987, but resurfaced as a brief mention under “Sexual Disorders Not Otherwise Specified”, which describes persistent and marked distress about one’s sexual orientation.
Update: The last paragraph describing subsequent diagnoses was revised and clarified, with thanks to Dr. Jack Drescher.