After a long battle over scientific, moral, political, and social issues, the American Psychiatric Association abandoned its official view of homosexuality as pathological.
The 1973 decision of the American Psychiatric Association (APA) to delete homosexuality from its list of pathological disorders grew out of a complicated struggle that spanned several years and confronted deeply held traditional beliefs about the psychology of homosexuals. With the rise of psychiatry in the nineteenth and twentieth centuries, homosexuality, considered a sin and a crime in Western religious and legal traditions, was categorized as a mental illness. Although they were unclear as to its genetic or environmental basis, most psychiatrists affirmed the call for treatment and “cure.” These assumptions were first challenged in 1948, when Alfred Kinsey,
Such research raised eyebrows but did little to change minds in the psychiatric establishment. The APA issued its first official list of mental disorders, The Diagnostic and Statistical Manual of Mental Disorders (DSM), in 1952, classifying homosexuality as a “sociopathic personality disturbance.” In the late 1950’s, Irving Bieber of the New York Society of Medical Psychoanalysts surveyed seventy-seven psychiatrists with comprehensive questionnaires on more than two hundred patients, half of whom were homosexual. The results confirmed assumptions of pathology, latent heterosexuality, and obsessive parent-child relationships.
During the 1960’s, the conceptual basis of psychology came under attack by “anti-psychiatrists” who questioned the deterministic view of behavior and saw moral bases to supposedly scientific formulations. At the same time, the Civil Rights movement, the women’s movement, and opposition to the Vietnam War created an atmosphere of activism that fed the anger and hopes of homosexuals. In 1968, the second edition of the APA manual, commonly referred to as DSM-II, reclassified homosexuality as one of the “non-psychotic mental disorders,” a slight liberalization. That same year, the attack on the psychiatric establishment began with protests at an American Medical Association lecture by psychiatrist Charles Socarides on the pathology of homosexuality and a Columbia University panel led by Lawrence Kolb
The spontaneous riots against police harassment at New York’s Stonewall Inn in June, 1969, are generally considered the birth of the gay liberation movement. After Stonewall, the goals of assimilation and accommodation, embodied by such gay groups as the Mattachine Society,
The activists changed their approach for the 1972 APA convention in Dallas. Robinson continued as liaison between the activists and the organization, but this time there was little disruption or ferocity. The Falk Foundation funded a gay booth under the title “Gay, Proud, and Healthy,” and the panel included Kameny, lesbian activist Barbara Gittings,
On October 8, 1972, during a protest by the New York Gay Activist Alliance (GAA) at a New York meeting of the Association for the Advancement of Behavior Therapy, Robert L. Spitzer, a member of the APA Committee on Nomenclature, was impressed by the activists’ arguments and presentations. Ronald Gold, one of the GAA leaders, convinced Spitzer to arrange a presentation to the committee and a panel at the 1973 convention devoted specifically to the listing issue. The meeting took place on February 8, 1973, with a written statement and oral presentation by Charles Silverstein
The meeting was reported in The New York Times. Bieber and Socarides mobilized by forming an ad hoc committee against the deletion of homosexuality from the manual. In May, the APA’s executive council urged patience and further consideration, but Spitzer, inspired by the research and the activists themselves, kept his promise and formed a mixed panel for the 1973 convention in Honolulu that included Bieber, Socarides, Marmor, and Gold. The session attracted nearly a thousand participants. Gold also took Spitzer to a Gay Psychiatric Association function, further convincing him of the need for action.
The two men drafted a moderate proposal to replace the word “homosexuality” with “sexual orientation disturbance” in DSM-II and also drew up a resolution supporting the civil rights of homosexuals. The Nomenclature Committee supported the resolution but was divided on the proposal. They sent it to the APA Council on Research and Development, which approved it in October. In November, the Assembly of District Branches of the APA and the APA Reference Committee also approved the proposal. All that remained was endorsement by the board of trustees. Bieber and Socarides were given time to present their arguments to the board, but, on December 15, a vote of thirteen to zero with two abstentions passed the proposal. The substitute listing, under “sexual orientation disturbance,” read as follows:
This category is for individuals whose sexual interests are directed primarily towards people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation. This diagnostic category is distinguished from homosexuality, which by itself does not necessarily constitute a psychiatric disorder.
The press proclaimed a gay victory, and the battle seemed over, but Bieber’s and Socarides’ ad hoc committee invoked APA procedure and petitioned for a referendum of the full membership. Such referenda were intended for administrative rather than scientific matters, but, despite criticism, the APA leadership granted the petition. Robinson obtained the support of Marmor and other prominent APA figures in a letter to the membership that was processed, with a minimum of publicity, by the National Gay Task Force
The deletion of homosexuality from the list of psychological disorders directly affected the two communities that were intensely involved in the controversy: homosexuals and psychiatrists. In the psychiatric profession, dissent and division persisted after the referendum. The ad hoc committee attempted to create a scandal by publishing the links between Marmor and the NGTF as well as that organization’s involvement in the support letter sent to the membership. In June of 1974, the board of trustees appointed a committee to investigate the ethics surrounding the referendum; in July, the signers of the letter denied any impropriety and took full credit for its content; and in December, the committee absolved them and the NGTF of wrongdoing in the writing and mailing of the letter and Socarides of wrongdoing in seeking media pressure in the controversy.
Each side of the deletion debate deplored the intrusion of politics into what should have been a strictly scientific determination. Opponents of the deletion believed that the APA had abandoned the evidence and bowed to pressure from outside the realm of psychiatric inquiry. Conversely, supporters applauded the APA for recognizing the evidence of sound scientific research and abandoning a hypothesis that was based not on fact but on morality. While both factions opposed the institutionalized discrimination that homosexuals faced throughout society, they differed on whether such discrimination derived from the orthodox psychiatric position and where, if at all, the rectification of social ills fit into the proceedings of a professional medical organization.
Within the APA, the deletion allowed gay psychiatrists, long forced into the closet by their own profession, to acknowledge their homosexuality. By the time of the 1975 convention, a gay, lesbian, and bisexual caucus had formed to fight discrimination in the profession and its training programs. Bruce Voeller, a former GAA president and leading activist on the NGTF, believed that the pathological categorization of homosexuality had contributed to decades of persecution. He urged the APA to take an aggressive role in fighting for equal rights for homosexuals in employment, housing, immigration, military service, divorce, adoption, and student organization. Although the APA rejected the proposal, avoiding a close alliance, its leaders spoke out occasionally on specific issues. Marmor, as the organization’s president in 1975, criticized the unconditional exclusion of homosexuals from military service; former president John Spiegel condemned school boards for not hiring gay teachers; and president Jack Weinberg, in 1977, protested the government’s refusal to naturalize homosexuals as U.S. citizens on the basis of psychopathology. Perhaps more telling, at least symbolically, was the replacement in the ubiquitous Comprehensive Textbook of Psychiatry of Bieber’s essay on homosexuality with one by Marmor.
The reorientation of the APA concerning homosexuality was part of a gradual shift in national attitudes. The momentum of the gay rights movement increased, and the lives of homosexuals became more open and free as institutional barriers fell and social acceptance grew. Like the APA, other institutions, especially religious and professional groups, were forced to reexamine their assumptions. The American Bar Association, the American Medical Association, and the American Psychological Association all supported the decriminalization of homosexual behavior. In 1975, the U.S. Civil Service Commission
In many ways, the 1973 decision of the APA was more symbolic than real, more a question of semantics than of practice. A large proportion of psychiatrists continued to view, and thus treat, homosexuality as an illness. The question of whether homosexuality per se should be part of any diagnostic formulation threatened to grow into a comparable crisis when it came up during the drafting of DSM-III in 1978. Pitted this time on the conservative side against Marmor, Spitzer found a compromise, and a replay of 1973 was avoided. The new diagnosis was called “ego-dystonic homosexuality”—characterized by a persistent lack of heterosexual arousal that interfered with heterosexual relationships, as well as persistent distress over unwanted homosexual arousal. The diagnosis of homosexuality was entirely removed from subsequent editions of the DSM.
The APA decision marked an important point in one of the ongoing human rights sagas in the United States. It forced psychiatrists, homosexuals, and the general population to search for objective truth among a maze of beliefs and values, and it crystallized in a single document the heated controversy over a complex aspect of human sexual behavior.
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Adam, Barry D. The Rise of a Gay and Lesbian Movement. Boston: Twayne, 1987. Traces the history of homosexual community and politics from medieval times through the 1980’s. Concise, well developed, and exhaustively referenced, this study maintains an expansive view of developments in both gay society and the world. -
Bayer, Ronald. Homosexuality and American Psychiatry: The Politics of Diagnosis. New York: Basic Books, 1981. Definitive work traces from start to finish the process that led to the 1973 deletion. Blends a wealth of facts and names and clear consideration of the issues into an enjoyable narrative. Comprehensive index. -
Cozic, Charles P., ed. Sexual Values: Opposing Viewpoints. San Diego, Calif.: Greenhaven Press, 1995. Unique volume of essays on sexuality is geared to the student, with prefatory questions and prescribed critical exercises. Contains opposing views on sexual issues, including the psychological basis of homosexuality, and implicitly explores the nature of debate on psychosexual subjects. -
Dean, Tim, and Christopher Lane, eds. Homosexuality and Psychoanalysis. Chicago: University of Chicago Press, 2001. Collection of essays examines the contentious relationship between same-sex desire and psychoanalysis and reexamines works by Freud, Lacan, and others. -
Karlen, Arno. Sexuality and Homosexuality: A New View. New York: W. W. Norton, 1971. Traces homosexuality through human history in cultural, social, political, and literary terms. Chapter titled “Cure or Illusion?” explores the medical debate. Includes bibliography. -
Teal, Donn. The Gay Militants. New York: Stein & Day, 1971. Comprehensive treatment of the incident at the Stonewall Inn and the gay liberation movement in the year that followed. Provides names, dates, and events with an appreciation of press reaction and influence. Provides an insider’s view, with rich, fast-moving, even frenetic prose. -
Willis, Stanley E. Understanding and Counseling the Male Homosexual. Boston: Little, Brown, 1967. Reflects the psychiatric approaches in the late 1960’s, under the pathological theory of homosexuality. Combines discussion of psychoanalytic roots with a compassionate, often patronizing, view to treatment and cure.
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