Podcast: Psychiatry and Homosexuality

This week, All in the Mind rebroadcast a documentary from This American Life on the deletion of homosexuality from the DSM in 1973.  (Read the transcript or get the MP3.)

It’s a fascinating examination of a topic rarely discussed.

Homosexuality was once labeled a mental disease by psychiatry.  But in 1973 the challenge came from within.  The American Psychiatric Association had a change of heart.  And with the tweak of the 81-word definition of sexual deviance in its own diagnostic manual, lives were reclaimed, and values confronted.  Reporter and narrator Alix Spiegel tells the gripping story from the inside, revealing the activities of a closeted group of gay psychiatrists who sowed the seeds of change, amongst them her own grandfather, president-elect of the APA at the time.

AHP has previously presented a bibliography of the histories homosexuality in psychology, but a more precise version (specific to the APA decision in 1973) is appended below.

Further readings.

  • Drescher, J.  (2002).  Don’t ask, don’t tell: A gay man’s perspective on the psychoanalytic training experience between 1973 and 1991.  Journal of Gay & Lesbian Psychotherapy, 6(1), 45-55.

In 1973, the American Psychiatric Association adopted a normal variant paradigm of homosexuality and took the diagnosis out of the diagnostic manual. At the time, the decision was deemed unacceptable by much of the psychoanalytic community which tried to override the decision. The fervor with which mainstream psychoanalysis opposed this change meant that one of the implications of depathologizing homosexuality-namely nondiscrimination in the selection of openly lesbian and gay analytic candidates-was not officially accepted by the American Psychoanalytic Association (APsaA) until 1991. That period, between 1973 and 1991, roughly coincides with the time between the author’s receiving a college degree and the completion of his psychoanalytic training. This paper focuses on what those years were like for many gay men and lesbians seeking analytic training or treatment. The author believes several things can be learned from the experiences between 1973 and 1991. These include how institutional biases were rationalized by clinical theory; how difficult it is to separate a scientific theory from the cultural matrix in which it is formulated; and how vulnerable patients and trainees are to the human frailties and prejudices of their analysts, supervisors and teachers.

  • Friedman, R. C. & Downey, J. I.  (1998).  Psychoanalysis and the model of homosexuality as psychopathology: A historical overview.  The American Journal of Psychoanalysis, 58(3), 249-270.

A pathological model dominated psychiatric and psychoanalytic thinking about homosexuality until recently. This historical overview comments on psychoanalytic attitudes and assumptions that contributed to bias against homosexual people. This is discussed from an historical perspective, beginning with Freud’s complex and inconsistent views about homosexuality; he stated that homosexuality was neither a vice nor an illness and that it is not possible to change sexual orientation with psychoanalysis, yet other writings suggest that gay people compulsively flee from passionate relationship with people of the opposite sex. The review covers the relationship between American psychiatry and psychoanalysis in the 1940s, the attitudes of psychoanalytic institutes, psychopharmacology and psychoanalysis in the 1950s, S. Rado’s theory of sexual orientation, and the psychoanalytic treatment of homosexual patients prior to the APA referendum in 1973. It is concluded that, for much of the 20th century, psychoanalytic ideas have largely supported the concept that homosexuality is pathological. It is noted that this idea was not restricted to patients, but was applied to homosexual psychoanalysts as well, many of whom were rejected from psychoanalytic training on the basis of sexual orientation.

  • Kirby, M.  The 1973 deletion of homosexuality as a psychiatric disorder: 30 years on.  Australian and New Zealand Journal of Psychiatry, 37(6), 674-677.

Pays tribute to John E. Fryer, who was instrumental in changing the way the American Psychiatric Association viewed homosexuals and homosexuality, and discusses the 1973 deletion of homosexuality as a psychiatric disorder.

  • Mendelson, G.  (2003).  Homosexuality and psychiatric nosology.  Australian and New Zealand Journal of Psychiatry, 37(6), 678-683.

In this brief review I shall describe the status of homosexuality as a distinct diagnosis in several systems of psychiatric classification both prior to and after 1973, with an emphasis on the International Classification of Diseases and Diagnostic & Statistical Manual systems. Discussion of the social and political factors that contributed to the removal of homosexuality from psychiatric classifications, whether or not it falls within the definition of ‘mental disorder’, as well as a consideration of the clinical arguments advanced by proponents and opponents of that change, is outside the scope of this review. The interested reader is referred to the select bibliography at the end of this article.

  • Robertson, P. K.  (2004).  The Historical Effects of Depathologizing Homosexuality on the Practice of Counseling.  The Family Journal, 12(2), 163-169.

December 2003 marked the 30th anniversary of the American Psychiatric Association’s decision to remove homosexuality from its list of mental illnesses in the Diagnostic and Statistical Manual of Mental Disorders. The tolerance and acceptance of homosexuality as a normal sexual orientation have broadened the scope of ethical standards and therapeutic approaches when working with gay, lesbian, bisexual, and transsexual individuals. This review provides an overview of the circumstances leading to the decision and the effect it has had on the helping professions.

See also:

  • Krausz, E. O.  (1991).  Homosexuality as a compulsion neurosis.  Individual Psychology: Journal of Adlerian Theory, Research & Practice, 47(2), 285-293.

Presents a paper read by E. O. Krausz at the 1948 meeting of the American Psychiatric Association. Definitions of homosexuality are discussed, and working hypotheses about homosexuality are proposed based on therapeutic experiences. These suggest that (1) the term homosexuality is a misnomer, (2) homosexuality is a functional neurosis and as such is a compulsion neurosis, and (3) homosexuality does not represent a biological entity but a neurotic syndrome with as much chance for therapeutic success or failure as any other neurosis.

About Jeremy Burman

Jeremy Trevelyan Burman is a senior doctoral student in York University’s Department of Psychology, specializing in the history of developmental psychology and its theory (especially that pertaining to Jean Piaget). Prior to returning to academia, he was a producer at the Canadian Broadcasting Corporation.

2 thoughts on “Podcast: Psychiatry and Homosexuality

  1. As a retired high school teacher, I hope the above is covered in psychology classes. While today’s youth are far more tolerant, accepting, and supportive of gays and lesbians than their parents, it would reinforce their own progressive thinking. It would also help them to understand how pervasive and recent the discrimination was by professionally educated people who were in charge of the souls of their patients.

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