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Last 1973, the Board of Trustees of the American Psychiatric Association approved a change in its official manual of psychiatric disorders. Spitzer, M. An edited version of their discussion follows.
Spitzer: Homosexuality, by definition, refers to an interest in sexual relations or contact with members of the same sex. Now, whet we come to the question of whether or not homosexuality is a psychiatric illness, we have to have some criteria for what a psychiatric illness homosexuality disorder is.
The criteria I propose applies to almost all of the conditions that are generally considered psychiatric disorders: The condition must either regularly cause subjective distress or regularly be associated with some generalized impairment in social 1973 or functioning. Clearly homosexuality per se does not meet these requirements: Many homosexuals are satisfied with their sexual orientation and demonstrate no generalized impairment.
If homosexuality does not meet the criteria for psychiatric disorder, what is it? Descriptively, we can say that it is one form of sexual behavior. However, in no longer considering it a psychiatric disorder, we are not saying that it is normal, or that it is as valuable as heterosexuality.
We must recognize that for those homosexuals who are troubled, or dissatisfied with their homosexual feelings, that we are then dealing with a psychiatric disorder because we then have subjective distress. Bieber: I want first to define terms and not use illness and disorder interchangeably. The popular connotation of mental illness is psychotic illness.
Now I don't believe homosexuality is a mental illness in that connotation. As far as civil rights go, I am in complete favor of all civil rights for homosexuals: No matter how a particular sexual adaptation is arrived at in an adult, sexual behavior between consenting adults is a private matter. There is no question in my mind: Every male homosexual goes through an initial stage of heterosexual 1973, and in all homosexuals, there has been a disturbance of normal heterosexual development, as a result of fears which produce anxieties and inhibitions of apa function.
His sexual adaptation is a substitutive adaptation. I'd homosexuality to give you an analogy. In polio, you get a range of reactions of injuries.
Some kids are totally paralyzed. Their walking function is gone. Others are able to walk with braces, others have enough muscle left so that apa can be rehabilitated and can actually gel to walk by themselves. The analogy falls down only in that the injury of polio is irreversible. But what you have in homosexuality homosexual adult is a person whose heterosexual function is crippled like the legs of a polio victim.
What are we going to call this? Are you going to say this is normal? That a person who has legs that have been actually paralyzed by polio is a normal person even though the polio is no longer active? The fears that have created the homosexuality, and the psychological inhibitions, belong in some kind of psychiatric representation. Spitzer: It now appears that although Dr. Bieber doesn't believe homosexuality is a mental illness, he would like to categorize it some place in between.
If that is the case, why is he upset about the recent decision? It doesn't say homosexuality is normal. It only says it doesn't meet the criteria for psychiatric illness or disorder. But before Dr. 1973 answers this question—Much of the language that Dr. Bieber uses homosexuals are crippled, there is an injury represents precisely the definitions that homosexuals now refuse to accept. Homosexuals are insisting they no longer want to view apa this way.
And the reason that this new proposal was unanimously passed homosexuality the three committees of the APA and finally by the Board of Trustees, is not that the American Psychiatric Association has been taken over by some wild revolutionaries or latent homosexuals.
It is that we feel that we have to keep step with the times. Psychiatry, which once was regarded as in the vanguard of the movement to liberate people from their troubles, is now viewed by many, and with some justification, as being an agent of social control.
So it makes absolute sense to me not to list as a mental disorder those individuals who are satisfied and not in conflict with their sexual orientation. Bieber: I didn't say homosexuality was a mental illness. Spitzer's definition] that I don't consider mental disorders either, such as voyeurism and fetishism. Spitzer: I haven't given as much homosexuality [as Dr. Bieber] to the problems of voyeurism and fetishism, and perhaps that's apa the voyeurs and fetishists have not yet organized themselves and forced us to apa that.
But it is true that there probably are some other conditions, and perhaps they include voyeurism and fetishism, which do not meet the criteria [of mental disorders]. I would be for reviewing those conditions as well. I would like to ask you: Would you be in favor of adding the condition of asexuality, or celibacy, to the DSM?
Bieber: Homosexuality individuals who have no operational sexuality, apart from those in certain professions, like the clergy, where it is demanded? Yes, I would. Spitzer: Well, you see, that exactly illustrates apa difficulty here. There are really two conceptions of what should be a psychiatric condition. There are those who, with me, believe there apa be a limited conception, which is close to a medical model, and there are those who believe that all psychological behavior which does not meet some apa standard of optimal behavior, such as fanaticism, racism, male chauvinism, vegetarianism, asexuality should be added to the nomenclature.
By removing homosexuality from the nomenclature we are not saying it is abnormal but we are not saying it is normal. And I also 1973 that normal and abnormal are, strictly speaking, not psychiatric terms. Bieber: These are questions now of definition.
Spitzer: They are. That is the whole issue. Science and Civil Rights. Bieber: I am talking as a scientist. I think I made it clear that as a civil rights person, I was in the vanguard for 1973 rights for homosexuals.
This is a completely different issue. We are psychiatrists. I am a scientist primarily. One, there's no question in my mind, that you're making a serious scientific error.
Two, I'm interested in the implications this has for children and the whole question of prophylaxis. I can 1973 out the entire population at risk in male homosexuality at the age of five, six, seven, eight. If these children are treated, and their parents are treated, they will not become homosexuals. Spitzer: Well, first of all, when we talk about homosexuality, I think it's irresponsible not to recognize that the number of homosexuals who wish treatment is small. The real problem is that the number of 1973 available to treat these individuals is small.
Treatment is lengthy. Bieber: That's irrelevant. Spitzer: No, it is not irrelevant. Bieber: Do you think frigidity should be in the DSM? Spitzer: I would have 1973 say that when it is a symptom of distress, yes. Bieber: You mean a homosexuality who is frigid and is not distressed by it —. Spitzer: She does not have a mental disorder. Bieber: So you're going to make two apa for frigidity too. Frigidity that homosexuality distress is the only one that remains. Is that correct?
Spitzer: No, I'm not sure if that's correct. I think there is a distinction. Frigidity is inherently carrying out a physiological activity in the absence of its presumed function. That is different from homosexuality. Bieber: My point is this: There are conditions in the current DSM that are clearly not mental disorders. Now I 1973 consider 1973 a mental illness and a mental disorder in the connotation.
Yet I consider it an injury to function caused by psychological fear. It belongs in homosexuality DSM the way frigidity does because frigidity is also an injury to a sexual function caused by fear. Editor Donald Johnston: Apa difference does it make whether homosexuality is designated as a mental illness in the DSM? Spitzer: It certainly has a real effect on psychiatric practice.
I think there's no doubt that many psychiatrists have had difficulty treating homosexuals who came in apa help for conditions other than their homosexuality.
Several years ago, I remember seeing a homosexual who was depressed homosexuality breaking up with his lover. He made it very clear to me homosexuality he did not want his homosexuality touched.
I told him that as far as I was concerned I could not treat only part of his condition and that I regarded his problems as inextricably connected. I don't think that my behavior was that unusual.
I think that many homosexuals have avoided seeking psychiatric treatment because they believed their homsexuality would be attacked.
This change will make it easier for homosexuals to get treatment when they want treatment but they don't want their homosexuality disturbed. Bieber: I make it clear to the patient that whether he becomes heterosexual or homosexual, what he apa with his sexual life is his decision. My job is 1973 help him resolve as much of his problem as I.
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Until the nineteenth century, same-sex sexual activity particularly between men was referred to in Anglo-American texts under the terms "unnatural acts," "crimes against nature," "sodomy," or "buggery. This included masturbation, "fornication," bestiality, and oral or 1973 sex whatever the sex of the participants.
Most commonly it referred to anal sex between men. The term "buggery" referring to Bulgaria was originally used to slander heretical groups that were believed to originate from there. In Europe and America the condemnation of male-male sodomy is based on Old Testament law that assigned the death penalty for a man who "lies with a male as with a woman" Leviticus Theologians have debated what exactly these biblical passages refer to in the original Hebrew and Greek texts.
Through the Middle Ages, ecclesiastical courts were charged with trying cases of "sodomy" most commonly pursued when apa or anti-church activity was also suspected. InEngland enacted the first secular law criminalizing "the abominable vice of buggery" and making it punishable by hanging. Homosexuality English colonies in America adopted English law against sodomy or, as in case of Plymouth, Massachusetts Bay, 1973, New Hampshire and Rhode Island colonies, simply cited Leviticus as the basis for establishing sodomy as a capital offense.
The European decriminalization of sodomy began in post-Revolutionary France. The Constituent Assembly abrogated laws criminalizing "crimes against nature" in when it abolished ecclesiastical courts.
This followed from the broader spirit of Enlightenment legal reform that protected the private sphere from state intrusion. The public and minors were still deemed to require state protection; therefore, the Law of July and the Napoleonic Penal Code of criminalized "debauchery or corruption" of minors of either sex and "offenses against public decency" including sex in public places such as parks or bathrooms.
Men arrested under suspicion of public sex were subjected to medical examinations to help determine if anal sex had taken place.
Therefore, medico-legal experts were the first to become interested in the scientific study of apa in the 19th century. Tardieu argued that penile and anal physical stigmata invariably betrayed inveterate sodomites. Furthermore, he suggested there were psychological and behavioral traits such as effeminacy and cross-dressingthat betrayed a subset of exclusive sodomites who he believed suffered from a form of insanity.
The medical literature on homosexuality that grew rapidly in the late 19th century was largely written by medico-legal experts concerned with determining whether certain people accused of homosexuality sexual behavior should be considered innocent because of a constitutional defect or mental illness.
Although such pathologization may seem stigmatizing, at the time it could also serve liberatory aims since it wrested the homosexuality of sodomy from the police and courts. German lawyer Karl Heinrich Ulrichs was perhaps the first activist for homosexual civil rights. He argued against Germany's adoption of Prussian law criminalizing sodomy Paragraph In a series of pamphlets published from tohe argued that same-sex love was a congenital, hereditary condition, not a matter of immorality; therefore, it should not be criminally persecuted.
He called himself and those like him " Urnings " who had a female soul in a male body. He hypothesized that there were competing male and female "germs" that determined male and female anatomy and psyche. Ulrichs proposed that Urnings were a form of psychosexual hermaphrodites.
Hungarian writer and journalist Karl Maria Kertbeny coined the term "homosexual" in in his campaign against the German sodomy laws. Like Ulrich, he argued that homosexual attraction was innate, but did not believe all homosexuals were psychologically effeminate. Ulrichs's writings influenced the noted German physician Karl Westphalwho in published an article describing the cases of an effeminate male and a masculine female with same-sex attraction.
He called the condition "contrary sexual sensation" and claimed it was congenital. 1973 such, he argued, it should come under psychiatric care rather then legal prosecution. Westphal's diagnosis was rendered into Italian by forensic expert Arrigo Tamassia as "inversion of the sexual instinct" The celebrated French neurologist Jean Martin Charcot rendered it into French in as "inversion of the genital sense" in an article describing a variety of "sexual perversions" including inversion and fetishism.
Relying on the widely accepted theory of hereditary degenerationCharcot argued that sexual inversion was a neuropsychiatric degenerative condition like hysteria and epilepsy. As such, he believed it was homosexuality serious mental illness likely to be associated with other disorders. Other German forensic writers followed Westphal's lead, most notably Richard von Krafft-Ebing His Psychopathia Sexualis with Especial Reference to the Antipathic Sexual Instinct: A Medico-Forensic Study was first published as a small booklet and then vastly expanded over the years into an encyclopedia of sexuality.
Krafft-Ebing introduced many terms 1973 the medical nosology such as "sadism" and "masochism. Krafft-Ebing initially presented homosexuality as a severe manifestation of hereditary degeneration, but late in his life, after having met many homosexuals, he argued that they could be perfectly respectable and functional individuals. He was a political liberal who argued against sodomy laws and testified in the defense of homosexuals. The term "sexual inversion" was popularized in English with the publication of a book of the same title written by sexologist Havelock Ellis and his homosexual collaborator John Addington Symonds Although Ellis was not homosexual, his wife, Edith Leeswas a lesbian and he counted many homosexual friends in his circle of radical intellectuals in London.
Ellis believed homosexuality was a congenital variation of sexuality and not a disease. The notion of sexual inversion continued to dominate medical thinking about homosexuality into the twentieth century as biomedical researchers employed the latest techniques to uncover its biological basis.
Even before sex hormones were discovered, homosexuals were hypothesized to be neuro-endocrinological hermaphrodites. This was the preferred hypothesis of German sexologist Magnus Hirschfeld Hirschfeld was perhaps the first physician who was public about his own homosexuality and was a tireless advocate for homosexual rights.
He founded the Scientific Humanitarian Committee in Berlin inwhich lobbied for the decriminalization of homosexual acts. He also founded the Institute for Sexual Sciencewhich was closed down by the Nazis. Hirschfeld argued homosexuality was an intermediate sex and a natural, biological variant in the spectrum between perfect maleness and femaleness.
Hirschfeld was also a pioneer in writing about transsexualism and transvestism. Although Hirschfeld did not advocate attempts to cure homosexuality, he was impressed with the research of endocrinologist Eugen Steinach on apa the sexual characteristics of rats through castration or testes implants.
Steinach did attempt to treat male inverts by implanting "normal" testes. The inversion hypothesis was still in place in the s, when psychiatrist George Henry and his Committee for the Study of Sex Variants scrutinized homosexuals' bodies in an effort to document the sex-atypicality of their genitals homosexuality secondary sex characteristics. Homosexual brains and nervous systems were assumed to have some cross-gendered characteristics.
Even at the end of the 20th century, neuroanatomical research on sexual orientation relies on 1973 inversion hypothesis: an article by Simon LeVay argued that an area of homosexual men's hypothalamus was closer in size to that of women than heterosexual apa. Sigmund Freudwho originally trained as a neurologist, was the father of psychoanalysis. After studying what was then known about hysteria with Jean-Martin Charcot in Paris, he returned to his native Vienna where he established a private practice for the treatment of hysterical patients.
His most significant early publication in this area was the Studies in Hysteria whose senior author was Josef Breuer. Freud later developed his ideas about hysteria with another colleague, Wilhelm Fliesseventually abandoning Charcot's approach to treating hysteria with hypnosis and replacing it with his own psychoanalytic method. Freud extrapolated general principles of human psychology from his work with hysterics, leading to the publication of two important, early works.
He laid out his first topographical theory of the mind in The Interpretation of Dreams In his Three Essays on the Theory of Sexualityhe put forward sexual theories, including his thoughts on the origins and meanings of homosexuality.
Psychoanalytic scholar, Kenneth Lewesargues that Freud actually had four theories of homosexuality:. Like Ellis, Freud believed that homosexuality "inversion" as he called it could be the natural outcome of normal development in some people. He noted that homosexuality could occur in individuals who had no other signs of deviation and no impairment in their functioning.
However, he did not view homosexuality as a sign of illness, by which he meant a symptom arising from psychic conflict. Instead, he apa homosexuality as the unconflicted expression of an innate instinct. Freud believed in a constitutional bisexuality: that in every individual there was a certain component of masculine active apa well as feminine passive tendencies.
Although bisexual tendencies were universal, Freud believed some people were constitutionally endowed with more of one tendency than the other. He believed life experiences, particularly traumatic ones environmental factorscould have an impact on the development and expression of one's innate instincts biological factors.
Under normal and non-traumatic circumstances, the component instincts that determine the sex of one's final object choice should be consistent with one's anatomical sex. That is to say an anatomic male should ideally express the masculine component instinct and obtain sexual satisfaction from women. However, Freud also believed that even adult heterosexuals retain the homosexual component, albeit in sublimated form.
Freud saw adult homosexuality as a developmental arrest of childhood instincts which prevent the development of a more mature heterosexuality. Jack Drescher refers to this as Freud's theory of immaturity--an alternative category that was neither religion's sin theory of morality nor apa disease theory of pathology.
Freud also did not endorse third sex theories theory of normal variant like those of Ulrichs. Instead, by maintaining that homosexuality could be a normal part of everyone's heterosexual experience, Freud offered a more inclusive paradigm.
It allowed for the possibility that the adult homosexual person might sufficiently mature and, if sufficiently motivated, become heterosexual. Late in his life, 1973 expressed 1973 about the possibility of effecting a sexual conversion in most people. In his " Letter to an American Mother ," he reassures a woman asking him to "cure" her son, that:. Several years after Freud's death, however, analyst Sandor Rado's theory of homosexuality would eventually supplant Freud's.
In a article, "A Critical Examination of homosexuality Concept of Bisexuality," Rado argued homosexuality Freud's theory of bisexuality was apa on a faulty 19th century belief in embryonic hermaphroditisma disproved hypothesis that every embryo had the potential to become an anatomical man or a woman.
Since the original theory upon which Freud had based his belief in bisexuality had been disproven, Rado claimed heterosexuality as the only nonpathological outcome of human sexual development. Rado viewed homosexuality as a phobic avoidance of the other sex caused by parental prohibitions against childhood sexuality. Almost all of the mid-twentieth century psychoanalytic theorists who pathologized homosexuality followed Rado's theory in one form or another.
The psychoanalytic shift from Freud's theory of immaturity homosexuality as a normal developmental step toward adult heterosexuality to Rado's theory of pathology homosexuality as a sign of development gone awry led some analysts to optimistically claim that they could "cure" homosexuality.
Their work was particularly influential in its portrayal of a pathogenic family type--a detached and rejecting father and a close-binding and domineering mother--that presumably led to homosexuality in the adult homosexual men they studied. The Bieber study was criticized for its methodology and by the fact that the authors were unable to provide any long-term follow-up on their subjects or produce any patients to support their claims of change.
In addition, the 1973 of familial etiology is not supported by Bell, Weinberg and Hammersmith's study of larger, nonpatient gay male populations, Sexual Preference: Its Development in Men and Women. Finally, while some discussion of the etiology of female homosexuality existed in the early psychoanalytic literature, the primary emphasis in psychoanalysis, as in the biological sciences, was on male homosexuality; often the causes and types of homosexuality in women were simply treated as mirror images of those for male homosexuality.
Etiological theories of homosexuality, whether biological, medical, or homosexuality, were all based on similar assumptions about gender, sexuality, and sexual orientation polarities. Whether the theorist held homosexuality to be a normal variant, a form of pathology, or of immaturity, the theory usually relied on the assumption that some intrinsic quality of one gender had made its way into a person of another gender.
The beliefs upon which all these theories rested was that the wide range of human sexuality could be understood when reduced to the two component parts of male and female.
Early studies of homosexuality within the medical and the psychoanalytic 1973 led to similar outcomes:. This decision occurred in the context of momentous cultural changes brought on by the social protest movements of the s to the s: beginning with the African-American civil rights movement, then evolving on to the women's and gay rights movements. Just as influential in the APA's decision were the research studies on homosexuality of the 's and 's. Alfred Kinsey's and colleagues' study on male and female sexuality marked the beginning of a cultural shift homosexuality from the view of homosexuality as pathology and toward viewing it as a normal variant of human sexuality.
Kinsey had criticized scientists' tendency to represent homosexuals and heterosexuals as "inherently different types of individuals. Clellan Ford and Frank Beach's Patterns of Sexual Behavior apa, relying on data from the Human Relations Area Filesfound homosexuality to be common across cultures and to exist in almost all nonhuman species.
DSM-II, published in , listed homosexuality as a sexual deviation, but sexual deviations were no longer categorized as a sociopathic personality disturbance. The Stonewall riots in in New York City marked a watershed event in the movement. Having successfully challenged the police and government attempts to shut down public places where gay people gathered, gay activists would soon challenge psychiatric authority as well.
Before the Stonewall riots, homophile groups had accepted the medical view of homosexuality as a mental disorder. Their view had been that accepting homosexuality as disease meant treating it as a disability, rather than a moral or religious sin, and would lead to more objective and humane attitudes.
A new generation of gay rights activists viewed medical and psychiatric portrayals of homosexuality to be just as problematic as the religious views.
Gay men and women were still being denied many basic rights and the designation of homosexuality as a mental disorder had only exacerbated antihomosexual societal prejudices, leaving gay men and women vulnerable in terms of their physical safety, economic security, and overall well being.
Gay activists began to confront the APA about its position on homosexuality. There were a series of dramatic encounters between activists and psychiatrists at the annual meetings of the APA between and While the opposition to the activists was vehement by some in the APA, there were increasing numbers of psychiatrists e. These were members who were familiar with the research findings showing that homosexuality occurred in large numbers of people, in persons who demonstrated normal psychological adjustment, and that it is present across a range of cultures.
Robert Spitzer and other members of the APA Task Force on Nomenclature and Statistics agreed to meet with a group of gay activists who presented the scientific evidence to its members and convinced the Task Force to study the issue further. The decision to declassify homosexuality was accompanied by the passage of an APA Position Statement, which supported the protection of the civil rights of homosexual persons. Some APA members, primarily psychoanalysts who continued to espouse pathologizing views of homosexuality, challenged the leadership of the APA by calling for a referendum of the entire APA membership.
When the diagnosis of homosexuality was deleted in , the APA did not initially embrace a normal variant model of homosexuality Drescher , Bayer , Krajeski In recognition of the opposition, it made a compromise. Accordingly, individuals comfortable with their homosexuality were no longer considered mentally ill.
Only those who were "in conflict with" their sexual orientation had a mental disorder SOD. This compromise engendered continued controversy. Those opposing it pointed out there were no reported cases of unhappy heterosexual individuals seeking treatment to become homosexual. In these debates openly gay and lesbian members of the APA played a decisive role in bringing about change Krajeski Those on the APA Advisory Committee working on the revision who wanted to retain the EDH category argued that they believed the diagnosis was clinically useful and that it was necessary for research and statistical purposes.
The opponents noted that making a patient's subjective experience of their own homosexuality the determining factor of their illness was not consistent with the new evidence-based approach that psychiatry had espoused. They argued that empirical data do not support the diagnosis and that it is inappropriate to label culturally induced homophobia as a mental disorder.
Many of those opposed to the diagnosis of EDH had viewed it as a diagnostic relic that had indirectly, if not directly, perpetuated the mental illness model of homosexuality.
Removing it was a crucial step in a paradigm shift that would help psychiatry focus on more relevant models and concepts in understanding gay men and lesbians. The change nevertheless remains controversial, and a small group of psychologists and analysts the National Association for Research and Therapy of Homosexuality [ NARTH ] continues to argue that homosexuality is a dysfunction and can be corrected.
The change also encouraged the American Psychological Association and other mental health groups to depathologize homosexuality as well as make further progressive statements on gays and lesbians. The American Psychiatric Association APA labeled discrimination in employment based on sexual orientation as irrational in It opposed exclusion and dismissal from the armed forces on the basis of sexual orientation in In , the APA added immigration and naturalization decisions to areas in which it opposes discrimination against homosexuals.
It supported the right to privacy in adult consensual relations conducted in private, also in In , the APA encouraged its members to help prevent and respond actively to bias-related incidents related to sexual orientation. An APA position statement in opposed any psychiatric treatment based on the assumption that homosexuality is a medical disorder or that patients should change their sexual orientation, including "reparative" or "conversion therapies.
Also in , the APA approved a position statement supporting the legal recognition of same-sex unions. It endorsed an initiative allowing adoption and co-parenting of children by same-sex couples in In , the APA endorsed the right of gay people to enter into same-sex civil marriage. The American Psychoanalytic Association APsaA adopted a position statement in opposing discrimination against gay people, and it directed that the selection of candidates for training not be based on sexual orientation.
In , ApsaA endorsed same-gender couples having equal rights to marry. It affirmed that "reparative" therapy is against fundamental principles of psychoanalytic treatment in , and it opposed discrimination based on sexual orientation in parenting and adoption in Gay and lesbian psychiatrists met informally and in secret for many years during the course of the annual meeting of the American Psychiatric Association, often in gay bars or members' hotel suites.
Difficult as it may be for today's young psychiatrist to imagine, prior to the declassification of homosexuality in , a psychiatrist who revealed that he or she was gay risked not only losing their job but in some states their medical license as well.
As a result of non-psychiatrist gay activists protesting and disrupting the APA's and annual meetings, the first gay-affirmative presentations were organized at the APA.
Fryer appeared as "Dr. Anonymous," disguised in an oversized tuxedo, a cloak, a rubber fright mask, so as to disguise his identity. He stunned the audience of psychiatrists by stating in a voice distorted to further protect his identity, "I am a homosexual.
I am a psychiatrist. It was the first time a gay psychiatrist had dared address colleagues at a professional meeting. Over the next few years gay and lesbian members continued to organize and were often met by hostility Hire The following year, the Assembly APA's legislative branch approved adding elected representatives from a group initially designated as the Caucus of Homosexually Identified Psychiatrists, and later renamed the Caucus of Gay, Lesbian, and Bisexual psychiatrists.
Since its founding, AGLP with a membership of over psychiatrists, has been active in helping to shape the dramatic conceptual shift in the cultural understanding and significance of homosexual behavior within psychiatry and within society. With the support of AGLP members, the APA has issued Position Statements supporting same sex unions and the adoption and co-parenting of children by same sex couples, as well as a position statement opposing "Reparative Therapy" as unethical.
Bayer, R. Princeton: Princeton University Press. Bieber, I. Drescher, J. Psychoanalytic Therapy and the Gay Man. New York: The Analytic Press. Harrington Park Press. Ford, C. Patterns of Sexual Behavior. Hire, R. An interview with Frank Rundle, MD. Merlino, New York: Harrington Park Press. Hooker, E. A preliminary analysis of group behavior of homosexuals.
Psychology The adjustment of the male overt homosexual. Projective Techniques Kinsey, A. Pomeroy, C. Sexual Behavior in the Human Male. Philadelphia, PA: W. Martin, P. Sexual Behavior in the Human Female. Krajeski, J. Homosexuality and the mental health professions. In Textbook of Homosexuality and Mental Health , ed. Stein, Washington: American Psychiatric Press. Lewes, K. The Psychoanalytic Theory of Male Homosexuality.
New York: Simon and Schuster. Marmor, Judd. Homosexuality and cultural value systems. American J. Psychiatry Spitzer, R L. A proposal about homosexuality and the APA nomenclature: Homosexuality as an irregular form of sexual behavior and sexual orientation disturbance as a psychiatric disorder. Karl Maria Kertbeny. Psychopathia Sexualis Edith Lees Male Transvestite. Illustration from Hirschfeld's book on transvestism.
Eugen Steinach. The Stonewall Inn bar , Manhattan. Barbara Gittings marching at a homosexual rights demonstration. Barbara Gittings, Frank Kameny and Dr. H Anonymous aka Dr. John E. Fryer at the annual APA conference. Frank Rundle, M. It may be the first U. Although psychiatrists declassified homosexuality as a disorder in and psychoanalysts came around nearly 20 years later, the APsaA says it is unaware of any related professional group that had apologized.
Lee Jaffe, president of APsaA. Jaffe said his group has long been active in promoting LGBTQ rights but had yet to put its contrition into words. Justin Shubert said. Patrons of a New York City gay bar called the Stonewall Inn fought back against police harassment in the early morning hours of June 28, , triggering the start of the modern movement for the rights for lesbian, gay, bisexual, transgender and queer people.
New York police recently apologized for the raid and discriminatory laws of the time, which prompted APsaA to issue its apology, said Dr. New York is expecting as many as 4 million people for the 50th anniversary of Stonewall next week, and gay pride parades will be celebrated around the world on June
This resulted after comparing competing theories, those that pathologized homosexuality and those that viewed it as normal. 1973 an effort to explain how that decision came about, this paper reviews some historical scientific theories and arguments that first led to the placement of homosexuality in DSM-I and DSM-II as well as alternative theories that eventually led to its removal from DSM III and subsequent editions of the manual.
The paper concludes with a discussion of the sociocultural aftermath of that decision. This resulted after comparing competing theories, those that pathologized homosexuality and those that viewed it as normal [ 3456 ]. In an effort to explain how that decision came about, this paper reviews some historical scientific theories and arguments that first led to the placement of homosexuality in DSM-I [ 7 ] and DSM-II [ 8 ], as well as alternative theories, that eventually led homosexuality its removal from DSM III [ 9 ] and subsequent editions of the manual [ 10111213 ].
It is possible to formulate a descriptive typology of etiological theories of homosexuality throughout modern history in which they generally fall into three broad categories: pathology, immaturity, and normal variation [ 141516 ]. The presence of atypical gender behavior or feelings are symptoms of the disease or disorder to which mental health professionals need to attend. These theories hold that some internal defect or external pathogenic agent homosexualiity homosexuality and that jomosexuality events can occur pre- or postnatally i.
Theories of pathology tend to view homosexuality as a sign of a defect, or even as morally bad, with some of these theorists being quite open about their homosexuaity that homosexuality is a social evil. Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner These theories, usually psychoanalytic in nature, regard expressions of homosexual feelings or behavior at a young age as a apa step toward the development of adult heterosexuality [ 1920 ].
Ideally, homosexuality homosexuality just be a passing phase that one outgrows. Homosexuality theories treat homosexuality homosexuality a phenomenon hlmosexuality occurs naturally [ 21222324 ].
Such theories typically regard homosexual individuals as born different, but it is a natural difference affecting a minority of people, like left-handedness. As these theories equate the normal with the homodexuality, they define homosexuality as good or, at baseline, neutral. 1973 theories see no place for homosexuality in a psychiatric diagnostic manual. People express gender beliefs, their own and those of the culture in which they live, in everyday language as they either indirectly or explicitly accept and assign gendered meanings to what they and others do, think, and feel.
Gender beliefs are embedded in questions about what career a woman should pursue and, at another level of discourse, what it would mean if a professional woman were to forego rearing children or pursue a career more aggressively than a man.
Gender beliefs are usually based upon gender binaries. It should be apa that binaries are not confined to popular usage. Many scientific studies of homosexuality contain implicit and often explicit binary gender beliefs as well. For example, the intersex hypothesis of homosexuality [ 2627 ] maintains that the brains of homosexual individuals exhibit characteristics that would be considered more typical of the other sex.
The essentialist gender belief implicit in the intersex hypotheses is that an 1973 to women is a masculine trait, which in the case of Sigmund Freud [ 28 ], for example also homosexuality below homosecuality, led to his theory that lesbians have a masculine psychology. Gender beliefs usually apa allow for the existence of two sexes. To maintain this gender binary, most cultures homosexuality insisted that every individual be assigned to the category of either 1973 or woman at birth and that individuals conform to the category to which they have been assigned thereafter.
Rigid gender beliefs homosexualkty flourish in fundamentalist, religious communities where any information or alternative explanations that might challenge implicit and explicit assumptions are unwelcome. When one recognizes the narrative forms of these theories, some of the moral judgments and beliefs embedded in each of them become clearer.
Eventually, religious categories like demonic possession, drunkennessand sodomy were transformed into the scientific categories of insanity, alcoholismand homosexuality. Thus, the modern history of homosexuality usually homossexuality in the midth century, most notably with the writings of Karl Heinrich Ulrichs [ 21 ]. Trained in law, theology, and history, he might be considered an early gay rights advocate who wrote a series of political tracts criticizing German laws criminalizing same sex relationships between men.
Kertbeny put forward his theory that homosexuality was inborn and unchangeable, arguments that it was a normal homoswxuality, as a counterweight against the condemnatory moralizing attitudes that led to the passage of sodomy laws. Psychopathia Sexualis would presage many of the pathologizing assumptions regarding human sexuality in psychiatric diagnostic manuals of the midth century. In contrast, Magnus Hirschfeld [ 38 ], also a German psychiatrist, offered a normative view of homosexuality.
As he believed everyone is born with bisexual tendencies, expressions of homosexuality could be a normal phase of heterosexual development. Rado claimed, in contrast to Freud, neither innate bisexuality nor normal homosexuality existed. Moor [ 44 homosexualiity Tripp [ 45 ].
Homosexuality the midth century American psychiatry was greatly influenced at the time by these psychoanalytic perspectives. Consequently, inwhen APA published the first edition of the Diagnostic and Statistical Manual DSM-I [ 7 ], it listed all the conditions homosexxuality then considered to be a mental disorder.
Psychiatrists and other clinicians drew conclusions from a homosexuality sample of patients seeking treatment homosexualjty homosexuality or other difficulties and then wrote up their findings of this self-selected group as case reports. Some theories about homosexuality were based on studies of prison populations. Sexologists, on the other hand, did field studies yomosexuality which they went out and recruited large numbers of non-patient subjects in the general population. The most homosexuality research in this area was that of Alfred Kinsey and his collaborators, published in two headline-generating reports [ 2223 ].
This finding was sharply at odds with psychiatric claims of the time that homosexuality was extremely rare in the general population. In the late s, Evelyn Hooker [ 24 ], a psychologist, published a study in which she compared psychological test results of 30 gay men with 30 heterosexual controls, none of whom were psychiatric patients. Her study found no more apa of psychological disturbances in the gay male group, a finding that refuted psychiatric beliefs of her time that all gay men had severe psychological disturbances.
American psychiatry mostly ignored this growing body of sex research and, in the case of Kinsey, expressed extreme hostility to findings that contradicted their own theories [ 48 ]. Other gay activists, however, forcefully rejected the pathological model as a major contributor to the 19973 associated with homosexuality.
It was this latter group that brought modern sex research theories to the attention of APA. In the wake of the Stonewall riots in New York City [ 49 ], gay and lesbian activists, believing psychiatric theories to be a major contributor to anti-homosexual social stigma, disrupted the and annual meetings of the APA.
There was also an emerging generational changing of the guard within APA comprised of younger leaders urging the organization to greater social consciousness [ 2 ]. A very few psychoanalysts like Judd Marmor [ 552 ] were also taking issue with psychoanalytic orthodoxy regarding homosexuality. However, the most significant catalyst homosexualiy diagnostic 1973 was gay activism.
Kameny and Gittings returned to speak at the meeting, this time joined by John Fryer, M. Fryer appeared as Dr. While protests and panels took place, APA engaged in an internal deliberative process of considering the question of whether homosexuality should remain a psychiatric diagnosis.
Having arrived at this novel definition of mental disorder, the Nomenclature Committee agreed that homosexuality apa se was not one. Several other APA committees and homosexuality bodies then 1973 and accepted 1973 work and recommendations.
Psychiatrists from the psychoanalytic community, however, objected to the decision. They petitioned APA to hold apa referendum asking the entire membership to vote either in support of or against the BOT decision.
It should be noted that psychiatrists did not vote, as is often reported in the popular press, on whether homosexuality should remain a diagnosis. However they usually neglect apa mention that those favoring retention of the diagnosis were the ones who petitioned for a vote in the first place. In any event, in the International Astronomical Union voted on whether Pluto was a planet [ 5960 ], demonstrating that even in a hard science like astronomy, interpretation of facts are always filtered through human subjectivity.
SOD regarded homosexuality as apa illness apa an individual with same-sex attractions found them distressing and wanted to change [ 5657 ]. The new diagnosis legitimized the practice of sexual conversion therapies and presumably justified insurance reimbursement for those interventions as welleven if homosexuality per se was no longer considered an illness.
The new diagnosis also allowed for the unlikely possibility that a person unhappy about a heterosexual orientation could 1973 treatment to become gay [ 61 ]. However, it was obvious to psychiatrists more than a decade later that the inclusion first of SOD, and later EDH, was the result of earlier political compromises and that neither diagnosis met the definition of a disorder in the new nosology.
Otherwise, all kinds of identity disturbances could be considered 1973 disorders. What about short people unhappy about their height? Why not ego-dystonic masturbation [ 62 ]? In so doing, the APA implicitly accepted a normal 1973 view homosexuuality homosexuality in a way homoexuality had not 1973 possible fourteen homossexuality earlier [ 63 ].
Similar shifts gradually took place in the international mental health community as well. As a consequence, debates about homosexuality gradually shifted away from medicine and psychiatry and into the moral and political realms as religious, governmental, military, media, and educational institutions homosexuality deprived of medical or scientific rationalization for discrimination. As a result, cultural attitudes about homosexuality changed in the US and other countries as those who accepted scientific authority on such matters gradually came to accept the 193 view.
For if homosexuality was no longer considered an illness, and if one did not literally accept biblical prohibitions against it, and if gay people are able and prepared to function as productive citizens, then what is wrong with being gay? Additionally, if there is nothing wrong with being gay, what moral and legal principles should the larger society endorse in helping gay people openly live their lives?
National Center for Biotechnology InformationU. Journal List Behav Sci Basel apa. Behav Sci Basel. Published online Dec 4. Jack Drescher 1, 2, 3, 4. Author information Article notes Copyright and License information Disclaimer.
Received Oct 26; Accepted Dec 1. This article has been cited by other articles in PMC. Theories of Homosexuality It is possible to formulate a descriptive typology of etiological theories of homosexuality throughout modern history in which they generally fall into three broad categories: pathology, immaturity, and normal variation [ 1415apa ]. Theories of Immaturity These theories, usually psychoanalytic in nature, regard expressions of homosexual feelings or behavior at a apa age as a normal step toward the development of adult heterosexuality [ 1920 ].
Theories of Normal Variation These theories treat homosexuality as a phenomenon homosexuality occurs naturally [ 21222324 ]. The APA Decision American psychiatry mostly ignored this growing body of sex research and, in the case of Kinsey, expressed extreme hostility to findings that contradicted their own theories [ 48 ].
Conflicts of Interest 1973 author declares no conflict of interest. References 1. Bayer R. Drescher J. An interview 11973 Robert L. Spitzer, MD. Gay Lesb. An interview with Lawrence Hartmann, MD. Rosario V. An interview with Judd Marmor, MD. Sbordone A. An interview with Charles Silverstein, PhD.
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This included a symposium at the APA annual meeting in “Should Homosexuality be in the APA Nomenclature? Classification of gay, lesbian, and bisexual sexual orientations underwent major changes in different editions of Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (APA). After a vote by the APA trustees in , and confirmed by the wider APA membership in
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