December 18, 2018

When you live through a seismic cultural change it often catches individuals and nations by surprise.  This occurred in 1973 when the American Psychiatric Association changed the defining of homosexuality from a disease to a dysphoria disorder which was then quietly removed in the succeeding years.  The circumstances surrounding the transition is a combination of activism and gay psychiatrists within the APA rising to the highest and most strategic positions.  In this American Life the granddaughter of the gay psychiatrist who was president-elect of the APA when the change was made explores the personal, political and cultural dynamics which brought about the change.  Although we like to think it was the science that led to the removal of the designation of homosexuality as a DSM disorder it was not.

The story begins with our author, Alix Spiegel, explaining first in 2002 and recently repeated on This American Life on December 16, 2018:

“Alix Spiegel

This is the story of a definition, three single sentences composed of 81 words. It’s the story of how this particular definition became another definition, nine sentences, composed of 237 words.

Now according to some parties, this change from 81 words to 237 words liberated an entire category of humanity. According to other parties, it undermined the basic family unit, compromised the scientific authority of psychiatry, and quote, “tampered with the basic code and concept of life.”

Now, I should tell you that I know this story not because I read it in a book or learned it in any class, but because it’s one of those stories that my family uses to explain itself. Like most family stories– anyway, like most stories told in my family– the version I heard growing up was an exaggeration, the relevant family member cast as a conquering hero. The actual story, the story I hope to tell you is, of course, much more complicated. But I’m getting ahead of myself….

Spiegel continues:

“My grandfather was a psychiatrist, but not in any sense an expert on what was then called sexual deviance. Still, he was asked to testify about the mental health of homosexuals and the mental health effects of discrimination against homosexuals in Ireland, in Texas, in Maine, in front of Congress, and too many places to mention.

He was asked because, in 1973, he happened to be president-elect of the American Psychiatric Association when the organization decided that homosexuality was not a mental disease. Up until that time, psychiatrists had always thought of homosexuality as a pathology– a problem so profound it affected, as one psychiatrist told me, the total personality.

Now, because psychiatrists believed that homosexuals were pathological, it gave scientific sanction for the rest of the country to see it the same way. Gays were routinely fired from teaching jobs, denied security clearances and US citizenship. For that matter, they were barred from practicing psychiatry, because you don’t let someone who’s pathological practice medicine on other people who are pathological. Or anyway, that’s what the psychiatrists thought.

That’s what it said in the bible of their profession, what the psychiatrists called the DSM, or the Diagnostic and Statistics Manual, a book which listed in clear, clinical language every possible permutation of psychosis, every variant of paranoia, every deviant mental tick that the children of Freud had ever encountered, all nicely bound together under an industrial yellow cover with an authoritative OED staid font.

There it was, diagnosis number 302.0, 3 sentences, composed of 81 words, which certified homosexuality as sick…”

Alex Spiegel continues later:

“To hear my family tell it, it was my grandfather alone who banished those 81 words from the DSM. When I was young, the family legend was that my grandfather, president of the American Psychiatric Association, single-handedly changed the DSM because he was a big hearted visionary, a man unfettered by prejudice who worked on behalf of the downtrodden.

This story was wrong on two counts. A, my grandfather was not president of the American Psychiatric Association in 1973– he was president-elect. B, he didn’t single-handedly change anything.

But never mind, because this version of events was discarded, anyway– discarded after the family went on vacation to the Bahamas to celebrate my grandfather’s 70th birthday. I remember it well, remember the plane, and the drive from the airport, and arriving and discovering that the hotel had a swimming pool installed about 50 feet away from the beach. I remember thinking that a pool so close to the water was both ridiculously decadent and somehow incredibly exciting.

I also remember my grandfather stepping out of his beachfront bungalow on that first day, followed by a small, well-built man, a man that later, during dinner, my grandfather introduced to a shocked family as his lover, David.

David was the first of a long line of very young men that my grandfather took up with after my grandmother’s death. It turned out that my grandfather had had gay lovers throughout his life, had even told his wife-to-be that he was homosexual two weeks before their wedding.

And so, in 1981, the story that my family told about the definition in the DSM changed dramatically. My grandfather was no longer seen as a purely enlightened visionary, but as a closeted homosexual with a very particular agenda.”

To read the entire account including the events leading up to the change of the DSMV and the 1970’s virtually universal understanding in psychiatry of the treatable pathology of homosexuality to the current rejection of any designation for homosexuality and making it unethical to try and change same-sex desire, click here.

To read a research paper looking at this same event click here.

Another short explanation of the intentions of the activists in their own words click here. “The short-range goal of the activist committee was obvious: to remove homosexuality between consenting adults from the list of mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We intended to make sexual orientation change unacceptable, even if the patient asked for it (Silverstein, 1977). Because the psychiatric profession was one of the “gate-keepers” of society’s attitudes, we believed that this change would have profound effects on...”

In another article, Right Answers Wrong Reasons,  it is explained that it was not the science that produced this change, click here: “The deletion of homosexuality from DSM-II and subsequent diagnostic manuals is generally seen as a triumph of science over prejudice and oppression. An examination of actual circumstances of the deletion and of the changes that it engendered shows that this view overlooks crucial points. Specifically, the received version conceals the way that deletion served a nonscientific vision of justice, as well as that postdeletion practice regarding homosexuality is inescapably political and moral. These concealments help to maintain the mental health professions’ claim to scientific authority, a claim that has little basis in fact. Furthermore, the deletion represented an inadvertent application of social constructionist principles to psychotherapeutic practice, one that makes clear the pragmatic value of postmodern psychologies to contemporary psychotherapy. (PsycINFO Database Record (c) 2016 APA, all rights reserved)”

Here is the 1987 resolution which completely removed any reference to homosexuality or ego-dystonic homosexuality from the DSM:  “Be it resolved that the American Psychological Association: Urge its members not to use the “302.0 Homosexuality” diagnosis in the current ICD-9-CM or the “302.00 Ego-dystonic Homosexuality” diagnosis in the current DSM-III or future editions of either document.”