APA Classifies Homosexuality as a Mental Disorder

Homosexuality was classified as a mental disorder in the first edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), leading to attempts to “treat” persons who had same-gender sexual desires and identities. The classification also led to the founding of Christian-based organizations in support of psychiatry’s claims of reparative therapy and to groups claiming to “cure” GLBT individuals.

Date 1952

Locale United States

Key Figures

• Karl Friedrich Westphal (1833-1890), credited with the first scientific study of homosexuality
• Martin Charcot (1825-1893), first doctor to use hypnosis on lesbians and gays
• Irving Bieber (1908-1991) and
• Sandor Rado (1890-1972), two psychiatrists who helped develop the DSM classification on homosexuality
• Bruce Voeller (1934-1994), biologist and member of the National Gay Task Force

Summary of Event

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered the bible of psychiatry and of psychiatric illness. In its fourth edition, it contains the criteria and diagnostic tools for determining all classified psychiatric disorders. The first edition of the DSM, published in 1952 by the American Psychiatric Association (APA), included the category “homosexuality” as a mental disorder under the subcategory “sexual deviation.”

Sexual deviation was broadly classified as a “personality disorder.” Personality disorders were further broken down into three groups: personality pattern disturbance, personality trait disturbance, and sociopathic personality disturbance. Sexual deviation (including homosexuality) was considered a sociopathic personality disturbance. The other diagnoses that fell under this subcategory were antisocial reaction and drug and alcohol addiction.

Homosexuality was characterized as a mental disorder, however, long before it was classified as such by the APA. In Outlines of Lectures on Mental Disease (1826), Sir Alexander Morison (1779-1866), a Scottish physician, declared that “it is a consolation to know that [homosexuality] is sometimes the consequence of insanity.” Homosexuality, however, was not studied scientifically until the close of the nineteenth century. The first study, undertaken by German psychiatry professor Karl Friedrich Westphal in 1869, examined the traits of one lesbian woman over the course of several years. Westphal later expanded his study to include more than two hundred subjects, and ultimately he devised a system for classifying behaviors thought to be associated with homosexuality. In the mid-nineteenth century, French psychiatrist Martin Charcot was the first to attempt—and fail—to cure homosexuality through hypnosis.

Diagnosing homosexuality with the guidance of the DSM was similar to that of diagnosing mental disorders in general, and “treatment” for homosexuality reflected the treatment administered for the other disorders. Though many patients were openly gay or lesbian, others were forced into treatment by family members. Because it was considered a mental disorder, treatment could not begin until the patient admitted to having a “problem.”

Aside from traditional psychotherapy, a host of treatments for homosexuality became available shortly after its DSM classification. Treatments included aversion therapy, nausea-producing drugs, castration, electric shock, brain surgery, and breast amputation. Of these, aversion therapy and shock therapy were used most often. Both involved “training” the subconscious mind to associate homosexual thoughts and desires with pain. It was believed that administering a painful stimuli when a patient had homosexual desires (at what point this could be determined is unclear) would lead to the eventual disappearance of those desires. Not until the early 1970’s did psychiatrists and other professionals move to abandon these and other treatments.

Prior to the 1952 DSM classification, leading psychoanalysts were optimistic about the classification and treatment of homosexuality as a mental disorder. Not surprisingly, this optimism was based on little more than conjecture. Sandor Rado was an analyst who theorized that homosexuality was a phobic response to members of the opposite gender. His “science” was to observe that lesbians choose women considered masculine and gays seek men considered feminine. Rado then concluded that heterosexual inclinations are innate and can be uncovered.

Irving Bieber, another prominent analyst, conducted an infamous study in 1962, published as Homosexuality: A Psychoanalytic Study of Male Homosexuals. The study has been widely criticized as inadequate because Bieber analyzed only 106 individuals; also, at least one-quarter of the subjects had previously diagnosed character disorders. Although Rado and Bieber each had a unique focus, both believed homosexuality to be unnatural and “fixable.”

Significance

The inclusion of homosexuality in the DSM incited debate that has extended into the twenty-first century. After homosexuality (as a mental illness) was removed from the DSM in 1973, Bruce Voeller, biologist and founder of the National Gay Task Force (now the National Gay and Lesbian Task Force), argued that it was the moral responsibility of the APA to undo the injuries it caused by classifying homosexuality as an illness.

In addition to insisting that gays and lesbians be given rights to become foster parents, he declared firmly that high schools across America have a social obligation to reach out to GLBT teens who have been marginalized by society’s pernicious ignorance. One way to reach out is to form GLBT student organizations.

Despite Voeller’s call for the APA, local lawmakers, and secondary schools to act, and despite other radical moves to amend the injury caused by the APA’s classification, many people continue to insist that homosexuality is a mental disorder and that it can be treated. Reparative therapy was devised in the nineteenth century, and it was based on the notion that because people were inherently heterosexual, homosexuality, therefore, could be “unlearned.”

Unlike the more secular current of the era leading up to the 1950’s, the latest belief in the ability to “cure” gays and lesbians is almost entirely backed by conservative Christian ministries, such as Coral Ridge and Focus on the Family. Furthermore, Exodus International, a Christian-based group, boasts large numbers of people claiming to have been “saved” from their homosexuality. In the 1990’s, reparative therapy had been reintroduced and revitalized by Joseph Nicolosi and Charles Socarides of NARTH—the National Association for Research and Therapy of Homosexuality.

Bibliography

Bayer, Ronald. Homosexuality and American Psychiatry: The Politics of Diagnosis. New York: Basic Books, 1981.

Cory, Donald Webster (pseud.), and John P. LeRoy (pseudo.). “Why Homosexuals Resist Cure.” Sexology 30, no. 7 (1964): 480-482.

Galeano, Eduardo. “The Heresy of Difference.” The Progressive 68 (January, 2004): 16-17.

Martin, Karen A. “Gender and Sexuality: Medical Opinion on Homosexuality.” Gender & Society 7, no. 2 (June, 1993): 246-250.

Zucker, Kenneth J. “The Politics and Science of ’Reparative Therapy.’” Archives of Sexual Behavior 32 (October, 2003): 399-402.