Unmaking the Disease (Part 1)

To mark the recent passing of prominent psychiatrist Robert Spitzer, I am re-running this two-part post describing how homosexuality came to be removed from the list of psychiatric diseases in 1972. 

Unmaking The Disease  (Part One of Two)

Prior to 1960, there were few concepts more widely accepted in psychology and psychiatry than the notion that homosexuality was abnormal. 

Not that there was actual evidence to back up the disease model for homosexuality, mind you.  Despite occasional periods of tolerance throughout history, homosexuality was routinely treated as an abomination for the past two thousand years.  Along with Biblical commands to "be fruitful and multiply", any sexual practices that failed to result in childbirth were dismissed as perverse and unnatural.  Homosexuality in particular, was reviled due to specific passages in Leviticus and Deuteronomy.  Although contraception came to be grudgingly allowed (at least in some societies), "crimes against nature" legislation was rigidly enforced almost everywhere.  The death penalty for "buggery" in England was only abolished in 1861 (the penalty was reduced to a ten-year sentence with hard labour).  Well into the 20th century, homosexuals could be routinely arrested and forced to serve long prison sentences in most countries around the world.  

Given this background of intolerance, you can imagine how it influenced the scientific study of homosexuality which began in the 19th century.  Case studies of male and female homosexuals were published by early pioneers such as Richard von Kraft-Ebing and Jean Martin Charcot (who concluded that homosexuality was congenital after failing to cure it with hypnosis).  Other psychiatrists suggested that homosexuality could be caused by a combination of environmental factors and an inborn predisposition to perversion.  Cesare Lombroso, the 19th century criminologist, argued that homosexuals were at a lower stage of evolutionary development than heterosexuals and, due to their condition being innate, could not be held responsible for their actions.  Although homosexuals continued to be punished, the focus gradually shifted from prisons to insane asylums.

That's not to say that there wasn't opposition to the mainstream view on homosexuality.  Beginning in 1862, Karl Heinrich Ulrichs took the courageous step of coming out to his family and friends as an Urning and crusading for reform.   Although his books were later banned across Germany (he was always on the move to avoid arrest), he eventually managed to flee to Italy where he died in 1895.  Largely forgotten today, Ulrichs is chiefly remembered as an early pioneer in sexological research and same-sex relationships.  Later researchers, including Havelock Ellis and Magnus Hirschfeld, were also outspoken in their support of homosexuality as being natural but the conservatives prevailed. 

It was hardly surprising that there was little opposition in 1952 when the American Psychiatric Association included homosexuality in its first Diagnostic and Statistical Manual, Mental Disorders (DSM-I). Designed to replace previous classification systems that were regarded as inadequate, the DSM-I was intended to be a major advance in placing psychiatry among the more scientifically-focused medical disciplines.  Along with other sexual deviations, homosexuality was classified as a "sociopathic personality disturbance" due to the lack of subjective distress or dysfunction involved.  In other words, homosexuals fit the criteria regardless of how well-adjusted they actually were.  Simply engaging in homosexual behaviour was enough to qualify for the diagnosis and the DSM-I explicitly stated that homosexuals were "ill primarily in terms of society and of conformity with the prevailing cultural milieu.:"  This classification would remain unchanged until 1968.

It's perhaps inevitable that "curing" homosexuality would become a prime goal for psychiatrists.  Sigmund Freud remained skeptical about the use of psychoanalysis in treating homosexuals.  In a famous "Letter to an American Mother" which he wrote in 1935 to a mother asking for help in changing her son's homosexuality, he stated that "In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted."

Despite Freud's pessimism, other psychoanalysts were more hopeful about the value of therapy in correcting homosexuality.  Sandor Rado broke away from Freud in the 1930s and presented an alternate view of sexuality which, among other things, argued that homosexual desires developed due to a phobic response to members of the opposite sex.  Inspired by Rado, the New York Society of Medical Psychoanalysts carried out an extensive study comparing more than 100 homosexuals with an equivalent sample of heterosexuals.  Data was collected on a full range of early childhood, social, family, and therapeutic factors and the results were published in 1962 under the  title of Homosexuality: A Psychoanalytic Study.  Although the lead author, Irving Bieber, emphasized that the study was not designed to "pathologize" homosexuality, he didn't hesitate to represent heterosexuality as the norm from which homosexuals deviated.  He concluded that "Our findings point to the homosexual adaptation as an outcome of exposure to highly pathologic parent-child relationships and early life situations".   Poor maternal and paternal relationships were blamed for "abnorma" sexual development.  In particular,  Bieber identified a familial "triangular system" that was most likely to cause homosexuality in children.

Albert Ellis, who became known as the father of rational-emotive therapy, was also an outspoken advocate of using counseling techniques to change homosexuality (he viewed exclusive homosexuality as being due to a phobic response to the opposite sex).  Along with Ellis and Charles Socarides (who became increasingly influential in the 1960s and 1970s), Irving Bieber and his rejection of innate homosexuality would influence mental health professionals for a generation.  It would also play a profound role in how the legal system treated convicted homosexuals since court-mandated treatment was often made a condition of release.

Beginning in the 1950s however, the dissenters began to make themselves heard.  In a groundbreaking study published in 1948, Alfred Kinsey presented the results of a stratified nationwide survey of male sexual behaviour.  Among the findings that shocked the American people, Kinsey showed that actual sexual practices varied widely from the rigid cultural standards that were largely taken for granted.  An astonishing thirty-seven percent of males interviewed reported having had at least one sexual encounter with another man with ten percent saying that had been almost exclusively homosexual for at least some part of their lives.  As Kinsey and his associates dealt with the tremendous backlash of criticism (scientific and moralistic) for these findings, homosexuals felt increasingly empowered by the revelation that they were more than just a marginal group. By the time of Alfred Kinsey's death in 1956, he had a warm relationship with many of the Homophile associations of the time who regarded him as their patron saint.

While Kinsey's research helped challenge the popular view of homosexuality as abnormal, it was Evelyn Hooker and her research into the psychology of homosexuals which triggered a radical shift in clinical views on sexual orientation.  Born Evelyn Gentry in 1907, she later earned her doctorate at John Hopkins University in Maryland and trained at the Berlin Institute of Psychotherapy during Hitler's rise to power in Germany.  Returning to the US at the outset of World War II, she was a psychology teacher at UCLA when a student, Sam From, introduced her to what would become her life's work.  As part of the lesbian and gay subculture of the time, From was in a good position to introduce Hooker to many of his friends and show her the routine persecution that homosexuals of the time faced.  After From challenged her to "study people like him",  Evelyn Hooker became increasingly aware that many self-identified homosexuals didn't conform to the standard image of tormented individuals that were reported on in the scientific literature being published by clinicians.  

Continue to Part 2


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