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The legacy of medicalising 'homosexuality': A discussion on the historical

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 Anderson & Holland: The Legacy of Medicalising Homosexuality

The legacy of medicalising ‘homosexuality’: A discussion on the

historical effects of non-heterosexual diagnostic classifications
Joel Anderson (Joel.Anderson@unige.ch)
Unité de Psychologie Sociale
Université de Genève, 1211 Genève, Switzerland

Elise Holland (Elise.Holland@unimelb.edu.au)

Melbourne School of Psychological Sciences
The University of Melbourne, Parkville, VIC 3010, Australia

Abstract Those of us living in certain urban cities will even

be exposed to the occasional public display of
The classification of non-heterosexuality has same-sex affection. It appears that both popular and
changed considerably over the past century. Once scientific ideas of sexuality and sexual orientation
considered as medical conditions attracting legal
have rapidly evolved in a relatively short amount of
complications and serious social stigma,
expressions of non-heterosexuality are now
time. Although some cultures have arguably
broadly considered to be normal variations of become tolerant of gay men and lesbian women
human sexuality. The historical inclusion of (Baunach, 2011; Loftus, 2001), there is still
homosexuality in the psychiatric literature may evidence to suggest that not all individuals (or
still have implications for how sexual orientation cultural groups) concur with this attitudinal shift.
is viewed today, including the ongoing treatment Furthermore, there is also evidence that
of homosexuality as an illness despite its institutionalised heteronormativity (i.e., the
delisting from medical diagnostic nomenclatures. assumption that heterosexual is the default sexual
This discussion paper explores the historically
orientation) is socially and psychologically
recorded diagnostic classification of
homosexuality, reviews the processes that led to
functional for heterosexual members of society (for
the reclassification in the nomenclature and a full review, see Herek & McLemore, 2013).1
closes with a commentary for current The psychiatric and psychological
implications of this medical legacy. nomenclatures (Diagnostic and Statistical Manual
of Mental Disorders [DSM]) have historically
classified a homosexual orientation2 as a 'sexual
Keywords: Homosexuality; gay men; lesbian; DSM; deviation' and as a classifiable mental illness. The
sexual orientation disorder; realignment therapy; very fact that being gay was medically diagnosable
conversion therapy, SOCE.
afforded the general community a scientific
sanction to treat gay men and lesbian women
“The only unnatural sex act is that which you differentially to their heterosexual counterparts.
cannot perform.” Examples of this treatment include firing
- Alfred Kinsey homosexual individuals from their jobs (upon
disclosure of their sexuality), denying them
security clearances, expelling them from their
Introduction family and social groups, and turning down their
United States citizenship applications (Adam,
1987). Also, gay men and lesbian women were
Sexuality appears to be celebrated in many of
today’s societies. In just a few decades, 1
Although the term ‘non-heterosexuality’
homosexuality has gone from being taboo, encompasses intersex and transsexual individuals, we
associated with an ‘underground’ existence, to will limit the scope of this paper to a focus on gay men
becoming publicly visible and freely expressed in and lesbian women. We would like to acknowledge,
many Western cultures. This is evidenced by however, that issues surrounding medicalized
changing social norms (Pew Research Centre, discrimination towards these targets are differentially
2014), popular culture, and in some instances even complex, and a future investigation into the legacy of the
being associated with a certain level of cachet. For medicalization of these populations is warranted.
2
We recognise the suggestion of the APA publishing
example, gay and lesbian pride events (e.g., Mardi
guidelines that the term gay and lesbian is preferred to
Gras) have become annual events on many tourism the term homosexual, however, when used in the context
calendars, popular musicians have included ‘gay of a historical discourse it is appropriate to use the latter
kisses’ in their music videos, and most popular term. Please note that when we refer to homosexuals, we
television shows feature at least one gay character. are referring to a collective of same-sex attracted
individuals (regardless of their gender).

Sensoria: A Journal of Mind, Brain & Culture 4

prevented from practicing psychiatry, under the psychologically-adjusted as their heterosexual
premise that someone who manifests counterparts (Rothblum & Factor, 2001); this
psychopathology is not an ideal candidate for being population as a whole, however, has a higher risk
a medical practitioner (Drescher, 2008). More of depression, anxiety, and related problems, when
specifically, up until the 1970s, psychiatrists who compared to an exclusively heterosexual
disclosed a homosexual orientation were not only population (Cochran, Mays, Alegria, Ortega, &
at risk of losing their job, but in some parts of the Takeuchi, 2007; Feinstein et al., 2012).
US this would result in their medical license being Furthermore, recent research shows that the higher
revoked (Drescher, 2008). The original prevalence of such conditions can be causally
nomenclature in the early 1950s clinically attributed to the experiences of discrimination
stigmatised homosexuality, indisputably classifying (Meyer, 2003; Thoits, 2013). It is worth noting that
it as a mental illness (American Psychiatric there is still some lingering debate about whether
Association [APA], 1952, pp. 38-39). The homosexuality is a pathological condition or a
controversy regarding whether being gay should be normal sexual variant (Drescher & Zucker, 2013;
regarded as a pathological sexual development or Nicolosi et al., 2009; Nicolosi, Byrd, & Potts,
as a normal variant of human sexuality was debated 2000; Nicolosi & Nicolosi, 2002). Although those
in academic circles and in the popular press (e.g., who argue the former are a numerical minority, and
Bell, Weinberg, & Hammersmith, 1981; Bullough, most have had their registration revoked from their
1976; Ford & Beach, 1951; Hooker, 1969; Kinsey, relevant psychological communities, the fact that
Pomeroy, & Martin, 1948; Kinsey, Pomeroy, any doubt remains indicates to the wider public that
Martin, & Gebhard, 1953; Socarides, 1978a; there is an unresolved consensus within the medical
Spector, 1977). A combination of changing community.
attitudes and social pressures led to a ‘deletion’ (we This article will discuss how the discourse on
will argue that this was a reclassification) of how sexual orientation has evolved over time. We will
homosexuality was defined in the DSM in 1973. start with a review of how non-heterosexuality has
This elaboration from 81 to 237 words (APA, been viewed medically, by providing an extensive
1968) was considered by some as a progressive review of the changes in the DSM over time and
step that liberated this sexual minority (e.g., John examining what medical classifications have
Fryer, John Spiegel; see Spiegel, 2007) . existed in print. We will then collate the various
Simultaneously, the main opposing school of personal communications, relevant articles, and
thought posited that it was a threat to the basic interviews that have been conducted with key
family unit, and undermined the scientific authority players in this debate to provide a parsimonious
of psychiatry (e.g., Irving Bieber, Charles story of how decisions were made about these
Socarides; see Spitzer 1973, 1974) . classifications. We will then critically question the
A substantial body of literature has emerged medical legacy that has been bequeathed to gay
that supports hypotheses of non-heterosexuality men and lesbian women, based on the historical
being compatible with normal mental health and treatment of sexual orientation by the medical
social adjustment (e.g., Barnes & Meyer, 2012; profession(s). Finally, we discuss intervention
Bostwick, Boyd, Hughes, West, & McCabe, 2014; techniques that have been (and continue to be)
Herek, 2010b; Herek & McLemore, 2013; Hooker, applied to ‘re-align’ gay people with the ‘default’
1958; Kinsey et al., 1948; Kinsey et al., 1953; heterosexual orientation (e.g., conversion and
Marshal et al., 2008; Oberstone & Sukoneck, 1976; sexual re-alignment therapies, sexual orientation
Siegelman, 1972, for a review, see Karejeski, change efforts [SOCE], etc.), before closing with a
1996). However, experiences of discrimination challenge to the psychiatric disciplines. Examining
have been empirically linked to the gay male and the histories of this topic from a multidisciplinary
lesbian population having a greater prevalence of perspective allows greater overall understanding to
mental health and substance misuse problems be developed as to how the values and knowledge
(Feinstein, Goldfried, & Davila, 2012). Thus, we from the past influence concepts and attitudes
argue for the existence of a diagnostic-cycle; today.
although professional psychology bodies clearly
state otherwise (e.g., American Counselling Homosexual orientation and the DSM
Association [ACA], 2006; APA 2000a, 2007; The Diagnostic and Statistical Manual of
Australian Psychological Society [APS], 2007) , a Mental Disorders (DSM) originated as a method
higher prevalence of mental health problems for collecting statistics concerning public mental
provides fuel to anecdotal notions that being gay health after psychiatry began to move towards
may be a mental disorder. This contributes to empirical, evidence-based diagnoses. Although
stigma and anti-gay attitudes, which generates conceived and published in the United States of
stressors for gay people, which in turn leads to America, it is now commonly used throughout the
clinical diagnoses. The current literature suggests Western world by mental health practitioners as the
that gay men and lesbian women are as standard manual for the classification of mental

Sensoria: A Journal of Mind, Brain & Culture 5

disorders. Before the DSM was established in that would not draw a clinical diagnosis. Consider
1952, homosexuality was first classified under the the prisoner who committed same-sex rape: he
category of ‘psychopathic personality’ in the would avoid the clinical diagnosis because the
Standard classified nomenclature of disease (1935, ‘normal’ sexual object of a female partner was not
in Stengel, 1959). Specifically, homosexuality was available.3 Conversely, the long-term gay couple in
classified as a ‘pathological sexuality’ (p. 608), a functioning relationship would be classified as
which refers to sexual disturbances that require having a non-psychotic mental disorder (DSM-II
diagnosis, treatment, and prevention. code 302.0; American Psychiatric Association,
Contemporary sexual pathologies include 1968, p. 44).
impotence, infertility, and sexual perversions. Reprints of DSM-II from 1974 onwards no
Interestingly, there is a marked absence across all longer listed homosexuality as a category of
nomenclatures in differences as a function of disorder explicitly (discussed in the next section).
gender; despite current understandings of the The new classification was 'sexual orientation
different experiences of gay men and lesbian disturbance [homosexuality]'. One of the six
women, they have been historically treated as a revisions of the DSM-II involved an important
single social category. advance with the removal of ‘sexual deviations’
from the general heading of Sociopathic
Published Nomenclature(s) Personality Disturbance. Even if only by name, this
removed connotations of antisocial behaviour from
DSM-I (APA, 1952). being associated with homosexuality.
In the first edition of the DSM, homosexuality
was classified under the diagnostic category of The  de-­‐classification  
'sexual deviation', within the sub-category of
'sociopathic personality disturbances'. The In 1973, homosexuality was ‘deleted’ from the
diagnosis specified the type of pathologic DSM-II classification of mental disorders.
behaviour, such as homosexuality, transvestism, However, it was replaced by the category Sexual
paedophilia, fetishism, and sexual sadism Orientation Disturbance; a diagnosis for gay men
(including rape, sexual assault, and sexual and lesbian women who were dissatisfied with their
mutilation). Although referring to sexual sexuality.4 While compiling the communications
orientation as a sociopathic personality could be around this deletion, it becomes apparent that this
considered offensive by contemporary standards, was not a progressive step forward so much as a
Mendelson (2003) suggests this classification was a compromise between differing schools of
progressive step. Placing homosexuality into this psychiatric thought; essentially homosexuality is
category allowed the diagnosis of deviant sexuality either a mental disorder (e.g., Irving Bieber,
to be separated from more severe syndromes, such Charles Socarides; see Spitzer, 1973, 1974) or a
as schizophrenia and obsessional reactions. normal sexual variant (for a discussion, see Stoller
et al., 1973).
DSM-II (APA, 1968). Prior to the official declassification of
homosexuality, Spitzer was heavily involved in the
Although the second edition of the DSM
re-designing of the DSM structure, in terms of
continued to classify homosexuality under the sub-
classifying mental disorders within discrete
diagnostic category of 'sexual deviation', it was
included within the subdivision dealing with
3
'personality disorders and certain other non- In accordance with the literature on contemporary
psychotic mental disorders'. This category included rape analysis, we highlight that sexuality and rape are
any individual who had any sexual interest other non-related; research shows the major motivator for rape
than opposite-sex coitus. This is problematic as this is power (MacCannell & MacCannell, 1993; Scully,
classification placed being gay in the same 2013).
4
classification as people who copulate with animals, The Minutes from the APA Council suggested
inclusion of “Heterosexual Orientation Disturbance”
children, and dead persons. The justification for
(APA, 1973). However, this suggestion of diagnosing
this classification is that, although many gay people who were disturbed with the knowledge that they
individuals found their own sexual practices to be are heterosexual was met with ‘ridicule’ that led to
distasteful, they were unable to substitute them for heterosexuality as a disorder being deleted (Socarides,
‘normal sexual behaviour’ (Socarides, 1978a). 1973). Also noteworthy is the reaction of one leading gay
There was also a note in the DSM-II that this activist at the time, Frank Kameny. He showed no
diagnosis is not applicable for individuals who only objection to the modification of how homosexuality was
perform deviant sexual acts because ‘normal’ classified. He was under the impression that any
sexual objects are not available to them (e.g., homosexual who was distressed at being homosexual
was clearly ‘crazy’ and in need of intervention to get rid
incarcerated males; 1968, p.44). Issues exist here
of the societally-induced internalised anti-gay attitudes
regarding the motivation behind homosexuality; (in Spitzer, 1981).
there is clearly room for situational homosexuality

Sensoria: A Journal of Mind, Brain & Culture 6

categories, and implementing specified diagnostic (Bayer, 1987; Bayer & Spitzer, 1982; Spitzer,
criteria (Spitzer, 2008). According to Spitzer’s new 1981). Opponents of this classification (e.g.,
definition, a condition can only be a mental individuals such as Green, Pillard, and Marmor)
disorder if it causes distress or disability. Spitzer’s viewed Spitzer’s insistence on including a special
position came to be adopted by the APA, as is category for distressed homosexuals as a poorly
evident by the inclusion of ‘Sexual Orientation disguised reintroduction of homosexuality into the
Disorder’ in the nomenclature. Cooper (2004) new nomenclature. This compromise did not put
suggests that Spitzer formulated a definition of the argument to rest. Arguments were fuelled by
mental disorder that he claimed was satisfied by all speculation that this classification still seemed
the conditions in the DSM-II (including founded in latent anti-gay attitudes, and since the
homosexuality). She suggests that he did this as a psychological problems related to ego-dystonic
way of defending his homophobic stance without homosexuality could be treated within other
drawing criticism for its continued inclusion in the general diagnostic categories, it was argued to be a
manual. Richard Green (personal communication, redundant classification that allowed for a
1977; in Bayer & Spitzer, 1982) viewed Spitzer’s continued irrational prejudice.5
insistence on including distressed homosexuals in
the nomenclature as a poorly disguised effort to DSM-III-R (1987).
reintroduce the ‘homophobic bias’ of psychiatry The classification of ‘ego-dystonic
into the new DSM, and made a very public homosexuality’ was removed in the revision of the
resignation from the APA nomenclature committee DSM’s third edition. However, professionals
over this. wishing to do so could still classify homosexuality
under "sexual disorder not otherwise specified".
DSM-III (1980). This classification can occur with manifestations
The new category of ‘sexual orientation including ‘persistent and marked distress about
disturbance [homosexuality]’ was replaced with one’s sexual orientation’ (APA, 1987).
‘ego-dystonic homosexuality’. With this new Ego-dystonic homosexuality was delisted from
classification, homosexuality was classified on the DSM-III-R in 1987 because it was argued that
Axis I, in the diagnostic class of 'Psychosexual “empirical data [did] not support the diagnosis, that
Disorders'. it [was] inappropriate to label culturally induced
During the preparation of DSM-III (1980) there (i.e., internalised) homophobia as a mental
was important, although non-public, debate among disorder, that the diagnosis was rarely used
American psychiatrists (Spitzer, 1981). From 1977, clinically, and that few articles in the scientific
‘sexual orientation disorder’ was no longer listed in literature [used] the concept” (Krajeski, 1996,
the DSM-II. Before the eventual classification was p.26).
decided upon for the DSM-III, there was a new
interim classification of ‘homodysphilia’, that was DSM-IV (APA, 1994) and DM-IV-TR
quickly changed to ‘dyshomophilia’ (Socarides, (APA, 2000).
1978a; N.B., the medical prefix [dys] is commonly Although no ostensible classification was
used to signify a disturbance in normal available, clinicians had room to make a diagnosis
functioning). This medical prefix (i.e., ‘dys’) is of ‘sexual disorder not otherwise specified’ for
commonly used to signify a disturbance in normal people who have symptomology revolving around
functioning; none of the other philias in the DSM at distress about his or her sexual orientation.
this time contained this prefix. Thus, the term
‘dyshomophilia’ was particularly extreme, DSM-V (2013).
sanctioning homosexuality as an atypical type of
In the 5th and current edition of the DSM, there
sexual attraction that signified a disturbance in
still remains the unchanged potential for sexual
normal functioning. According to Bayer (1987) it
orientation to be classified under ‘Other Specified
was also suggested that a new diagnostic category
Sexual Dysfunction’. This classification is so
of 'heterodysphilia' be introduced for 'heterosexuals
broadly defined that its application would be
. . . distressed by their sexual orientation'.
applicable to non-heterosexuals who experience
‘Homosexual conflict disorder’ also briefly entered
the nomenclature, but eventually a classification
was decided upon for DSM-III; ‘ego-dystonic 5
Arguably, while any stigma associated with non-
homosexuality’ (American Psychiatric Association, heterosexuality exists, there will be a ‘coming out’ phase,
1980; Spitzer, 1981; Suppe, 1984). or an initial phase in which individuals reveal their
The inclusion of this diagnosis in the DSM-III homosexual orientation, which could be considered ego-
represented a compromise between the various dystonic; a parallel argument to this would be that
clinicians and scientists who had argued in favour vegetarians aren’t mentally ill because of their vegetarian
of delisting homosexuality from the DSM-II, and orientation to life; the only vegetarians who need help
with their vegetarianism are the ones who eat meat.
the conservative school of psychiatric thought

Sensoria: A Journal of Mind, Brain & Culture 7

distress about their sexual desires or actions. It is socio-political struggle regarding what were
worth noting that the APA Task Force on deemed to be the rights of homosexuals (Bieber,
Appropriate Therapeutic Responses to Sexual 1987), involving violent protests, secret meetings,
Orientation (APA, 2000a) do not support such symposiums and referendums.
classification, instead encouraging mental health
professionals to promote affirmative (Bartoli & Protests
Gillem, 2008; Crisp, 2005) and client-centred The catalyst for the protests started in the early
therapeutic approaches (e.g., Glassgold, 2008; 1960s when the psychiatric status of homosexuality
Haldeman, 2004). became topical, and the debate was publically
Although the focus of this paper has been the dominated for that decade by two New York
APA’s DSM, it is worth briefly mentioning the psychoanalysts: Irving Bieber and Charles
International Classification of Disorders (ICD). Socarides. Bieber (1965) collected data on over
Produced by the World Health Organization, ICD-9 100 gay men on sexual behaviour from 77 doctors,
(1977) also originally listed homosexuality as a and concluded that the cause of homosexuality was
mental illness and continued to do so until 1990, a combination of over-protective mothers and
with the publication of the ICD-10. At this point, detached rejecting fathers. This work is still the
there is still a diagnosis (F66.1) that covers when basis of Sexual Orientation Change Efforts
an individual’s sexual orientation is clear, yet the (SOCEs) and reparative therapies today (an
‘patient’ has another behavioural or psychological empirical critique of reparative therapy is found
disorder which makes that patient want to change later in this article). Bieber's study was used as
it. The diagnostic manual notes that a sexual proof that homosexuality was pathological;
orientation is not a disorder in itself. however, strangely absent from Bieber’s literature
review are the findings of Hooker’s (1957) seminal
The Backstory to the De-Classification research published only eight years beforehand.
The deletion of homosexuality from the This research revealed that homosexual populations
nomenclature of psychiatric disorders in 1973 was and heterosexual populations do not differ
not a result of the empirically derived notion that significantly in their psychological adjustment. In
homosexuality in itself was not a pathological 1970, the New York County District Branch of the
orientation. We argue that this de-classification was APA appointed Socarides, a renowned
actually no more than a re-classification. Although psychoanalyst who devoted much of his career to
the ‘deleted’ classification could still be diagnosed understanding homosexuality, which he believed
(i.e., through ‘Sexual Orientation Disturbance’) could be altered with therapy, as chairman of the
there were many unhappy parties involved; the pro- Task Force on Homosexuality. The task force
gay half of the argument were unhappy that the unanimously reported in 1972 that homosexuality
classification was not deleted in its entirety, and the represented a ‘disordered sexual development not
conservative half were unhappy that it was changed within the range of normal sexual behaviour’, and
at all. Perhaps as a reflection of the patriarchal that it arises ‘experientially from a faulty family
nature of the psychiatric profession, the momentum constellation’ (Socarides, 1973).6
behind the de-classification was largely driven by It was the combination of Bieber s' study, and
gay males. As such, there is a noticeable absence of the report from the Task Force that attracted the
lesbian women in the dialogue that is presented in attention of the psychiatric world. Protests followed
subsequent sections. The extensive correspondence in response to these two events; these protests drew
between the key players revolving around this the attention of gay activists and led to history-
controversy is evidence of an unresolved conflict changing protests at several of the annual APA
over homosexuality within American psychiatry. conferences. Gay activists disruptively
demonstrated at the annual APA conventions from
1969 – 1973. This included violent and vocal
The ‘Re-Classification’ protests, with both Socarides and Bieber being
The official story is that in December 1973, the personally targeted (Spector 1977). In an interview
Board of Trustees of the American Psychiatric with Bieber’s wife (Spiegel, 2007) she said both
Association (APA) voted to remove homosexuality
from the DSM, and that this decision was 6
Interestingly, in 1992, Socarides was a founding
sanctioned through a referendum in which 58% of member of the National Association of Reparative
members of the APA approved of removal of this Therapy for Homosexuals (NARTH, which was
classification (Mendelson, 2003). It is often publically disavowed by the APA). It is also interesting
assumed the deletion arose as a result of careful to be aware that Socarides publicly maintained his views
deliberation based on new-found knowledge that that homsoexuality was a ‘neurotic adaption’ until his
death in 2005 (Fox, 2005), despite his son’s prominent
was derived empirically. Actually, the deletion of
role as Senior White House Advisor for Public Liaison
homosexuality from the DSM resulted from a for gay and lesbian issues for the Clinton presidency
lengthy and very public debate that climaxed in a (Crea, 2004).

Sensoria: A Journal of Mind, Brain & Culture 8

were shocked and saddened by the protests, as they symposium, entitled “Should Homosexuality be in
felt they were genuinely helping gay men and the APA nomenclature?”, that the debate reached
lesbian women navigate their maladjusted natures. its public peak. The nomenclature committee
The most successful protest was at the 1972 claimed that homosexuality held no clinical
APA convention with an address to the convention symptoms, no course of development, and no
by Dr. John Fryer. Fryer was previously a resident effective treatment. This was in direct opposition to
in psychiatry at the University of Pennsylvania who the task force on homosexuality’s position on this
was fired from his position because his boss issue, as well as the general psychiatric
suspected he was gay. Rumours of his sexual understanding at the time (Stoller et al., 1973). The
preference followed him and he was unable to find symposium is reported as finishing with a
gainful employment. After being approached by presentation by Ron Gold entitled “Stop it – you’re
activists, he appeared (uninvited and unannounced) making me sick” in which he claimed the diagnosis
at the convention in cognition. Staging himself as of illness for homosexuality is the greatest tool of
Dr. Anonymous, in an oversized tuxedo and a oppression imaginable (in Socarides, 1973).
rubber mask of Nixon, Fryer took control of the Following the symposium, homosexuality was
stage and stated, “I am a homosexual. I am a deleted from the DSM, upon approval from the
psychiatrist”, and went on to inform the convention Board of Trustees of the APA in December 1973.
of the issues involved with declaring all The Psychiatric News claimed that the Board of
homosexuals as mentally ill (Lenzer, 2003). This Trustees essentially made its decision based on an
gave the protesters a new wave of energy, and official position paper by the Chairman of the
sparked an understanding in the profession that Nomenclature Task Force on Homosexuality,
closet homosexuals must be practicing. The Robert Spitzer (see Spitzer, 1974). The
protests became more vocal and violent until the presentation of this paper asserted that
declaration that homosexuality “by itself does not homosexuality did not meet the requirements of a
necessarily constitute a psychiatric disorder” was psychiatric disorder; it repeated Kinsey’s earlier
made (Spector, 1977). suggestion that homosexuality does not cause
regular subjective distress, nor is it associated with
Closed meetings impairing social functioning (as cited in Drescher,
Coincidently, at the same time as these protests 2003). This statement implied that homosexuality
were externally pressuring the psychiatric was a normal variation of sexuality, which in turn
profession, internal events were also making allowed sexual orientation disturbance to be
waves. According to an article in the New York substituted for homosexuality.7
Times (Rensenberger, 1973) an underground group Socarides argues that this deletion of
which was jokingly entitled the GayPA ‘homosexuality’ occurred without presenting
(comprising of men like Fryer, who had made it ‘substantive evidence for such a drastic revision of
through medical school without the disclosure or basic concepts of healthy vs. unhealthy sexual
detection of their sexual orientation) allegedly met development’ (Socarides, 1978b) . In support of his
with the Nomenclature Committee of the APA in a argument, he stated that the WHO had not changed
closed meeting. They requested the deletion of their stance on the classification of homosexuality.
‘homosexuality’ from the DSM at the start of 1973. It is noteworthy to mention that to this day the
The article suggests that the group constituted WHO still remain ambivalent about homosexuality
several leaders of the APA, other psychiatrists, and stating that ‘it may or may not be a disorder’ (ICD-
members of the Gay Activists Alliance. John 10; 1990).
Spiegel, APA president-elect at the time (who was
later revealed as a closet homosexual; Spiegel,
2007) was heavily involved in organising these
closed meetings. A few months later the APA
committee on Nomenclature and Statistics was 7
seriously considering the removal of homosexuality In a polarised change of opinion, Spitzer presented a
from DSM-II; however, Socarides (1978a) claims paper in 2001 claiming that successful change of
orientation was achievable in highly motivated
that deletion was being considered without
individuals. Although it was criticised by the APA in an
appropriate consultation of those who had worked official statement for its sampling method and the criteria
in this area of clinical research (i.e., Bieber and for ‘success’, the study was peer reviewed and published
himself). two years later (Spitzer, 2003 . Criticisms include
classifying bisexuals as homosexuals (who obviously are
The symposium going to be more capable of heterosexual functioning)
The combination of external political pressure and using large samples of participants who had
leadership roles in transformational religious institutions
from activists and internal pressures from the
(Robinson, 2010). Spitzer recently repudiated these
members of the GayPA, led to the holding of a findings (Spitzer, 2012, see also Armelli, Moose, Paulk,
Symposium in May 1973. It was at this & Phelan, 2012).

Sensoria: A Journal of Mind, Brain & Culture 9

 The referendum (1973, 1992) suggested that appropriate therapy
Following the official deletion of can only be based on accurate diagnosis. Since
homosexuality from the nomenclature, Bieber and sexual orientation is no longer grounds for a
Socarides formed an ad hoc committee for APA medical diagnosis, we must question how and why
members who did not agree with the de- SOCE and conversion therapies continue to exist.
classification. Based on their research, they argued There is a legitimate concern that the mere
that homosexuality was not a normal variation of existence of any conversion-type therapies can
behaviour and therefore warranted a place in the cause social harm. For example, portraying
diagnostic nomenclature. Under the pretence of inaccurate views about the nature of sexual
advocacy, they suggested that deletion of the orientation (i.e., as a perversion), implying that
descriptor terms jeopardised the treatment of sexuality may be a choice or preference rather than
children who were identified as ‘being at risk for an innate orientation, and suggesting (even if it was
becoming homosexual’ (Bieber, 1987, p. 431). empirically proven to be possible) that sexual
They suggested that the task force was not orientation should be changed regardless of the
competent to handle this matter, as they lacked individual’s need or desire to change (i.e., ignoring
experience and research in the area of the fact that homosexual or bisexual individuals
homosexuality. may be happy with their orientation) are
This committee accused the leadership of the irresponsible and incorrect messages that should
APA of giving way to political pressures, and, as a not be associated with science. The counter-
result, in 1974 the board called for a referendum argument is that these therapies may sound
amongst all members of the APA (Bayer & Spitzer, reactionary and anti-gay, but that for those men and
1982). A letter from the president-elect, vice- women who seek an alternative to the gay lifestyle,
president and the three candidates for president- this could be a progressive treatment that should be
elect for the APA was circulated to members available if there is a chance it works, and will re-
encouraging them to vote against revoking the de- align the orientation of the patient with their
classification. The referendum ballots were desired preference (National Association for
returned by 9,644 members (37%), with only 3,810 Research & Therapy of Homosexuality [NARTH],
voting to revoke the decision. In a controversial 2010).
discovery by Bieber (1987), the letter turned out to Spitzer (1984) makes an interesting suggestion:
be developed and financed by the National Gay If there were an available and reliably effective
Task Force. This activist group allegedly solicited ‘treatment’ for homosexuality, there would be a
the signatures and purchased the membership list of strong case for re-classifying it as a disorder. As
17,900 psychiatrists from the APA board of the term presupposes, if there is a treatment for it,
Trustee’s (Bieber, 1987). The APA ethics there must be a need to cure it; this in turn implies
committee investigated the matter after concerns disorder. In an attempt to remain politically neutral
that the circulated letter was not a true reflection of on the topic he adds that he would make the same
the opinions of the APA executive committee.8 prediction regarding left-handedness, although the
implications of homosexuality being categorised as
Current Implications for the Mental clinically dysfunctional may be far more severe
Health Professions than for which hand you ‘choose’ to write with.
The group ‘Parents and Friends of Ex-Gays’ (i.e.,
The medical legacy of homosexuality PFOX, supporting individuals who were, and are
no longer, gay or lesbian) claims that
The historical lineage of medical and homosexuality should still be classified as a mental
psychological diagnostic criteria retains disorder based on the distress it causes the
considerable implications when applied to a individual; “In the history of psychiatry, no
clinical context to homosexuality today. Evidence heterosexual has ever sought treatment for distress
of these remnants is found in the ongoing, albeit about his heterosexuality and wished to become
diminishing, presence of reparative therapies and homosexual” (Griggs, 2007) .
other sexual orientation change efforts.9 Socarides In 1997, the Council of Representatives of the
8 APA affirmed its position that homosexuality is not
The ethics committee decided that, although ‘unwise’, a disorder and raised concerns about reparative
there had been no ethical breach of impropriety (Bieber, therapies. In particular, the APA resolution raised
1987). Bieber also suggests that there was an over-
representation of younger voters which influenced the
the question of whether it is ethically possible for a
outcome, and that a compulsory vote should been psychologist to conduct conversion therapy with
instituted which he argues would have resulted in the
referendum producing the opposite result. prevalence is steadily reducing (Silver, 2014) with many
larger clinics in the United States and Australia closing in
9
The prevalence of such therapies is difficult to quantify. the previous 12 months and with many clinics now only
By nature of their controversial practices, they do not offering contact online. For a review, see Venn-Brown
widely advertise, however what is known is that their (2015) elsewhere in this special edition.

Sensoria: A Journal of Mind, Brain & Culture 10

individuals who are not capable of informed The task force evaluation
consent, including minors (APA, 1997). In 2009, the Task Force on Appropriate
Therapeutic Responses to Sexual Orientation
Professional Recommendations: conducted extensive research into conversion-style
A statement by the APA (2000) suggests that therapies. Although some individuals showed
the role of the ‘therapist should not involve lessened physiological arousal to all sexual stimuli,
determining the goal of any treatment, either there was not a single reported significant change
coercively or through subtle influence’. It goes on to other-sex attractions that could be empirically
to explicitly state that psychotherapeutic validated. They found "serious methodological
interventions claiming to convert or ‘repair’ problems in this area of research, such that only a
homosexuality are ‘based on theories with highly few studies met the minimal standards for
questionable scientific validity’. Furthermore, evaluating whether... such efforts to change sexual
anecdotal claims of ‘cures’ are offset by reports of orientation are effective" (APA, 2009, p.2). Other
psychological harm. Although there are many research also suggests that fundamentalist religious
published books by leading ‘researchers’ in this organisations often claim to have changed
area, (e.g., Konrad, 1997; Macnutt, 2006; Nicolosi homosexuals to heterosexuals, but generally have
et al., 2009; Nicolosi & Nicolosi, 2002), these not been documented in such a way as to permit
leading reparative therapists are yet to produce any their critical evaluation (Haldeman, 1991, 1994).
scientific research to substantiate or validate their Most claims about the ‘success’ of conversion
claims of cure. This assertion is echoed by the APA therapies have appeared mainly in the mass media,
(e.g., 2000, 2009) and APS (e.g., 2007). rather than in scientific journals. Apart from the
Questionable case studies and anecdotal stories previously mentioned Spitzer (2001) study, there
provide a pleasing form of face validity, but do not are two exceptions located using extensive search
hold up to the empirical basis that psychology as a procedures (i.e., Byrd & Nicolosi, 2002; Nicolosi et
science should be built on. al., 2000), and both have received criticism of their
The APS currently recommends that, until credibility (Herek, 2010a).
quantifiable research is produced, practitioners
refrain from attempts to change the sexual Conclusion
orientation of their patients. It is also recommended It is evident through the course of this paper
by the APA that parents, guardians, and families of that the evolution of attitudes towards sexual
gay men and lesbian women avoid any form of orientation throughout the last century has been
treatment that portrays homosexuality as both rapid and extreme. This social category has
dysfunctional, a mental illness, or a developmental seen its members move from clinically insane law-
disorder. Although a homosexual or bisexual breakers to liberated activists over the course of
individual may experience conflict with their this time. Although the official position is that
society, such conflict is not a symptom of homosexuality has been delisted from both the
dysfunction in the individual. Alternatives to DSM and the ICD (APA, 2000, 2009), we argue
treatment include seeking psychotherapies, psycho- that this is merely a re-listing; in 1973, the term
education services and social support services "that homosexuality was removed, however, in the
provide accurate information on sexual orientation current DSM and ICD-10, both have room to utilise
and sexuality, increase family and school support non-heterosexuality for clinical diagnoses. As such,
and reduce rejection of sexual minority youth" this removal is arguably a matter of
(APS, 2007). Furthermore, the APS encourages reclassification. Regardless of whether the delisting
academic research to determine the efficacy or is regarded as a removal or a reclassification, there
otherwise of therapies or treatments that attempt to seems to be remnants of unresolved conflicts
change a person’s sexual orientation.10 within psychiatric circles.
Between the orthodox psychiatrists demanding
10
The reparative therapy literature actively stigmatises
referendums, and the progressive psychiatrists
homosexuality, whilst conveniently ignoring the impact being involved in staging activist attacks at
that such stigma would have in motivating people to conventions, the entire debate became around
want to ‘cure’ their homosexuality. This is confounded diagnosis became theatrical debacle. A dispute
by the fact that it does all this under the guise of fuelled by political controversy, much more so than
psychological expertise. The leader in this field, Joseph by questions of science, raged between two
Nicolosi, has entitled his work “Handbook of therapy for opposing schools of psychological thought. The
unwanted homosexual attractions” although it is referendum outcome lacked objectivity, meaning
criticised by the APA for methodological reasons (APA,
the debate became a matter of subjective opinion.
2009). Also, it is worth mentioning that the reparative
To avoid the extraneous factors (i.e., political and
therapy literature neglects to refer to any potential risks
to patients, or the strains this will place on their personal social influences) that became involved in this
lives and interpersonal relationships. decision, an appropriate decision-making model
could have been adhered to. For example, the

Sensoria: A Journal of Mind, Brain & Culture 11

decision could have acknowledged only clinical or research lacking in empirical grounding. Based on
scientifically based data that was relevant to the its medical legacy, clinical professions arguably
argument of homosexuality as a variation on sexual need to take some of the blame for the lingering
behaviour, and whether it fell within the realm of anti-gay attitudes in society; the clinical
sexual normality. Nomenclature inclusion should professions also have a responsibility to further the
be based in empirical evidence of a variation on research in this arena until the matter is resolved.
sexual behaviour considered ‘other than normal’,
otherwise it should be entirely removed with no Research Profile
room for subjective bias from a clinician. Joel Anderson is completing a post-doctoral
It could be argued that any diagnostic criteria in research fellowship at the University of Geneva in
the DSM that allows for a clinical classification, Switzerland. His primary research interest is in
regardless of how subtle or ambiguous the attempting to understand implicit biases (or non-
classification might be, presumes that in some conscious attitudes) towards various social groups,
situations an appropriate intervention is to help the and in particular towards gay men and lesbian
individual develop a heterosexual arousal pattern. women. He has a particular interest in methods
Although this goes against the stances of both the used for measuring non-conscious attitudes towards
APA and the APS, classifications such as in the gay men and lesbian women, and he is now
current DSM (‘sexual disorder not otherwise extending this research in his post-doctoral
specified’ for people who have symptomology research, which aims to better understand how
revolving around ‘distress about his or her sexual theories of biologically determined sexual
orientation’) suggest an appropriate therapeutic orientation interact with both conscious and non-
activity is to help the individual concerned become conscious attitudes towards gay people.
more comfortable with his or her homosexual
orientation, rather than attempting change. There Elise Holland is a Postdoctoral Research Fellow
appears to be an ethical issue with this in the Melbourne School of Psychological Sciences
incongruence; issues arise when people are led to at the University of Melbourne, Australia. Her
believe orientation can be changed through research broadly examines what it means to view
intervention, and the same reparative therapies that and treat people as sexual objects. In particular, her
are denounced by the APA can gain legitimacy work investigates the factors that facilitate sexual
purely through their existence, without room for objectification, the perceptual and behavioural
‘loophole endorsements’ through this classification ramifications of objectifying others, and the effects
issue. of experiencing interpersonal objectification. Her
For an extreme exemplar of the power this most current research explores the sexual
medical legacy still holds over attitudes towards objectification of young girls, and the implications
sexuality, look no further than Uganda, which of objectifying girls on perceptions and behaviour.
instigated the Anti-Homosexuality Bill of 2009.
The bill originally called for seven years in prison References
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