TMQH:"20,000,000 Gay People Cured!"

In 1973, the headline "20,000,000 Gay People Cured!" appeared in the Chicago Gay Crusader in response to the American Psychiatric Association (APA) removing homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). This month, we delve into how a coalition of gay activists, medical professionals, and psychiatrists succeeded in declassifying homosexuality as a mental disorder. 

Show Notes: 

https://docs.google.com/document/d/1_ZMdgTyqwRS28u9ItvJ5xXvfdOWw2QulPUb43hGRDo4/edit?usp=sharing

Please note that some of the sources for this episode are decades old and use outdated, medicalized, and stigmatizing language towards queer people. Please take care while reading. 

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Transcript

“As homosexual psychiatrists, therefore, we must use our skills and wisdom to help all of them and ourselves grow to be comfortable with that little piece of humanity called homosexuality.”

[TMQH Theme Music]

That was the voice of Dr. John Fryer, a gay psychiatrist. He is speaking at the annual conference for the American Psychiatric Association, better known as the APA. He gave that speech on May 3rd 1972, flanked on one side by activists Frank Kameny and Barbara Gittings, who invited him to speak at the conference, and two non-gay psychiatrists on the other. He wore a disguise - a Richard Nixon mask, a curly dark wig, and a suit three sizes too big, and spoke through a microphone with a voice modulator. All this, along with introducing himself under the name Dr. Henry Anonymous, was necessary because being outed as a gay psychiatrist would have torpedoed his career. Agreeing to speak at all was incredibly brave on his part.

His speech is often credited as the impetus for the APA removing homosexuality from the DSM, but even in 1972, he was backed by gay activists, iconoclastic medical professionals, and a rising tide of public opinion turning slowly toward gay rights.

The cultural conversation that the diagnostic and statistical manual of mental disorders, or DSM for short, was born into in 1952 was unequivocally anti-gay.  While to many, the understanding of gayness as a moral sin was still at the forefront of their minds, the last 70 years had brought a new “understanding” of gayness thanks to the rapidly advancing medical profession, that being gay was itself medical in nature. Opinions were split over whether it was an in-born proclivity or some kind of acquired sickness, but both carried the implication that it should be cured.

In the burgeoning new field of psychiatry, being gay was considered a mental disorder, not unlike schizophrenia or psychosis. Not all of the early medical study of gayness was this negative, but the dominant psychiatric opinion of homosexuality was that it was a sexual perversion, being listed under the DSM as “sociopathic personality disturbance,” alongside “transvestism, pedophilia, fetishism and sexual sadism.” This theoretical framework fed into the (now discredited and broadly outlawed) practice of conversion therapy, in which gay people would be pressured through mental and sometimes physical abuse to renounce being gay. 

Even back then, though, the practice of conversion therapy and the diagnosis itself of homosexuality as a psychiatric sexual perversion was not without its detractors across multiple medical fields. Building off the work of Havelock Ellis and Magnus Hirshfield, Alfred Kinsey, an American sexologist, was conducting massive studies of the sexualities of American men and Women throughout the 1940s. He would eventually publish his results in two large volumes, "Sexual Behavior in the Human Male" (1948) and "Sexual Behavior in the Human Female" (1953), known collectively as the Kinsey reports. These reports, which we covered on a previous iteration of this podcast, challenged all of the cultural narratives about homosexuality, both in the medical field and in the US at Large, by revealing that a large portion of the population had engaged in at least some homosexual activity, implying that it was much more common and not nearly as deviant as people believed. 

The belief that being gay was rare was one of the most important factors underpinning the pathologization of gayness. For something to be disordered, it must go against the natural order. Now what is the natural order? Even back then, the rare socially-conscientious psychiatrist would admit that definitions of disorder were highly dependent on cultural norms. This lays bare the fact that the diagnosis that they were giving based on the DSM were not diseases, with known causes and known processes in the body, but simply aberrations from what they believed proper behavior to be. 

One such conscientious psychiatrist who recognized that homosexuality was neither abnormal nor aberrant was Dr. Evelyn Hooker. Already standing out in her field for being a woman psychiatrist in the 1940s and 50s, Dr. Hooker put her career on the line by publishing a study of straight men and homosexual men that demonstrated that the rates of “psychological maladjustment” were no different between the two groups. The study effectively shot down another one of the defenses of homosexuality being in the DSM, which was that it was distressing or harmful to the person that was homosexual. This clearly was not borne out by Dr. Hooker's data. 

So, by 1972, there was a considerable amount of data that the APA's reasoning behind including homosexuality in the DSM was wrong. But, other psychological studies will tell you that statistics only do so much to convince people that they're wrong: what they really need is human stories. That is where Dr. John Fryer comes in. So, on May 3rd of 1972, Dr. Fryer put on that rubber Richard Nixon mask and addressed a conference room full of his professional colleagues from across the US. In his presentation, he spoke to the humanity of gay people, and his speech clearly moved those in the audience. In December of the following, the APA Board of Trustees voted unanimously to remove homosexuality from the DSM, and when they put it to a vote amongst members of the APA the next spring, it would pass with just an 8% margin. 

The word homosexuality was no longer in the DSM. Job done then, right? Well… you see, the APA still couldn't really let go of the fact that they thought being homosexual would cause mental disturbances to the people who are homosexual, and so in the next edition of the DSM, the diagnosis was replaced with the category sexual orientation disturbance, which is a fancy way of saying that someone is upset that they're gay. The next edition of the DSM didn't really help things, replacing that diagnosis with ego-dystonic homosexuality. Doubling down on their pathologization of queer people, that edition of the DSM also introduced gender identity disorder, implicitly asserting that being transgender was a mental illness. Homosexuality, in the form of distress over one’s sexuality, would not fully leave the DSM until 2013 when the DSM 5 was released. It was also in that edition of the DSM that gender identity disorder got an update to gender dysphoria, which was defined as gender identity related distress. That diagnosis is still in the most current edition of the DSM, the DSM-5 revised, which came out in 2022. It's not hard to see how the same watering down of the pathological diagnosis for homosexuality is now being applied to transgender identity in the DSM. 

These days, the reasoning for including gender dysphoria in the DSM that's generally given is different from the reasoning given for keeping homosexuality in the DSM. Many will argue that gender dysphoria needs to be in the DSM for insurance reasons, as a mental diagnosis of dysphoria is required for coverage of many transgender health procedures, like gender affirming surgery and hormone therapy. In practice, many transgender people have found that their insurance still denies them coverage even with a psychiatric diagnosis of gender dysphoria, because, despite gender divergence being in the DSM in some form or another for more than 30 years, there is still no official recommended treatment for gender dysphoria in the DSM, allowing insurance companies to claim that no treatment is needed and deny coverage. 

It's worth noting, as well, that very few other medical diagnoses require seeing a psychiatrist to confirm that you need coverage. One could easily imagine a world in which gender dysphoria is a medical diagnosis, rather than a psychiatric diagnosis, meaning that one could be diagnosed by their physician in office and treated using standard informed consent protocols, the kind that are used for other medical procedures. There are many other medical concerns that can be boiled down to: a patient comes in and tells the doctor, “This part of my body is causing me pain. Can we fix it?” And the doctor confirms that pain, and then treats them. 

At least here in the US, where our medical system does require a diagnosis for coverage of care, changing gender dysphoria to a medical diagnosis instead of a psychiatric one would reduce the barriers to care for many trans people, and the removal of gender dysphoria from the DSM would likely result in a reduction in stigma the same way it did for homosexuality. As it stands, its inclusion in the DSM corroborates the cultural narrative that being transgender is a mental illness. The diagnostic change would be, if nothing else, a step in the right direction. 

I'll end with a quote from Dr. Hooker about the stigma towards queer people: ‘What is called this year “evil” and whatever, next year may constitute the blessing of the human race.’ - Evelyn Hooker

Thank you for tuning in for the eleventh episode of This Month in Queer History. Join us next month for our twelfth episode, a special Pride episode about the creation of the rainbow pride flag.