Psychology's Sexual Dis-Orientation

Article excerpt

Within the American mental health profession, there is now a strong movement to prevent conversion therapy, a type of psychotherapy in which a homosexual patient's sexual orientation is changed to heterosexual. Resolutions to this effect have already been adopted by the Washington State Psychological Association and a committee of the National Association of Social Workers and are now under consideration by the American Psychological Association and the American Psychiatric Association.

Many liberals who vigorously oppose any outside interference in the private decision between a woman and her doctor about aborting a fetus have no qualms about interfering in the decision between that same woman and her doctor concerning a change in her sexual orientation. This is only one of many ironies in the extraordinary history of the American mental health profession's struggle with homosexuality, a history that can itself be characterized as a "conversion." This history opens a window on our societal ambivalence toward not only homosexuality but also the broader questions of mental illness and individual rights.

Early in this century, American psychiatry was dominated by psychoanalysis. According to early psychoanalytic theory, the normal outcome of psychosexual development is an adult whose sexual activity is predominantly heterosexual vaginal intercourse. Homosexuality was therefore seen as a failure of development brought about by some childhood trauma. Ironically, this psychoanalytic position was seen by many advocates of homosexual rights as progressive because it was an advance over traditional beliefs that homosexuality is a form of moral degeneracy or even a punishable crime.

DIAGNOSING HOMOSEXUALITY

In 1952 the American Psychiatric Association formalized its system of diagnosis and published the Diagnostic and Statistical Manual of Mental Disorders (DSM). Today, a DSM listing has practical consequences; whether treatment for a problem is paid for by health insurance companies or a psychological problem qualifies as a disability under various laws often depends on whether it is listed in DSM.

Not surprisingly, given the psychoanalytic theory shared by most clinicians, the DSM listed homosexuality as a psychiatric disorder. Interestingly, it was classified as a sociopathic personality disturbance, meaning that the diagnosis could be made purely on the basis of the homosexuality alone, despite the absence of subjectively experienced distress. In the 1968 revision of the DSM, homosexuality was still included as a disorder but classified more descriptively under "sexual deviations" along with disorders such as fetishism and pedophilia. What followed is unprecedented in the annals of medicine.

The publication of DSMII coincided with the founding of a militant gay liberation movement whose goals included the normalization of homosexuality as a legitimate "lifestyle." Gay activists mounted a furious attack on the American Psychiatric Association for designating homosexuality a disease. Their most effective form of protest consisted of demonstrations at several professional conventions, most critically the 1970 disruptions in San Francisco. Over the next three years, the association was forced to reconsider not only the inclusion of homosexuality in DSMIII but also the entire conceptual basis for defining a mental disorder.

The gay liberation movement considered the psychiatric designation of homosexuality a major basis for antihomosexual attitudes in American society. It justified a wide variety of antihomosexual legislation, ranging from laws barring homosexuals from immigrating to the United States or serving in the military to regulations in New York requiring homosexual taxicab drivers to undergo semiannual psychiatric examinations. In a broader sense, the designation reinforced the prevalent attitude that homosexuality is an "illness." According to the activists, this stigmatization not only justified bigotry but also caused gay men and lesbians to turn against themselves in self-hatred. …