History of LGBTQ People and Psychiatry
The pathologization of same-sex sexual activity and transgender identity in Western culture is often traced to Biblical times, specifically the explicit condemnation of male homosexual behavior in the book of Leviticus. Beginning in the sixteenth century, specific laws against homosexual sexual activity were termed alternately “sodomy,” “buggery,” or broadly “unnatural acts.” The medical field began writing extensively on same-sex sexual activity in the late 19th century; German physician Karl Westphal (1833-1890) was one of the first proponents of a “congenital” model of homosexuality to be treated psychiatrically rather than with legal means. The pathologization of homosexuality was further advanced in the works of the German writer von Krafft-Ebing’s 1886 work Psychopathia Sexualis with Especial Reference to the Antipathic Sexual Instinct: A Medico-Forensic Study, which dissected same-sex attraction as a “severe manifestation of hereditary degeneration” (see “The History of Psychiatry and Homosexuality,” cited below). Krafft-Ebing’s work also contributed to the conflation of homosexuality and transgender presentations as he made no distinction between the two in his work. Many physicians in the late 19th and early 20th century conducted studies of the bodies of homosexual and transgender individuals in an attempt to outline a physical basis for homosexuality, to no avail.
Psychoanalytic theory figured heavily into early modern psychiatry’s conception and treatment of male homosexuality (there is little mention in the literature of the time of transgender identity, and only a single case report related to female homosexuality; Freud, 1920). Sigmund Freud’s theories related to the development of homosexuality began to take hold early in the 20th century as well. In essence, Freud believed that male homosexuality arose from the Oedipal realization by the over-attached boy that his mother was “castrated,” leading him to seek to love others of the same sex the same way his mother loved him (see Lewes, 2009). Rather than pathologizing it, however, Freud conceptualized homosexuality as a state of arrested sexual development that was unlikely to be modifiable. Later on in the 20th century, work by Sandor Rado and colleagues contradicted Freud’s assertion that male homosexuality was a normal variant, asserting that heterosexuality was the only nonpathological developmental outcome. This line of theory led some investigators to attempt to “cure” homosexuality using conversion therapy, an unsupported and damaging practice that continues to the present day (APA, 2009 and Drescher, 1998).
Homosexuality was first listed in the DSM-1 in 1952 as a “sociopathic personality disturbance,” and was later recategorized to a “sexual deviation” with the publication of the DSM-II in 1968. During this period, however, the burgeoning civil rights movement as well as expanding interest and research in human psychology began to challenge forcefully the pathologization of homosexuality. Work by the likes of Albert Kinsey and Clellan Ford asserted that homosexuality was much more common than previously thought, and a landmark 1957 study by the psychologist Evelyn Hooker found no greater presence of psychopathology in homosexual as compared to heterosexual men (Ford et al, 1951; Kinsey et al, 1948; Kinsey et al, 1953; Hooker et al., 1957). Homosexuality was officially “de-pathologized” by the American Psychiatric Association (APA) in 1973, after years of research, advocacy, and protest at APA meetings. (This included the appearance at the 1972 APA meeting of “Dr. Anonymous” (AKA John Fryer), a psychiatrist who attended in “"a Nixon mask, a fright wig, an oversized tuxedo and used a voice-distorting microphone so as not to be recognized" when he spoke on a panel about his experiences of discrimination working as a gay psychiatrist (Bayer, 1981; Drescher et al, 2007; Drescher, 2015; Scasta et al, 2002).) De-pathologization of transgender presentations would come much later, with the ICD-11 formally removing the diagnosis of “gender incongruence” in 2019.
CME Question:
Under what behavioral category did the DSM-II, published in 1968, define homosexuality?
Sociopathic personality disturbance
Normal variant of human sexuality
Sexual deviation
Representation of unconscious longing for the father
Answer: 3