50 years ago, psychiatrists stopped calling homosexuality a mental illness

The Washington Post

By Donald Beaulieu

December 15, 2023

Fifty years ago Friday, on Dec. 15, 1973, the board of trustees of the American Psychiatric Association voted to remove homosexuality from its diagnostic manual of mental illnesses. Newspaper stories the next day mostly treated it as a technical change rather than a seismic shift that would transform the lives of gay people. The activists who fought for the change knew otherwise.

“When the diagnosis existed,” said Jack Drescher, a psychiatry professor at Columbia University and author of “Psychoanalytic Therapy and the Gay Man,”“military groups, religious groups, education groups, medical groups could use that diagnosis as an excuse for discrimination. When the diagnosis was finally removed, a major rationalization for discrimination was taken away.”

He added, “Nothing happened overnight — it took a long time. But it was a world-changing event.”

The treatment of homosexuality as a mental disorder in the mid-20th century had its roots in Freudian psychoanalysis. “The Freudians had a great deal invested in the idea that homosexuality was the result of arrested development, and a form of mental illness,” said Andrew Scull, a sociology professor at the University of California in San Diego.

The manual that catalogues every psychiatric illness recognized by the APA is called the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. When it was first published in 1952, the DSM defined homosexuality as a “sociopathic personality disorder,” and inadequate parenting was commonly deemed the cause. “The psychoanalytic stereotype of the family that created a homosexual,” Drescher said, “was an overbearing mother and a distant or hostile father.”

Psychoanalysts still dominated the field of psychiatry in the early 1970s, just as the gay rights movement picked up momentum after the 1969 protests that followed the police raid of the Stonewall Inn, a gay bar in New York’s Greenwich Village. “It is an interesting period when gay activists are finally coming out of the closet, but it is a very fraught environment,” Scull said. “Gay sex is still illegal in many jurisdictions, and public prejudices are very high.”

By 1970, gay and lesbian activists looked at the APA diagnosis of homosexuality in the DSM as one of the biggest obstacles to achieving equality for gay people. “And so it was determined,” Drescher said, “that psychiatry was the enemy of gay people.”

Here is the story of how, in three short years in the early 1970s, the gay community managed to move from all-out warfare with psychiatrists to the removal of homosexuality as a disorder in the DSM.

1970

In May 1970, activists gathered in San Francisco to picket the APA’s annual meeting and disrupt some of the sessions. The most rancorous encounter occurred during a panel on sexuality at a presentation by a psychiatrist on aversion therapy — a treatment in which psychiatrists would attempt to convert gay people to heterosexuality by, for example, showing a man gay pornography and delivering electric shocks when he became aroused. “Shouts of ‘vicious,’ ‘torture,’ and ‘Where did you take your residency, Auschwitz?’ greeted the speaker,” Ronald Bayer wrote in “Homosexuality and American Psychiatry.”

Most of the psychiatrists were outraged by this intrusion. “As one protester attempted to read a list of gay demands,” Bayer wrote, “he was denounced as a ‘maniac.’ A feminist ally was called ’a paranoid fool.’” One attendee called for the police to shoot the protesters.

1971

Even more picketing and confrontation occurred at the next year’s APA convention in Washington, D.C. But the association continued to resist making any changes to its classification of homosexuality.

There were some allies in the APA, however, even among the psychoanalysts, and they helped the activists organize a panel at the 1971 convention called “Gay Is Good.” The activists, wrote Drescher in the journal Behavioral Sciences, explained “to psychiatrists, many who were hearing this for the first time, the stigma caused by the ‘homosexuality’ diagnosis.”

But elsewhere, tensions persisted. Frank Kameny, a full-time gay rights activist who had lost his job as an astronomer with the Army Map Service in 1957 because he was gay, grabbed the microphone from a lecturer at the convention and addressed the room. “Psychiatry is the enemy incarnate,” he told the shocked audience. “Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you.”

1972

For the 1972 conference in Dallas, the APA allowed the activists to present another panel. This time, they found a gay psychiatrist — John Fryer — was willing to join them, Bayer said. But Fryer had conditions. He had already lost a job — a psychiatric residency at the University of Pennsylvania — after being outed to the university. Fryer wanted anonymity.

So he was presented to the audience only as “Dr. Henry Anonymous.” Wearing a baggy tuxedo, a wig and a distorted Richard Nixon mask, Fryer spoke into a voice-altering microphone and told his colleagues that it was possible “to be healthy and be homosexual.” He informed them that more than 100 gay psychiatrists were attending the convention. They knew one another — many of them met informally in a group dubbed the Gay PA — but they were closeted to the rest of the association. And Fryer, at that moment, was their lone voice.

“This is the greatest loss: Our honest humanity,” Fryer said. “Pull up your courage by your bootstraps and discover ways in which you and homosexual psychiatrists can be closely involved in movements which attempt to change the attitudes of heterosexuals — and homosexuals — toward homosexuality.”

Fryer received a standing ovation. He would not reveal his identity until 1994, 22 years later.

1973

The issue of whether homosexuality should remain a psychiatric diagnosis had still not been considered by the APA — but that was about to change. A symposium to address exactly that was planned for the APA convention in Honolulu in May 1973. Panel members would represent both sides of the argument.

One speaker who advocated retaining the homosexuality diagnosis, Charles Socarides, received mostly boos from the crowd. Socarides asserted during the discussion, “All of my gay patients are sick.” According to Lawrence Hartmann, a psychiatry professor at Harvard University who served as APA president in the early 1990s, another panelist replied, “All of my straight patients are sick.”

The last to speak was Ronald Gold, media director for the Gay Activists Alliance and the only panelist who was not a psychiatrist. Gold, who as a child was subjected to aversion therapy by a psychoanalyst, told the packed ballroom, “Your profession of psychiatry — dedicated to making sick people well — is the cornerstone of oppression that makes people sick.” Gold’s speech got a standing ovation, just as Fryer’s had the year before.

After the panel discussion, members of the Gay PA invited Gold to join them at a gay bar in Honolulu. Gold then asked the symposium’s organizer, Robert Spitzer, to come with him. Spitzer was the chairman of an APA task force examining homosexuality as a diagnosis, and he had once told Gold that he had never met a gay psychiatrist and didn’t know if there were any. “And I said,” Gold later told “This American Life,” “you just come along.”

When they arrived, Spitzer was astounded. Sitting in the bar were dozens of esteemed psychiatrists, some of whom were the heads of psychiatry programs at prestigious universities. As Spitzer spoke with them, an Army psychiatrist in a military uniform entered the bar, walked up to Gold, hugged him and broke down crying. Fearful for his career, he had been closeted all his life. He wanted to thank Gold for his speech, and he “saw me and all these gay psychiatrists,” Gold told “This American Life.” “And it was too much for him. He just cracked up.”

The entire evening, Bayer wrote, “succeeded in substantiating Spitzer’s belief that being homosexual had little to do with one’s capacity to function at a high level.”

That night, Gold said, Spitzer went back to his hotel room and started writing a position paper calling for the removal of homosexuality from the DSM and an end to discrimination against gay people.

The APA board approved the final resolution unanimously, with two abstentions, on Dec. 15, 1973. It included a provision for a new diagnosis of people who were troubled by their sexual preference called “sexual orientation disturbance.” In 1980 it was renamed “ego-dystonic homosexuality” in the third edition of the DSM, and removed in 1987.

In 1985, members of the Gay PA founded the Association of Gay and Lesbian Psychiatrists, which today claims to be the oldest professional LGBTQ organization in the country. In 1998, the APA announced that it was opposed to any psychiatric treatment intended to convert a gay person to heterosexuality. And in 2005, the APA established the John Fryer Award, given to an individual for improving the mental health of sexual minorities.

“Here we are 50 years on, and we have gay marriage, and we have a much more tolerant attitude,” Scull said, reflecting on the APA vote in 1973. “Decades later, we can look back and say that was the start of something quite profound — something that changed a lot of lives.”