www.worldandi.com/public/1997/april/ar5.cfm
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. 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 DSMII 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. The DSMII diagnosis was seen as a societal attempt to control human sexuality under the guise of a medical diagnosis. After intense lobbying and debate, in December 1973, the Board of Trustees passed the proposal to remove homosexuality from DSMII. This compromise allowed homosexuality to be dropped as a disorder, giving the gay lobby what it wanted, and, at the same time, it allowed psychiatrists to treat homosexuality under the new diagnosis. The boards decision unleashed a storm of counterprotest from many psychiatrists. Opponents saw the boards decision as a capitulation to gay activism rather than a reasoned judgment based on medical evidence. They forced the leadership to submit its decision to a referendum of the organizations membership. After an intense campaign, of the approximately ten thousand votes cast, the proposal passed with 58 percent. In retrospect, it seems shocking that the question of whether a condition is a psychiatric disorder should be decided by a vote, but a closer look at the debate indicates that a vote is not as strange as it seems. DECIDING WHAT IS HEALTHY AND WHAT IS A DISORDER Although the gay liberation movements arguments were based mostly on the social implications of the diagnosis, the board tried to limit its consideration to scientific and medical arguments. The scientific considerations were based on two kinds of evidence. One was a body of research strongly pointing to a major biological basis for homosexuality. This included ethological studies finding homosexuality throughout the animal kingdom, cross-cultural investigations indicating homosexuality is a human universal and in some cultures, socially accepted, and neuroendocrinological studies showing the effects of hormones on brain development. The implication was that homosexuality is not simply the result of childhood trauma. The more important evidence came from psychological studies of gay men and lesbians in the general population. A major criticism of pathological theories of homosexuality was that they were derived from observations of homosexual patients who were seeking professional help. Not surprisingly, they found that homosexuality was closely associated with a variety of psychopathologies. However, when nonpatient homosexual populations were studied, it was found that many homosexual adults were leading well-adjusted, fulfilling lives. In general, homosexuality was not associated with any increased incidence of psychopathology. To be sure, findings supporting a biological contribution to homosexuality undermine the early psychoanalytic explanations. But the evidence is not all in, and even today it is too early to prejudge the issue. More important, even if homosexuality is shown to be genetically based, biological determination does not preclude a condition from being a disorder or from being treated. Some forms of depression and anxiety are known to have biological causes but are nevertheless considered psychiatric disorders and are often effectively treated, both biologically and psychologically. The second argument, that homosexuality is not associated with other conditions recognized as psychopathologies, also falls short. It begs the question as to whether homosexuality in and of itself is a psychopathology. From the fact that a person can be perfectly healthy except for a broken bone, we would not argue that fractures are not medical problems. One could just as well argue that because many people with phobic anxieties manage to cope well, live full lives, and show no symptoms other than their narrowly focused anxiety, phobias are not psychopathologies.
Now, a sexual disorder, such as pedophilia, cannot be diagnosed unless the client shows clinically significant distress or impairment in important areas of functioning. Thus, pedophilia, in and of itself, is no longer a disorder, a change supported by the North American Man-Boy Love Association, an organization committed to the legitimization of pedophilia. Three years after the publication of DSMIII-Revised, Congress passed the Americans with Disabilities Act. Ironically, in formulating this law, an alliance emerged between gay rights supporters and congressional conservatives. The former did not want to see homosexuality included as a disability because they considered it healthy, and the latter also opposed its inclusion because they did not want homosexual citizens to be granted accommodations and protections under the law. Consequently, the act explicitly disqualifies homosexuality as a disability. Thus, in the early nineties, despite the elimination of homosexuality itself as a disorder, clients seeking conversion therapy could still be diagnosed and obtain treatment. For example, the Gay and Lesbian Caucus of the American Psychiatric Association advocated declaring the practice of conversion therapy to be professionally unethical. In response, the National Association for Research and Therapy of Homosexuals NARTH was founded in 1992 to protect the right to conversion therapy. NARTH planned to hold a 1995 conference, and, as is standard professional practice, it attempted to publish an announcement of its conference in the monthly newspaper of the American Psychological Association, the Monitor. The association refused to publish the announcement, however, because of NARTHs position that homosexuality is a treatable mental disorder. This incident clearly indicates the ideological nature of the debate over the psychiatric status of homosexuality. Our understanding of sexuality, both homosexual and heterosexual, is very limited. We do not know, for example, how either comes about or what explains the great variety in the ways they are manifested. But it hardly makes sense, given our ignorance, for a professional group to take a firm stand if the issue were purely scientific. Only if the decision is seen as a value judgment is it reasonable for the APA to say, as a matter of policy, that homosexuality is not a mental disorder and to try to silence another professional group holding a different opinion. CONVERSION THERAPY Thus, the current proposal discouraging conversion therapy is simply the culmination of a long series of steps in the mental health professions conversion. Within the American Psychological Association, pressure to pass ...
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