When the APA reclassified homosexuality from sin to mental disorder to a lifestyle
To those who viewed the 1973 decision sympathetically, psychiatry had displayed a remarkable capacity to acknowledge the significance of new research findings and to rethink its approach to sexuality.
Psychiatry did not capitulate to the pressure of Gay Liberation, but rather revealed an admirable flexibility. Unlike those who were unyieldingly committed to anti-homosexual values rooted in the Judeo-Christian past, the leadership of the American Psychiatric Association had demonstrated wisdom, insight, and the strength to break with conventional but scientifically unwarranted beliefs.
Both those psychiatrists who fought to preserve the status of homosexuality as a pathology and those who, in alliance with Gay Liberation groups, wished to remove it from the list of psychiatric disorders understood the profound significance of the battle that had been joined.
Both those psychiatrists who fought to preserve the status of homosexuality as a pathology and those who, in alliance with Gay Liberation groups, wished to remove it from the list of psychiatric disorders understood the profound significance of the battle that had been joined.
Each side mobilized the full range of resources it would need to prevail, limited only by the standards of professional decorum. But despite the tactical maneuvers, both sides recognized the very deep and fundamental questions involved: What is normal sexuality?
- What is the role of sexuality in human existence?
- Do the brute requirements of species' survival compel an answer to the question of whether homosexuality is a disorder?
- How should social values influence psychiatry and help to define the concept of mental illness?
- What is the appropriate scope of a nosology of psychiatric disorders?
- How should conflicts over such issues be resolved?
- How should the opposing principles of democracy and authority be brought to bear in such matters?
Each side sought to respond to these issues with intellectual rigor consistent with what it considered the standards of "science." But they disregarded history and the Biblical ethic.
Ronald Bayer presents a political analysis of the psychiatric battle over homosexuality.
Such an analysis is not, however, external to the "real issue" of whether homosexuality represents a psychiatric disorder. To assume that there is an answer to this question that is not ultimately political is to assume that it is possible to determine, with the appropriate scientific methodology, whether homosexuality is a disease given in nature.
The status of homosexuality is a political question, representing a historically rooted, socially determined choice -it ignores Biblical scripture law - and ignores the ultimate purpose of human sexuality. It requires a political analysis.
In The Triumph of the Therapeutic Phillip Rieff noted that the rejection of sexual individualism, which divorces pleasure and procreation, was the "consensual matrix of Christian culture."
In The Triumph of the Therapeutic Phillip Rieff noted that the rejection of sexual individualism, which divorces pleasure and procreation, was the "consensual matrix of Christian culture."
That ethos has all but crumbled in the West, subverted by profound social changes, battered by movements no longer bound to its influence, and increasingly deserted by the populations over which its strictures once held sway. Not only have procreation and pleasure been divorced, but the priority of the former has been displaced by that of the latter.
Does this make it right, correct, noble, good? - No!
It is in this context that the struggle on the part of homosexuals for the social legitimation of their sexual orientation, the striking— if grudging—willingness of society to grant tolerance to sexual practices previously held in abhorrence, and ultimately the decision on the part of the American Psychiatric Association to delete homosexuality from its nomenclature of mental disorders must be understood.
Just because people have sex outside of marriage, have multiple affairs, before, during marriage is not justifiable or acceptable and neither makes homosexual sexual activity acceptable.
In explaining the hegemonic status of procreative sexuality, Herbert Marcuse argued in Eros and Civilization, his radical reading of Freud, that the demands of the "performance principle" required that sexuality be limited to genital functions directed at the opposite sex. Only in that way could the body be desexualized and made available for work. Only heterosexuality could guarantee the reproduction of labor so necessary for the conquest of nature.
In a repressive order, which enforces the equation between the normal, socially useful and good, the manifestations of pleasure for its own sake must appear as flours du mal. Against a society which employs sexuality as a means for a useful end, the perversions uphold sexuality, as an end in itself; they thus place themselves outside the dominion of the performance principle and challenge its foundations.
The potentially seductive character of homosexuality unfettered by the performance principle explains not only the existence of powerful taboos against the perversions, and the reliance on the criminal law to repress them, but the disgust experienced by those who encounter them.
In explaining the hegemonic status of procreative sexuality, Herbert Marcuse argued in Eros and Civilization, his radical reading of Freud, that the demands of the "performance principle" required that sexuality be limited to genital functions directed at the opposite sex. Only in that way could the body be desexualized and made available for work. Only heterosexuality could guarantee the reproduction of labor so necessary for the conquest of nature.
In a repressive order, which enforces the equation between the normal, socially useful and good, the manifestations of pleasure for its own sake must appear as flours du mal. Against a society which employs sexuality as a means for a useful end, the perversions uphold sexuality, as an end in itself; they thus place themselves outside the dominion of the performance principle and challenge its foundations.
The potentially seductive character of homosexuality unfettered by the performance principle explains not only the existence of powerful taboos against the perversions, and the reliance on the criminal law to repress them, but the disgust experienced by those who encounter them.
As a leading figure on the Left during the 1960s, Marcuse gave voice to what was perceived by rebellious students as a struggle against an antiquated sexual morality. He linked that struggle to the revolutionary attack on the prevailing social order. Concerned that the lifting of restrictions on sexual pleasure and perversions might occur without a concomitant radical social transformation, he warned against the reactionary consequences of "repressive desublimation." Idiot!
As Western societies have increasingly redirected their energies from the tasks of capital accumulation toward consumption, the hold of the values upon which the primacy of the procreative rested has attenuated.
As Western societies have increasingly redirected their energies from the tasks of capital accumulation toward consumption, the hold of the values upon which the primacy of the procreative rested has attenuated.
Though taking a form Marcuse abhorred, the search for sexual pleasure is no longer deemed antithetical to the survival of civilization and orderly social life. Renunciation, restraint, and inhibition, so crucial to the periods of human history characterized by scarcity and to the era of early capitalist development, are now perceived as old-fashioned virtues. Indeed, their replacement is virtually required by a society in which consumption is considered a condition of, rather than an antagonist to, higher levels of production. Desires and behaviors that men and women in the past felt constrained to hide or deny have become increasingly matters of public acknowledgment, tolerated when not openly encouraged. Sin hidden now has no shame as it parades itself publically
The success of the contraceptive movement dramatically illustrates this shift.
While efforts to control conception have a long history, it is a history marked by condemnation on the part of those who spoke in the name of Judeo-Christian culture. As scientific and technical advances in the nineteenth century enhanced the possibility of effective birth control, those who sought to promote the use of contraceptive devices, often under the banner of neo-Malthusian doctrines, were typically subject to assault by the state. Jail sentences imposed under statutes designed to prohibit obscenity were not unusual. Though resistance to the popular dissemination of birth control information remained fierce, pressure for change eventually prevailed.
If the success of the contraceptive movement is explained in part by the transformation of sexual values, the struggle to achieve social acceptance for birth control advanced that transformation.
If the success of the contraceptive movement is explained in part by the transformation of sexual values, the struggle to achieve social acceptance for birth control advanced that transformation.
Leaders of the early sex reform movement like Havelock Ellis and Magnus Hirschfeld appreciated the relationship between the battle to win social acceptance for contraception and that for acceptance of other forms of non-procreative sex.
For most others, however, the weight of tradition precluded the possibility of extending to homosexuality the implications of accepting heterosexual pleasure as an end in itself. Vern Bullough, a historian of sexuality, certainly overstates the case when he argues that
"once the public came to accept non-procreative sex, then homosexuality, a form of non-procreative sex, also had to be examined."
While the first six decades of the twentieth century had witnessed many of the changes necessary for the transformation of social attitudes toward homosexuality, these changes were not in themselves sufficient for such a radical break to occur.
The abhorrence of homosexual practices, so deeply rooted in the Western cultural tradition, had taken on a force of its own and could not collapse merely because conditions were ripe. Indeed, the history of the contraceptive movement provides ample evidence of the extent to which the emergence of social forces willing to struggle for change was required for the subversion of dominant sexual values.
That history reveals, in addition, that for such a shift to occur, the internal cohesion of the interests opposing change must have been subject to erosion. In the case of homosexuality, the appropriate confluence of forces did not emerge until the 1960s. Thus the relative ease with which the early radical critics of society's anti-homosexual posture were consigned to oblivion.
The modern homophile movement in the United States did not surface until after World War II. In its early phases, it was marked by a defensive posture and was chiefly concerned with the dangers that beset the homosexual in his or her effort to live anonymously in a society still committed to the repressive use of vice squads and the law.
The modern homophile movement in the United States did not surface until after World War II. In its early phases, it was marked by a defensive posture and was chiefly concerned with the dangers that beset the homosexual in his or her effort to live anonymously in a society still committed to the repressive use of vice squads and the law.
Only gradually did those with the audacity to identify themselves as homosexuals begin to challenge the primacy of heterosexual standards. By the late 1960s the tentative thrusts of the early leaders of the movement had become a full-blown attack, with homosexuality presented as an "alternative life style" worthy of social acceptance on a par with heterosexuality.
Mere tolerance was no longer the goal; the demand was for social legitimation.
The struggle for Gay Liberation was influenced profoundly by the civil rights and feminist movements of the mid- and late 1960s. Like Blacks, homosexuals began to see themselves as an oppressed minority injured not only by the arrangement of social institutions, but also by deeply entrenched ideological standards that, in ways both subtle and blatant, denied them dignity.
Like racism, anti-homosexuality required both a fully developed socio-cultural critique and a political assault. And homosexuals, like women, began to challenge the dominant standards of sexuality. Sexism was thus perceived as the ideological reflection of the power of male heterosexuals incapable of acknowledging the erotic desires of women or of homosexuals.
Like so many other client populations, homosexuals turned on those formerly perceived as protectors, their sense of self-confidence enhanced by an awareness that they were part of an upsurge of protest directed at every social institution in America.
Thus American psychiatry emerged as a primary target of their radical disenchantment.
For much of the first half of this century many homosexuals who were willing to express themselves publicly welcomed the psychiatric effort to wrest control of the social definition of their lives from moral and religious authorities.
Better sick than criminal, better the focus of therapeutic concern than the target of the brutal law. By the late 1960s, however, homosexual activists had discarded whatever lingering gratitude remained toward their former protectors and in a mood of militancy rose up to challenge what they considered the unwarranted, burdensome, and humiliating domination of psychiatry.
Armed with the techniques of social protest, homosexuals subjected American psychiatry to a striking series of jolts.
While the homosexual revolt against heterosexual domination mirrored the process of social upheaval on the part of marginal, disenfranchised groups, the assault upon psychiatry must be viewed as echoing the contemporary attack on what had been, until the 1960s, the unassailable status of science and technology, medicine in particular.
Ivan Illich, perhaps more than any other single figure, has sounded the battle cry for this anti-modernist movement. He has drawn a portrait of a civilization impoverished by its own inventions, its own scientific and technological advances.
It is a portrait of the progressive alienation of the power of ordinary men and women to elites who rule in the name of superior and inaccessible knowledge.
Though his polemical assaults have been directed against all the professions that mask their acts of usurpation with a benign ideology of service, medicine is paradigmatic and has drawn his sharpest fire.
He presents the medicalization of ever wider domains of social life as inimical to the ends of health and human welfare. A new class of physicians has not only orchestrated this process, but attained with each advance of medicine a more dangerous power to dominate. Illich is not alone.
Both the reception given his work and the wave of antagonistic commentaries directed at medicine suggest that he is representative of a significant and growing movement. From within medicine and without, from the Right as well as the Left, the criticism is to be heard.
The attack on medicine as a social institution was prefigured by a more narrowly framed reaction against psychiatry.
In seeking to provide explanations for aberrant behavior, psychiatry has been charged with having assumed from the faltering religious tradition the function of serving as a guarantor of social order, substituting the concept of illness for that of sin.
At the same time, having sought to base its formulations upon the deterministic models of the natural sciences, it has been held responsible for the subversion of the most crucial assumptions of the Western tradition.
By seeking the sources of social deviance in factors beyond the will of the individual, it has denied the relative importance of human agency, and thus has made the attribution of individual responsibility for violations of socially sanctioned standards of behavior increasingly difficult to justify.
As psychiatrists have sought to assume responsibility for the control of a range of behaviors previously considered immoral—criminality, violence, alcohol and drug use, juvenile delinquency, sexual deviance—they have been charged with attempting to arrogate to themselves unlimited authority, laying the foundations for a therapeutic state.
They have stressed the need to reverse the tendency toward extending the concept of mental illness to the universe of social problems and have sought to narrow the range of behavioral aberrations upon which the language of psychopathology is imposed.
Those who viewed the development of psychiatry as an enormous advance over the pre-scientific understanding of human behavior have reacted to the move toward retrenchment with dismay.
Psychiatrists like Karl Menninger had proclaimed the humanizing mission of their profession; they had anticipated an era of rational social control founded upon the progressive extension of the newly acquired knowledge. Appalled by the brutality of policies derived from the moral tradition and its retributionist principles, they had held out the prospect of a therapeutic response to aberrance designed to restore the deviant to normality.
They promised a degree of efficacy unattainable by reliance on the more primitive instruments of social control. But even when they were less sanguine about their capacity to cure, psychiatrists believed that the control they exercised in custodial institutions represented an advance over what prevailed in punitive settings.
With a therapeutic vision so dominant a feature of psychiatric thinking, a divergence between the interests of psychiatry and those to whom it sought to minister was almost inconceivable. Indeed, psychiatrists often saw themselves as the protectors of deviants who had suffered at the hands of society and the more traditional forces of social control.
With a therapeutic vision so dominant a feature of psychiatric thinking, a divergence between the interests of psychiatry and those to whom it sought to minister was almost inconceivable. Indeed, psychiatrists often saw themselves as the protectors of deviants who had suffered at the hands of society and the more traditional forces of social control.
Protected from understanding the potentially negative consequences of their own power by a benign ideology, they rarely anticipated an outraged response on the part of those to whom they proffered their concern. Only when psychiatry's vision of itself as a humanizing force is appreciated can the pain, sorrow, and anger of those who are reproached, not only by anti-psychiatrists but by those they have claimed as their patients, be fully comprehended.
While it is of course possible to argue that such cries represent nothing more than the distress of those whose power and authority have been challenged, such an interpretation fails to capture the tragic dimension of the situation of psychiatrists whose commitment to therapeutic concern has been subjected to assault and ridicule.
Under attack from many quarters and torn by internal disputes regarding its appropriate mission, psychiatry was especially vulnerable to the challenge of an increasingly militant Gay Liberation movement.
Though symbolically powerful, psychiatry was in fact a target that could be attacked with relative impunity. Thus it was with stunning ease that the Gay Liberation movement was able to force the American Psychiatric Association to reconsider the inclusion of homosexuality in its official nomenclature of disorders, the Diagnostic and Statistical Manual.
To many observers the ensuing rancorous debate among psychiatrists over the status of homosexuality reflected an almost inexplicable concern with definitions and classifications.
To many observers the ensuing rancorous debate among psychiatrists over the status of homosexuality reflected an almost inexplicable concern with definitions and classifications.
Bemused by the American affair, one Spanish psychiatrist remarked on the irony of his colleagues in the United States— products of a "supertechnical education"—becoming involved in a debate comparable only to those that had engaged the medieval nominalists.
To many in the United States, the focus on the American Psychiatric Association's official listing of disorders seemed a legalistic distraction from the more serious issue of psychiatric theory and practice, a semantic quibble with little substantive merit.
To dismiss the significance of the debate over whether homosexuality ought to be included in the APA's nosological classification, however, is to miss the enormous importance it carried for American society, psychiatry, and the homosexual community.
By investing the dispute with great meaning, the participants had themselves transformed it from a verbal duel into a crucial, albeit symbolic, conflict. The gay community understood quite well the social consequences of being labeled and defined by others, no matter how benign the posture of those making the classification.
