Fifty years ago, psychiatrists in the United States made an important decision that had a lasting impact on the mental health and societal standing of gay individuals. The American Psychiatric Association (APA) voted to remove homosexuality from its list of mental disorders, marking a significant shift in LGBTQ rights. This decision was the result of years of activism and internal reform within the psychiatric community, fueled by various civil rights movements of the 1960s. The move to depathologize homosexuality was met with resistance from some APA members who believed in reparative treatment for homosexuality.
Historian Regina Kunzel explores the influence of psychiatry on the perception and treatment of gays and lesbians in her book, “In the Shadow of Diagnosis: Psychiatric Power and Queer Life.” She highlights the mistreatment and torment experienced by gay and gender-nonconforming individuals at the hands of the psychiatric establishment. Psychiatry, Kunzel argues, sought to exert power and authority by pathologizing homosexuality and promoting the heterosexual nuclear family as a defense against communism during the Cold War era.
The pathologizing of homosexuality by psychiatrists led to various treatments aimed at curing homosexual urges and behaviors, including lobotomy, shock therapy, and aversion therapy. Gay activists began protesting such mistreatment in the early 1970s, demanding an end to the discrimination and delisting of homosexuality as a disorder. The APA leadership gradually accepted newer research suggesting that homosexuality was a normal variant of human sexuality, leading to the pivotal decision in 1973 to remove homosexuality as a mental illness.
Despite the progress made by the APA in depathologizing homosexuality, various diagnoses related to distress over one’s sexual orientation remained in the DSM for decades. Critics argue that these diagnoses helped legitimize conversion therapy efforts, which have since been discredited as harmful and ineffective. The ongoing debate now focuses on depathologizing transgender identities and removing the gender dysphoria diagnosis from the DSM.
The APA continues to face pressure to fully depathologize transgender identities, while also recognizing the need for diagnostic codes to cover hormone therapy and other transition-related treatments. The organization acknowledges the importance of including lived experiences from transgender individuals in discussions about these diagnostic categories. As discussions around gender identity and mental health evolve, further research and insights are needed to navigate the complexities of depathologization.
Looking back on the impact of striking homosexuality from the DSM, Dr. Lawrence Hartmann, a key figure in the APA decision, believes that it has helped many individuals build self-esteem, address psychiatric issues, and advocate for justice. The decision to remove homosexuality as a mental disorder paved the way for progress in LGBTQ rights and societal acceptance. As the conversation around gender identity continues to evolve, there is hope for further advancements in depathologizing transgender identities and promoting inclusivity within the mental health field.
