The Implications of Removing Homosexuality from the DSM as a Mental Disorder

Abstract

On February 8, 1973, the Nomenclature Committee of the American Psychiatric Association (APA) met with an ad hoc committee of gay activists. The activist committee was actually representative of New York City’s Gay Activist Alliance, but, for political considerations that made sense in that decade, they denied that they represented a gay organization. The most complete account of the meeting and subsequent political conflicts leading to the recommendation of the Nomenclature Committee is discussed in Bayer (1981). The short-range goal of the activist committee was obvious: to remove homosexuality between consenting adults from the list of mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We intended to make sexual orientation change unacceptable, even if the patient asked for it (Silverstein, 1977). Because the psychiatric profession was one of the ‘‘gate-keepers’’ of society’s attitudes, we believed that this change would have profound effects on the lives of gay people; it would hasten the elimination of sodomy laws and ‘‘moral turpitude’’ clauses in state regulations that prohibited the licensing of otherwise qualified professionals (e.g., physicians and lawyers). We also expected it to help establish civil rights protection for gay people, including non-discrimination in housing and employment. On December 15, 1973, the Board of Directors of the APA declassified homosexuality per se as a mental disorder from the DSM-II (American Psychiatric Association, 1973). Accepting the recommendation of the Nomenclature Committee, they declared that only some homosexuals suffered from Sexual Orientation Disorder (302.0) in the DSM-II (American Psychiatric Association, 1974) and were in need of treatment; the others did not. By DSM-III (American Psychiatric Association, 1980), homosexuals were classified as either ego-syntonic toward their sexual orientation, and not in need of treatment, or ego-alien, and therefore, suffering from a mental disorder. They left unclear whether treatment should be directed toward sexual orientation change or developing an ego-syntonic homosexuality. Presumably, the decision was left up to the patient and his/her therapist. In the DSM-III-R (American Psychiatric Association, 1987), the diagnosis of Ego-dystonic Homosexuality was removed. Left was the residual diagnosis, Sexual Disorder Not Otherwise Specified (e.g., ‘‘persistent and marked distress about one’s sexual orientation’’), but this could apply to ‘‘any’’ sexual orientation. What has not yet been discussed in print is the long-range goal of the activist committee. A hint of it is obvious in my presentation to the Nomenclature Committee (Silverstein, 1976–1977). I argued that psychiatric diagnosis was the child of morality and that Judeo-Christian values controlled psychiatric practice. The activist committee did not discuss the implications that followed from the argument that religion and morality