Death of a Diagnosis: Homosexuality As a Mental Illness (1952-1973)
Until 1973, homosexuality was considered a mental illness by the American Psychiatric Association. This diagnosis helped justify harsh antigay laws. (Homosexuality was illegal in 42 states and the District of Columbia at the time.) The APA classification also gave medical authority to barbaric treatments—as late as the 1940s, some psychoanalysts had approved lobotomies to “cure” homosexuality.
But in December 1973, in a landmark decision, the APA’s leadership reversed itself, voting to remove homosexuality from the Diagnostic and Statistical Manual, its catalog of mental illnesses. In 1974 the full membership ratified the decision.
This would have a major impact on the lives of gay people. But how would I know? I was only five years old at the time. The big news in the Rocca house that year was the arrival of the 22-volume set of the World Book Encyclopedia. Oh how I loved our 1974 World Book Encyclopedia set growing up. On so many afternoons, after coming home from elementary school, I’d lie on my stomach on the red carpet in the family room paging through the volumes.
I would pore over the “Facts in Brief” for different countries—the capital city, the official language, the basic unit of money—and commit them to memory. And I loved how it captured the drama of the Cold War. The entry for “Germany” included a picture of West Berlin—a man in sunglasses lounging at a bustling outdoor café, surrounded by brightly colored shops . . . right next to a picture of East Berlin—a pile of rubble on a deserted street on an overcast day.
Never mind that I was reading this same set well into the 1980s. A few years ago, after my mother sold the house I grew up in, I laid claim to the full set. It lines the wall in my bedroom now. That’s how close the 1974 World Book is to my heart.
No volume got pulled off the shelf more than the “H.” Even today it opens to page 275, which begins with a short entry on HOMONYM and ends with a paragraph on the Syrian city of HOMS. But fascinated as I was with linguistics and Middle Eastern trading centers, my real interest was the entry in the middle of the page: HOMOSEXUALITY.
My God, I’m looking at it now and I remember that electric combination of curiosity, excitement, and most of all terror that shot through my body when I even saw the word.
As a child, I only dared to read this article when I knew I was home alone. I had a secret to keep. I must have read it over a hundred times, that’s how hungry I was for information. If I was defective, I wanted to know if I could be fixed. The answers had to be in here somewhere. After all, this was the encyclopedia.
“Most homosexuals appear no different from other members of their own sex.” Note to self: Be like those homosexuals.
“But some behave, dress, and talk like members of the opposite sex.” Note to self: Don’t be like those homosexuals.
“Sometimes two homosexuals establish a long-term relationship that is similar in some ways to marriage.” Yeah, right.
“According to the most widely accepted theory, a child can learn to be attracted to either of the sexes . . .” Okay, I’m a quick learner. Tell me what to do.
“Some people may try to change their homosexual preference through psychiatric treatment. The younger the person—and the stronger his motive for changing his preference—the more likely he is to be able to change.” I’m smart and I’m motivated. So this is on me. Once again, tell me what to do!
The short paragraph on the history of homosexuality included this tantalizing morsel: “Some ancient Greeks not only accepted homosexuality but considered it an ideal relationship. . . . Such men believed that only men could fulfill the role of true friend and lover.” If I had a time machine, I knew where I was headed.
But the end of that paragraph brought the end of the reverie: “Still others have forbidden it, and some have punished it harshly.”
I wanted the measly entry to go on longer but it never did. I think I thought that if I read the 1974 World Book entry enough times a new sentence would magically appear, offering what, I don’t know. Reassurance?
That homosexuality was ever a psychiatric diagnosis may seem strange to people today. Trust me, I know a lot of crazy gay people, but they’re not crazy because they’re gay.
Homosexuality first became a subject of psychological study in the 19th century, just as modern psychology was coming into being. Doctors and researchers began to study and classify all varieties of human sexuality. Loads of fancy words entered the dictionary: sadism, masochism, nymphomania, copromania, undinism, pagism, picacism, satyriasis . . . Happy googling! Two of these novel classifications were homosexuality and heterosexuality, terms coined in 1868.When, in 1952, the APA published the first Diagnostic and Statistical Manual, they classified homosexuality as a “sociopathic personality disturbance.”
Of course same-sex sexual activity is as old as life itself. (I am a complete sucker for any news item about gay animals. Gay penguin stories seriously make me squeal.) But the sexologists’ view was new in that it saw homosexuality not in religious terms as a sinful behavior, or in legal terms as a criminal act, but as an inborn trait of the whole person. In other words, it wasn’t just something you did. It was something you were.
Some sexologists, like the German physician Richard von Krafft-Ebing, viewed the condition as pathological—that is, as a mental illness. In his major work, Psychopathia Sexualis (“Mental Illness of Sex”), he compiled more than 200 case studies of various sexual practices, including instances of shoe fetishism, whipping, the “violation of corpses,” and along with them, homosexuality. For many, it was the first time they read about homosexuality. Bear in mind that Krafft-Ebing also thought that excessive masturbation could turn you into a murderer, so we should take his views with a grain of salt.
Then came Sigmund Freud. He viewed homosexuality much more compassionately. In 1935 he wrote to a mother seeking therapy for her gay son, assuring her that homosexuality was neither a “vice” nor a “degradation” nor an “illness.” He noted that Plato, Michelangelo, and Leonardo da Vinci had been gay, and called the persecution of homosexuals “a great injustice.” He wrote that he would not aim to change her son’s orientation but rather would strive to “bring him harmony [and] peace of mind.”
In the United States, however, later generations of psychiatrists departed from Freud, adopting the views of a Hungarian émigré named Sandor Rado. Rado viewed homosexuality as a mental illness produced by bad parenting. (Typically the “blame” was laid on an overbearing mother and a distant father.) Edmund Bergler, a leading psychoanalyst of the 1950s, wrote this about homosexuals:
I have no bias against homosexuals; for me they are sick people requiring medical help. . . . Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner . . . [their] shell is a mixture of superciliousness, fake aggression, and whimpering.
No bias there!
When, in 1952, the APA published the first Diagnostic and Statistical Manual, they classified homosexuality as a “sociopathic personality disturbance.” To be sure, some researchers disagreed. Among these were psychologist Elizabeth Hooker and the Czech physician Kurt Freund, known to posterity as the inventor of a machine that measures male arousal called the penile plethysmograph. (If I weren’t such a grown-up, I’d call it a “bonerometer.”) But as long as the APA was committed to the belief that homosexuality was a mental illness, the chances of wide-scale acceptance and equality for gay people remained bleak.
When lobotomies went out of fashion in the mid-1950s, in came A Clockwork Orange–style behavioral treatments, involving nausea-inducing drugs and electric shocks to the brain or the genitals. Forced institutionalization was common, and hysterectomies and castration were deemed legitimate medical “remedies.”
The fight against the pathologizing of homosexuality was led by two activists, Barbara Gittings and Frank Kameny. Gittings, raised in a religious Catholic home, had found herself struggling to come to grips with her attraction to women while a student at Northwestern University in the late 1940s, eventually spending so much time researching homosexuality in the campus library that she neglected her classwork and failed out.
A trip to San Francisco introduced her to a “homophile” organization called Daughters of Bilitis, the first lesbian civil rights group in America. She soon started a New York chapter, became editor of its journal, and began to organize public demonstrations for gay rights.
Kameny, meanwhile, had been born to a Jewish family in Queens, New York. He attended college at 16, served in the army during World War II, and earned a PhD in astronomy from Harvard. Soon after getting his doctorate, however, he was arrested in a police sting operation in a men’s room in San Francisco. (Because California was the first state where gay bars were legal, local police departments frequently sought to entrap gay men there in the 1950s.)
When the arrest came to light, Kameny was fired from the United States Army Map Service; President Eisenhower had barred gays from federal employment. Kameny’s dismissal roused him to activism, and he founded a Washington, DC, chapter of a gay rights group called the Mattachine Society. (Gay rights organizations had such great names back then.) He fought against DC sodomy laws and became a leader in the 1960s gay liberation movement.
Kameny recognized that as long as doctors pathologized homosexuality, changing wider social attitudes would be difficult. When Gittings heard Kameny talk at a 1963 convention of gay rights groups, she was fired up by his rejection of the medical establishment and his insistence that he and other homosexuals were perfectly healthy. Appearing on David Susskind’s popular talk show in 1971, Gittings challenged the host when he invoked “a great body of medical research” that regarded homosexuality as an illness.
For her, the real sickness was not homosexuality but the hatred of it. As she said to Susskind: “Your attitudes toward us are the problem. There’s nothing wrong with homosexuality. The only thing wrong with it is that you people are upset about it. Why are you upset?” As she put it, it was the supposed science that had to be questioned.
In 1970 gay and lesbian rights groups picketed the annual American Psychiatric Association conference in San Francisco. The next year, Gittings, Kameny, and other activists infiltrated the meetings themselves. During a public lecture, Kameny grabbed the microphone and declared: “Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you.”
This bold call to arms prompted soul-searching among the psychiatrists, many of whom were startled to find themselves cast as oppressors of the people they thought they were helping.
Sympathetic elements within the APA helped Gittings and Kameny organize a panel, “Psychiatry: Friend or Foe to the Homosexual?,” at the next year’s meetings in Dallas. But Gittings and Kameny needed a psychiatrist on the panel to give them legitimacy. Gittings invited a gay, untenured Temple University psychiatry professor named John E. Fryer to attend.
Fryer had been fired from the University of Pennsylvania a few years before after being outed by his own cousins. He was nervous about speaking: “I was not feeling very secure. . . . But I thought about it and realized it was something that had to be done. I had been thrown out of a residency because I was gay; I had lost a job because I was gay. That perspective needed to be heard from a gay psychiatrist.” But coming out could mean the end of his career.Today the horrifying malpractice known as “conversion therapy,” though discredited in the mental health professions, remains legal in 34 states.
Fryer’s solution? A disguise. “I told Barbara that I would participate on the panel but I could not do it as me,” he later recalled. Fryer stood six foot four inches tall and weighed close to 300 pounds; he would not be easy to disguise. But his boyfriend at the time had been a drama major in college and helped him design an effective costume. Wearing a wig, a baggy tuxedo, and a stretched-out Richard Nixon mask, and speaking through a voice modulator, Frye addressed a ballroom full of curious shrinks in Dallas.
Identified to the 1972 audience as “Dr. Anonymous,” Fryer spoke about the closeted life he led as a member of the “Gay PA”—that group of gay APA members who knew of each other’s existence. He told the audience that he was forced to keep his two lives separate, and compared his situation to that of a black man passing as white, having to live in constant fear of being exposed. And he stressed that it was perfectly possible to be both “healthy and homosexual.”
In a moving conclusion, Fryer acknowledged that coming out was a big risk for one’s career and livelihood. But hiding one’s identity, he said, meant “an even bigger risk,” the risk of “not accepting fully our own humanity.” He pressed his fellow psychiatrists to help others become more open-minded: “We must use our skills and wisdom to help them—and us—grow to be comfortable with that little piece of humanity called homosexuality.”
Fryer’s talk—and the entire panel—made an impact. The APA did what any self-respecting professional organization would do: it formed a committee to investigate the question. That committee found no scientific evidence to support the continued inclusion of homosexuality in the DSM, and the next year the APA Board voted to remove the diagnosis, urging that “homosexuals be given all protections now guaranteed other citizens.”
Kameny cheekily called it the day “we were cured en masse.” The “Gay PA” eventually became an official subgroup of the APA, and today the Association of Gay and Lesbian Psychiatrists (AGLP) is, by its own account, the oldest professional LGBTQ organization in America.
Still, the change was not complete. Homosexuality was removed from the DSM but a new diagnosis, “sexual orientation disturbance,” replaced it, said to afflict people “in conflict with” their sexual orientation. Not until 1987 did homosexuality completely disappear from the DSM. The World Health Organization did not remove homosexuality from its International Classification of Diseases until 1992. Today the horrifying malpractice known as “conversion therapy,” though discredited in the mental health professions, remains legal in 34 states.
Diagnoses are meant to help identify what ails people, and to help make these people better. But in the case of homosexuality, a diagnosis did the opposite. It gave credence to deep-seated prejudices. It made an untold number of gay people believe they were defective. And who knows how many gay people who had real problems didn’t seek psychiatric counseling because they viewed psychiatry as the enemy?
Barbara Gittings, Frank Kameny, and John Fryer had the self-knowledge and the courage to challenge accepted wisdom, to stand up to the experts. They were willing to tell the leading body of psychiatrists in America that when it came to gay people . . . it was wrong on psychiatry. They were right.
That article on Homosexuality in the 1974 World Book was written by a man named Carlfred Broderick. At the time I thought the name might be made up. (Who would dare attach a name to the topic?) It turns out Broderick was a University of Southern California sociology professor and marriage counselor (and a Mormon bishop) who made six appearances on The Tonight Show with Johnny Carson in the mid-1970s. Since then I’ve watched all those appearances.
He’s a tall rangy guy—looks a little like Ray Bolger—and he’s funny, not a prude or scold, at ease talking about infidelity and “sexual problems.” He even makes a crack about being known as a “licensed” sexologist. I’m not sure why but when I was watching those appearances on my laptop in 2019 I was really hoping he’d mention homosexuality, even just hint at it. But he doesn’t. I guess it really was unspeakable back then, even on a late-night show.
Looking back, I feel lucky to have been born when I was. A friend of mine who’s 20 years older than I am used to go to his high school library to sneak looks at Krafft-Ebing’s book. That was his only resource. The word aberrant, which he learned from the book and which was used to describe homosexuals, has stayed with him. Gay people of my and future generations owe a lot to the activism of Barbara Gittings (1932–2007), Franklin Kameny (1925–2011), and John Fryer (1937–2003).
From Mobituaries: Great Lives Worth Reliving. Used with the permission of the publisher, Simon & Schuster. Copyright © 2019 by Mo Rocca.