Chris Aiken and Kellie Newsome discuss the history and complexities surrounding the removal of homosexuality from the DSM. They explore the challenges faced by gay psychiatrists, controversial beliefs of Robert Spitzer, and different perspectives within psychiatry. A pivotal encounter prompts the removal of homosexuality from DSM-2.
The process of removing homosexuality as a diagnostic code from the DSM was a complex and contentious debate marked by tensions between activists and psychiatrists.
Research, including zoological studies and psychological research, played a significant role in challenging the classification of homosexuality as a mental illness and contributed to its eventual removal from the DSM.
Deep dives
The Complex Story of Homosexuality in Psychiatry
The American Psychiatric Association removed homosexuality as a diagnostic code in 1973, but the process was more complicated than commonly believed. In the midst of the APA conference, over a thousand psychiatrists gathered to discuss whether homosexuality should be included in the APA Nomenclature. The conference was marked by tensions between activists and psychiatrists. Psychiatrist John Fryer, disguised as Dr. Anonymous, talked about the discrimination he faced as a gay psychiatrist. This discussion led to a stalemate, but one encounter at a gay tiki bar changed Robert Spitzer's perspective. He realized that homosexuality did not cause significant distress or impair functioning, leading to his later work to remove it from the DSM.
The Middle Ground and Controversies
Within the debate, there were three positions regarding homosexuality. Charles Sakarades believed he could 'mend' toddlers towards heterosexuality. Irving Bieber argued that homosexuality was not a disease, but could be reversed through psychotherapy. Robin Stoller and Richard Green, who went on to create Gender Identity Disorder, argued that homosexuality was abnormal but not a mental illness. Changing homosexuality from a diagnosis to a behavioral quirk was seen as a compassionate stance, but maintaining it as a disorder perpetuated stereotypes.
The Influence of Research and Human Rights
Research played a significant role in the debate. Zoological research highlighted that homosexuality is a natural behavior, and Alfred Kinsey's work showed its prevalence. Psychologist Evelyn Hooker's study found no difference in mental health outcomes between homosexual and heterosexual men. Judd Marmer, the APA vice president, also emphasized the importance of human rights, highlighting that societal prejudice, not patient disorder, contributes to stigma against homosexuals. Despite a stalemate, an encounter between Robert Spitzer and gay activists at a tiki bar led to the drafting of an APA statement that would eventually remove homosexuality from the DSM.
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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