Abnormal, Pathological, Deviant: Classifying Homosexuality As a Mental Disorder

In 1952, the American Psychiatric Association (APA) officially classified homosexuality as a "sociopathic personality disturbance"; in 1968, it was reclassified as a sexual deviation. Over the next decades, the fight for reversal of this diagnosis "became a focus of the gay rights movement", the fight to be accepted as normal, as the classifications had an enormous impact on society's view of homosexuality. Disputing negative views became difficult since the APA classification "was supposedly based on scientific findings". In 1970, gay rights activists disrupted an APA convention in San Francisco aiming to be heard. "Hard words" were exchanged between the protestors and the APA members who hired security. Nevertheless, the protests had some impact and gay rights activists had a gay-focused panel at a convention that took place in 1971. The panel wanted the diagnosis to be removed from the DSM (Diagnostic and Statistical Manual of Mental Disorders published by the APA), it remained. The activists returned in 1972 and asked again that homosexuality be not classified as a mental disorder, their request was denied again. Members of the panel were either homosexuals or psychiatrists, no speaker was both.


Photograph above: APA 1972 booth

The activists had difficulty finding a gay psychiatrist who was willing to be on the panel, risking stigma and career damage, but they were finally able to convince Dr. John Fryer to participate (Drescher & Merlino, 2007). However, Fryer was still reluctant to come out to his colleagues, so calling himself Dr. H. Anonymous, he wore a wig and a mask to disguise his face and used a microphone to distort his voice. Bauthey-Gill, 2011

Today, the APA has an award named after John E. Fryer (1937-2003), the masked gay, anonymous psychiatrist (see photograph below) (via).



At the 1973 convention, the APA's Nomenclature Committee pointed out that a mental disorder was defined as something causing subjective distress on a regular basis and that was associated with impairment in social effectiveness of functioning. The conclusion was that  homosexuality was not a disorder based on the definition of the term. The diagnosis was removed from the DSM in December 1973, newspapers ran headlines saying that "Twenty Million Homosexuals Gain Instant Cure". Not all APA members supported the decision, so the APA sent out a ballot in 1974 to vote on the removal and 58% voted to uphold the decision. Controversy continued but the APA stood behind the decision not to classify homosexuality as a disorder and in 1978, created  the Association of Gay and Lesbian Psychiatrists and a gay and lesbian task force. The DSM II, published in 1974, compromised and defined homosexuality as a Sexual Orientation Disturbance only if the person was "disturbed by, in conflict with, or wished to change their sexual orientation". This was removed in 1987 (Baughey-Gill, 2011).

Despite this new controversy and a few others like it, the APA has helped make tremendous advances towards the recognition of homosexuality as normal since its 1973 decision. In part because of the APA’s decision, the United States will continue to see more research in the 21st century that includes subjects of all sexual and gender orientations as well as the increased acceptance of homosexuality by society as a whole. As for now, being gay is finally okay with the APA. Baughey-Gill, 2011

The ICD (International Statistical Classification of Diseases and Related Health Problems published by the World Health Organisation) removed homosexuality from its classification only in 1992 but kept "ego-dystonic sexual orientation" (via) - which was introduced as a "part of the consensus-building process connected with the removal of homosexuality" by the APA. It was removed in 1987 (Cochran et al, 2014).
The APA recommended to the WHO that the sexual orientation diagnoses be deleted from its ICD-10 version saying:

Since ICD-9, positive changes have occurred in the perceptions and legal status of homosexuality in many societies worldwide. Nevertheless, persons with non-heterosexual sexual orientation identities and/or behavior are still subject to societal stigma and discrimination that harm their health. The psychological and behavioral disorders associated with sexual development and orientation in ICD-10 are historically rooted in and support continuing unscientific stigmatization of homosexuality by health professions. Because stigmatization continues, the diagnoses in category F66 are likely to be used to diagnose homosexuality despite its accompanying caution against that practice. Further, use of F66 codes may impede appropriate treatment of underlying disorders (e.g., Major Depression).
No scientifically accepted treatment method has been shown to effectively treat F66 diagnoses. A recent systematic review of the research literature found that insufficient evidence to support sexual orientation change efforts (SOCE) in adults, no evidence that SOCE in children and adolescents affected adult sexual orientation, harm from SOCE, and the benefits that some reported from SOCE were related to non-SOCE aspects of treatment.
Health professionals in nations where the American Psychiatric Association Diagnostic and Statistical Manual is used have operated without ICD F66-like diagnoses for more than 20 years without difficulties emerging. In doing so, they have appropriately used diagnostic codes that reflected the nature of complaints from the standpoint of distressing symptoms.
APA

Its sixth revision, the ICD-6, published in 1948, classified homosexuality as a sexual deviation based on a personality disorder. The ICD-10 stated that sexual orientation per se was not the disorder but that there were mental disorders linked to sexual orientation (Cochran et al, 2014; Reed et al., 2017).
For its 11th revision, the ICD-11, published in 2017, the Working Group recommended the complete deletion of "Psychological and behavioural disorders associated with sexual development and orientation", as:

In this way, ICD-11 can address the needs of people with a same-sex orientation in a manner consistent with good clinical practice, existing human rights principles and the mission of WHO. Cochran et al., 2014

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Quotes from the Sid Davis (1916-2006) "safety" film Boys Beware (1961) below in which homosexuals are equated with pedophiles (colorised version: WATCH):

"What Jimmy didn't know was that Ralph was sick - a sickness that was not visible like smallpox, but no less dangerous and contagious - a sickness of the mind. You see, Ralph was a homosexual: a person who demands an intimate relationship with members of their own sex."

"One never knows when a homosexual is about. He may appear normal and it may be too late when you discover he is mentally ill."

Sid Davis, who made over 150 films, receives particular mention for his excesses, exaggerations, and distortions, which went unchallenged because, unlike other filmmakers, he did not have a committee of educational advisors or a peer group overseeing his work. Davis's films focused on misery (...) and often ended in violent death, simply because a boy had driven too fast (The Bottle and the Throttle, 1968) or hitched a ride with a homosexual (Boys Beware, 1961) (Besley, 2002).

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- Baughey-Gill, S. (2011). When Gay Was Not Okay with the APA: A Historical Overview of Homosexuality and its Status as Mental Disorder. Ocean's Razor, 1(2), 4-16, via
- Besley, T. (2002). Counseling Youth. Foucault, Power, and the Ethics of Subjectivity. Westport: Praeger Publishers.
- Cochran, S. D., Drecker J., Kismödi, E., Giami, A., Garcia-Moreno, C., Atalla, E., Marais, A., Meloni Vieira, E., & Reed, G. M. (2014). Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11). Bulletin of the World Health Organization, 92, 672-679, via
- Reed, G. M., Drescher, J., Krueger, R. B., Atalla, E., Cochran, S. D., First, M. B., Cohen-Kettenis, P. T., Arrango-de Montis, I., Parish, S. J., Cottler, S., Briken, P., & Saxena, S. (2017). Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry, 15(3), 205-221, via
- photographs via and via