APA Removes Homosexuality from the DSM (1973): A Turning Point

On 15 December 1973 the Board of Trustees of the American Psychiatric Association (APA) voted to remove homosexuality from its Diagnostic and Statistical Manual of Mental Disorders, the reference book used across the United States to define mental illness. The decision followed several years of protest by gay activists, most prominently Frank Kameny and Barbara Gittings, and a dramatic appearance by a masked psychiatrist known as “Dr. H. Anonymous”. It removed a medical label that had been used to justify firing, imprisoning and “treating” gay men and lesbians.

Background: an illness by definition

The first edition of the manual, DSM-I (1952), placed homosexuality under “sociopathic personality disturbance”. DSM-II (1968) listed it among the “sexual deviations”. In practice the diagnosis gave official support to a wide range of discrimination: gay people were barred from federal jobs and security clearances, discharged from the armed forces and sometimes subjected to aversion therapy or institutionalisation.

Research had already begun to challenge the label. In 1957 the psychologist Evelyn Hooker published a study comparing gay and heterosexual men and found that experienced evaluators could not tell the groups apart on standard psychological tests. Her work showed that gay men were not, as a group, more disturbed than anyone else, but many leading psychoanalysts continued to treat homosexuality as a disorder to be cured.

The activists

Frank Kameny, an astronomer dismissed from the Army Map Service in 1957 because he was gay, co-founded the Mattachine Society of Washington in 1961. He argued that the illness label was a matter of prejudice rather than science, and in 1968 coined the slogan “Gay is Good”. Barbara Gittings, who had founded the New York chapter of the lesbian organisation Daughters of Bilitis in 1958 and edited its magazine The Ladder, worked alongside him.

After the Stonewall riots of 1969, a more confrontational gay liberation movement joined the older “homophile” groups. Activists disrupted the APA’s annual meeting in San Francisco in 1970, and in 1971 Kameny took the microphone at the Washington, D.C. meeting to denounce psychiatry’s treatment of gay people. The APA responded by allowing gay speakers onto its programme.

Dr. H. Anonymous at Dallas, 1972

At the 1972 annual meeting in Dallas, Gittings and Kameny sat on a panel entitled “Psychiatry: Friend or Foe to Homosexuals? A Dialogue”. Gittings had struggled to find any gay psychiatrist willing to take part, because openly gay doctors risked losing their licences and hospital posts.

One agreed on condition of disguise. John E. Fryer, a psychiatrist from Philadelphia, appeared as “Dr. H. Anonymous”, wearing a rubber mask, a wig and a baggy suit and speaking through a voice-distorting microphone. He told the audience that he was a homosexual and a psychiatrist, and that many colleagues in the room were gay but felt forced to hide it. His testimony made a deep impression and made the issue harder to dismiss as an outside attack on the profession.

The decision

In 1972 and 1973 activists, among them Ronald Gold of the Gay Activists Alliance, met Robert Spitzer, a member of the APA’s committee on nomenclature. Spitzer organised a panel at the 1973 annual meeting in Honolulu and then drafted a proposal: homosexuality as such would no longer be a mental disorder, and a new, narrower category, “sexual orientation disturbance”, would cover only people distressed by their orientation.

On 15 December 1973 the Board of Trustees approved the change, with 13 votes in favour and two abstentions. Opponents led by the psychoanalysts Irving Bieber and Charles Socarides demanded a vote of the whole membership. In the referendum of April 1974, about 58 per cent of those who voted supported the board’s decision.

Consequences and later steps

The change was gradual rather than complete. DSM-III (1980) replaced the 1973 category with “ego-dystonic homosexuality”, which was in turn removed from the revised DSM-III-R in 1987. The American Psychological Association passed a resolution in 1975 supporting the decision and urging professionals to work to remove the stigma of mental illness long associated with gay people.

Internationally, the World Health Organization removed homosexuality from its classification of diseases when the World Health Assembly approved ICD-10 on 17 May 1990. In the United States the APA decision became an argument used by activists in court cases and political campaigns, including the struggles over gay teachers in which Harvey Milk took part.

Myths and facts

It is sometimes said that the APA simply gave in to political pressure. Pressure was certainly part of the story, and the activists were open about it. But the decision also rested on research, such as Hooker’s, which showed no evidence that homosexuality in itself caused distress or impaired functioning, the test the committee applied to other diagnoses.

Another misconception is that the 1973 vote ended all psychiatric treatment of homosexuality. So-called conversion therapies continued for decades, and professional bodies only later issued formal statements against them.

Timeline

• 1952: DSM-I lists homosexuality as a “sociopathic personality disturbance”.
• 1968: DSM-II classifies it as a “sexual deviation”; Kameny coins “Gay is Good”.
• May 1970: Activists disrupt the APA annual meeting in San Francisco.
• May 1972: “Dr. H. Anonymous” speaks on a panel with Gittings and Kameny in Dallas.
• 15 December 1973: The APA Board of Trustees votes to remove homosexuality from DSM-II.
• April 1974: A membership referendum upholds the decision.
• 1987: DSM-III-R drops “ego-dystonic homosexuality”.
• 17 May 1990: The World Health Assembly approves ICD-10, which no longer lists homosexuality.

Why it matters

The 1973 vote removed the medical justification behind much legal and social discrimination against gay people in the United States, and later influenced psychiatric bodies worldwide. It also showed that people labelled by a profession could change that profession by speaking for themselves. As the later AIDS activism of ACT UP would again show, patients and campaigners could reshape medicine from outside.