Removal of Homosexuality from DSM

In the 1950’s and 1960’s, in the United States, homosexuality had grown out of its characterization as a sin and transformed into what was considered a serious mental illness. Homosexuals were placed in insane asylums and subjected to heinous cures. The most well known is conversion therapy. Conversion therapy is any treatment used in an attempt to change the gender identity or expression or sexual orientation of a person. This type of therapy involved a number of different treatments, most often performed on men. During these treatments, homosexual men would be shown images of naked male figures and would be given medications to induce vomiting in an effort to create an aversion to the male body. Following this torment, the men would be sent off on “dates” with female nurses with the hope that they could be swayed to enjoy heterosexual intercourse. In more brutal cases, men would receive electric shocks to their genitals when they became aroused by the naked pictures. In the most extreme cases, lobotomies were conducted on homosexual individuals.

Homosexuality was not illegal for women as it was for men, but it was still categorized as a sexual dysfunction that required treatment. When behaviorism became popular, behaviorists wanted to test conversion therapy on women. This was primarily done with the use of shocks when women's eyes lingered on an image of a sexualized female . The American Psychological Association has since stated that same-sex romantic and sexual interest are normal. In 1997, the American Psychiatric Association stated that no published evidence was available to support the claims of conversion therapy’s efficacy. The APA reported that such therapies can lead to increased mental health issues and self injurious behaviors.

The first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952. Within this first edition, there were a series of sexual disorder diagnoses, homosexuality included within them. This meant that those who were homosexual were seen as being sick and in need of curing. It was believed that any sexual intercourse that could not result in the production of a child was unnatural, and therefore unacceptable . Significant discrimination against homosexuals led to assaults, verbal abuse, negative physical and mental health effects, and higher rates of self-injury and suicide.

Beginning in the 1960’s with the civil rights movement, what was coined the “homophile movement” began when LGBTQ+ activists started gathering together in major cities to fight for their rights. At this time, psychiatric professions seemed to dominate the social beliefs and attitudes surrounding the acceptability of homosexuality. This was significant power to hold, understanding that their decisions could greatly impact the lives of LGBTQ+ individuals. In the 1970’s there was a massive division in the acceptance and support of homosexuality . This negative social climate lead to discrimination against LGBTQ+ people and limited their opportunities for housing and employment .

In 1973, a nomenclature committee met with APA officials to begin the fight towards having homosexuality removed from the DSM, though they did not identify as being members of the LGBTQ+ community. Many things were done in an attempt to convince board members that homosexuality was not a disorder. Activists presented as being productive members of society to show that same-sex attraction is not a disruption to daily life and functioning. However, they believed hearing from one of their own would be more beneficial. Gay psychiatrist, John Fryer, presented at the APA conference wearing a mask and using a microphone that distorted his voice. He spoke on his successes and worked to appeal to his fellow psychiatrists .

In what was known as the “greatest gay victory of all time,” the activists convinced the APA board of trustees to vote to remove homosexuality from the DSM in 1973. This would potentially lead to a decrease in the pathologizing of same-sex attraction. It was the hope that sodomy laws would be more quickly removed to allow professions who were highly qualified to be properly licensed.  However, for some, this change had come too late; stigma was already so prevalent and unfortunately did not subside after the removal was finalized.

However, it was not removed entirely. It was instead replaced with “sexual orientation disturbance” or “sexual orientation disorder”. With this “disorder,” it is understood that the sexual orientation of the person is established and well known by them but they feel distress about it and wish to change it . It lies under section 302.01 of the DSM-III and is known as ego dystonic homosexuality. Despite questions of appropriateness, this restructuring was ultimately the compromise that was made . It is clear that external stigma could lead a person to this disorder. However, it is internal stigma, also known as internalized homophobia, that can increase the likelihood of someone wanting to change their sexual orientation.

Presently, there are questions over what should truly be considered a sexual disorder. The most current DSM (DSM-V)  has many paraphilic disorders such as sadism, masochism, fetishism, voyeurism, frotteurism, and more. However, the distinction between consensual “kinks” and sexual dysfunction is unclear, with debate over the inclusion of any of these disorders in the DSM. There have also been suggested additions and revisions of the DSM. Some suggested that rape could be defined as a sexual dysfunction, but this idea was rejected as it seemed to excuse the behavior of sexual perpetrators. The discussion continues on diagnostic inclusion and need for treatment of these disorders along with updated sexual norms.

The removal of homosexuality from the DSM had a variety of favorable consequences. This change helped frame homosexuality as a natural occurrence rather than a sickness or problem in need of fixing; this was a great stride in the normalization of same-sex relationships. There was a broad change in cultural beliefs which began to take place at this time . Beginning immediately after the change to the DSM, there were changes in how people viewed the rights of homosexual individuals. However, large-scale changes did not really begin to occur until the 1990’s. At this time, same sex civil unions were allowed in many states but marriage equality was unheard of. However, the removal had a lasting impact, allowing individuals to find the strength to push for marriage equality as well as many other equal rights. Studies show that over time after the DSM change, approval of same sex relationships went from 11% in 1988 to 46% in 2010.

In June 26, 2015, same sex marriage was legalized in the United States at the federal level. This was one of the most important victories for the LGBTQ+ community since the removal of homosexuality from the DSM. Along with this change came other successes. In 2003, sodomy laws were revoked, a huge win for the LGBTQ+ community. More laws came into legislation to protect the rights of same-sex couples. Homosexuals are now allowed to enlist and serve openly in the military. Adoption rights for same sex couples became more lenient and reasonable. These are just a few victories that came about due to the catalyst of depathologizing homosexuality.

**Further Reading:**

1. Drescher J. (2015). Out of DSM: Depathologizing Homosexuality. *Behavioral sciences (Basel, Switzerland)*, *5*(4), 565–575. https://doi.org/10.3390/bs5040565
2. Javier N. M. (2021). Palliative care needs, concerns, and affirmative strategies for the LGBTQ population. *Palliative care and social practice*, *15*, 26323524211039234. https://doi.org/10.1177/26323524211039234
3. Stein, D. J., Palk, A. C., & Kendler, K. S. (2021). What is a mental disorder? An exemplar-focused approach. *Psychological medicine*, *51*(6), 894–901. https://doi.org/10.1017/S0033291721001185

**References:**

1. ↑ 1.0 1.1 *Conversion therapy*. GLAAD. (2018, November 8). Retrieved December 4, 2021, from https://www.glaad.org/conversiontherapy.
2. ↑ 2.0 2.1 Perina, K. (2015, September 18). *When homosexuality stopped being a mental disorder*. Psychology Today. Retrieved December 4, 2021, from https://www.psychologytoday.com/us/blog/hide-and-seek/201509/when-homosexuality-stopped-being-mental-disorder.
3. ↑ Scot, J. (2017, December 7). *Shock the gay away: Secrets of early gay aversion therapy revealed (photos)*. HuffPost. Retrieved December 4, 2021, from https://www.huffpost.com/entry/shock-the-gay-away-secrets-of-early-gay-aversion-therapy-revealed\_b\_3497435.
4. ↑ Spandler, H., Carr, S., Woodward, J., & Sen, D. (2020, January 22). *The shocking 'treatment' to make lesbians straight*. Wellcome Collection. Retrieved December 4, 2021, from https://wellcomecollection.org/articles/XhWjZhAAACUAOpV2.
5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Levy Uyeda, R. (2021, May 26). *How LGBTQ+ activists got “homosexuality” out of the DSM ...* JSTOR Daily. Retrieved December 4, 2021, from https://daily.jstor.org/how-lgbtq-activists-got-homosexuality-out-of-the-dsm/.
6. ↑ 6.0 6.1 Cabaj, R. P. (n.d.). *Working with LGBTQ Patients*. Psychiatry.org. Retrieved December 4, 2021, from https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-lgbtq-patients.
7. ↑ 7.0 7.1 7.2 7.3 7.4 Silverstein, C. (2008, November 11). *The implications of removing homosexuality from the DSM as a mental disorder*. Archives of Sexual Behavior. Retrieved December 4, 2021, from https://link.springer.com/article/10.1007/s10508-008-9442-x.
8. ↑ 8.0 8.1 *Americans move dramatically toward acceptance of ... - Norc*. NORC at University of Chicago. (n.d.). Retrieved December 4, 2021, from https://www.norc.org/NewsEventsPublications/PressReleases/Pages/american-acceptance-of-homosexuality-gss-report.aspx.
9. ↑ World Health Organization. (n.d.). *Disorders of Adult Personality and Behavior*. World Health Organization. Retrieved December 4, 2021, from https://icd.who.int/browse10/2019/en#/F66.1.
10. ↑ Smith, J. (2004, March 5). *Ego-dystonic homosexuality*. Comprehensive Psychiatry. Retrieved December 4, 2021, from https://www.sciencedirect.com/science/article/abs/pii/0010440X80900887.
11. ↑ First, M. B. (2014, June 1). *DSM-5 and paraphilic disorders*. Journal of the American Academy of Psychiatry and the Law. Retrieved December 4, 2021, from http://jaapl.org/content/42/2/191.
12. ↑ Allen Frances, M. D. (2020, November 16). *DSM-5 confirms that rape is crime, not mental disorder*. Psychiatric Times. Retrieved December 4, 2021, from https://www.psychiatrictimes.com/view/dsm-5-confirms-rape-crime-not-mental-disorder.
13. ↑ 13.0 13.1 Drescher, J. (2015, December 4). *Out of DSM: Depathologizing homosexuality*. Behavioral sciences (Basel, Switzerland). Retrieved December 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/.
14. ↑ 14.0 14.1 Drescher, J. (2012, January 11). *The removal of homosexuality from the DSM: Its impact on today's marriage equality debate*. Taylor & Francis. Retrieved December 4, 2021, from https://www.tandfonline.com/doi/full/10.1080/19359705.2012.653255.
15. ↑ 15.0 15.1 *The journey to marriage equality in the United States*. HRC. (n.d.). Retrieved December 5, 2021, from https://www.hrc.org/our-work/stories/the-journey-to-marriage-equality-in-the-united-states.