I have been intending to do research into the nature of our medical community's support of gay activism for some time. For example, it has often seemed to me that it was largely a political decision to remove homosexuality from the list of mental illnesses.

What I have come to discover is that it has always been political as to what psychiatrists and psychologists choose to regard as a problem and what is not. My conclusion then is that medicine should withdraw from the field of politics in the sense that we should minimize the extent to which science declares something moral, ethical, or normal outside of practices within their own field.

My first reading on this specific topic was Homosexuality and American Psychiatry – The Politics of Diagnosis by Ronald Bayer. One of the recurring themes in the book is that the decision to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) II was to a great extent, perhaps even exclusively, a matter of political activism and not one based on science. Mr. Bayer is sympathetic to the gay agenda at least inasmuch as he seems supportive of the cause of removal of the behavior from the DSM. There is little room for criticism of his views based on any supposed political opposition to liberal causes.

What Dr. Bayer reveals in this book is that in the early 70's, homosexuals took advantage of communist “progressive” popularity in our nation's leftist subculture to assume for their own purposes the status of victim of the Capitalist system. He sets the stage by noting that there were challenges to the idea of homosexuality being any sort of disorder well before the DSM was changed. The most convincing argument to me was the fact that there had been an undercurrent of academics, Thomas Szasz and others of like mind, claiming that much of psychiatry was merely the result of the medicalization of what was in fact merely odd behavior. Some would even resist the phrase “odd behavior” itself. In short, psychiatry had come alongside society and declared certain unpopular behaviors “sick” simply because society disapproved when in fact there was nothing intrinsically wrong with them.

I find myself in agreement with this as far as it goes. This issue has grown, coming out of the shadows of “counterculture” and into our hospitals and classrooms. We all experience more and more pressure to conform to some predetermined “medical” norm or ideal, and I for one am not comfortable with medicine's growing power over us, and government's growing power over medicine. It is merely another conformation of the ages old trap of having those who decide what is right or wrong also enforce what is right or wrong without the populace having anything to say on the matter. In short, it bypasses the separation of church and state by replacing “church” with “psychiatry”.

What, then, disturbs me at all about the removal of homosexuality, or any other “illness” that does no direct harm to the supposedly ill, nor to those around them, from the DSM? It is that the APA never acknowledges that this is what they did. Indeed, the DSM is still replete with the sorts of “illnesses” that the anti-psychiatrists discuss. Instead, it is claimed repeatedly that new discoveries in psychiatry led to the change. This leads to a false perception that there has been some growing body of knowledge about homosexuality that backs the decision, made for purely scientific reasons, to remove homosexuality per se from the DSM. Few things could be further from the truth. What actually happened was that liberal psychiatrists made a political move and have systematically influenced the intrinsically subjective field of psychiatric diagnosis ever since in order to make that move appear prescient rather than merely expedient.

In his book, Bayer expounds on pages 132 and 133 on the details of how all of this was done in utterly irregular fashion and without one person specializing in homosexuality having anything to do with the 1973 decision. The sorts of political forces at work to effect this change were staggeringly left of center.

“Emerging from the battles between the police and the homosexuals of Greenwich Village was the Gay Liberation Front. (GLF), a radical organization that sought to make its opposition to the social order manifest through the assumption of a name evocative of the communist struggle in Vietnam against American military intervention.” (Bayer, p. 93)

“Our oppression as homosexuals stems from the same source as other repressed groups: the restrictive, competitive social roles necessitated by a capitalist economy and a ruling elite.” (Bayer, p. 94)

Red Butterfly, “Gay Liberation”, p.12

Not all gay activists are avowed Communists obviously, but it is telling that these were the original political allies of gay activists, and this was their mindset leading up to the protests and interventions that led to the changes in psychiatry's views on homosexuality. Nor was this merely a bunch of talk from gays who in actuality never made a real impact on the issue. Repeated protests expressing violent disregard for any sense of the rights of people to peaceably assemble led directly to the inclusion of an all gay panel in a 1971 APA conference. What sort of protests?

At a panel on transsexualism and homosexuality, Irving Bieber experienced his first face-to-face denunciation. Having become accustomed to the written attacks of those who had labeled him Public Enemy Number One, he was still unprepared for the kind of rage that greeted him. His efforts to explain his position to his challengers were met with derisive laughter. Since the norms of civility were considered mere convention designed to mute outrage, it was not difficult for a protester to call him a “motherf*er.” “I've read your book, Dr. Bieber, and if that book talked about black people the way it talked about homosexuals you'd be drawn and quartered and you'd deserve it.” (Bayer, p.102-103)

Having not yet read Bieber or any of the others who held what until 1973 was the official professional opinion on homosexuality, I can not defend or attack the work of those psychiatrists. What I will repeat is that there was a tendency then, as now, to subsume a number of issues more appropriately matters of public policy, or perhaps matters of personal preference only, and formulate methods whereby the medical community could dictate what was and was not “proper”. This led to some very improper treatment of homosexuals indeed, including what was referred to as “aversion therapy”. Some of you may be familiar with the practice of sitting a smoker in front of a mirror and forcing them to chain smoke until they vomit. This sort of “treatment” enjoys precious little success in situations where a person later leaves the clinical environment and is all too aware that they do not have to smoke until they puke. Likewise, reports as to the effectiveness of such therapy for homosexuality have been grim, from what I have been given to understand.

Still, this is not the picture of a process being moved along by emerging science. It is a picture of a group of activists putting their feet down and demanding change no matter what science may have to say about the subject.

“To those who had so boldly challenged the professional authority of psychiatry it was clear that only the threat of disorder or even violence had been able to create the conditions out of which such a dialogue could occur. The lesson would not be forgotten.” (Bayer, p. 104)

The activists found a willing ally in Robert Spitzer. Despite the fact that the board in charge of nomenclature was headed by Henry Brill, Spitzer took an active and decisive roll during the period leading up to the 1973 change in DSM II. It's worth noting that no one on this board was an expert on homosexuality, and that no steps were taken to invite the opinions of practitioners who were considered experts on homosexuality. In contrast, when Brill, frustrated by Spitzer's usurpation of the process and mindful of the irregular methods being used to force this decision on the psychiatric world, asked for a stratified sample of APA members to be taken to at least get a sense of where the profession as a whole stood on the matter, he was rejected. He was refused because, in the words of Russell Monroe, “you don't devise nomenclature through a vote.” (Bayer, P. 137)

Apparently you do, since the decision was made by vote of the Committee on Nomenclature while it was actively resisting the efforts of experts on this subject to be heard. After pressuring the Committee on Nomenclature for a hearing, some psychiatrists did indeed get a chance to discuss the issue before the vote – right before the vote. Charles Socarides tried to beat back the attack on the established status quo. His Task Force's work was ultimately rejected because it relied too heavily on “psychoanalytic theory” despite the fact that the council stressed that the clinical conclusions of the Task Force about the pathological status of homosexuals was acceptable. Having found no professional reason to question the Task Force's work, they merely swept aside psychoanalytic theory and ignored the only smidge of actual professional science that had been introduced into the process. Continuing in his resistance, Socarides accused the panel of New York with colluding with the national leadership of the APA. The only response from the New York contingent's Robert Osnos was that the New York branch had been reluctant to embrace the Task Force findings because of its controversial nature. Collusion or cowardice?  Either way, it was a political decision and not a scientific one. (Bayer, p. 115)

As I will note later, the issue was eventually raised up to the membership in general, with the gay activists using their inside influence with the liberal leadership to influence the vote itself.

The extent to which the issue was clouded by political activism can be seen in the absurd suggestions that were being bandied about at the same time. Apparently not satisfied with merely removing homosexuality per se from the list of psychiatric ailments, some psychiatrists, such as Ronald Gent, suggested that homosexuality was essentially indistinguishable from heterosexuality.

Ronald Gold sent a letter to the Council on Research and Development stating heterosexuals too could be in conflict over the sexual orientations, and characterized any idea that homosexuality was “suboptimal” as putting gays at the risk of being treated for internalizing, “effects of anti-homosexual bigotry.” (Bayer, p. 131)

Spitzer went on to present “religious fanaticism,” vegetarianism, and celibacy, among others, as similarly “odd behaviors” comparable to homosexuality. (Bayer, p. 127)

There were indeed criteria for declaring something a disorder even in the eyes of Spitzer.

“His restricted definition of mental disorders, articulated after he had decided that homosexuality had been inappropriately classified, entailed two elements: For a behavior to be termed a psychiatric disorder it had to be regularly accompanied by subjective distress and/or 'some generalized impairment is social effectiveness or functioning.'” (Bayer, p. 127 )

My mind reels at the thought that homosexuality somehow does not meet this standard at the very least in the event that the homosexual him or herself complains about the orientation. The utter inability to attain suitable heterosexual functioning to ever have a family does not entail “some generalized impairment in social effectiveness or functioning?” Did the APA just decide that having a normal family was not at all related to effective social functioning even in cases when the prospective patient deems that it is?

The aforementioned popular referendum was therefore invoked due to outrage over the decision and its irregular methodology. A letter was sent out supporting the nomenclature change that was initiated by Kent Robinson after being contacted by gay activists. It was also payed for and administered by The National Gay Task Force. The letter did not acknowledge it had been sent under such circumstances. (Bayer, p. 145)

In Report Ad Hoc Committee to Investigate the Conduct and the Referendum, Recommendations, 1C and 1D, the ad hoc committee stated that questions of science should be “discussed” by experts, but that the Board of Directors need not pay any attention to these experts. “...neither they nor the membership in its entirety should be put into the position of deciding scientific questions by vote.”

Yet this is exactly what happened, and there was no effort at all to go back and correct the situation. Not only this, but the results of the referendum, which as noted above were influenced by a letter sent directly from gay activists yet appearing to be a letter recommending the science behind the decision, were documented as being reversed just four years later. In a survey of 10,000 taken in 1977 by Medical Aspects of Human Sexuality, 69% of psychiatrists believe that homosexuality usually represented a pathological adaptation. 70% believed problems experienced by homosexuals were a result of personal conflicts and not stigmatization. (Bayer, p.167)

So, four years later, there still was no “emerging science” to support the nomenclature change, at least in the opinion of the vast majority of psychiatrists.

This massive difference from the referendum could be the result of cooling sensibilities toward the reform, or it could represent the effect of the misleading mail sent out under the auspices of the leadership, motivated by gay activists and the leadership's self professed liberalism. It was acknowledged by both sides that the leadership was liberal (Bayer, p. 149-151) probably because, at the time, “liberal” had not acquired the negative connotation it has suffered over recent years. In hindsight, the importance of this to the question of whether or not political pressure had anything to do with the decision to declassify homosexuality per se as a mental illness cannot be overemphasized.

Irving Bieber and Charles Socarides continued to be targets of militant homosexuals in their lectures, but the militants apparently recognized an ally in Spitzer and abstained from the sort of interference that had characterized the previous nomenclature discussion when he pushed homosexual behavior further into the recesses of Psychiatric nomenclature while chairing the next Committee on Nomenclature. (Bayer, p. 178)

To this day, despite all the hooplah about the normality of homosexuality in the eyes of psychiatry, there is still mention of it in the current DSM. In a section marked, "Sexual Disorder Not Otherwise Specified," if a person complains of, "...persistent and marked distress about sexual orientation," treatment can still be given. And so, at long last, the absurd effort to make homosexuality appear as if it were the behavioral peer of heterosexuality was realized. One wonders how many heterosexuals in the history of psychiatry have ever complained of such a thing, but problems with homosexual orientation that are manifestly related to the orientation are not labelled as "homosexual” anymore.

At the end of his book, Bayer begins to lay out the reasoning for why he believes that, despite the politics involved, this was a good outcome. The argument rests on the idea that “sickness” is a human concept. He believes that given this, psychiatry, by its very nature, must from time to time make subjective, political decisions as to how it is going to proceed. This argument either ignores or dismisses another obvious and much more productive tack that medical professionals could take. They could concentrate on classifying things in terms of their frequency of occurrence and their own ability to treat a given symptom without expressing any judgment one way or the other on these issues apart from whether or not a potential patient complains about the prospective ailment. It would be the more strictly neutral and scientific approach.