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Homosexuality Anderson & Holland: The Legacy of Medicalising Homosexuality The legacy of medicalising ‘homosexuality’: A discussion on the historical effects of non-heterosexual diagnostic classifications Joel Anderson ([email protected]) Unité de Psychologie Sociale Université de Genève, 1211 Genève, Switzerland Elise Holland ([email protected]) Melbourne School of Psychological Sciences The University of Melbourne, Parkville, VIC 3010, Australia Abstract Those of us living in certain urban cities will even be exposed to the occasional public display of The classification of non-heterosexuality has same-sex affection. It appears that both popular and changed considerably over the past century. Once scientific ideas of sexuality and sexual orientation considered as medical conditions attracting legal have rapidly evolved in a relatively short amount of complications and serious social stigma, expressions of non-heterosexuality are now time. Although some cultures have arguably broadly considered to be normal variations of become tolerant of gay men and lesbian women human sexuality. The historical inclusion of (Baunach, 2011; Loftus, 2001), there is still homosexuality in the psychiatric literature may evidence to suggest that not all individuals (or still have implications for how sexual orientation cultural groups) concur with this attitudinal shift. is viewed today, including the ongoing treatment Furthermore, there is also evidence that of homosexuality as an illness despite its institutionalised heteronormativity (i.e., the delisting from medical diagnostic nomenclatures. assumption that heterosexual is the default sexual This discussion paper explores the historically orientation) is socially and psychologically recorded diagnostic classification of functional for heterosexual members of society (for homosexuality, reviews the processes that led to 1 the reclassification in the nomenclature and a full review, see Herek & McLemore, 2013). closes with a commentary for current The psychiatric and psychological implications of this medical legacy. nomenclatures (Diagnostic and Statistical Manual of Mental Disorders [DSM]) have historically classified a homosexual orientation2 as a 'sexual Keywords: Homosexuality; gay men; lesbian; DSM; deviation' and as a classifiable mental illness. The sexual orientation disorder; realignment therapy; very fact that being gay was medically diagnosable conversion therapy, SOCE. afforded the general community a scientific sanction to treat gay men and lesbian women “The only unnatural sex act is that which you differentially to their heterosexual counterparts. cannot perform.” Examples of this treatment include firing - Alfred Kinsey homosexual individuals from their jobs (upon disclosure of their sexuality), denying them security clearances, expelling them from their Introduction family and social groups, and turning down their United States citizenship applications (Adam, 1987). Also, gay men and lesbian women were Sexuality appears to be celebrated in many of today’s societies. In just a few decades, 1 Although the term ‘non-heterosexuality’ homosexuality has gone from being taboo, encompasses intersex and transsexual individuals, we associated with an ‘underground’ existence, to will limit the scope of this paper to a focus on gay men becoming publicly visible and freely expressed in and lesbian women. We would like to acknowledge, many Western cultures. This is evidenced by however, that issues surrounding medicalized changing social norms (Pew Research Centre, discrimination towards these targets are differentially 2014), popular culture, and in some instances even complex, and a future investigation into the legacy of the medicalization of these populations is warranted. being associated with a certain level of cachet. For 2 example, gay and lesbian pride events (e.g., Mardi We recognise the suggestion of the APA publishing guidelines that the term gay and lesbian is preferred to Gras) have become annual events on many tourism the term homosexual, however, when used in the context calendars, popular musicians have included ‘gay of a historical discourse it is appropriate to use the latter kisses’ in their music videos, and most popular term. Please note that when we refer to homosexuals, we television shows feature at least one gay character. are referring to a collective of same-sex attracted individuals (regardless of their gender). Sensoria: A Journal of Mind, Brain & Culture 4 prevented from practicing psychiatry, under the psychologically-adjusted as their heterosexual premise that someone who manifests counterparts (Rothblum & Factor, 2001); this psychopathology is not an ideal candidate for being population as a whole, however, has a higher risk a medical practitioner (Drescher, 2008). More of depression, anxiety, and related problems, when specifically, up until the 1970s, psychiatrists who compared to an exclusively heterosexual disclosed a homosexual orientation were not only population (Cochran, Mays, Alegria, Ortega, & at risk of losing their job, but in some parts of the Takeuchi, 2007; Feinstein et al., 2012). US this would result in their medical license being Furthermore, recent research shows that the higher revoked (Drescher, 2008). The original prevalence of such conditions can be causally nomenclature in the early 1950s clinically attributed to the experiences of discrimination stigmatised homosexuality, indisputably classifying (Meyer, 2003; Thoits, 2013). It is worth noting that it as a mental illness (American Psychiatric there is still some lingering debate about whether Association [APA], 1952, pp. 38-39). The homosexuality is a pathological condition or a controversy regarding whether being gay should be normal sexual variant (Drescher & Zucker, 2013; regarded as a pathological sexual development or Nicolosi et al., 2009; Nicolosi, Byrd, & Potts, as a normal variant of human sexuality was debated 2000; Nicolosi & Nicolosi, 2002). Although those in academic circles and in the popular press (e.g., who argue the former are a numerical minority, and Bell, Weinberg, & Hammersmith, 1981; Bullough, most have had their registration revoked from their 1976; Ford & Beach, 1951; Hooker, 1969; Kinsey, relevant psychological communities, the fact that Pomeroy, & Martin, 1948; Kinsey, Pomeroy, any doubt remains indicates to the wider public that Martin, & Gebhard, 1953; Socarides, 1978a; there is an unresolved consensus within the medical Spector, 1977). A combination of changing community. attitudes and social pressures led to a ‘deletion’ (we This article will discuss how the discourse on will argue that this was a reclassification) of how sexual orientation has evolved over time. We will homosexuality was defined in the DSM in 1973. start with a review of how non-heterosexuality has This elaboration from 81 to 237 words (APA, been viewed medically, by providing an extensive 1968) was considered by some as a progressive review of the changes in the DSM over time and step that liberated this sexual minority (e.g., John examining what medical classifications have Fryer, John Spiegel; see Spiegel, 2007) . existed in print. We will then collate the various Simultaneously, the main opposing school of personal communications, relevant articles, and thought posited that it was a threat to the basic interviews that have been conducted with key family unit, and undermined the scientific authority players in this debate to provide a parsimonious of psychiatry (e.g., Irving Bieber, Charles story of how decisions were made about these Socarides; see Spitzer 1973, 1974) . classifications. We will then critically question the A substantial body of literature has emerged medical legacy that has been bequeathed to gay that supports hypotheses of non-heterosexuality men and lesbian women, based on the historical being compatible with normal mental health and treatment of sexual orientation by the medical social adjustment (e.g., Barnes & Meyer, 2012; profession(s). Finally, we discuss intervention Bostwick, Boyd, Hughes, West, & McCabe, 2014; techniques that have been (and continue to be) Herek, 2010b; Herek & McLemore, 2013; Hooker, applied to ‘re-align’ gay people with the ‘default’ 1958; Kinsey et al., 1948; Kinsey et al., 1953; heterosexual orientation (e.g., conversion and Marshal et al., 2008; Oberstone & Sukoneck, 1976; sexual re-alignment therapies, sexual orientation Siegelman, 1972, for a review, see Karejeski, change efforts [SOCE], etc.), before closing with a 1996). However, experiences of discrimination challenge to the psychiatric disciplines. Examining have been empirically linked to the gay male and the histories of this topic from a multidisciplinary lesbian population having a greater prevalence of perspective allows greater overall understanding to mental health and substance misuse problems be developed as to how the values and knowledge (Feinstein, Goldfried, & Davila, 2012). Thus, we from the past influence concepts and attitudes argue for the existence of a diagnostic-cycle; today. although professional psychology bodies clearly state otherwise (e.g., American Counselling Homosexual orientation and the DSM Association [ACA], 2006; APA 2000a, 2007; The Diagnostic and Statistical Manual of Australian Psychological Society [APS], 2007) , a Mental Disorders (DSM) originated as a method higher prevalence of mental health problems for collecting statistics concerning public mental provides fuel to anecdotal notions that being gay health after psychiatry began
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