Homosexuality was included as a mental disorder in the first two editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), reflecting the societal and medical attitudes of the mid-20th century. Here, we explore the history of homosexuality’s inclusion in the DSM, its implications, and the eventual removal that marked a turning point in LGBTQ+ mental health and rights.
DSM-I (1952): Homosexuality as a Sociopathic Personality Disturbance
The first edition of the DSM, published in 1952 by the American Psychiatric Association (APA), categorized homosexuality as a mental disorder under the term “Sociopathic Personality Disturbance.”
- Definition: Homosexuality was classified as a sociopathic condition, grouped with other behaviors deemed socially deviant, such as alcoholism and sexual offenses.
- Context: This categorization reflected the prevailing belief that homosexuality was a pathological condition requiring treatment. The medical community’s perspective was shaped by societal stigma and limited scientific understanding.
DSM-II (1968): Homosexuality as a Sexual Deviation
In the second edition of the DSM, published in 1968, homosexuality was reclassified under a new category, “Sexual Deviations.”
- Definition: The DSM-II described homosexuality as a deviation from normal sexual behavior, alongside conditions like pedophilia, fetishism, and transvestism.
- Impact: This classification reinforced the idea that homosexuality was an abnormal and undesirable condition, contributing to stigma and discrimination against LGBTQ+ individuals.
- Cultural Context: The inclusion in DSM-II coincided with a period of significant social conservatism in the United States and other parts of the world. LGBTQ+ individuals faced widespread discrimination, legal persecution, and forced medical treatments, such as aversion therapy.
The Push for Change
By the late 1960s and early 1970s, societal and scientific attitudes toward homosexuality began to shift, driven by the LGBTQ+ rights movement and groundbreaking research challenging the pathologization of homosexuality.
- Activism: LGBTQ+ organizations like the Gay Liberation Front and the Gay Activists Alliance demanded the removal of homosexuality from the DSM, highlighting its role in perpetuating discrimination and harmful medical practices.
- Scientific Evidence: Research by pioneers such as Dr. Evelyn Hooker demonstrated that homosexual individuals were as psychologically healthy as their heterosexual counterparts. Her studies provided empirical evidence against the classification of homosexuality as a disorder.
- Cultural Shifts: Events like the Stonewall Riots in 1969 brought increased visibility to LGBTQ+ issues, pressuring institutions like the APA to reconsider their stance.
Removal in 1973: A Turning Point
In 1973, the APA’s Board of Trustees voted to remove homosexuality from the DSM-II, replacing it with a new diagnosis, “Sexual Orientation Disturbance.” This compromise acknowledged the existence of individuals distressed by their sexual orientation while removing the blanket classification of homosexuality as a disorder.
- DSM-III (1980): The diagnosis “Ego-Dystonic Homosexuality” was introduced, focusing on individuals who experienced significant distress over their sexual orientation. This category was later removed in DSM-III-R (1987), reflecting growing consensus that such distress was often the result of societal stigma rather than an intrinsic mental disorder.
Conclusion
Homosexuality’s inclusion in the DSM-I and DSM-II reflected the limited understanding and deep-seated prejudices of mid-20th-century society. Its eventual removal marked a critical step toward destigmatizing LGBTQ+ identities and advancing equality. The evolution of its classification serves as a reminder of the importance of evidence-based practice and advocacy in challenging harmful medical and societal norms.