i-688d28ff8ba0b4be056711def5369ac9-Dykes_on_b_m1195507.jpgOver at Respectful Insolence, a lot of people have been discussing the relationship between skepticism and scientific consensus, a topic I brought up recently. And commenter Alvaro has pointed out a kind of counterexample, to whit, that the consensus among US psychiatrists had defined homosexuality as a psychiatric condition up through 1974. This is classic Michel Foucault territory, and I think Alvaro’s point is interesting and apt. Being gay isn’t always easy in an at best semi-tolerant society, but it sure isn’t something that calls for treatment.

Reading up a little, I found something that surprised me. Wikipedia has a meaty article on the issue, demonstrating that there was no consensus among US psychiatrists about gays being nuts prior to about 1953, and only a very weak one after that date.

To begin with, Alvaro’s chronology is slightly off. In 1953, the Diagnostic and Statistical Manual of Mental Disorders Mk. I defined homosexuality as a mental disorder. So did the first (1968) edition of DSM II. But already in 1973, the trustees of the American Psychiatric Association voted unanimously to remove homosexuality from new printings of the DSM II. The following year, amid great controversy, 58% of the APA membership confirmed this decision by vote. So, if we accept the DSM as a direct reflection of the consensus in psychiatry (which is highly debatable), then we only need to discuss a period of 15 years from 1953 to 1968.

In science, no answer can ever be better than the question you ask. My reply to Alvaro is that the issue here is really how “psychiatric condition” was defined in the 50s and 60s. If the definition was something along the lines of “non-standard behaviour and/or mental states that impair a person’s functioning in society”, then gayness clearly did fit the bill. Because it is, statistically speaking, non-standard, and it did pose problems for people living in the even less tolerant US society of the time.

So my take on this issue is that from 1953 to 1968, US psychiatrists may not generally have been very gay-friendly; but their consensus that gayness was something they should try to treat was probably not just a result of homophobia. Many psychiatrists did feel that something must be wrong in the brain of a person who doesn’t want to bonk people of the opposite sex. But they were also asking, “Is being gay a problem for our patients?”. And in the mid-20th century US, it would be hard to argue that it was not. It’s still a problem, because society is intolerant of non-standard lifestyles. What US psychiatrists agreed upon only about 20 years after DSM I was that gayness could not productively be handled as a psychiatric issue, despite the fact that it resides in the brain. In fact, defining gayness as a mental health issue just made the problem worse for the patients through social stigmatisation. Besides, gayness can’t be treated and most gay people don’t want to become straight. This sets it emphatically apart from unequivocal psychiatric diagnoses such as depression and anxiety.

(On a lighter yet kind of sad note, let me mention that the “gays are nuts” perspective survived in unexpected places long after 1968. The 1985 role-playing game Teenage Mutant Ninja Turtles & Other Strangeness has a table that the game master uses to determine a diagnose when a character goes insane for some reason. One of the “afflictions” such a character can be hit with is homosexuality.)

As I’ve said before, in my opinion, a real skeptic accepts scientific consensus. But the 1948 Kinsey report had documented a very high incidence of homosexual behaviour in US men. Therefore, the psychiatrists who drafted the DSM I knew that gay sex was not an unusual aberration among the brain-damaged, but something that a large part of the healthy population was doing for fun. I don’t believe there was any scientific consensus that gayness equalled madness in the 1960s. Apparently, however, a consensus remained that gayness was the business of psychiatrists because it was a problem for many people. And this latter is sadly still the case.

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Comments

  1. #1 paddy
    December 31, 2007

    I once had a mail argument with a fundamentalist American christ-licker about gays. In turned out that the guy was against gays not because they were bad, or would go to hell, or that he believed they were hurting/deceiving themselves.

    No, he was against them because of the whole Soddom and Gommorah thing – that god would bring down his wrath on the whole society (i.e. the US) for allowing gays to exist. So he was really only worrying about saving himself from fire and brimstone, and didn’t really give a shit about “saving” or “curing” gay people.

    It’s scary that people who think like this are allowed to walk around. THEY are the ones who should be declared mad and locked away.

  2. #2 Bob
    December 31, 2007

    A minor quibble about the “non-standard” in this context, because for the lay person non-standard has a pejorative connotation that I’m absolutely sure you don’t mean. Unless there is a term of art that I simply don’t know, I would not say that being gay is non-standard.

    It is in the minority, yes, but considering that lgbt individuals have been a part of humanity for at least as long as we have records it wouldn’t class it as non-standard. It seems that it is one of the standard kinds of sexual interactions that are expressed in humans and other animals, even if it is not the majority.

    You wouldn’t call people with red hair and green eyes non-standard. They are definitely in the minority, but green eyes are one of the standard eye colors that occur in humans. I had an uncle with two very different colored eyes(green and brown IIRC) and that I would class as non-standard.

  3. #3 thadd
    December 31, 2007

    I think this entire argument misses a big point, that while skeptics etc should generally accept scientific consensus, they will still sometimes be wrong.
    Science, as any skeptic will accept, is sometimes wrong itself, so no matter what portion you accept, there is a chance, usually very small, that you will be wrong. Accepting consensus means listening people who know more than you do, and in the end, statistically speaking, this means you are likely to get a better number of survivable scientific theories.
    I would also say that during the period in discussion, homosexuality was in a way like string theory today, just barely opened for study, and really, when you look at the number of people still closeted today, one cannot possibly accept that we are really that far into an accurate period of study, where everyone agrees.
    It is also important to ask to what level was the opinion of homosexuality as a mental disorder based on non-scientific biases and beliefs. I certainly think that these need to be taken into account as well.

  4. #4 Caledonian
    December 31, 2007

    We already have a field for neurological problems: we call it ‘Neurology’. Psychiatry is for the people and behaviors that society views as unacceptable but cannot specify what is actually wrong with them.

    We may move more things from psychiatry to neurology as time goes on, but at present, it’s a consensus-only field, and the things in it are there only because enough psychiatrists think they should be there.

  5. #5 Ace of Sevens
    December 31, 2007

    My concern is similar to above. Even assuming homosexuality was widely considered a disorder, can this really be considered a scientific consensus? Is whether or not something is a disorder something you can really prove based on evidence? To the degree it is, it would seem to be socially relative.

  6. #6 Martin R
    January 1, 2008

    Bob, I see what you mean, but I don’t think it would have been any better to call gayness “abnormal” or “deviant”. These would actually have been more correct than “non-standard” as statistical terms in this context, but they carry an even stronger pejorative charge in the vernacular.

    I just meant that if you pick a random person out of humanity you are unlikely to grab someone who’s gay or has green eyes or has red hair.

  7. #7 Martin R
    January 1, 2008

    Ace, that was Foucault’s argument. But it doesn’t hold true for heavy stuff like psychosis, suicidal depression, obsessive-compulsive disorder etc. They are not simply socially constructed problems that would evaporate if society just accommodated them better.

  8. #8 Johnny
    January 1, 2008

    You said the following:

    In science, no answer can ever be better than the question you ask. My reply to Alvaro is that the issue here is really how “psychiatric condition” was defined in the 50s and 60s. If the definition was something along the lines of “non-standard behaviour and/or mental states that impair a person’s functioning in society”, then gayness clearly did fit the bill.

    Your question and hypothetical (the “if/then” statement) is incredibly flawed. Anyone who lived through that period, whether psychiatrist or not, knew that a psychiatric condition did not just mean “non-standard behavior”! How ignorant. It meant a “disorder” requiring treatment, including electro-shock and other painful and debilitating intervention; or simply imprisonment in a mental institution.

    The Diagnostic and Statistical Manual of Mental Disorders was and is just that: a guide to advise doctors how to treat severe disorders. Listing any sexuality as a disorder meant that you could be institutionalized and medically abused for loving or having sex against someone else’s norm.

    That you fail to point out these truly obvious and longterm distinctions between a disorder and any other kind of behavior (and the perils of so called “treatment” as a form of bigotry and abuse) borders on irresponsibility.

    Being a skeptic requires a lot more discernment than you exhibit here.

  9. #9 Martin R
    January 1, 2008

    The DSM was and is just that: a guide to advise doctors how to treat severe disorders. Listing any sexuality as a disorder meant that you could be institutionalized and medically abused for loving or having sex against someone else’s norm.

    No, the DSM has never confined itself to severe disorders. By your reasoning, anyone with e.g. a mild seasonal depression or a spider phobia would also have run the risk of being “institutionalized and medically abused”.

  10. #10 Johnny
    January 1, 2008

    No, Martin. Not by my reasoning AT ALL. Stop misinterpreting what I said.

    I pointed out that homosexuality was classified as a disorder in the DSM requiring treatment and not as just standard or non-standard behavior, as Dr Martin Rundkvist hypothetically suggested at one point in his post.

    This classification often led to inarguably abusive treatment by so-called medical professionals simply for being a homosexual: institutionalization, shock treatment, and other ridiculous interventions JUST for being gay or lesbian. If you don’t think those interventions for being gay are abusive then you are a spot-on bigot and their is absolutely no arguing with bigots possessed of irrational hate, rage, and fear of homosexuals.

    The DSM is controversial: some argue that certain conditions or disorders should not be in it, including some forms of depression.

    But, I was not talking about a depression, or a mania, or a phobia, Martin. I was talking about a sexuality and the fact that the DSM classified a particular sexuality as a medical disorder requiring treatment.

    That you conflate SEXUALITY with conditions like depression and misinterpret what I said is IGNORANT.

  11. #11 Jon H
    January 2, 2008

    I think it would be wise to keep in mind how primitive the field was at the time. I expect a fair number of practitioners, especially at the department head level, were still Freudian quacks.

    Psychiatry before the 80s is like chemistry before it shook off its mystical alchemical roots: Flawed, but of value for keeping people engaged in the study, which produced the later advances that made it a science.

    To answer Johnny, homosexuality was hardly the only ‘condition’ which was responded to in ways that we since realized were not justified. Severe treatments were used because, for the most part, that’s all that was available and some were seen as cutting edge.

  12. #12 Martin R
    January 2, 2008

    I agree about Freudians being quacks, but it seems that school of thought was generally pretty gay-friendly. Noted Freudian Erich Fromm nevertheless states in his Art of Loving (1956) that gay relationships would somehow never be as real and fulfilling as straight ones. Bollocks say I.

  13. #13 Caledonian
    January 2, 2008

    But it doesn’t hold true for heavy stuff like psychosis, suicidal depression, obsessive-compulsive disorder etc. They are not simply socially constructed problems

    They are socially-constructed categories with socially-constructed solutions. The problems are usually not rigorously defined, and they’re certainly not defined scientifically.

  14. #14 Jon H
    January 3, 2008

    “I agree about Freudians being quacks, but it seems that school of thought was generally pretty gay-friendly”

    Ah, my bad. I guess it makes sense, though. Still my main point was that we’re talking about an era not long past the time when icepick lobotomies were cutting edge. They were presumably trying to help, but really had only the vaguest notion of what they were doing.

    Things were pretty messed up all over, not just with how homosexuals were treated. But even there, for every gay person mistreated by the shrinks, just think how many were arrested and/or beaten up by the cops.

    It’s the kind of thing you just have to say “Well, that was messed up and sad. I’m glad that’s over with.” and work to make sure we don’t backslide.

  15. #15 vanderleun
    January 6, 2008

    paddy writes: “a fundamentalist American christ-licker about gays”

    paddy, can you explain to us again about bigotry?

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