The Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as an abnormal behavior until 1986, when the American Psychiatric Association (APA) removed it from the manual. Based on changing social perceptions and attitudes, discuss a currently-listed disorder that you believe may soon achieve declassification. Alternatively, you may discuss a condition not currently listed in the DSM that you believe the APA may soon include in the manual. Explain your reasons for this conclusion.

Out of DSM: Depathologizing Homosexuality

Jack Drescher

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Abstract

In 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM). This resulted after comparing competing theories, those that pathologized homosexuality and those that viewed it as normal. In an effort to explain how that decision came about, this paper reviews some historical scientific theories and arguments that first led to the placement of homosexuality in DSM-I and DSM-II as well as alternative theories that eventually led to its removal from DSM III and subsequent editions of the manual. The paper concludes with a discussion of the sociocultural aftermath of that 1973 decision.

Keywords: American Psychiatric Association (APA), diagnosis, Diagnostic and Statistical Manual (DSM), gender beliefs, gender binaries, homosexuality, psychiatry

1. Introduction

In 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM) [1,2]. This resulted after comparing competing theories, those that pathologized homosexuality and those that viewed it as normal [3,4,5,6]. In an effort to explain how that decision came about, this paper reviews some historical scientific theories and arguments that first led to the placement of homosexuality in DSM-I [7] and DSM-II [8], as well as alternative theories, that eventually led to its removal from DSM III [9] and subsequent editions of the manual [10,11,12,13]. The paper concludes with a discussion of the sociocultural aftermath of that 1973 decision.

2. Theories of Homosexuality

It is possible to formulate a descriptive typology of etiological theories of homosexuality throughout modern history in which they generally fall into three broad categories: pathology, immaturity, and normal variation [14,15,16].

2.1. Theories of Pathology

These theories regard adult homosexuality as a disease, a condition deviating from “normal,” heterosexual development [17]. The presence of atypical gender behavior or feelings are symptoms of the disease or disorder to which mental health professionals need to attend. These theories hold that some internal defect or external pathogenic agent causes homosexuality and that such events can occur pre- or postnatally (i.e., intrauterine hormonal exposure, excessive mothering, inadequate or hostile fathering, sexual abuse, etc.). Theories of pathology tend to view homosexuality as a sign of a defect, or even as morally bad, with some of these theorists being quite open about their belief that homosexuality is a social evil. For example, psychiatrist and psychoanalyst Edmund Bergler infamously wrote in a book for general audiences, “I have no bias against homosexuals; for me they are sick people requiring medical help... Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner... [their] shell is a mixture of superciliousness, fake aggression, and whimpering. Like all psychic masochists, they are subservient when confronted with a stronger person, merciless when in power, unscrupulous about trampling on a weaker person” [18], (pp. 28–29).

2.2. Theories of Immaturity

These theories, usually psychoanalytic in nature, regard expressions of homosexual feelings or behavior at a young age as a normal step toward the development of adult heterosexuality [19,20]. Ideally, homosexuality should just be a passing phase that one outgrows. However, as a “developmental arrest,” adult homosexuality is equated with stunted growth. Those who hold these theories tend to regard immaturity as relatively benign, or at least not as “bad” compared to those who theorize that homosexuality is a form of psychopathology.

2.3. Theories of Normal Variation

These theories treat homosexuality as a phenomenon that occurs naturally [21,22,23,24]. Such theories typically regard homosexual individuals as born different, but it is a natural difference affecting a minority of people, like left-handedness. The contemporary cultural belief that people are “born gay” is a normal variation theory. Such theories see no place for homosexuality in a psychiatric diagnostic manual.

3. Gender Beliefs

It is rare to find a theory of homosexuality that does not draw upon gender beliefs that contain implicit cultural ideas about the “essential” qualities of men and women [14,16,25]. “Real men” and “real women” are powerful cultural myths with which everyone must contend. People express gender beliefs, their own and those of the culture in which they live, in everyday language as they either indirectly or explicitly accept and assign gendered meanings to what they and others do, think, and feel. Gender beliefs touch upon almost every aspect of daily life, including such mundane concerns as what shoes men should wear or “deeper”

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