Psychology, Psychiatry, Psychoanalysis, and Sexology

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In the 1880s, American physicians and other scientists began investigating "sexual perversion." They were engaged in sexology, the scientific study of human sexual behavior, a field that emerged in the nineteenth century. Investigations of sexual behavior were also central to psychiatry, a medical specialty that diagnoses disorders of the mind and behavior; psychoanalysis, the school of clinical practice and theory established by Sigmund Freud; and psychology, the science of mental life and behavior.

Until the 1970s, most of the theories and practices developed by psychiatrists, psychoanalysts, psychologists, and other sexologists described homosexual and trans-gender behavior as pathological. There were some researchers in these fields, however, who took different positions. LGBT people occasionally produced, sometimes accepted, often ignored, periodically welcomed, and frequently confronted the conclusions of these experts. Scholars disagree on whether scientific and medical research on sexuality and gender can ever be liberating. Jennifer Terry, for instance, describes the scientific study of homosexuality as either oppressive or normalizing. Even at its more progressive, she warns, it is dangerous to subject sexual behavior to the scientific gaze. In contrast, Henry Minton asserts that gay men and lesbians successfully used emancipatory strands in American sexology to win acceptance. Joanne Meyerowitz points out that in contrast to gay men and lesbians, transsexuals initiated and funded much of the research on transsexuality and believed themselves dependent on science to meet their needs.

Inversion in the Late Nineteenth Century

In the late nineteenth century, American psychiatrists began publishing accounts of same-sex desire in medical journals. They drew upon European sexological literature, including that of Richard von Krafft-Ebing, a German psychiatrist, and Havelock Ellis, a British physician, as well as their own observations. An English version of Krafft-Ebing's Psychopathia Sexualis (1886) was first published in the United States in 1892, four years after his article "Perversion of the Sexual Instincts" ran in a major American psychiatric journal. Ellis's early articles on homosexuality appeared in American medical journals, and his study Sexual Inversion was published in the United States in 1901. Until 1920, his writings on sexuality were more widely read in the United States than were those of Freud. Until the 1890s, when the terms heterosexuality and homosexuality first appeared in the United States, sexologists labeled same-sex desire as "inversion" or "contrary sexual feeling." They asserted that an individual who expressed sexual feelings for a member of the same sex had the psyche of the opposite sex and was a sexual invert. Doctors assumed this inversion also took a physical form; inverts were effeminate men who desired masculine men or masculine women who desired feminine women. In this way, sexual desire remained heterosexual even if the bodies were not. The experts disagreed about whether inversion was caused by congenital factors or acquired through environmental influences. They also disputed whether inversion was pathological or a harmless variation.

American psychiatrists published a number of case studies of homosexuality in the late nineteenth century. They presented a harsher view of homosexuality than European sexologists. Their studies initially drew on observations of working-class Americans. Articles on female sexual inverts described women who had passed as men and were now institutionalized in mental asylums or prisons. Increasingly visible gay urban subcultures drew their attention, and they described drag balls and other places where male sexual inverts congregated. Experts feared that sexual perversion was spreading and blamed several factors, including the dangerous influences of immigration and class and race mixing. Many of them believed that sexual perversion was a sign of degeneration and advocated treatment, criminal penalties, or even sterilization.

The New Woman

Other social changes led psychiatrists and other sexologists to pathologize romantic friendships between women. By the late nineteenth century, many white middle-class American women were attending college and were working and living independent of men. Half of those attending women's colleges at the turn of the century never married, and many shared their lives with female partners. These women, many of whom became involved in the movement for female suffrage, were known as New Women. In 1895, Ellis published an article in an American medical journal, "Sexual Inversion in Women," which warned that feminism was causing increasing numbers of women to become lesbians. While Ellis believed that homosexuality in its congenital form was a benign variation deserving acceptance, he viewed "acquired" homosexuality, particularly in women, as a danger. Ellis held a much harsher view of lesbianism than he did of male homosexuality. He described congenital lesbians as masculine women who seduced heterosexual women and asserted that lesbianism was spreading rapidly. This article came on the heels of a growing American focus on lesbianism. In 1892, medical articles and national news stories analyzed the case of Alice Mitchell, a wealthy young woman from Memphis who had murdered her female lover.

American psychiatrists increasingly warned of the dangers of same-sex sexuality and, together with European sexologists, developed new medical labels: invert, pervert, and homosexual. As Michel Foucault and other scholars have noted, these terms described a type of person, in contrast to earlier notions of "sodomy" as a behavior, not an identity. Historians disagree over whether this psychiatric and sexological literature created the homosexual or codified an existing identity. Lillian Faderman believes that this literature created a lesbian identity and subculture, but at the great cost of pathologizing hitherto respected female romantic friendships. George Chauncey argues that sexologists described, but certainly did not invent, male homosexuals, who already had identities and subcultures. Lisa Duggan sees a circular process at work, whereby women in same-sex relationships became subjects of sensational media stories, which in turn became medical case studies, which in turn influenced the ways women conceptualized their identities. Siobhan Somerville argues that the new sexual taxonomies developed in the context of the classification impulses and discourses of scientific racism.

Sigmund Freud's Views on Homosexuality

In the 1910s and 1920s, the psychoanalytic theory of Freud began to enter American psychiatry and society. Freud first presented his views on sexual inversion in Three Essays on the Theory of Sexuality (1905). This work was translated into English by American psychoanalyst Abraham A. Brill and published in the United States in 1910, a year after Freud's only American visit, during which he gave a series of public lectures at Clark University. Freudian concepts of psychosexual development gained more of a foothold in America in the 1920s. Until World War II, however, most American psychiatrists were remarkably eclectic. They used psychoanalytic theory in combination with somatic theory, behaviorism, and other schools of thought.

Freud's views on homosexuality were complex and inconsistent, with both radical and normalizing elements. He distinguished between sexual aim (the preferred erotic activity) and sexual object (the type of partner desired). While he believed that inversion involved a deflection of sexual aim away from the ideal goal of reproductive heterosexual coitus, he did not view inverts as psychologically abnormal and did not believe that homosexuality was a mental illness. All human beings, he asserted, were constitutionally bisexual and were thus capable of sexual involvement with either sex. As a result, exclusive heterosexuality required as much of an explanation as did exclusive homosexuality. By claiming that reproductive heterosexuality was the result of a difficult developmental process that could have other outcomes, including inversion, Freud destabilized the idea of normative sexuality. While he felt that inversion was caused by arrested sexual development, he did not believe, as later psychoanalysts did, that this stunted other aspects of the personality. Inversion, he posited, was caused by both acquired and congenital factors that were outside the control of the individual. For that reason, he believed that psychoanalysts should not attempt to convert homosexuals into heterosexuals. Against the wishes of most of his colleagues, he also argued that homosexuals should not be barred from psychoanalytic training.

American psychiatrists promoted a much more normative sexuality and therefore seized upon the more conservative elements of Freudian thought. As Elizabeth Lunbeck explains, they built their discipline by studying matters of everyday life, such as marriage and sex. They needed to domesticate Freudian theory in order to make it useful. Not only were American psychoanalysts more concerned than Freud was with determining normality and abnormality, but they were also more optimistic about treatment, since they gave more emphasis to the influence of environmental factors, especially parenting.

Freud published his first full essay on lesbianism, "The Psychogenesis of a Case of Homosexuality in a Woman," in 1920. Reflecting his misogynist views, he described lesbians as masculine inverts and psychiatrically damaged. His relatively tolerant views of homosexuals primarily applied to men. Before the mid-1920s, psychiatrists generally viewed lesbians as masculine seductresses of heterosexual women rather than defining them by their choice of same-sex sexual partners. It was, as Lunbeck points out, the lesbian, not the gay man, whom psychiatrists defined as a "psychopath" in this period.

George Chauncey claims that by the 1920s most medical and scientific experts differentiated gender inversion from homosexuality, recognizing that some "inverts" were heterosexual and that some homosexuals were gender normative. Other historians have questioned whether such a distinct shift occurred. Donna Penn asserts that lesbianism remained closely associated with masculinity by many experts and lesbians well into the 1960s. Moreover some scholars of transgenderism argue that historians have falsely assumed that all "inverts" in the sexological literature were homosexual. Many of them, they point out, may have been transgendered.

Sexologists Study Lesbianism

While sexologists and psychiatrists had pathologized female romantic friendships and developed a stereotype of the lesbian as an aggressive masculine woman, alternative and more benign descriptions of lesbianism were published in the 1920s and 1930s. In Factors in the Sex Lifeof Twenty-Two Hundred American Woman (1929), sociologist Katharine Bement Davis asserted that lesbianism was widespread: 25 percent of the 1,200 college-educated white single women she surveyed had experienced an intense emotional same-sex relationship that included some form of sexual expression; 15 percent of married women had engaged in a sexual relationship with a woman. For Davis, lesbianism was a common and acceptable form of sexual expression and did not mark a woman as abnormal. Davis pointed out that her subjects were "normal individuals," unlike the institutionalized and clinical subjects upon which previous studies of sexuality had relied. Exemplifying the interdisciplinary nature of American sex research, Davis included female psychologists and psychiatrists on her research committee.

Another major study of American women was conducted by gynecologist Robert Latou Dickinson, who used sex surveys he collected between 1880 and 1920. Coauthored by Lura Beam, who had a background in applied psychology and a life-long relationship with another woman, The Single Woman: A Medical Study in Sex Education (1934) included a chapter on homosexuality. Although he detected lesbianism in only a few dozen cases among his two thousand female patients, Dickinson said that he had found no distinguishing features in these women and dismissed several stereotypes about lesbians. Dickinson claimed that women who had sex with other women were no more masculine than his other patients and that all who had been asked had told him that neither partner took the "male part" during sex. Almost all had married later, which only proved, Dickinson and Beam said, the theory of innate bisexuality. Most studies of homosexuality, they pointed out, had been done on men and on "psychopathic" cases of imprisoned or hospitalized individuals. An "effort to establish a type," they said, "is premature" (p. 204).

In an essay titled "The Gynecology of Homosexuality," which was included in psychiatrist George Henry's Sex Variants (1941), Dickinson noted that thirty-two of the forty female "sex variants" described in Henry's study had heterosexual experience. "Having tried both," he wrote, "they preferred women both as sexual partners and as loving comrades" (p. 1097). Dickinson claimed that women became lesbians because of dissatisfaction with heterosexual intercourse. He urged that lesbian sexual techniques, which provided a higher level of sexual satisfaction, be studied to improve marital sexuality. Alfred C. Kinsey later also asserted that men had much to learn from lesbian sexual practices. Unlike Kinsey, however, Dickinson felt that marital sex was preferred, and his research on, and acceptance of, homosexuality was in the service of improving heterosexual relations in marriage.

Studying Sexuality and Gender in the 1930s

In 1935, Dickinson launched a massive study of homosexual behavior, to be conducted by the Committee for the Study of Sex Variants. Dickinson established this project in order to build upon the three hundred case histories of lesbians that Jan Gay, a lesbian, had collected. Dickinson felt that this research needed to be legitimated by a committee of experts. Many of the nation's most prominent psychiatrists, psychologists, physicians, and social scientists joined the committee. They chose Henry to run the study of two hundred lesbians and gay men. He, like most other American psychiatrists engaged in sex research, used an eclectic methodology that included psychiatric interviews, psychological testing, and physical examinations.

Henry concluded that homosexuality was a form of sexual inversion caused by a combination of congenital and environmental factors. The most important etiological factor was having parents who did not follow proper gender roles. Henry, like Freud, believed that homosexual desires were universal; unlike Freud, he believed that homosexuality was a form of social maladjustment and urged that it be prevented by monitoring warning signs in effeminate boys and masculine girls.

Henry gave his subjects several psychological tests, including the Masculinity-Femininity Test (Attitude Interest Analysis Survey) developed by psychologists Lewis M. Terman and Catherine Cox Miles. In their study of sex differences, Sex and Personality (1936), Terman and Miles explained that since homosexuals almost always displayed inverted gender characteristics, a male homosexual would earn a score on the test much closer to the average female score. To investigate this, Terman's graduate student E. Lowell Kelly tested seventy-seven "passive male homosexuals," who took the "role of the female" in homosexual sex, and found that they had strikingly "feminine" scores (Terman and Miles, p. 240). All of the "passive male homosexuals" he interviewed, almost half of whom were prostitutes, would be considered transgendered today. They called themselves by female names, many passed as women, several worked as drag queens, and at least one had legally married his male partner. He also gave the test to forty-six male prisoners in Alcatraz who were serving sentences for sodomy. Kelly presumed that they were "active male homosexuals" and found that they had more "masculine" scores than did average men. The authors concluded that only passive males and active females were true homosexuals.

Based on a comparison of the scores of the passive male homosexuals and a group of "normal" males that consisted of ninety-eight junior high school students, Terman and Miles developed a tentative scale to measure male sexual inversion. They thought that it could be used to detect homosexuality. Like Henry, they believed that gender behavior should be monitored to prevent homosexuality and avoid the "difficulties of adjustment as a direct result of their deviation." They urged that boys with a high feminine score be given preventive treatment to "direct their sexuality into normal channels." It is from this group of inverts, they warned, "that homosexuals are chiefly recruited." They were unsuccessful in finding enough lesbian subjects to develop a test to give to tomboys. Female inverts, they bemoaned, had "been little studied except by the psychoanalysts" (Terman and Miles, pp. 467-468).

Shifting Psychoanalytic Views of the Homosexual

While American psychiatrists and psychologists in the 1930s increasingly warned of the maladjustment suffered by homosexuals, many of their writings exhibited sympathy toward their subjects. Homosexuality, they believed, while preventable if detected early in childhood, was not curable in adults. In contrast, beginning in the 1930s psychoanalysists came to view homosexuality more as pathology. For the next thirty years, psychoanalytic descriptions of homosexuality would become increasingly negative and culturally more powerful, affecting the lives of most American LGB people.

With the rise of Nazism in Germany in the 1930s, the center of psychoanalysis moved from Vienna to New York City. Psychoanalysis gained authority in the United States with the arrival of emigré analysts, who were central figures in the field. Kenneth Lewes points out that as psychoanalysis became Americanized, it became much more rigid and judgmental about homosexuality, dropping Freud's cosmopolitan and humane views on the subject.

The most significant change was developed by Sandor Rado, an emigré analyst from Berlin, who had grown increasingly critical of Freud and wished to make psychoanalysis more acceptable to Americans. In 1940, he published "A Critical Examination of the Concept of Bisexuality," in which he dismissed Freud's belief in innate homosexuality. Rado asserted that heterosexual object choice was the inevitable result of psychosexual development unless it was blocked. Only environmental factors in early childhood could explain how homosexuality, which he labeled a perversion, could emerge. Psychoanalytic treatment could uncover the cause, and thereby cure, homosexuality with what he called "reparative adjustment," a form of therapy still in use as of the early 2000s.

Almost all psychoanalysts for the next several decades based their views of homosexuality on Rado's article. Few retained Freud's tolerance for homosexuality or his skepticism about treatment. Their view that homosexuality was a mental illness that could and should be cured underwrote not only lengthy and expensive psychoanalysis of homosexuals, but also a range of harsh somatic treatments used in association with psychotherapy by a large number of psychoanalysts, psychiatrists, and psychologists. Homosexuals were subjected to lobotomies, castration, hormonal treatment, and electrical and chemical shock therapy. Beginning in the 1950s, for example, psychologists and psychiatrists treated homosexuals with aversion conditioning therapy based on the use of nausea-inducing chemicals that were administered with images of homosexual sex. It was the presentation of a paper on aversion therapy at the 1970 American Psychiatric Association (APA) conference that led to the first LGB protest at the association's annual meetings.

Psychiatry Goes to War

The hostile view of homosexuality gained strength during and after World War II. Psychiatric screening of soldiers began in the summer of 1940, largely through the efforts of psychiatrist Harry Stack Sullivan. While Sullivan, a closeted gay man, did not believe that homosexuality was pathological and did not include it among the mental disorders that should disqualify soldiers from serving in the military, other psychiatrists added homosexuality to the list. By May 1941, psychiatrists were told to screen soldiers at induction stations for homosexuality, now considered a "psychopathic personality disorder" (Bérubé, p. 12). Previously, soldiers had been court-martialed and imprisoned if convicted of sodomy, but the new screening policies, which excluded homosexuals from entering the service if they were detected and gave them undesirable discharges if they were diagnosed while in the military, affected a larger number of people.

As Allan Bérubé points out, many psychiatrists involved in military screening efforts, including prominent psychoanalyst William C. Menninger, held relatively sympathetic views on homosexuality and tried to ameliorate military policy. In the end, they were unsuccessful. All American psychiatrists, however, gained prestige through the screening and treatment programs established during the war. The increased status psychiatry garnered, points out John D'Emilio, brought the medical view of homosexuality to the attention of the public. It also made psychiatrists culturally respected figures and widened the domain of their authority. They now saw themselves, and were seen by the public, as experts on a range of social and political issues.

By the end of the war, the leaders in American psychiatry were psychoanalysts. While they agreed that homosexuality was a developmental disorder, a number of more liberal psychoanalysts, like Menninger, viewed it as a regrettable yet widespread maladjustment. But this more tolerant view was increasingly occluded by the work of psychoanalysts who harshly condemned homosexuality.

Kinsey Challenges Psychoanalysts

Sex researcher Alfred C. Kinsey counted upon this more liberal group of psychiatrists and psychoanalysts to assist him with his challenge to the psychoanalytic orthodoxy on homosexuality. Like Freud, Kinsey believed that people were capable of responding to all types of sexual stimuli and were not defined psychologically by their sexual behavior. Going further than Freud, he asserted that there were no heterosexuals or homosexuals, only heterosexual or homosexual behaviors. Sexual behavior and desires, Kinsey believed, could only be understood as existing on a continuum, with most people falling in between the extremes of exclusive heterosexuality or homosexuality. While Freud viewed reproductive coitus as the ideal form of sexual behavior, Kinsey asserted that all consensual forms of sexuality were equally acceptable.

Kinsey's research was based on interviews, and he used sympathy and a nonjudgmental approach to win trust. He was the first sexologist to fully explore gay subcultures and gain the enthusiastic cooperation of gay men. Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953) not only claimed that large percentages of Americans had engaged in homosexual behavior, but also presented radical arguments deconstructing notions of normality. Moreover, Kinsey repeatedly asserted that his findings disproved many central tenets of psychoanalytic theory. Chief among them was the view that homosexuality was abnormal. Behavior this widespread among humans and animals of other species, Kinsey said, could not be considered abnormal or unnatural. He confidently believed that psychoanalysts would revise their theory in light of his data.

Despite the considerable amount of ink psychoanalysts spilled criticizing Kinsey's interview methods and statistical analysis, it was his discussion of homosexuality that evoked their fury. Psychoanalysts in their reviews of Sexual Behavior in the Human Male repeatedly used the same analogy: just because the common cold was widespread did not mean that it was normal. They disputed Kinsey's data on the percentages of American men who had engaged in homosexual behavior and feared that homosexuals would be reassured by his findings, as many of them were, and no longer seek treatment to become heterosexual. Psychoanalytic theory on homosexuality took its most homophobic turn between 1948 and the late 1960s (in the midst of the Cold War), but the data-filled doubts cast by Kinsey opened a space for activists in the homophile movement to begin organizing for liberation.

Homosexuality on the Couch

During the 1950s, psychoanalysis helped to impose and legitimate the political repression and social conformity that marked the decade. In 1953, as the result of U.S. Senate sex perversion hearings held in 1950, President Dwight D. Eisenhower signed an executive order listing "sexual perversion" as grounds for dismissal from the civil service. Numerous sexual psychopath laws were passed by states, which led to the arrest of increasing numbers of gay men for consensual sexual behavior. Military policies toward LGB people became harsher. The language of pathology psychoanalysts used to describe homosexuality buttressed views that it was immoral and criminal.

Psychoanalysis was increasingly popularized in the 1950s. Edmund Bergler, who in the 1930s had helped run Vienna's Freud Clinic, wrote a number of books and articles, such as Homosexuality: Disease or Way of Life? (1956), attacking Kinsey's view of homosexuality. "There are no happy homosexuals," Bergler claimed (quoted in Lewes, p. 114). Homosexuals were "disagreeable people" who collected injustices and rabidly feared the opposite sex. But in 99.9 percent of cases, Bergler said, their dire condition was curable.

In 1962, Irving Bieber, a more highly respected psychoanalyst, published a study, Homosexuality: A Psychoanalytic Study of Male Homosexuality, that compared 106 male homosexuals with 100 heterosexual men, all in analytic treatment. Psychoanalysts viewed his study as a scientific validation of their theories about homosexuality. Bieber claimed that his data proved that domineering mothers and detached fathers caused male homosexuality. Drawing on Rado and reversing Freud, Bieber stated that "every homosexual is a latent heterosexual" (quoted in Bayer, p. 30). He asserted that analysts had cured 27 percent of the gay men in his study. Bieber's text remained important for the next two decades and made him the most influential analyst on homosexuality until 1973. Psychoanalyst Charles Socarides also became a leading authority on homosexuality in the 1960s. He has published numerous books in which he describes it as a severe psychopathology.

Psychoanalysts had paid far less attention to lesbians, but in the 1950s this began to change. In 1954, Frank Caprio published Female Homosexuality, the first medical book on lesbianism. Caprio claimed that lesbians were unstable and neurotic, but promised that they could be cured. The same year, Bergler coauthored Kinsey's Myth of Female Sexuality with gynecologist William S. Kroger; they described lesbians as dangerous. In 1967, a study of female patients in psychoanalysis modeled on Bieber's compared lesbians and heterosexual women and claimed that half had been cured.

Psychology in the 1950s and 1960s

American psychologists in this period presented a less unified front on homosexuality. In 1951, comparative psychologists Frank Beach and Clelland Ford published Patterns of Sexual Behavior. Drawing on studies of sexual behavior in nonhuman primates and cross-cultural data on seventy-six cultures, they found that forty-nine societies officially sanctioned homosexual behavior, usually in the form of a transgendered role, and that other species engaged in homosexual behavior. Just as Kinsey had done, Ford and Beach destabilized views of homosexuality as abnormal and unnatural. In contrast, clinical psychologist Albert Ellis, a leading expert on homosexuality who often lectured before chapters of the Mattachine Society (a homophile organization) and wrote numerous articles for the Mattachine Review, told homosexuals that their condition was pathological, a "phobic response to the opposite sex," and curable if they desired change.

But members of the emerging homophile movement in the 1950s had a more favorable psychological expert to draw on, Evelyn Hooker. In 1954, Hooker began a study of homosexual and heterosexual men who were not in clinical treatment and found that no psychological differences between the two groups appeared when they were given projective tests, including the Rorschach. Challenging psychiatric thinking on homosexuality, she asserted that homosexual men were varied and psychologically healthy except for the coping strategies they had developed to deal with an extremely homophobic society. In 1967,she chaired a National Institute of Mental Health Task Force on Homosexuality, which issued a report, completed in 1969 and published in 1972, that called for the elimination of criminal laws against consensual homosexual behavior and addressed the toll social discrimination took on homosexuals.

Shifting Diagnostic Categories

In 1952, the American Psychiatric Association (APA) included homosexuality and transvestism as sexual deviations under the category of sociopathic personality disturbance in its first Diagnostic and Statistical Manual of Mental Disorders (DSM), which standardized psychiatric nomenclature. A second edition published in 1968, DSM-II, described transvestism and homosexuality as sexual deviations included among the personality disorders. Significantly, the category of "transsexualism" did not appear as an official diagnosis until DSM-III was published in 1980.

Joanne Meyerowitz points out that the word "transsexual" first appeared in the United States in 1949, when psychiatrist David O. Cauldwell used the term in an article for the journal Sexology to describe people who desired to change sex. He, like most American psychiatrists who followed, believed that transsexuality was a form of mental illness that should be treated with psychotherapy, not surgery. Christine Jorgensen's widely publicized 1952 sex-change operation in Denmark engendered a debate among experts about transsexuality. Most psychiatrists rejected Jorgensen's view that biological sex was a continuum and that transsexuals were a blend of male and female. In contrast, endocrinologist Harry Benjamin, who publicized the term "transsexual" and became the leading scholar in the field, asserted that the sexes were overlapping and supported sex-change surgery for some.

In 1964, female-to-male transsexual Reed Erickson established a foundation to support research on transsexuality. With financial help from Erickson and backing from some colleagues, psychologist John Money established the Johns Hopkins Gender Identity Clinic in 1966. This was the first major university hospital to publicly announce that it would provide sex-change operations, which led many transsexuals to seek, although few were able to obtain, sex-change surgery. Money, a behavioral psychologist, had coined the term "gender" in 1955 to describe the way individuals socially learn how to be girls or boys. In 1964, Robert J. Stoller, a psychoanalyst, developed the concept of "gender identity." In contrast to Benjamin, Stoller believed that transsexuality was caused primarily by psychological, not biological factors. The view that transsexuality is a matter of psychological sex has dominated gender identity clinics and the practices of doctors who perform sex-change surgery. As a result, transsexuals have depended on psychiatric categories to obtain sex-change operations. In contrast, by the 1960s, homosexual men and women had begun to challenge psychiatric definitions.

Political Activism and Psychoanalysis

In the mid-1960s, Frank Kameny, the president of the Washington, D.C., chapter of the Mattachine Society, became the first LGB activist to call for a frontal attack on psychiatric views of homosexuality. Unlike most earlier homophile activists, Kameny told LGB people that they were the real authorities on the subject of homosexuality and urged them to take a more militant stance on this, as well as other issues. In 1970, LGB protesters disrupted several panels at the annual APA meeting in San Francisco. After the conference, a sympathetic psychiatrist met with one of the organizers of the protest and convinced the association to hold a panel presented by gay men and lesbians, including Kameny, on "Lifestyles of Non-Patient Homosexuals" (Bayer, p. 106) at the next annual meeting. Following the 1971 meetings, Kameny and another panel participant pressed for the deletion of homosexuality from DSM-II.

As a result of the political efforts of LGB activists, rather than internal developments in psychiatry, the board of the APA finally agreed to remove homosexuality as a diagnostic category in December 1973. Bieber and Socarides were outraged and organized a referendum on the decision, which was held in 1974. Fifty-eight percent of the membership supported the decision, although most psychoanalysts remained vehemently opposed and continued to view homosexuality as pathological. While the APA in December 1973 also passed a civil rights resolution calling for the end of legal discrimination against homosexuals and the elimination of laws against consensual homosexuality, it was only in 1992 that the association declared that it would allow homosexuals to be trained in psychoanalytic institutes.

Developments since 1973

When it removed homosexuality as a diagnostic category, the APA replaced it with "sexual orientation disorder," a term applying to homosexuals who wished to become heterosexual. In 1978, this diagnosis was changed to "ego dystonic homosexuality," which was finally removed in 1986. The current edition, DSM-IV, no longer includes the term "transsexualism," although the desire to physically change sex is included under "gender identity disorder" (Meyerowitz, p. 336), a category many transsexuals rely on to obtain the medical help they want. For many years before the removal of homosexuality as a diagnostic category, LGB psychiatrists socialized unofficially at the APA convention, calling themselves Gay-PA. In 1975, they organized a Committee on Lesbian and Gay Concerns, as well as a Gay, Lesbian, and Bisexual Caucus. In 1978, the APA approved an official task force on gays, lesbians, and bisexuals.

The American Psychological Association eliminated homosexuality as a category of mental illness in January 1975. At the same time, it passed a resolution calling on members to fight against any remaining stigma of mental illness attached to homosexuality. The Association of Gay Psychologists Caucus first met at the 1973 annual meeting. The Journal of Lesbian and Gay Psychotherapy was founded in 1989. The American Psychological Association established the Committee on Gay Concerns in 1980, and in 1984 the Society for the Psychological Study of Gay and Lesbian Issues was organized as Division 44.

Since the 1970s, LGBT psychologists and psychiatrists have run counseling centers and practices for LGBT patients and published numerous studies that have been influential in the larger psychotherapeutic community. This literature has focused on a broad range of topics, including homophobia, relationships, parenting, coming out, adolescence, and AIDS. More recent studies have examined the diversity of LGBT lives.

Yet not all developments have been positive. In the 1990s, an increasing number of groups claiming to cure homosexuals through reparative therapy appeared. Socarides and psychologist Joseph Nicolosi founded the National Association for Research and Therapy of Homosexuality in 1992. Closely allied with Christian groups, such as Exodus Institute, which was established in 1976, Socarides and Nicolosi draw on psychoanalytic theory to assert that homosexuality results from faulty gender identity and to claim to be able to cure a third of all homosexuals who seek treatment. In 1998, the APA announced its opposition to reparative therapy.

As psychiatry has increasingly focused on biochemical explanations of behavior and shifted to the use of psychotropic drugs to treat psychological disorders, psychoanalysis has to a certain extent faded as a medical specialty. Psychoanalytic theory, however, is used by many queer studies scholars in the humanities, including Leo Bersani, Judith Butler, Eve Sedgwick, and Teresa de Lauretis. They draw on the radical strands of Freudian theory and the work of French psychoanalyst Jacques Lacan to conceptualize sexualities and genders in new ways. Ironically, theoretical constructs that helped to create the homosexual and transsexual are now being used by queer scholars to deconstruct those identities.


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Lynn Gorchov

see alsobiology and zoology; davis, katharine bement; henry, george; hooker, evelyn; kinsey, alfred c.; lobdell, lucy ann; medicine, medicalization, and the medical model; money, john, and anke ehrhardt; psychotherapy, counselling, and recovery programs; sullivan, harry stack.

freud on homosexuality

In October 1950, Alfred C. Kinsey sent his friend Karl M. Bowman, a psychiatrist who was an associate editor of the American Journal of Psychiatry, a 1935 letter written in English by Sigmund Freud to an American mother of a homosexual son, who in turn had sent it to Kinsey after the publication of Sexual Behavior in the Human Male. Kinsey hoped the letter would convince American psychoanalysts to change their increasingly hostile view of homosexuality. The American Journal of Psychiatry published the letter in April 1951 ("Historical Notes, p.786–787):

April 9, 1935

"Dear Mrs….

"I gather from your letter that your son is a homosexual. I am most impressed by the fact that you do not mention the term yourself in your information about him. May I question you, why you avoid it? Homosexuality is assuredly no advantage but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest men among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime and a cruelty too. If you do not believe me, read the books of Havelock Ellis.

"By asking me if I can help, you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies, which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.

"What analysis can do for your son runs in a different line. If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. If you make up your mind he should have analysis with me—I don't expect you will—he has to come over to Vienna. I have no intention of leaving here. However, don't neglect to give me your answer.

" Sincerely yours, with kind wishes,


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Psychology, Psychiatry, Psychoanalysis, and Sexology

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