What Led To Declassifying Homosexuality As A Mental Disorder In 1990?

On May 17, 1990, the World Health Organization (WHO) made a landmark decision to remove homosexuality from its list of mental disorders. This monumental shift came after decades of considering homosexuality as a mental disorder, a perspective that influenced both societal attitudes and legal frameworks. The General Assembly's declaration that "homosexuality is not a disease, a disturbance or a perversion" was a significant victory for the LGBTQ+ community.

History of Homosexuality in the DSM

The pathologization of homosexuality began in 1952 with the publication of the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA). Homosexuality was categorized as a "sexual deviation" under the broader category of "sociopathic personality disturbance." This classification persisted through various editions of the DSM and was supported by studies that claimed to find pathological causes and effects associated with homosexuality. This stigmatization was deeply embedded in various systems of power, including the legal system, which criminalized homosexual behaviour, and societal norms, which rigidly enforced heteronormative gender roles.

The APA and the Path to Declassification

The APA was established in 1844 and saw significant growth post-World War II, primarily comprising male members due to gender restrictions in educational institutions. The first DSM, published in 1952, categorized various sexual behaviours, placing heterosexuality at the top and other sexual orientations as deviant. This classification reinforced the notion that non-heteronormative sexual behaviours were 'unnatural' and unhealthy.

Emergence of Activism

The campaign to remove homosexuality from the DSM gained momentum in the 1960s, driven by the broader civil rights, women’s rights, and gay rights movements. Activists from organizations in cities like New York, San Francisco, and Philadelphia began to challenge the APA's classification through public campaigns and direct action. A significant moment in this movement occurred when activists, including Karla Jay, disrupted APA conferences, demanding the declassification of homosexuality.

Confronting the APA

Activists faced considerable resistance from the APA. Members of the association could dismiss and discredit activists by labelling them as mentally ill. Despite this, activists persisted, recognizing the need for internal advocacy within the APA. In 1972, gay psychiatrist John Fryer, disguised as “Dr. Henry Anonymous,” provided critical testimony at an APA conference, urging his colleagues to reconsider their stance on homosexuality.

The Turning Point

Although Fryer's testimony did not immediately result in declassification, it marked a significant turning point. In 1973, the persistence of activists paid off. During the APA conference in Honolulu, activists like Ronald Gold delivered powerful speeches, challenging the association's stance and emphasizing the harm caused by their classification. The APA Board of Trustees eventually voted to remove homosexuality from the DSM, a decision influenced by both public pressure and internal advocacy.

Scientific Contributions and Controversies

The APA's decision was influenced by emerging scientific research and internal debates within the psychiatric community. Studies like those by Evelyn Hooker, which showed no significant psychological differences between homosexual and heterosexual men, were pivotal. Hooker's work debunked the myth that homosexuality was inherently linked to mental illness, arguing that previous research was flawed due to biased sampling from clinical populations.

Despite the change, there was resistance within the APA and the broader medical community. Critics argued that the decision was driven more by activist pressure than scientific evidence. Nonetheless, a referendum among APA members in 1974 upheld the decision with a 58% majority, marking a significant shift in psychiatric practice and public perception.

Homosexuality is Not a Mental Illness

The declassification effort highlighted significant gaps in the APA's understanding and definition of mental illness. Activists argued that the criteria for a mental disorder—causing distress or impairing social functioning—did not apply to homosexuality. Robert L. Spitzer, M.D., a member of the APA’s nomenclature committee, acknowledged that many homosexual individuals did not experience the distress or impairment that would qualify their orientation as a 'disorder'.

The Aftermath and Continued Struggles

Despite the declassification, the stigma surrounding homosexuality persisted. The APA's decision was a crucial step, but it did not immediately eliminate societal prejudices. Additionally, the declassification movement inadvertently contributed to the stigmatization of other mental illnesses and expanded the APA’s authority by necessitating more precise definitions of mental disorders.

Legacy and Impact

The successful declassification of homosexuality from the DSM remains a landmark achievement in LGBTQ+ history. It not only alleviated some of the social and psychological burdens on LGBTQ+ individuals but also set a precedent for challenging discriminatory classifications in other areas. However, the campaign also had complex repercussions, highlighting the nuanced and ongoing struggle for equality and understanding in the realm of mental health and beyond.

The declassification of homosexuality as a mental disorder had profound implications beyond psychiatry. It paved the way for the legalization of same-sex marriage in various countries, beginning with Massachusetts in 2004, nearly 14 years after the WHO's decision. This shift also influenced policies against discrimination and contributed to the broader movement for LGBTQ+ rights.

The removal of homosexuality from the WHO's list of mental disorders and its declassification in the DSM were significant milestones in the fight for LGBTQ+ rights. These changes reflected a broader shift towards understanding and accepting diverse sexual orientations and gender identities as natural variations of human experience. The legacy of these decisions continues to influence contemporary policies and discussions on mental health, rights, and social justice for the LGBTQ+ community.