Tag Archives: Diagnostic and Statistical Manual of Mental Disorders

The Academy’s 1964 Report on Homosexuality

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By Logan Heiman, Digital Collections Manager, and Paul Theerman, Director

When the New York Academy of Medicine published its 1964 report in its Bulletin,[1] it followed a salvo of other reports sounding the alarm about “the problem of homosexuality.” The committee’s findings, reported in the New York Times and other outlets, made plain the Academy’s position on the issue: “homosexuality is indeed an illness. The homosexual is an emotionally disturbed individual who has not acquired a normal capacity to develop satisfying heterosexual relationships.” The committee’s attention to homosexuality arose from its concern about a perceived connection between homosexuality and two other phenomena it had previously studied—the proliferation of “salacious literature,” as stories with gay characters became more and more visible; and the spread of sexually transmitted diseases. Committee members linked several factors to the emergence of homosexual traits in early childhood, many of them related to parenting practices, including “neglect, rejection, overprotection, [and] overindulgence.”

The report also struck a harsh note against efforts by gay and lesbian activists to promote acceptance over tolerance, prescribing psychotherapy as offering “the greatest probability of benefit.” The Committee on Public Health offered improved sex education as another needed intervention, citing society’s “preoccupation with sex as a symbol” as a challenge to implementing this recommendation.

Excerpt from Barbara Gittings’s editorial
rebuking the Academy’s report.
The Ladder: A Lesbian Review 8(11) (August 1964).

In its immediate aftermath, as well as in the following years, the report drew sharp criticism and condemnation from gay and lesbian activist groups and medical professionals. In June 1964, the Daughters of Bilitis, the United States’ first political and civil rights organization for lesbians, strongly rebuked the findings of the report, writing in a June 13, 1964, letter “to express our disappointment in noting that a report so widely publicized, and originating with so reputable a group as yours, offered so little substantiation for the claims made.”[2]

A decade later, Dr. William Ober wrote to Dr. James McCormack of the Committee on Public Health asking the New York Academy of Medicine to host a conference based on changing public attitudes regarding homosexuality and the views of doctors who “had to revise their thinking.” No evidence exists to suggest the committee responded to this request. But in the course of that decade came the Stonewall riots, in June/July 1969, protesting police aggression against the LGBTQ+ community. Professional opinions changed. Famously, Dr. John E. Fryer (1937–2003), disguised as “Dr. Henry Anonymous,” addressed the 1972 meeting of the American Psychiatric Association to share the challenges he faced as a gay psychiatrist. His testimony, as well as the work of pioneering psychological researcher, Evelyn Hooker, had an effect. In 1973 the APA, under the leadership of NYAM Fellow Alfred M. Freedman (1917–2011), removed “homosexuality” as an illness in its authoritative Diagnostic and Statistical Manual, a move hailed as “the single most important event in the history of what would become the lesbian, gay, bisexual and transgender movement.”[3]

Rainbow colors symbolize NYAM’s commitment to all people in its 175th year, expressed here on the Academy building entrance at its Access: Health event, June 7, 2022.

Since the time of the report, the medical community has increasingly “de-medicalized” gayness.[4] The Academy has itself taken steps to become a more open, equity-focused institution. During Pride Month 2021 we looked at our own history in “Virtual Visit: From the LGBTQ+ Archives.” For this year’s Pride Month, NYAM formally disavows the 1964 report on homosexuality. In an official statement, NYAM President Dr. Judith Salerno wrote, “The report was incorrect and perpetuated views that were not supported by science, and we recognize that NYAM’s inaction on addressing its content is shameful. It has taken us since 1964 to publicly acknowledge this report and we apologize for the hurt that this report, and our silence, has inflicted on the LGBTQIA+ community.” Read the full statement here.

[1] “Homosexuality: A Report by the Committee of Public Health, The New York Academy of Medicine,” Bulletin of the New York Academy of Medicine 40(7) (July 1964): 576–80. The article notes the committee’s approval of the report on May 11, 1964.

[2] The letter was reprinted in The Ladder: A Lesbian Review immediately following Gittings’s editorial.

[3] A concise historical article is Jack Drescher, “Out of DSM: Depathologizing Homosexuality,” Behavioral Sciences 5 (December 2015): 565–75; a more popular account is Ray Levy Uyeda, “How LGBTQ+ Activists Got ‘Homosexuality’ Out of the DSM,” JSTOR Daily, May 26, 2021, accessed June 8, 2022. For Freedman’s role, see “Alfred Freedman, a Leader in Psychiatry, Dies at 94,” The New York Times, April 20, 2011. Sue Hyde, LGBTQ activist and organizer, provided the assessment quoted in the obituary.

[4] Resistance in the medical community to the APA diagnostic change was long-lived. In 1976, a group of psychiatrists met at NYAM, though not under its auspices, to promote that homosexuality was an indicator of mental illness. Gay activists “zapped” them with disruptive demonstrations, recounted in John D’Emilio, “Zapping the New York Academy of Medicine, April 6, 1976,” Outhistory: It’s About Time!, n.d., accessed June 8, 2022. Even in 2002, Dr. Jack Drescher, chair of the APA’s Committee on Gay, Lesbian, and Bisexual Issues, noted that “every year, we get a group of people who . . . ask for homosexuality to be put back in the manual. . . . They’re, interestingly, the only group who does it. Every other group wants their diagnoses taken out . . . .” Drescher is quoted in Robert DiGiacomo, “Dr. H. Anonymous ‘Instant cure’ recalled: Being gay was an illness 30 years ago,” AGLP Newsletter, 28(3) (August 2002): 16–18 (reprinted from the Philadelphia Gay News), accessed June 8, 2022.

Dr. Evelyn Hooker and the Acceptance of Homosexuality

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By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

In the late 19th century, new legal, criminal, and scientific frameworks emerged seeking to understand, define, and in some cases control, human sexuality. In particular, homosexual activity between men became illegal in many countries, which opened up discussion about what counted as “normal” or “deviant” sexual expression. A significant body of research work began to be generated, such as Richard von Krafft-Ebing’s Psychopathia Sexualis (1886), seeking to understand the range of human sexuality and arguing that “deviancy” should be treated as a medical rather than criminal issue.1

Evelyn Hooker. Courtesy of UC Davis.

Evelyn Hooker. Courtesy of UC Davis.

By the 20th century, pioneering researchers like Evelyn Hooker (1907–1989) had begun to question whether homosexuality should be considered in medical terms. Hooker administered standard psychological tests to carefully selected groups of gay and straight men, who performed virtually identically. Her work was one in a series of investigations that eventually led to the removal of homosexuality from the list of mental disorders in the major official categorization of mental illness in the United States, the Diagnostic and Statistical Manual of Mental Disorders.

Born in Nebraska in 1907, Hooker went to the University of Colorado for her bachelor’s and master’s degrees in psychology. She undertook her Ph.D. work at Johns Hopkins, graduating in 1932. For the next eight years, she worked in a number of colleges, including Whittier College, was laid up with tuberculosis for two years, and had a fellowship year in Berlin. In 1940, she took up a research associate position at UCLA, where she remained for the next 30 years.2

Teaching was part of her purview. As the story goes, a friendship with a student who was gay, struck up in the mid-1940s, led to the student’s request that she research the gay community in Los Angeles. By 1953 she felt ready to do a controlled study, aided by a grant from the National Institute of Mental Health (NIMH). She assembled a group of 60 men, equal numbers of gay and straight, and matched for age, IQ, and education. In addition, the subjects had to be otherwise mentally healthy, that is, not in therapy nor showing any obvious mental disturbance. Finally, all were supposed to be “pure” in their orientation: purely heterosexual or purely homosexual. To this group, Hooker administered the Rorschach test, the Thematic Apperception Test (TAT), and the Make-A-Picture Story (MAPS) test, designed to measure personality, emotional stability, and coherence of thought. Recognized psychological experts evaluated the tests. After reviewing the results, Hooker found that they could not distinguish the tests completed by gay men from those by straight men. Any mental illness in this group was as likely to be found among heterosexual men as among homosexual ones.3

"Table II—Ratings on Overall Adjustment—Rorschach." In Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18-31.

“Table II—Ratings on Overall Adjustment—Rorschach.” In Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18-31. Click to enlarge.

Hooker presented her results at the 1956 meeting of the American Psychological Association. The editors of the Journal of Projective Techniques persuaded her to publish the results despite her wish to continue work until they were “incontrovertible.”4 In the following years, she continued to work and publish on the topic of gay men’s mental health—women were very little studied, the researchers themselves noted—with continued support from the NIMH. In 1967, the director of the NIMH, Dr. Stanley F. Yolles, appointed her the chair of the Institute’s Task Force on Homosexuality. Two years later, the task force finished its work. Its report concluded that “Homosexuality represents a major problem for our society largely because of the amount of injustice and suffering entailed in it, not only for the homosexual but also for those concerned about him.”5 It recommended establishing a Center for Study of Sexual Behavior within NIMH, to support research and training especially for mental health professionals, law enforcement personnel, and guidance and caretaking personnel.

Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18.

Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18.

And yet . . . if gay people didn’t track differently than straight people on a whole range of mental disorders, they definitely did in one instance, according to the diagnostic standards of the times. Homosexuality itself was considered to be a mental disorder. And as jarring as it is to see, the same task force report from 1969 included as its final working paper “Treatment of Homosexuals,” detailing psychoanalytic, group, and drug- and electric shock–based aversion therapies, all intended to redirect sexual orientation.6 At the same time, though, countervailing political and cultural forces pushed towards acceptance of homosexuality, its normalization and de-medicalization. A recent New York Times article captures some of that flavor, expressed in the pre-Stonewall 1960s. As is well known, the Diagnostic and Statistical Manual included homosexuality as a mental disorder as late as its second edition in 1968; the American Psychiatric Association removed this designation in 1973, and the third edition of the DSM, published in 1980, included only the disorder “ego-dystonic homosexuality,” for those gay people uncomfortable with their orientation.7 By the 1987 revision of DSM, this condition was further downgraded to a “disorder not otherwise specified.”8

“Other Psychosexual Disorders. 302.00 Ego-dystonic Homosexuality,” American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition) (Washington, DC: American Psychiatric Association, 1980), p. 281.

“Other Psychosexual Disorders. 302.00 Ego-dystonic Homosexuality,” American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition) (Washington, DC: American Psychiatric Association, 1980), p. 281.

Evelyn Hooker went on to be a beloved mentor, especially for psychiatrists and psychologists interested in gay studies.9 She was the subject of a 1991 documentary, Changing our Minds: The Story of Dr. Evelyn Hooker,10 and the recipient of many awards, including the Distinguished Contribution in the Public Interest Award of the American Psychological Association. She passed away in 1996.

References

1. A brief introduction to the history of sexology can be found at The Kinsey Institute, which continues to explore sexual health and knowledge worldwide: www.kinseyinstitute.org/resources/sexology.html. See also APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation (Washington, DC: American Psychological Association, 2009), especially chapter 2, “A Brief History of Sexual Orientation Change Efforts,” pp. 21–25; Jonathan Katz’s Gay American History: Lesbians and Gay Men in the U.S.A. (1976; reprint ed., New York: New American Library, 1992) and The Invention of Heterosexuality (New York: Dutton, 1995); and Jennifer Terry, An American Obsession: Science, Medicine, and Homosexuality in Modern Society (Chicago: The University of Chicago Press, 1999).

2. Biographical material on Evelyn Hooker, here and below, comes from “Psychology’s Feminist Voices: Evelyn Gentry Hooker,” http://www.feministvoices.com/evelyn-gentry-hooker/, accessed June 10, 2015.

3. Evelyn Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1958): 18-31.

4. Ibid., quotation from footnote on page 18.

5. National Institute of Mental Health Task Force on Homosexuality, Final Report and Background Papers, edited by John M. Livingood (Rockville, MD: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, 1972), quotation from page 2.

6. NIMH Task Force on Homosexuality, Final Report: Task Force Working Papers, “Treatment of Homosexuals,” by Jerome D. Frank, pp. 63–68.

7. APA Task Force, Report, p., 23; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition) (Washington, DC: American Psychiatric Association, 1980), pp. 281–83.

8. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Third Edition–Revised) (Washington, DC: American Psychiatric Association, 1987), p. 296.

9. See in particular, Linda D. Garnets and Douglas C. Kimmel, eds., Psychological Perspectives on Lesbian, Gay, and Bisexual Experiences, 2nd ed. (New York: Columbia University Press, 2003), especially the chapter “What a Light It Shed: The Life of Evelyn Hooker,” by Garnets and Kimmel.

10. Changing Our Minds: The Story of Dr. Evelyn Hooker, directed by Richard Schmiechen, DVD, 75 mins. (San Francisco: Frameline, 1991).