Science Triumphs Over Religion: Depathologizing Homosexuality

Being gay and of a generation that still recalls the era when homosexuality was classified as a form of mental illness and was classified as such in the American Psychiatric Association's (APA's) Diagnostic and Statistical Manual (DSM) - which certainly played a strong role in my refusal to accept my sexual orientation for many years - I find the role that science played in depathologizing sexual orientation.  Jack Drescher, MD, Clinical Professor of Psychiatry, New York Medical College
and Adjunct Professor, New York University, has a piece in Behavior Sciences Journal that looks at the original, principally Christian, religious basis for anti-gay and then tracks the scientific developments and research that ultimately brought an end to the treatment of homosexuality as a "disease" or "mental illness" outside of Christofascist circles.  Here are some article excepts:

Rigid gender beliefs usually flourish in fundamentalist, religious communities where any information or alternative explanations that might challenge implicit and explicit assumptions are unwelcome. When entering the realms of gender and sexuality, it is not unusual to encounter another form of binary thinking: “morality tales” about whether certain kinds of thoughts, feelings, or behaviors are “good or bad” or, in some cases, whether they are “good or evil” [14–16]. The good/bad binary is not confined to religion alone, as the language of morality is inevitably found, for example, in theories about the “causes” of homosexuality.

For much of Western history, official pronouncements on the meanings of same-sex behaviors were primarily the province of religions, many of which deemed homosexuality to be morally “bad” [36]. However, as 19th century Western culture shifted power from religious to secular authority, same-sex behaviors, like other “sins,” received increased scrutiny from the law, medicine, psychiatry, sexology, and human rights activism. Eventually, religious categories like demonic possession, drunkenness, and sodomy were transformed into the scientific categories of insanity, alcoholism, and homosexuality.

Thus, the modern history of homosexuality usually begins in the mid-19th century, most notably with the writings of Karl Heinrich Ulrichs [21]. Trained in law, theology, and history, he might be considered an early gay rights advocate who wrote a series of political tracts criticizing German laws criminalizing same sex relationships between men. He hypothesized that some men were born with a woman’s spirit trapped in their bodies and that these men constituted a third sex he named urnings. He also defined a woman who we would today call a lesbian as urningin, a man’s spirit trapped in the body of a woman.

Freud saw expressions of adult homosexual behavior as caused by “arrested” psychosexual development, a theory of immaturity. Toward the end of his life, Freud wrote “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” [39], (p. 423). This belief made him pessimistic about efforts to change a homosexual orientation to a heterosexual one: “In general, to undertake to convert a fully developed homosexual into a heterosexual does not offer much more prospect of success than the reverse, except that for good practical reasons the latter is never attempted”

As psychiatrists, physicians, and psychologists tried to “cure” homosexuality, sex researchers of the mid-20th century instead studied a wider spectrum of individuals that included non-patient populations. Psychiatrists and other clinicians drew conclusions from a skewed sample of patients seeking treatment for homosexuality or other difficulties and then wrote up their findings of this self-selected group as case reports. Some theories about homosexuality were based on studies of prison populations. Sexologists, on the other hand, did field studies in which they went out and recruited large numbers of non-patient subjects in the general population.

The most important research in this area was that of Alfred Kinsey and his collaborators, published in two headline-generating reports [22,23]. The Kinsey reports, surveying thousands of people who were not psychiatric patients, found homosexuality to be more common in the general population than was generally believed, although his now-famous “10%” statistic is today believed to be closer to 1%–4% [46]. This finding was sharply at odds with psychiatric claims of the time that homosexuality was extremely rare in the general population. Ford and Beach’s [47] study of diverse cultures and of animal behaviors, confirmed Kinsey’s view that homosexuality was more common than psychiatry maintained and that it was found regularly in nature. In the late 1950s, Evelyn Hooker [24], a psychologist, published a study Behav. Sci. 2015, 5 570 in which she compared psychological test results of 30 gay men with 30 heterosexual controls, none of whom were psychiatric patients. Her study found no more signs of psychological disturbances in the gay male group, a finding that refuted psychiatric beliefs of her time that all gay men had severe psychological disturbances.

[I]f homosexuality was no longer considered an illness, and if one did not literally accept biblical prohibitions against it, and if gay people are able and prepared to function as productive citizens, then what is wrong with being gay? Additionally, if there is nothing wrong with being gay, what moral and legal principles should the larger society endorse in helping gay people openly live their lives?

The result, in many countries, eventually led, among other things, to (1) the repeal of sodomy laws that criminalized homosexuality; (2) the enactment of laws protecting the human rights of lesbian, gay, bisexual and transgender (LGBT) people in society and the workplace; (3) the ability of LGBT personnel to serve openly in the military; (4) marriage equality and civil unions in an ever growing number of countries; (5) the facilitation of gay parents’ adoption rights; (6) the easing of gay spouses’ rights of inheritance; and (7) an ever increasing number of religious denominations that would allow openly gay people to serve as clergy. 

Most importantly, in medicine, psychiatry, and other mental health professions, removing the diagnosis from the DSM led to an important shift from asking questions about “what causes homosexuality?” and “how can we treat it?” to focusing instead on the health and mental health needs of LGBT patient populations.

Many young gays have no idea of the mental anguish I and others suffered in our teens and early twenties as we feared being labeled mentally ill.  Add to this the poison of religious brainwashing and it is little wonder that I remained closeted for years and contemplated suicide constantly.   I am thankful that science saved me from the hate, ignorance and bigotry of religion.