By Emily Aikten (she/her), Level 1 Psychology Student, University of Glasgow
How has psychology historically pathologized gender and/or sexual diversity and what impact has this had on LGBTQ people?
In 1952, homosexuality was listed as a mental illness – or more specifically a sexual deviation disorder – in the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychological Association (APA). This normalised discrimination based on sexual diversity, and further editions of the manual pathologized gender diversity (Kenneth et al., 2005; Margolin, 2021). The publication of these manuals by a highly esteemed psychological association had a serious impact on the LGBTQ community. This essay will review the progression of this and how individuals were affected.
When homosexuality entered the DSM in 1952, psychologists studied the cause. Some thought that mothers who smothered their sons and absent fathers contributed to the feminisation of their son. It was theorised that mothers who did this lacked emotional intimacy with their husbands and so imposed their affection on the child, who grew up resenting their fathers while also craving their love. This is said to have led to a fear of heterosexual relationships, which was a focus when trying to “cure” homosexuality (Gonsiorek, 1982; Coleman, 1982).
Psychologists tried to eliminate sexual diversity via conversion therapy. Psychoanalysis was used to decipher the root of the patient’s urges and determine how to convert them to heterosexuality. Coleman (1982) discusses the mental and physical methods of treatment used. Since many believed fear led to homosexual orientation, systematic desensitisation was used to make patients less scared of heterosexual acts. Aversion therapy involved the association of homosexual behaviour with negative physical stimuli. Patients were forced to view images of naked people of the same sex while inducing vomiting or transmitting electric shocks. The success of these procedures was measured in the participation of homosexual activity after receiving it, but this did not prove a change in orientation, only a fear of acting on it. The impact of these therapies on the LGBTQ community has since been studied. Most individuals reported that their sexual orientation did not change, and many expressed that they felt harmed by the experience (Shidlo et al., 2002). Despite the scientific evidence against them these therapies are still used, displaying the lasting impact that the treatments implemented by psychology have on LGBTQ individuals (Flores et al., 2020).
After contentious dispute, in 1973 the APA removed the word homosexuality from the DSM but kept the term ‘sexual orientation disturbance’ (which described homosexual attraction). The wording of this was changed multiple times, until the third edition of the DSM was published. The term “ego-dystonic homosexuality” was chosen for the fact that this did not directly describe homosexuality as pathological, even if it was implied (Margolin, 2021). Despite the APA’s progressive intentions, discrimination inflicted by psychologists did not end there. Some psychologists argued that they had helped their patients supress their homosexuality in the past, and that they were not forcing treatment onto the people who had sought help consensually. The doctors argued that the normalisation of homosexual behaviour did little to help people who wanted to be rid of homosexual desires (Berger, 1994). Whilst this is true, requesting help does not prove that their urges were abnormal, only that they did so because of ongoing stigma and discrimination based on sexual diversity. There is substantial evidence that members of the LGBTQ community face mental health problems at a higher rate, often due to societal stigma, but this shame is reinforced within the mental health service as many psychologists hold biases and are ignorant towards the nuances in the LGBTQ experience (Rees et al., 2021).
The same year that psychologists officially declassified homosexuality as a mental disorder, a new condition was introduced: gender identity disorder of childhood (GIDC). The disorder was diagnosed in males and females who engaged in activities that did not stereotypically fit into their gender role category, like boys playing with dolls and girls playing rough games (Kenneth et al., 2005). Some believe that this was an effort to prevent children from growing up to be homosexual, but it also pathologized transgender people (Zucker & Spitzer, 2005). The perpetuation of transphobia by psychologists led to them being treated similarly to gay people in society and Lombardi et al. (2002) discuss how transgender individuals are discriminated against and harassed, and how this leads to unemployment and increased suicide rates. Transgender discrimination is still prevalent today, and is especially harmful in healthcare (Kelley, 2021).
Despite the removal of homosexuality in 1973, psychologists continued to pathologize sexual diversity through the DSM. From 1981-2002, four DSM case books were published which stereotyped gay men as violent abusers and described homosexuals as being mentally disturbed. These casebooks were intended for use by psychologists to help treat their patients. This is problematic as these negative stereotypes were being published as scientific fact and spread to psychologists in an educational manner (Margolin, 2021). Although the books discussed patients who fitted the description of lesbian, bisexual, transgender and even heterosexual, none of these terms were ever directly used to describe them; only adult men were given the description of homosexual and it was often used to describe adult men who had sexual fantasies about young boys. This furthered the idea that male homosexuals were paedophiles, and made parents feel that their children were unsafe around homosexuals. The impact of this stigma was exemplified when LGBTQ athletes entering Russia were told to “leave our children alone” (Clark, 2014). The lack of reference to any other LGBTQ terms and groups perpetuated the idea that only men could be homosexual, and further erased other LGBTQ identities such as lesbian woman, bisexuals, and asexuals.
The stigmatisation of homosexuality and the othering of it as a mental disorder by psychologists led to society treating people as such. People in the LGBTQ community have historically experienced many forms of abuse. This ranges from abusive slurs and ostracization to the beating and murdering of known LGBTQ individuals. Many members of the community were discriminated against in the workplace and exiled by family and friends, which has been associated with poor mental health (Pillard, 1982). In 1993 a trans man, Brandon Teena, was raped in Wyoming by men who discovered his identity. When Brandon reported this incident, the men murdered him. In 1999 two men brutally murdered a gay 14-year-old boy in New Zealand. (Harper et al., 2003). Report of cases like these and the daily abuse that the LGBTQ community face as a result of being pathologized has led to some individuals seeking to conceal their identity, and many also face internalised homophobia.
Internalised homophobia in LGBTQ individuals can be attributed to the negative and pathological portrayal of the LGBTQ+ community in wider society. Psychologists’ description of homosexuals as deviant and promiscuous led to people feeling severe guilt over their sexuality, and in the past individuals would beg to be cured (Berger, 1994). This reaffirmed psychologists’ belief that they were helping their patients by delivering various forms of therapy, but it also led to a build-up of shame and self-hatred in LGBTQ people. This internalised homonegativity has been associated with poor mental health, suicidal feelings, and substance abuse (Costa et al. 2013). Negative feelings about sexual and gender diversity can also lead to people feeling ashamed to be open about their identity which is harmful to mental health (Suppes et al., 2021).
The perception of homosexuals as pathological had a huge impact on the acquired immunodeficiency syndrome (AIDS) pandemic in the 1980s. Human immunodeficiency virus (HIV) is a disease that destroys the body’s immune defence and if untreated can lead to AIDS (Cullen, 2003). When the APA described homosexuals as sexually promiscuous individuals whose lifestyles were inherently unhealthy and wrong, this stigmatised homosexuals in the eyes of the public and healthcare professionals. When people began dying of AIDS and links were found between homosexual sex and acquiring the disease, AIDS was deemed a punishment for homosexuals and the media resorted to blaming them. It became known as the ‘gay plague’ globally, and individuals suffering with HIV were labelled as deviants, using language reminiscent of homosexuality’s description in the DSM (Lupton, 1994). Not only did this lead to further discrimination of LGBTQ people societally, but it also caused circulation of misconceptions about homosexuality in healthcare which often led to refusal of treatment. A third of medical students in a midwestern university thought that they could refuse treatment of AIDS patients, and the reasoning behind this was linked to homophobia (Kopacz et al., 1999). The doctors refusing to treat LGBTQ AIDS patients led to delays in care, which is often fatal with illnesses like AIDS that requires urgent medication. Furthermore, recent studies have found that people living with HIV suffer symptoms of anxiety, depression, and posttraumatic stress at higher rates. (MacLean et al., 2021; Waldron et al., 2021)
In summary, psychologists have historically pathologized gender and sexual diversity in many ways, such as via educational and clinical documents, leading to the legitimisation and perpetuation of homophobia and transphobia. This contributed to the stigmatisation of the LGBTQ community, which led to decades of conversion therapy, physical and emotional abuse, and mental health disparities.
February is LGBT History Month in the UK and to celebrate we want to take the opportunity to showcase work from students in the School of Psychology and Neuroscience, University of Glasgow. As part of their first year curriculum, students study the history of psychology and are asked to write an essay detailing psychology’s history regarding race, gender identity and sexual orientation, women in STEM, the replication crisis, psychology and government policy, or neurodiversity. You can find more information about the assignment here. For LGBT History Month, the TILE Student Voice will publish a weekly essay from the gender and sexual orientation category.
TILE Student Voice
This is a section of the TILE Network that features the student voice in learning and teaching. We want to shine a light on the student perspective when it comes to teaching and learning practice and what better way to do this than letting the students express this themselves. This series also aims to give students to opportunity to engage in science communication and writing. Broadcasting scientific findings to a wider audience is a valuable skill and TILE provides students with the platform to practice that skill.
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Berger, J. (1994). The psychotherapeutic treatment of male homosexuality. American Journal of Psychotherapy, 48(2), 251-61. DOI: https://doi.org/10.1176/appi.psychotherapy.1918.104.22.168
Clark, F. (2014). Discrimination against LGBT people triggers health concerns. The Lancet, 383(9916), 500-502. DOI: https://doi.org/10.1016/S0140-6736(14)60169-0
Coleman, E. (1982). Changing Approaches to the Treatment of Homosexuality: “A Review”. The American Behavioral Scientist, 25(4), 397. DOI: https://doi.org/10.1177/000276482025004005
Costa, P. A., Pereira, H., & Leal, I. (2013). Internalized homonegativity, disclosure, and acceptance of sexual orientation in a sample of Portuguese gay and bisexual men, and lesbian and bisexual women. Journal of Bisexuality, 13(2), 229-244. DOI: https://doi.org/10.1080/15299716.2013.782481
Cullen, T. (2003). HIV/AIDS: 20 years of press coverage. Australian Studies in Journalism, 12(4), 65.
Flores, A. R., Mallory, C., & Conron, K. J. (2020). Public attitudes about emergent issues in LGBTQ rights: Conversion therapy and religious refusals. Research & Politics, 7(4), DOI: https://doi.org/10.1177/2053168020966874
Gonsiorek, J. C. (1982). Results of Psychological Testing on Homosexual Populations. The American Behavioral Scientist, 25(4), 385. DOI: https://doi.org/10.1177/000276482025004004
Harper, G.W., Schneider, M. Oppression and Discrimination among Lesbian, Gay, Bisexual, and Transgendered People and Communities: A Challenge for Community Psychology. Am J Community Psychol 31, 243–252 (2003). DOI: https://doi.org/10.1023/A:1023906620085
Kopacz, D. R., Grossman, L. S., & Klamen, D. L. (1999). Medical students and AIDS: knowledge, attitudes and implications for education. Health Education Research, 14(1), 1-6. DOI: https://doi.org/10.1093/her/14.1.1
Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2002). Gender violence: Transgender experiences with violence and discrimination. Journal of homosexuality, 42(1), 89-101. DOI: https://doi.org/10.1300/J082v42n01_05
Lupton, D. (2013). Moral Threats and Dangerous Desires: AIDS in the News Media. Routledge. DOI: https://doi.org/10.4324/9781315041063
MacLean, J. R., & Wetherall, K. (2021). The Association between HIV-Stigma and Depressive Symptoms among People Living with HIV/AIDS: A Systematic Review of Studies Conducted in South Africa. Journal of Affective Disorders. 287, 125–137. DOI: https://doi.org/10.1016/j.jad.2021.03.027
Margolin, L. (2021). The Third Backdoor: How the DSM Casebooks Pathologized Homosexuality. Journal of Homosexuality, 1-16. DOI: 10.1080/00918369.2021.1945340
Pillard, R. (1982). Psychotherapeutic Treatment for the Invisible Minority. SAGE Journals, 25(4), 407. DOI: https://doi.org/10.1177/000276482025004006
Rees, S. N., Crowe, M., & Harris, S. (2021). The lesbian, gay, bisexual and transgender communities’ mental health care needs and experiences of mental health services: An integrative review of qualitative studies. Journal of Psychiatric and Mental Health Nursing, 28(4), 578-589. DOI: 10.1111/jpm.12720
Suppes, A., van der Toorn, J., & Begeny, C. T. (2021). Unhealthy closets, discriminatory dwellings: The mental health benefits and costs of being open about one’s sexual minority status. Social Science & Medicine, 285, 114286. DOI: https://doi.org/10.1016/j.socscimed.2021.114286
Zucker, K. J., & Spitzer, R. L. (2005). Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex & Marital Therapy, 31(1), 31-42. DOI:10.1080/00926230590475251