By Ella Duff (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?
Gender and Sexual Diversity have been pathologized by psychology over the course of history. This essay will focus on the ways in which psychology has had a negative impact on LGBTQ people by discussing Conversion Therapy, bisexual erasure, and the impact of adopting a Western and cisgenderist lens through which to view gender and sexual diversity.
Conversion Therapy, or Reparative Therapy refers to any treatment or psychotherapy designed to change an individual’s sexual orientation to the perceived societal norm, in most cases from homosexual/bisexual to heterosexual. Reparative Therapy was first used under the assumption that anything non-heteronormative was an ‘illness’ and was an “unwanted and unhealthy condition” (Haldeman, 1994, p221). Haldeman notes that there are two hypotheses that form the basis for many of the therapies used in attempting to change sexual orientation. The first hypothesis is that homosexuality is due to a prevention in psychosexual development or in “pathological attention patterns” in early life. The second is that homosexuality is learned behaviour. From the late 19th century various methods were used in an attempt to ‘convert’ sexual desires: excessive exercise, employment of sex workers, electric-shock therapy, hypnotherapy, nausea-inducing drugs, hormone therapy and surgery (Murphy, 1992). However, many of these methods were found to be unhelpful in the attempt to change an individual’s sexual orientation, but were still used regardless. For example, oestrogen and testosterone were two hormones used in hormone therapy. During the 1950s, Karl Freund tried to replace men’s homosexual desires with heterosexual ones by injecting testosterone into them while viewing women in sexually explicit videos. This was eventually shown to be ineffective in changing the men’s homosexual desires to heterosexual ones (Sansweet, 1975, Sands, 1954, as cited by Murphy, 1992).
The impact of Conversion Therapy on LGBTQ people is wide and varied. Individuals having gone through different methods of Conversion Therapy report harm being done and that they have suffered trauma as a consequence. Depression and low self-esteem have been noted as negative impacts of Conversion Therapy, along with individuals having difficulties in their relationships with other people (Haldeman, 2002). The theories behind Conversion Therapy, regarding homosexuality as a ‘mental illness’ or ‘disease’ has further promoted discrimination and prejudice against the LGBTQ community. Through this discrimination, LGBTQ individuals have been victims of violence and hate crimes, seen as ‘abnormal’ and overall dehumanized.
In addition, sexual diversity has been pathologized in psychology/psychiatry by the production of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM was first produced in 1952 and contains descriptions and criteria for diagnosing mental disorders for medical use, and has multiple revised editions. In the first edition of the DSM (DSM-I), homosexuality was classified as a “sociopathic personality disturbance” (American Psychiatric Association, 1952, as cited by Drescher, 2015). Listing homosexuality as mental illness subjected LGBTQ people to discrimination and unfair treatment, suggesting there was something wrong with their sexuality and they needed to be ‘cured’. This led to both forced and consensual Conversion Therapy, with LGBTQ individuals seeking out treatments in the belief that they were abnormal and mentally ill. In subsequent editions of the DSM, homosexuality was still regarded as a mental disorder: in the DSM-II it was reclassified as “sexual deviation” (American Psychiatric Association, 1968, as cited by Drescher); in the 1974 DSM-II, it was removed as a disorder but “ego-dystonic homosexuality” remained as a category, referring to those who express distress regarding their sexuality and desires for the same-sex (American Psychiatric Association, 1980, as cited by Murphy, 1992). It wasn’t until 1987 that ego-dystonic homosexuality was also removed from the DSM-III-R, suggesting the American Psychiatric Association viewed homosexuality as normal (Drescher, 2015).
Bisexuality is a subject area in which psychology research is still lacking (Pollitt et al., 2018). By conducting a content analysis of abstracts and titles published in Psychology of Sexual Orientation and Gender Diversity, Pollitt et al. discovered that less than 1% of 223 articles published focussed on the bisexual community. The articles were categorized into four groups: bisexual-focused content, some bisexual content, minimal bisexual content, and no bisexual content. In total, 29 (13%) articles were in the three bisexual categories (bisexual-focused content, some bisexual content, minimal bisexual content) and only 12 (0.5%) of these articles were categorized as bisexual-focused content. Similarly to Pollitt et al., Ross et al. (2018) conducted a meta-analysis of studies that reported data on standardized measures of mental health issues, such as anxiety and depression that were specific to bisexual people. The meta-analysis found that bisexual individuals experience higher rates of anxiety and depression than heterosexual and homosexual individuals. They report that they identified three possible contributors to these mental health differences between bisexual and hetero/homosexual people: “sexual orientation-based discrimination; bisexual invisibility and erasure; and lack of bisexual-affirmative support” (Ross et al., p450.). The lack of inclusion and focus on the bisexual population in psychology has the potential to cause serious decline in the psychological and mental well-being of bisexual individuals. Bisexuality is just as much a part of LGBTQ as homosexuality is, and needs to be recognised as such by not just psychologists and researchers, but by society too.
Furthermore, psychology has historically pathologized gender and sexual diversity by focussing on a predominantly Western perspective. Horne (2020) explores how psychology in “WEIRD (Western, Educated, Industrialised, Rich and Democratic)” countries and contexts can influence and shape transnational LGBTQ concerns. LGBTQ psychology is dominated by American and British perspectives when the majority of LGBTQ people live outwith WEIRD spaces where their sexual orientation and/or gender identity is “criminalized, legally restricted, and/or medically or psychologically pathologized” (I.L.G.A. World, 2019; Nakamura & Logie, 2020; Arnett, 2008; Hegarty & Rutherford, 2019; Henrich et al., 2010; Thalmayer et al., 2020, as cited by Horne, p.1360). By focusing on a WEIRD context, psychology is limiting the knowledge and experiences of other countries on LGBTQ concerns. For example, using a WEIRD influenced identification method for LGBTQ identity reduces the variation and uses a generalization when LGBTQ identities are not rigid but fluid. This limitation of identities through a Western perspective could be harmful to the LGBTQ community within and outwith WEIRD contexts, as this enforces a rigid framework which may not be suited to all LGBTQ individuals.
Finally, cisgenderism is one way in which psychology has pathologized gender identity. ‘Transgender’ refers to a gender identity that differs from the assigned sex given at birth, whereas ‘cisgender’ refers to a gender identity that is the same as the assigned sex given at birth. Cisgenderism is a systematic and cultural, prejudicial ideology (Ansara & Hegarty, 2012) that pathologizes self-identified gender identities. Ansara and Hegarty conducted a study to examine articles published between 1999 and 2008 to evaluate two types of cisgenderism within the psychological literature. They looked for misgendering language – language that incorrectly identified the children’s own gender assignment – and pathologizing language – language that viewed the children’s gender assignment as ‘disordered’. Ansara and Hegarty discovered that pathologizing language was more prominent than misgendering language, suggesting that self-assigned gender identities are still being viewed as a mental disorder and unnatural. Moreover, they also discovered that cisgenderism is neither increasing or decreasing over time, and that those who work in the field of mental health are more cisgenderist than other authors in their study. This suggests that there is not much change in the views of self-identified gender identities, and that cisgender ideology is more prominent in the field. The use of cisgenderist language has a negative impact on LGBTQ people as it dehumanises and erases their identities, illustrating and suggesting that non-cis individuals are not part of the societal norm and even regarded as the human beings in which they should be.
In conclusion, psychology has historically pathologized gender and sexual diversity, and this has had a negative impact on the LGBTQ population. Through ideas and theories suggested by psychologists, conversion therapy was used to ‘cure’ people of their homosexual desires, which caused harm to the individuals it was used on. The Diagnostic and Statistical Manual of Mental Disorders classified homosexuality as a disorder for years which led to many LGBTQ seeking treatment for their sexuality believing it was wrong. Psychology lacks proper focus when it comes to bisexuality which is harmful to bisexual individuals as there are proven rises in mental health issues relating to the ‘invisibility’ and erasure of it in the field. Viewing LGBTQ concerns predominantly through a Western perspective is also harmful to LGBTQ individuals. Cisgenderist language is prominent with psychological literature which suggests that self-identified gender identities are not accepted and viewed the same as cisgender identities. Psychology has had a negative impact on LGBTQ studies and people, but moving into the future there is hope that LGBTQ people will not be erased and seen as abnormal as psychology progresses.
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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Ansara, G. Y., & Hegarty, P. (2012). Cisgenderism in psychology: pathologizing and misgendering children from 1999 to 2008. Psychology & Sexuality, 3(2), 137-160. https://doi.org/10.1080/19419899.2011.576696
Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioural sciences, (5)4, 565-575. https://doi.org/10.3390/bs5040565
Haldeman, D. C. (1994). The practice and ethics of sexual orientation conversion therapy. Journal of Consulting and Clinical Psychology, 62(2), 221-227. https://doi.org/10.1037/0022-006X.62.2.221
Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology, Research and Practice, 33(3), 260-264. https://doi.org/10.1037//0735-7028.33.3.260
Horne, S. G. (2020). The challenges and promises of transnational LGBTQ psychology: Somewhere over and under the rainbow. The American Psychologist, 75(9), 1358-1371. https://doi.org/10.1037/amp0000791
Murphy, T. F. (1992). Redirecting sexual orientation: Techniques and justifications. The Journal of Sex Research, 29(4), 501-523. https://doi.org/10.1080/00224499209551664
Pollitt, A., Brimhall, A. L., Brewster, M. E., & Ross, L. E. (2018). Improving the field of LGBTQ psychology: Strategies for amplifying bisexuality research. Psychology of Sexual Orientation and Gender Diversity, 5(2), 129-131. https://doi.org/10.1037/amp0000791
Ross, L. E., Salway, T., Tarasoff, L. A., MacKay, J. M., Hawkins, B. W. & Fehr, C. P. (2018). Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian and Heterosexual Individuals: A Systematic Review and Meta-Analysis. The Journal of Sex Research, 55(4-5), 435-456. https://doi.org/10.1080/00224499.2017.1387755