Whose Planet Is It Anyway?

Friday, September 07, 2007

When Resistance Succeeds

In the early 1970s, a group of gay activists, who had some help from closeted gay psychiatrists, successfully fought to get the Diagnostic and Statistical Manual (DSM) edited so that it no longer classified homosexuality as a disorder. A documentary produced by Chicago Public Radio describes how they confronted prejudice and asserted their pride in their identity. (Many thanks to Lili Marlene for posting a link to the transcript.)

The classification of homosexuality as a mental disorder was not merely an issue of semantics. For decades, it had given the appearance of legitimacy and scientific rationality to society's entrenched discrimination against gay citizens:

...because psychiatrists believed that homosexuals were pathological, it (gave) scientific sanction for the rest of the country to see it the same way. Gays were routinely fired from teaching jobs, denied security clearances and US citizenship...for that matter they were barred from practising psychiatry, because you don't let someone who's pathological practice medicine on other people who are pathological.

Most psychiatrists gave little thought to the social consequences of their belief that homosexuality was a pathological condition. In their practices, they often counseled unhappy and anxious gays who wanted to be "cured" of homosexuality (or whose families wanted them to be cured) in order to become socially acceptable. This, of course, reinforced the psychiatrists' view that gays were tragically disordered and in need of a cure. They had never seen anyone who thought it was OK to be homosexual until they began encountering gay civil rights activists:

...then a relatively small group of homosexual activists started making noise about their designation in the DSM. Specifically the activists rejected the idea that they needed to be cured of their desire. They said that they only needed the stigma of insanity to be removed from homosexuality so that they could get jobs teaching children or practising psychiatry -- basically so that they could finally achieve equal rights.

At first, the gay activists' civil rights arguments had very little impact on the psychiatrists. After all, there was a great mass of scientific literature describing homosexuality as a mental disorder. Even most of the closeted gay psychiatrists thought of themselves as suffering from a mental illness. John Fryer, a gay psychiatrist, described his feelings in these terms: "From the very beginning I learned that it was pathology, it was very difficult to get over that... Because of our own internalised homophobia, most of us probably agreed that it was OK to be a disease."

Despite being closeted, however, Dr. Fryer became a victim of discrimination based on his employers' suspicions that he might be gay. He was dismissed by two hospitals, and he was unable to get teaching positions for which he applied. After these experiences, Dr. Fryer agreed to help the gay activists by giving a speech at the 1972 American Psychiatric Association (APA) convention describing the harm that had resulted from the classification of homosexuality as a disorder. Because he still did not dare to be known openly as a gay man, he wore a wig and a Nixon mask during his speech and called himself Dr. Anonymous. He received a standing ovation, and his speech caused many psychiatrists to reconsider their views on homosexuality.

Soon afterward, a number of liberal candidates who were sympathetic toward the cause of gay civil rights were elected as officers and directors of the APA. Empowered by this, the gay activists became much more vocal. Three activists were able to meet with the APA's nomenclature committee, which was the group responsible for the wording in the DSM. One of the members of the committee organized a forum on the issue, held at the 1973 APA convention, where the gay activists argued persuasively that diagnosing homosexuality as an illness was a tool of social oppression. Not long afterward, the diagnostic category for homosexuality was edited so that it encompassed only homosexuals who were troubled by their sexual orientation; it was later removed entirely.

What struck me about this accomplishment, in reading the transcript of the documentary program, was how quickly a small number of involved and committed activists could bring about such far-reaching changes. The protests against categorizing homosexuality as a mental illness began in 1970 with a group of gay activists in San Francisco, who got almost no sympathy from anyone at first; but, a little over three years later, they had achieved their goal of editing the DSM to remove the objectionable classification.

To anyone who doubts whether a small group of neurodiversity activists can change society's view of autism in just a few short years... history has shown that it's not impossible at all.

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  • It's important to remember that in this case, the activists were able to back themselves up with over 15 years of solid research showing that nearly all of the assumptions behind the notion that homosexuality was pathological were false (wingnuts typically argue that the decision was purely political and that the APA was intimidated into making it. BTW, there were some political aspects to the decision; at the time there was a power struggle in the APA between behaviorists and psychoanalysts, and demonstrating that homosexuality was non-pathological had the effect of falsifying quite a bit of psychoanalytic theory).

    Let's hope that Mottron, Dawson, Fombonne, Gernsbacher and the like will be to the autism spectrum what the likes of Hooker and Weinberg were to homosexuality.

    By Blogger ebohlman, at 5:01 PM  

  • That was one effective movement. They would prevent psychiatrists from entering the APA facilities. They declared war on psychiatry.

    The official line is that there was a review of the science, and a vote on it (58% to 42%). But without the activism, would they have moved one finger?

    Besides, psychiatrists are not even clear on how to determine whether something is pathological or not. They came up with some ideas precisely because of the issue of homosexuality, but even those are kind of dogmatic and don't necessarily make sense.

    The situation is a little different in the case of autism. For one, we're kind of passive. We're trying to convice by making reasonable arguments.

    One remarkable aspect of the gay rights movement is that before deletion of homosexuality from the DSM-II, it appears that it was pretty common for homosexuals to believe they were suffering because of homosexuality. Today, that's practically unheard of. That's the non-trivial power of social constructs for you.

    By Anonymous Anonymous, at 5:13 PM  

  • This should happen, but I wish that the bigger problem (the one that messes with the lives of everyone with a DSM diagnosis of everything) would somehow get addressed without just pulling people one by one out of the sociological group of "insane" (as they add more categories all the time).

    By Blogger ballastexistenz, at 7:52 PM  

  • This is very encouraging from an 'activism works' POV. But if autism and AS went out of the DSM, we'd all suddenly be diagnosis-less- and that would be bad news as far as workplace and educational accommodations go. And that would suck.

    By Blogger Unknown, at 8:39 PM  

  • "This is very encouraging from an 'activism works' POV. But if autism and AS went out of the DSM, we'd all suddenly be diagnosis-less- and that would be bad news as far as workplace and educational accommodations go. And that would suck."

    Not if autism was made the province of education rather than medicine, and worked with developmentall/educationally rather than clinically.

    By Blogger David N. Andrews M. Ed., C. P. S. E., at 9:46 PM  

  • Classifications don't need to be monopolized by psychiatry to be acknowledged. For example, is 'developmental delay' part of the DSM-IV?

    By Anonymous Anonymous, at 10:35 PM  

  • Removing something from the DSM does disqualify the people who had that diagnosis from equal access. For instance, gays are fighting for the right to marriage, even though homosexuality is not a disorder.

    In fact, having something in the DSM makes it easy to rationalize denying equal access on the basis that "it's their problem, not mine." When a disorder becomes a difference, then the onus of responsibility is more clearly (in some people's minds) a societal one.

    As far as the autistic community being passive, well so is the GLBT community.

    By Blogger Chasmatazz, at 11:43 PM  

  • Meant to say...

    does NOT disqualify

    By Blogger Chasmatazz, at 11:44 PM  

  • An important difference between the early gay rights movement, and the autistic rights movement of today is the money issue. Some very powerful entities have a financial stake in keeping autism classified as a disorder. This was not the case with homosexuality.

    By Blogger Chasmatazz, at 11:51 PM  

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