Holiday Issue: ‘The Empty Couch’

Published in: November-December 2022 issue.


LET US celebrate the fiftieth anniversary of the American Psychiatric Association’s decision to delist “homosexuality” as a mental illness in its Diagnostic and Statistical Manual (DSM). This is the bible for psychiatric theory and practice, the arbiter of what is “normal” and what is pathological, so the inclusion of homosexuality was a constant drag on any effort by gay people to gain social acceptance or to organize a political movement to that end.

            The reversal came late in 1973 when the APA board voted to declassify homosexuality as a psychiatric condition. But the most dramatic and memorable event came a year earlier at their annual meeting, which featured a panel of gay and lesbian activists, one of whom, John E. Fryer, appeared in a mask so that he could tell his story as a gay psychiatrist, which he did with passion and eloquence.

            This event was discussed in an article by Malcolm Lazin in our May-June 2022 issue, which elicited a letter to the editor from Lawrence Hartmann, a psychiatrist who played a major role in the decision to delist, who points out that the APA’s decision was the culmination of a lot of hard work and persuasion inside the organization. In an Open Letter, Dr. Hartmann takes us behind the scenes and reveals what it took to get the board to reverse its position on a critical social issue.

            Another influential member of the APA, Jack Drescher, is interviewed in this issue about his extensive research on the DSM decision and its aftermath. He suggests that most psychiatrists at this time still believed that homosexuality was a mental illness but grudgingly voted to delist in an APA-wide vote the following year. After that, the medical model fell into fairly steep decline, and the APA has been a leading opponent of “conversion therapy” for many years.

            The collapse of the medical model invites the question of where it came from initially, and a thorough answer is provided in a reprised piece by Vernon Rosario, who traces the origins of “homosexuality” as a medical condition to late 19th-century Germany. It made its way from Europe to the U.S. and eventually into the first DSM in 1952. This was the era in which treatment for homosexuality included electro-shock, aversion therapy, and even chemical castration. Indeed “the couch” was only the mildest intervention that was used.

            Clearly the APA’s turnabout was a response to changes in “the Zeitgeist,” which was exploding with Women’s Lib, the Sexual Revolution, and post-Stonewall activism. Barbara Gittings embodied all of these strains as a radical lesbian feminist, and she was one of the people on the famous John Fryer panel (along with Frank Kameny). In a speech that’s reprinted here, she describes the background to the APA panel and the importance of its decision, which made it possible for the gay liberation movement to go forward, unencumbered by the stigma of mental illness.