Unmaking the Disease (Part 2)

Continued from Part I

Since existing research helped reinforce negative attitudes (and the repressive legislation that made homosexuals fearful of being open about their sexuality), Evelyn Hooker began a formal study of her own  in 1954.  She recruited research subjects from several California-based homophile groups (including the Mattachine Society and One Inc.).  Although she acknowledged that there was a selection bias in her subjects, she also pointed out that previous case studies involving homosexuals almost invariably focused on men and women who were either: 1.desperate to change their orientation or  2. forced into treatment by the criminal justice or mental health systems.  She also pointed out that homosexuality was largely hidden due to fear of arrest or persecution so a truly representative sample wasn't possible.  After recruiting thirty homosexual men, she matched them to a same-sized sample of heterosexual men in terms of IQ scores, age and educational background.  She then administered a battery of projective tests (including the venerable Rorschach).  After collecting her data for a year, she presented the 60 test profiles to a panel of expert clinicians and asked them to determine whether the homosexuals had greater pathology than the heterosexuals (the clinicians were given no information on the sexual orientations of the subjects).  All three judges, despite their lengthy experience with projective tests, were unable to find any meaningful difference between the two groups.  There was also no indication that homosexual males showed any more psychopathology than heterosexuals (despite it being a formal psychiatric diagnosis at the time).

Considering the era in which the study was done, these conclusions were mind-boggling.  Despite Evelyn Hooker's own objections over the preliminary nature of her research, the then-editor of the Journal of Projective Techniques urged her to publish her findings in a 1957 issue.  In writing about her research, Hooker acknowledged that a homosexual orientation might represent a "social" maladjustment (given the cultural and legal problems openly homosexual individuals faced) but that psychological well-being wasn't necessarily affected.  She also investigated family background of her homosexual subjects and failed to find the pathological upbringing that mainstream clinicians insisted lay at the root of homosexuality.  Hooker's research also looked into same-sex relationships and found that two-thirds of her subjects had formed long-term partnerships.  This was in direct opposition to the mainstream view that homosexuals were incapable of forming stable relationships.  While she did find an increased tendency towards "disturbed" behavioural patterns in homosexuals, she linked this to the very real societal risks that they faced as a stigmatized minority.  In a 1956 paper, Hooker wrote that "It would be strange indeed if all the traits due to victimization in minority groups were in the homosexual produced by inner dynamics of the personality, since he is also a member of an outgroup which is subject to extreme penalties involving, according to Kinsey, cruelties which have not often been matched except in religious and social persecutions".  

Almost inevitably, Evelyn Hooker's research won her enormous support in the growing homophile movement (which also developed an increasing antagonism towards mainstream psychiatry).   Along with Thomas Szasz (whose anti-psychiatry crusade came to include homosexuality as another focus of psychiatric repression) and Judd Marmor, Evelyn Hooker became part of the more accommodating movement that rejected orthodox views of homosexuality as a disease.  It was during this same era that homosexual activists became increasingly militant (although they were largely overshadowed by the more high-profile protest movements of the 1960s).  Gay Liberation became a popular rallying cry and providing treatment to change homosexual behaviour (voluntary or not) was vilified as a tool of social repression.  Civil rights group, while focusing on racial and sexual discrimination, also began pushing for better legal protections for sexual minorities.  The Stonewall riots of 1969 became a potent symbol for a more aggressive struggle for legal recognition.  Psychiatrists who presented lectures on treating homosexuals could expect hostile picketers and public ridicule.  Leaving aside the question of whether this sort of public confrontation was an appropriate way to express outrage over negative portrayals of homosexuality, it certain provided ample publicity for the Gay Liberation cause.

Naturally,the American Psychiatric Association (APA) became the focus of this protest.  After failing to remove homosexuality as a disease in the second edition of the DSM which came out in 1968 (it was still listed as a "sexual orientation disturbance"), activists routinely protested their annual conventions (especially the 1970 convention in San Francisco).  The presence of Irving Bieber and other prominent advocates of homosexuality's disease status led to a mobilized response by gay and feminist groups.  During one panel presentation, Bieber was verbally abused by one protester who told him, "I've read your book, Dr. Bieber, and if that book talked about black people the way it talks about homosexuals, you'd be drawn and quartered and you'd deserve it."  When Nathaniel McConaghy presented a paper on aversive conditioning in treating homosexuals, demonstrators disrupted the talk and the room fell into chaos.   Although gay activists drew strong criticism for their tactics, the organizers argued that their actions were necessary since the Association had refused to let homosexuals take part in the official program.

As a compromise, a special panel was organized for the 1971 APA convention held in Washington, D.C.  Chaired by psychiatrist, Kent Robinson, the panel featured prominent gay activists who, for the first time ever, presented psychiatrists with a look at their daily lives (without the assumption of psychopathology).  One limited panel wasn't felt to be enough to advance the gay activists' cause however and a series of protests were also held.  On May 3, 1971, gay and antiwar activists stormed into the Convocation of Fellows where their leader denounced the psychiatric profession by saying: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you."  Using forged credentials, activists also entered the exhibit area and demanded the removal of a display advertising aversive conditioning techniques for treating homosexuals.  The APA complied and the arranged panel went on as scheduled.

Continue to Part 3.

Comments

[Dexter Edge]

The "publish her findings" link to PsycNet appears to be broken. At any rate, on my system (Firefox 3.6 on Mac), it leads me to the most elaborate "Sorry, we can no longer locate this search" message that I've ever seen.

I'm in the middle of linking to your post on my blog (idiography.blogspot.com), and I wanted to provide a direct link to Hooker's publication.

[Romeo Vitelli]

Thank for letting me know. I changed that link to another web page that includes the reference for Hooker's article. Unfortunately, many research databases don't date back that far.

[DNA]

"Along with Thomas Szasz (whose anti-psychiatry crusade came to include homosexuality as another focus of psychiatric repression) and Judd Marmor, Evelyn Hooker became part of the more accommodating movement that rejected orthodox views of homosexuality as a disease."

Be careful with Szasz, he's a slippery character.

Firstly, I understand he rejects the term "anti-psychiatry" applied to himself because he says he has no problem with consensual psychiatry, only with the use of psychiatry to justify force (even if no crime) or to excuse people from prison (even if a crime). He actually uses "anti-psychiatry" as a term of abuse to describe others, which bearing in mind that he is himself a psychiatrist may not actually be that surprising.

Secondly, it turns out that by his own admission his anti-disease philosophy stems from his Eastern European teenage politics, prior to his psychiatric training/experience in the US, and is applied across the board. And according to this book http://books.google.com/books?id=OY05uZUCaTsC the gay rights movement was pretty selective in using him for support, because he apparently wrote in 1965 (I don't know if he later withdrew this assertion?): "I believe it is very likely that homosexuality is, indeed, a disease in the second sense [expression of psychosexual immaturity] and perhaps sometimes even in the stricter sense [a condition somewhat similar to ordinary organic maladies]."

He added that he thought that regardless of its disease status, it was a fit subject for moral judgement.

[Romeo Vitelli]

I don't know where Szasz fell on the entire gay rights issue, simply that he used it as an example of psychiatry's role in enforcing orthodoxy. My impression is that he is not considered a gay rights reformer in the way that Evelyn Hooker and Judd Marmor are.