By the time of the
1972 convention in Dallas, enough progress had been made for activists
to avoid the confrontation tactics of previous conventions. Kent
Robinson, who by then had become the unofficial APA liason with the gay
community, arranged for a booth to be displayed in the exhibit area.
The booth was run by several gay activists with the logo of "Gay, Proud,
and Healthy" designed to win support for the removal of homosexuality
from the DSM. A panel chaired by Robinson included Judd Marmor, gay
activist Frank Kameny, as well as "Dr. H. Anonymous", a gay psychiatrist
who chose not to reveal his name openly (he wore a mask for the panel
presentation). "Dr. Anonymous" was the most memorable speaker and he
announced that there were over two hundred gay psychiatrists attending
the conference. He stated that, "As psychiatrists who are homosexual,
we must know our place and what
we must do to be successful. If our goal is high academic achievement, a
level of earning capacity equal to our fellows, or admission to a
psychoanalytic institute, we must make sure that we behave ourselves
and that no one in a position of power is aware of our sexual
preference and/or gender identity." His presentation, along with the
other speakers of the panel, made a powerful appeal for greater
tolerance and acceptance among psychiatrists in dealing with their
patients and the community at large. It would be a major turning point
in changing orthodox views on homosexuality.
Although critics later argued that the disruptive tactics of the gay lobby had done more harm than good, the formal panel seemed a vindication of its success. As Barbara Gittings pointed out, the event would likely have taken decades longer to be held "if gay people had politely waited to be asked". In a provocative article published in 1972 in the International Journal of Psychiatry, Richard Green argued against the disease interpretation of homosexuality and invited six formal responses. On the six, only the responses by Charles Socarides and Lawrence Hatterer supported the traditional psychiatric perspective and rejected the reopening of the question of homosexuality's status as a disease. Although Socarides continued to fight against any attempt at normalizing homosexuality, other mental health organizations, including the National Association for Mental Health urged that homosexual behaviour be decriminalized. Meanwhile, the protests continued at the 1972 conference of the Association for the Advancement of Behavior Therapy (which the protesters accused of torture over the use of aversion therapy to change sexual orientation). It was at this conference where Robert Spitzer, a then-member of the APA's Committee on Nomenclature, agreed to allow them to make a presentation before the committee at the 1973 APA conference.
Despite an internal split among gay groups over the presentation, Charles Silverstein of the Institute for Human Identity was chosen to organize it. Along with prepared statements from a number of gay-positive psychiatrists and psychologists, Silverstein called for the removal of homosexuality from the DSM in his presentation on February 28, 1973. The lengthy case statement surveyed research findings and documented how the psychiatric diagnosis of homosexuality reinforced existing social and legal restrictions on homosexual behaviour. In his final summation, Silverstein pointed out the psychological consequences of maintaining that homosexuality was a disease: "We are told, from the time that we first recognize our homosexual feelings, that our love for other human beings is sick, childish and subject to "cure." We are told that we are emotional cripples forever condemned to an emotional status below that of the "whole" people who run the world. The result of this in many cases is to contribute to a self-image that often lowers the sights we set for ourselves in life, and many of us asked ourselves, "How could anybody love me?" or "How can I love somebody who must be just as sick as I am?""
Although the committee was impressed by Silverstein's presentation, there was active opposition. An ad-hoc committee organized by Charles Socarides and Irving Bieber, supported by psychoanalytic societies, urged the APA not to revise the DSM-II. By the time the APA convention was held later that year, the political forces on both sides of the debate were fully engaged in the battle over changing the DSM. After a proposal that the matter be settled through a survey of APA's members was rejected, the Council on Research and Development met in October of that year and voted unanimously to delete homosexuality from the DSM-II. Although there was continuing debate over whether a new diagnosis of "sexual orientation disturbance" should take its place (which could apply to heterosexuals and homosexuals alike), the final decision on December 15 was carefully worded to make the decision to delist homosexuality as a mental disorder as neutral as possible. In handing down the decision, Allen Freedman, then-president of the APA stated that the resolution would "help to build a more accommodative climate of opinion for the homosexual minority in our country, a climate which will enable homosexuals to render the maximal contribution to society of which they are capable."
Newspapers across the country announced the decision with headlines such as "Doctors Rule Homosexuals not Abnormal" and "Victory for Homosexuals". Although critics such as Bieber and Socarides remained outspoken in denouncing the decision (and accusing APA of caving in to political pressure), the new perspective on sexual minorities was largely welcomed by the community at large. There was enough opposition to the change for a petition to be circulated among the APA membership calling for a popular vote on the decision. When the vote was finally held in 1974, the Board's decision was ratified.
It wasn't a complete reversal of psychiatric thinking on homosexuality however. When the third revision of the DSM came out in 1980 (DSM-III), a new psychiatric diagnosis was approved: ego-dystonic homosexuality. With diagnostic criteria including: 1.a persistent lack of heterosexual arousal and 2. persistent distress from unwanted homosexual arousal, the new diagnostic label was intended as a compromise to appease those psychiatrists who still felt that changing sexual orientation was a reasonable goal. Gay activists railed against a diagnosis which they felt helped reinforce antigay biases. Since legal and social barriers to acceptance of homosexuals were still strong, couldn't all homosexuals be considered ego-dystonic to some extent? Ego-dystonic homosexuality was completely removed in the revised version of the DSM which came out in 1986 (DSM-III-R). There are still vestiges remaining in the newest version of the DSM under the heading of Sexual Disorder Not Otherwise Specified (a catch-all diagnostic label which includes "Persistent and marked distress about sexual orientation" as one of its criteria although the label is rarely used these days).
Not surprisingly, there was continuing resistance to the changes in how the APA dealt with homosexuality. In 1992, Charles Socarides, Benjamin Kaufman and Joseph Nicolosi founded the National Association for Research and Therapy in Homosexuality (NARTH). Described as a "non-profit, educational organization dedicated to affirming a complementary, male-female model of gender and sexuality”, NARTH's mission statement "offers hope to those who struggle with unwanted homosexuality". Opposing the APA reversal on conversion therapy for changing sexual orientation, NARTH remains affiliated with with religious organizations such as Focus on the Family and PATH (Positive Alternatives to Homosexuality). Despite concerns raised by the American Psychological Association and the Royal College of Psychiatrists that NARTH "creates an environment in which prejudice and discrimination can flourish), the organization remains active. Until his death in 2005, Charles Socarides remained a dominant voice in NARTH's policies as well as being a widely sought authority in civil rights cases opposing liberalization of anti-homosexual legislation.
Despite the opposition from conservative psychiatrists, the mainstream view on homosexuality and conversion therapy has undergone a dramatic shift over the past thirty years. Pioneers such as Evelyn Hooker, Judd Marmor and "Dr. Anonymous" (who since revealed himself as John E. Fryer) lived long enough to see their once-reviled stand on homosexuality as a normal expression of sexuality become accepted. Not coincidentally, that same era has seen a wider change in social and legal acceptance of sexual minorities. Although the struggle still continues (with ongoing controversy over DSM definitions of gender disorders), the American Psychiatric Association and the American Psychological Association have become advocates of gay-affirmative treatment as well as supporting legislative changes. Whether this positive voice will continue in an era of increasing resistance to acceptance of sexual minorities is something that only time will tell.
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