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How Psychiatry Has Fed Modern-Day Homophobia

Heteronormative institutions thrive on the control of sexuality to protect such sexual practices that may be necessary for the reproduction of the dominant structures of power. The anxiety created in the gatekeepers of patriarchal power by the channelisation of sexual behaviour in any subversion from reproductive consequences drive structural efforts for suppression and annihilation. By virtue of the same politics, the institution of psychiatry has been historically used as the laboratory for a systematic attempt to “control,” “correct” and “cure” homosexuality, rooted strongly within narratives of violence,  backed by an agenda of restoring patriarchal, heteronormative order in the society and abnormalising homosexuality in various ways for their non-conformity.

The Indian Psychiatric Society recently released a Position Statement on homosexuality that read “Homosexuality is not a psychiatric disorder and we recognise same-sex sexuality as a normal variant of human sexuality much like heterosexuality and bisexuality”. While the stance is highly encouraging, especially in the wake of the hearings in the Supreme Court regarding the Constitutionality of Section 377 of the IPC, psychiatry in itself has had a long, complex history of aligning itself with the “normal variant” position. This article attempts to state this history briefly by looking at the various manifestations of Psychiatry’s stance on Homosexuality through its apex body, the American Psychiatric Association.

Locating Homosexuality in Psychiatric Discourse

The location of homosexuality within the psychiatric discourse is historicized in religion. Religious opinion of homosexuality forms the comparative ground from which psychiatric explorations started, mostly to depart from this opinion in a “scientific,” “rational,” “objective” manner.
Ronald Bayer briefly discusses the religious history of the homosexuality discourse by pointing out that the nature of anatomical design itself seemed to reveal a “Divine plan” for the morally acceptable use of sexual organs. This understanding influenced the interpretation that sexual desire, therefore, is only in the service of procreation, as human strength was the only source of power available for the domestication of nature. Diversion from this procreative purpose of sex was not only considered a violation of God’s will, but also against the task of human survival.

This idea has become the basis for the religious position of homosexuality, often condemned by fora for religious dissemination such as the Church. Bayer also says that in this discourse on Homosexuality, it was spoken of in the language of “sin” and a fear psychosis was propagated to emphasise that cities that failed to get rid of practices shall be punished with natural disasters, a fear carried well into the Middle Ages.

With the rise of the modern State, a political will to persecute homosexuality also arose, thus now extending this language of morality to secular law. And it was this same fear that made homosexuality a “punishable offence” under the regime of Henry VIII of England. He did this by removing it from the jurisdiction of ecclesiastical courts and placing it under state law, declaring it a “detestable and abominable vice,” to be punished by death. This death penalty remained a matter of statute till 1861, when the Offenses Against Persons Act was passed, reducing the punishment to a maximum of ten years’ imprisonment. It was in the background of this moral discourse that the “scientific” study of homosexuality began in the 19th century with the objective of departing from the “pre-modern” emphasis on morality to contemporary categories of analysis such as “health” and “pathology.”

Jack Drescher traces the history of homosexuality as psychiatric diagnosis by formulating the etiological theories of homosexuality into three broad categories according to the research done. These categories and their assumptions are:

1) Theories of Normal Variation

These theories understand homosexuality as a naturally occurring phenomenon. The idea of people being “born gay” in contemporary culture falls under the theory of normal variation. Since these theories equate ‘the normal’ with ‘the natural’, they do not see a place for homosexuality in the Diagnostic and Statistical Manual of Psychiatry. This view of homosexuality was held by, for instance, Hungarian journalist Karoly-Maria Kertbeny, who first coined the terms “homosexuality” and “homosexual” in response to the Paragraph 143 (a Prussian law later codified in Germany’s Paragraph 175) that criminalised homosexual behaviour. Kertbeny proposed that homosexuality was inborn and unchangeable and therefore merely a normal variation, and he opposed the moralising attitudes that led to the passage of the sodomy laws.

2) Theories of Pathology

Proponents of these theories believe that homosexuality is a disease, a condition of deviance from the standard, heterosexual development. They understand that feelings atypical of gender behaviour are symptoms of a disease, caused by internal or external pathogenic agents, either prenatally or postnatally. Thus, the ‘condition’ requires the attention of mental health professionals. An example of such an approach would be the one offered by Richard von Krafft-Ebing, a German Psychiatrist, who considered homosexuality a “degenerative” disorder. Though he conceded that one might be “born gay” with a ‘homosexual predisposition’, he believed the condition should be considered a congenital disease.

3) Theories of Immaturity

These theories regard homosexuality as a feeling or behaviour (occurring at a young age) as normal a step as moving toward adult heterosexuality, fundamentally, a ‘phase’ that one ‘outgrows’. However, in adulthood, it is seen as “developmental arrest”. The belief is that homosexuality is relatively benign or unharmful. There is no suggestion of it being disordered or evil as theories of pathology might propose. A proponent of such theories would be Sigmund Freud who held the belief that everyone is born with bisexual tendencies and an expression of homosexuality can be a normal, passing phase of heterosexual development.

Changing Institutional Stances on Homosexuality

Drescher reflects that after the 20th century, most psychiatrists took a pathological stand towards homosexuality, including many who believed the psychoanalytical lens can be used to offer “cures” for homosexuality. They mostly alluded to the work of Rado, a Hungarian immigrant to the USA, whose theories had a major influence on American psychiatry and psychoanalytic thought. He was of the opinion that there was nothing like innate bisexuality or normal homosexuality, in contrast to Freud. He considered homosexuality as a phobic avoidance of the other sex caused by inadequate parenting. The newer generations of psychoanalysts also viewed developmental arrest in homosexual persons as being less benign than Freud. Such discourses that pathologised homosexuality sanctioned the use of “cure” studies.

At the same time, sexologists had focused their explorations on sexualities, more on non-patient populations than following the footsteps of clinicians who wrote their findings from biased self-selected samples in the clinical settings. Alfred Kinsey’s research in the studies called “Sexual Behaviour in the Human Male” and “Sexual behaviour in the Human Female” point to the findings about the large prevalence of homosexuality among the population, in contrast to what psychiatry maintained. However, American psychiatry ignored the vast body of literature produced in the field of sexology. It was in this period that the APA published its first edition of the DSM, which classified homosexuality as a “sociopathic personality disturbance” (American Psychiatric Association, 1952). In the next edition of the DSM (1968), homosexuality was re-classified as a “sexual deviation”. However, by 1970, the advocacy of the scientific community for a non-pathological view of homosexuality was brought to the attention of the APA. Bayer notes that factors that were both internal and external to the APA were responsible for this reconceptualisation of homosexuality in the DSM. Some of these factors included (i) the growing opposition to psychiatry vis-à-vis the new findings of research in other fields, (ii) the change in the leadership of the APA comprising younger leaders with greater social consciousness, and (iii) some opposition within psychology itself. However, the most significant voice in opposition was LGBTQ activism, especially in the aftermath of the Stonewall Riots in New York City. Gay and lesbian activists, who considered psychiatric theories as fuelling anti-homosexual stigma, disrupted the 1970 and 1971 annual meetings of the APA. This compelled the APA to rethink its position on homosexuality. It constituted two educational panels which made groundbreaking discoveries about the social consequences of the diagnostic views on homosexuality.

In light of these protests, the 1973 APA annual meeting opened the floor for deliberations on the question of whether homosexuality should be in the APA nomenclature, and shortly after published the proceedings in the American Journal of Psychiatry. The Nomenclature Committee of the APA was also rethinking the very definition of ‘mental disorder’ itself and after much deliberation concluded that “with the exception of homosexuality and perhaps some of the other ‘sexual deviations,’ they all regularly caused subjective distress or were associated with generalized impairment in social effectiveness of functioning’’. Following the new definition of mental disorder, homosexuality was not included as being one. After the review of the proceedings of the Nomenclature Committee by the other committees of the APA, the Board of Trust (BOT) proposed the removal of homosexuality from the DSM, which was upheld by 58% of the voting members. Further, the APA devised a position paper supporting civil rights protection for and condemning the discrimination and violence against homosexual persons. Though this ended the American classification of homosexuality as an illness, it did not mean that the APA was endorsing a normal variant model of homosexuality in place of a pathological model. An excerpt from their position paper cited by Drescher clarifies their stand as follows:

No doubt, homosexual activist groups will claim that psychiatry has at last recognised that homosexuality is as ‘‘normal’’ as heterosexuality. They will be wrong. In removing homosexuality per se from the nomenclature, we are only recognising that by itself homosexuality does not meet the criteria for being considered a psychiatric disorder. We will in no way be aligning ourselves with any particular viewpoint regarding the aetiology or desirability of ‘homosexual behaviour’” (American Psychiatric Association, 1973, pp. 2–3).

Psychiatry’s disenchantment with homosexuality was far from over, though. The DSM-II created a new diagnostic category called Sexual Orientation Disturbance (SOD) in place of homosexuality, suggesting that people unhappy with their sexual orientation to the point of it causing them distress could seek change, legitimising the practice of sexual conversion therapies. In 1980, widespread opposition to SOD caused APA to drop it from the DSM, however replacing it with Ego Dystonic Homosexuality in the DSM-III. This constant effort of the APA to subliminally reinterpret the pathologisation of homosexuality was called out during the review meeting for DSM-III which caused the removal of Ego Dystonic Homosexuality from the DSM-III-R in 1987. Drescher believes that in doing so, the APA accepted a standard variant view of homosexuality for the first time in 14 years.

While psychiatry has institutionally declassified homosexuality as a mental disorder for more than four decades now, apparently the stance has hardly translated into psychiatric practice. As with heteronormative patriarchal control of all institutions, psychiatry has continued to be influenced by procreative ideas of the body and the mind. As such, society continues to locate people identifying as ‘homosexual’ as subjects for “cure” rather than for “care.” While this raises several questions regarding the politics and sociology of “science,” it probably also opens up the opportunity for amends, indicating that Science does have the scope for those. The Indian Psychiatric Society’s latest stance on homosexuality is perhaps a formal recognition of the need for these amends, the urgency for this translation. The only thing that remains to be seen in the light of the historic hearings at the Supreme Court on the Constitutionality of Section 377 of the IPC is whether psychiatry’s attempts to present its case bear just consequences and they then give it the legal responsibility of undoing its own past.

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