Today we celebrate and recognize the 47th anniversary of homosexuality being delisted as a mental disorder by the American Psychiatric Association. Of course, there was and continues to be much work to be done for the LGBTQ+ in relation to the field of medicine. However, today we want to focus on the wins over the last century and how our movement went from a group of so-called insane, sexual deviants, to a thriving, openly queer revolution. And as we look back on this year and the devastating effects of COVID-19, we want to dedicate this episode to the frontline healthcare workers who have remained in the trenches against insurmountable odds. Your work and your sacrifices are seen and appreciated.

Thank you frontline healthcare workers
We want to dedicate this episode to the frontline healthcare workers who have remained in the trenches against insurmountable odds. Your work and your sacrifices are seen and appreciated. Image Source

But now we launch into a complicated and tumultuous relationship that has spanned nearly 150 years of medicine. Beginning with the 1869 coining of the term homosexual by journalist and activist Karl-Maria Kertbeny. Prior to this time period, sodomy laws ruled the day. After the Christian Church’s worldwide crusade to outlaw queer identities, most countries had implemented severe punishments for acts of sodomy or sapphic practices. But Kertbeny began to anonymously campaign for the decriminalization of LGBTQ+ people and his advocacy soon reached the ears of prominent physicians of the time. Including the well-known sexologist Karl Heinrich Ulrich.

Karl Heinrich Ulrich
Karl Heinrich Ulrich, Image Source

Ulrich was actually a jack of all trades. He held the titles of lawyer, activist, writer, journalist, and eventually sexologist. Sexology is the scientific study of human sexuality and the field is somewhat outdated in modern medicine. However, throughout the end of the 19th century and well into the 20th, the medical field was booming with the likes of Sigmund Freud, Richard von Kraft-Ebbing, and Magnus Hirschfeld. Ulrich made the term homosexuality popular as he traveled the world educating doctors, journalists, and law makers on same sex attraction. He was one of the earliest individuals to have a public “coming out” in an era that now saw LGBTQ identities as abnormal or something to be hidden. It was largely due to his efforts that the field of sexology and the focus on queer identities began to pique the interest of the medical field.

But every time there’s a hero there is also a villain and while Karl Ulrich worked to show that queer people were not criminals or deviants, he met his counterpart in Richard von Krafft-Ebbing. Ebbing was the first to use the term homosexual in his writings, only Ebbing believed that queer people were mentally disturbed. This showed through in his 1886 book title, Psychopathia Sexualis. His book also popularized the terms sadist, masochist, bisexual, and necrophilia. In his beliefs, Ebbing saw all of these as variations of the same type of mental disorder. He advocated for consideration of a sex deviants disease during sentencing but firmly held that these people were dangerous. His works would be used for nearly a century to justify the imprisonment and later institutionalization of LGBTQ+ people.

Richard von Krafft-Ebbing
Richard von Krafft-Ebbing was the first to use the term homosexual in his writings, only Ebbing believed that queer people were mentally disturbed, Image Source

Yet though Ebbing’s works were kept on hand by bigots and fear mongers, it would be Magnus Hirschfeld and Sigmund Freud who truly captivated the medical world and remain celebrated figures to this day. The two men had different approaches to queer identities, though they certainly veered far from Ebbing’s stunted beliefs. For his part, Hirschfeld was quite the advocate and educator, issuing his first pamphlets on gay love in 1896. Sappho and Socrates explained the naturalness of same-sex attraction. The physician was quite moved by his gay patients and the fact that so many either committed suicide or attempted suicide. He believed that science and fact could shift public opinion of homosexuality. And in some respects he was right but he underestimated the power of unfounded fear and hate.

As Magnus worked for equality for gays and lesbians in Germany, a young neurologist was building the new field of psychology. Sigmund Freud has possibly been the most frustrating, large player, in a queer history of medicine. His desire to over-analyze everything combined with wide generalizations left a lot of confusion in the realm of sexual identities. It also laid the foundation for many of the stereotypes around queer people which further muddied the waters of treatment and therapy. Freud believed that every person was made up of both genders and therefore every person was born bisexual. It was our nature or nurture that lead an individual to the path of homosexuality or heterosexuality.

Sigmund Freud
Sigmund Freud believed that every person was made up of both genders and therefore every person was born bisexual, Image Source

Though Freud did not see queer identities as inherently wrong, it wouldn’t be fair to say he saw them as normal. Heterosexual, cisgender identities were certainly the preferred way and this shone through in the sympathetic way he spoke about LGBTQ people. Freud was also a proponent of inversion theory - the idea that people are gay because they are really transgender. This theory had been made popular by sexologist Havelock Ellis (originally credited with coining the term homosexuality; however, that is not true). Ellis and Hirschfeld were hard at work on early transgender theory and treatment. But while Magnus saw gender identity and sexual orientation as separate, Ellis conflated the two. Freud’s preference and promotion of Ellis’s writings would add fuel to the sweeping studies and lectures on inversion theory.

In 1914, Magnus Hirschfeld published possibly the most comprehensive study of Queer culture of the first half of the 20th century.  The Homosexuality of Men and Women tracked cases and stories of LGBTQ+ people in countries all around the world. Hirschfeld wanted to prove the queer people had always existed. The book should have been a bombshell and was somewhat popular, but the outbreak of World War I greatly stunted its outreach. When the war ended, Magnus went back to work advocating for queer communities. He had coined the term transvestite in 1910 and continued to develop his theories around gender identity. By the 1930s, he had organized the First Congress for Sexual Reform, started the Institute for Sexual Sciences, and categorized 64 different variations of orientation and identity. During this brief period of queer utopia in Berlin, Hirschfeld and his team were even able to issue certificates to transgender individuals which allowed them to freely express their gender without social harassment.

Magnus Hirschfeld
In 1914, Magnus Hirschfeld published possibly the most comprehensive study of Queer culture of the first half of the 20th century; The Homosexuality of Men and Women. Image Source

But Hitler’s rise brought the sexual revolution of Berlin to an end and the institute was destroyed by Nazi soldiers. Hirschfeld would pass away in 1935 leaving behind an incredible legacy. However, in America, a new wave had swept the medical field’s treatment of queer people. Now it seemed that every doctor, psychiatrist, and local hack was seeking a cure for the disease. Throughout the 1920s the advocacy to decriminalize homosexuality had resulted in lighter prison sentences, though often accompanied by a public outing and harsh fines. Another requirement was a psychological evaluation that included a stay in an institution and sometimes resulted in castration. The studies around homosexuals and transvestites had allowed people to realize they weren’t alone. But the prospect of remaining this way had driven countless individuals, along with their friends and family, to seek a cure for the disease.

Plenty of bizarre experiments became a result of the desire to cure the mental disorder. The 1920s saw a brief spike in testicular transplants; in which a gay man was castrated and then refitted with “straight” testicles. The 1930s saw the emergence of the lobotomy cure; in which an icepick was placed in the individual’s eye socket until it hit their frontal lobe and then tapped with a small hammer. The most popular forms of treatment though were talk therapy combined with electroshock. Here a therapist would interview the queer person for hours before eventually hooking them up to electrodes that attempted to shock the gay away. These methods would later be toned down to resemble the aversion therapy techniques we still see today. In these scenarios, a person is perhaps given a pill that makes them vomit or forced to inhale foul smells as they look at images or discuss experiences where they indulged their queer identity.

Queer electroshock therapy
The most popular forms of treatment though were talk therapy combined with electroshock. Image Source

The 1952 Diagnostic and Statistical Manual was the first edition published and classified homosexuality as a “sociopathic, personality disturbance”. Interestingly, this classification came after Alfred Kinsey’s 1948 study on male sexuality which showed consistent gay and bisexual traits in at least 10% of the population. Kinsey would follow up with a study on women in the early 50s and Dr. Evelyn Hooker would release groundbreaking research on gay men in 1953. But while most other doctors and therapists had turned to treating LGBTQ people like lab rats, Dr. Hooker very much resembled Magnus Hirschfeld in her efforts to destigmatize and legalize same-sex relationships. Her work, along with that of many LGBTQ activists, say a slight reduction in the classification of homosexuality in the 1968 revision of the DSM. The Diagnostic and Statistical Manual II labeled gays and lesbians as sexual deviants - a term that had become popular during the height of the McCarthy era.

While Hooker and Kinsey worked on LGB awareness and freedoms, another doctor was joining the foray. In 1966, Dr. Harry Benjamin published The Transsexual Phenomenon, a watershed book in queer medicine and queer history. Benjamin had sort of become a celebrity surgeon after his work on “blonde bombshell” Christine Jorgenson. It was because of this that he drew the attention of transgender philanthropist Reed Erikson. Reed not only sought treatment from Benjamin, but he also funded much of Harry’s work and research. With these three powerhouses in the field of sexology, the world of medicine and its interpretation of LGBTQ+ identities began to shift in favor of the queer community. Hospital wings and research labs sprang up as funding poured in to understand this new concept of orientation and gender identity. The Gay Rights movement launching in late 1969 brought even more awareness and attention in the medical field.

On December 15, 1973, the American Psychological Association voted to delist homosexuality as a mental disorder. It would be another 14 years until same-sex attraction was removed entirely from the DSM and nearly 20 years before the World Health Organization removed homosexuality from its list of illnesses and disorders. Sadly, trans identities were added to the DSM in the early 80s and would remain there until 2013, and only just last year WHO remove gender identity disorder from its mental health classifications. While there is still some work to do, these wins are huge for the LGBTQ+ community. For more than 100 years doctors and nurses have continued to be some of our biggest allies and supporters - as well as some of our biggest obstacles. But as complicated as this relationship has been, we can undoubtedly thank our health workers for where we are today.

Your recommended resources are a talk given by Samual Brinton and their experience in conversion therapy. It is available on YouTube and linked on our script. If you are in the medical field we suggest the manual Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. And if you’re looking for a good book on queer history, check out Magnus Hirschfeld: The Origins of the Gay Liberation Movement by Ralf Dose.

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Clips to Watch

Harry Benjamin and the birth of HRT
Evelyn Hooker
People Take The Kinsey Test
A Brief History of Gay Conversion Therapy | Queer 101 | The Advocate

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References

Out of DSM: Depathologizing Homosexuality
In 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM). This resulted after comparing competing theories, those that pathologized ...
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Terminology of homosexuality - Wikipedia
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Karl Heinrich Ulrichs - Wikipedia
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Richard von Krafft-Ebing - Wikipedia
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Magnus Hirschfeld - Wikipedia
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Sigmund Freud - Wikipedia
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When Homosexuality Stopped Being a Mental Disorder
Not until 1987 did homosexuality completely fall out of the DSM.
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Hidden from history? A brief modern history of the psychiatric “treatment” of lesbian and bisexual women in England
It is well documented that homosexuality was classified as a mental illness in theDSM until 1973, when it was replaced with the diagnosis of “sexual orientation disturbance”.While it is widely known that homosexual men were criminalised and risked a spellin prison or aversion therapy in a psychia…
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Gay Conversion Therapy’s Disturbing 19th-Century Origins
In the late 19th century, psychiatrists and doctors began to label same-sex desire in medical terms—and looking for ways to reverse it.
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Where Transgender Is No Longer a Diagnosis
Denmark becomes the first country to declassify it as a mental disorder
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