Wednesday, June 18, 2014

The declassification of homosexuality as a mental disorder by American Psychiatric Association in 1973 remains a significant moment in the history of psychiatry, not simply from the perspective of human rights but also because it forced psychiatrists to confront the complex and deep-seated conceptual issue of what it means to say that a condition is a 'mental disorder'. It was following this debate that DSM under Robert Spitzer, for the first time, attempted to provide a definition of mental disorder. Also, what is less apparent to many is how politically-driven APA's decision was. What is seemingly a scientific question, the pathology or non-pathology of homosexuality, was eventually settled by a democratic vote, a referendum of the full APA membership, following a bitter controversy.

Homosexuality and American Psychiatry: The Politics of Diagnosis by Ronald Bayer is a political analysis of this historic event. It recounts in details the socio-political background and the events which led to this decision, and the fierce debates within the discipline which all but fractured the psychiatric community. For anyone interested in the topic, it is a highly recommended book.

Ronald Bayer explains in the introduction why he chose a primarily political vantage point for this analysis:

"To assume that there is an answer to this question that is not ultimately political is to assume that it is possible to determine, with the appropriate scientific methodology, whether homosexuality is a disease given in nature. I do not accept that assumption, seeing in it a mistaken view of the problem. The status of homosexuality is a political question.... It requires a political analysis."

The philosophical significance of the debate is explained by Bayer as well. Again, I quote:

"For psychiatrists engaged in clinical work, the extent to which normative considerations inform contemporary definitions of mental health and illness remain largely an unexamined matter.... Only when their conventional orientations have been challenged by extraordinary occurences have therapists been forced to assume a more self-reflective posture. The dispute over the status of homosexuality as a psychiatric disorder did just that, compelling many clinicians to confront the extent to which social values frame the most basic elements of their professional work."

For this reason the case of homosexuality is an excellent case study to investigate the ways in which medical diagnoses are shaped by social and political considerations.

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