Recalling APA's Historic Step
By Alfred M. Freedman, M.D.
It was with great pleasure that I read a clipping from the Washington Post of December 16, 1999, that had been forwarded to me. Throughout 1999 the newspaper daily published a feature story that appeared on a corresponding date earlier in the 20th century.
For December 16, 1999, the Post in an article titled "Sick No More" reprinted an article that appeared on December 16, 1973, describing the action of APA on December 15, 1973, declaring that "homosexuality by itself does not necessarily constitute a psychiatric disorder."
With the headline "Doctors Rule Homosexuals Not Abnormal," it noted "homosexuality" had been removed from the APA’s DSM-II. This historic act has since been recognized as a landmark in the liberation of views and laws in regard to homosexuality. It is gratifying that this action of APA is considered an outstanding event of the 20th century.
The Board of Trustees’ resolution urged an end to "cruel" private and public discrimination in jobs, housing, and other areas, including repeal of "irrational" laws discriminating against homosexual individuals. It should be noted that the change in nomenclature in the official classification passed the Board of Trustees unanimously with two abstentions, while the accompanying civil rights resolution passed with one abstention.
That period from the late 1960s through the early 1970s was a time of ferment with the introduction of new ideas including those concerning sexual orientation. There was pressure from both within and without APA for a new look at men and women "whose sexual interests are directed primarily to people of the same sex."
The gay community had become more vocal and assertive following the "Stonewall uprising" in June 1969 in New York, in which the gay community demonstrated against a police raid on a gay bar called the Stonewall Inn.
In the APA elections of 1972 and 1973 concern over social issues brought in a number of individuals as members of the Board of Trustees who were committed to change, including removal of homosexuality per se from the official APA nomenclature. As a matter of fact, at the meeting of the newly elected Board in Hawaii in May 1973, the late Dr. Jack Weinberg made a motion to make the change in DSM-II, but while it was evident that the motion might pass, it was felt by the Board that input from the Assembly and other components of APA as well as a recommendation from the Task Force on Nomenclature was necessary.
However, major credit must be attributed to Dr. Robert Spitzer for the action of the Board.
Dr. Spitzer was a member of the Task Force on Nomenclature, chaired by Dr. Henry Brill. Dr. Spitzer had been in contact with gay activists who appeared at meetings in New York. He organized a symposium at the APA annual meeting in Hawaii with representatives from all sides including gays and lesbians. Dr. Spitzer concluded from this meeting that action was necessary. He brought the issue to the attention of Dr. Brill who then assigned Dr. Spitzer the task of preparing a resolution and a memo ensuring that the document to be presented was scientifically sound and persuasive.
It should be noted that the resolution had already been approved by the Council on Research and Development, the Reference Committee, and the Assembly. Yet in order to obtain passage of the resolution, certain compromises had to be made to secure unanimity of the Board. Thus, the recommendation of the task force that homosexuality is "a normal variant of human sexuality" was rejected by the Board.
The Board changed the wording of the task force that homosexuality "by itself does not constitute a psychiatric disorder" to "does not necessarily constitute a disorder." The unanimous approval by the Board of Trustees made history, and for most of us on the Board it was gratifying moment and one of the high points of my APA presidency.
A group of psychoanalysts then filed a petition for a referendum to reverse the action of the Board. The referendum was held during the regular APA election, and the Board action was supported by 58 percent of the voters, with 37.8 percent in favor of overturning the action out of slightly more than 10,000 voting.
The action of the APA Board of Trustees ushered in a new understanding of homosexuality that had great influence not only on APA members but also the public in general. Yet many alterations were made in successive editions of the DSM. Thus, DSM-III included "ego dystonic homosexuality" under the general category of psychosexual disorders. In DSM-III-R that category was deleted, and homosexuality no longer appeared, remaining absent in DSM-IV.
APA’s historic 1973 action helped the further recognition of homosexual citizens as deserving of the same rights and protection as everyone else. In the decades since 1973, great progress has been made in reducing discrimination against homosexuals and in their increasing acceptance as ordinary valued citizens, even though discrimination and violence against them do persist. Much must still be done, and psychiatrists will no doubt play a key role in these endeavors.
Dr. Freedman is a former president of APA.