For a quarter century beginning in the early 1970s, APA has been involved in a concerted effort to respond positively to the mental health needs of gay patients and the concerns of gay APA members. Yet most of those years-marked by APA's 1973 decision to stop equating homosexuality with psychopathology - remained "trying" ones for those who attempted to effect a similar shift in thinking among psychoanalysts.
For almost all of those 25 years, and despite changes in perceptions about homosexuality by much of the mental health field, leading psychoanalysts did not modify their long-held view that homosexuality was the pathological result of developmental conflicts and had to be resolved if a person was to be considered mentally healthy.
In the last five years, however, psychoanalysts finally began to accept some change, according to psychoanalyst Diana Miller, M.D. Speaking at an APA annual meeting forum in Toronto in June, Miller pointed out that as recently as the 1980s openly gay or lesbian physicians were not eligible to become candidates at training institutes affiliated with the American Psychoanalytic Association unless they agreed to work during an analysis toward heterosexuality. By the mid-1980s they were, however, occasionally accepted by nonmedically oriented training institutes.
Miller is a member of the Los Angeles Institute for Psychoanalytic Studies, which is not affiliated with the American Psychoanalytic Association, and is on the clinical faculty at UCLA.
One of the rare openly gay or lesbian psychoanalytic trainees in the early 1980s, she said she was bombarded at seminars and conferences with "the anxiety and ignorance many analysts demonstrated about homosexuality and by the unconscious alienation many analysts had toward gay and lesbian persons."
In 1987 and again in 1989 the psychoanalytic organization rejected proposals introduced by psychiatrist and psychoanalyst Richard Isay, M.D., to open training positions to gay and lesbian candidates who were open about and content with their sexual orientation. The tenor had shifted somewhat by 1991, she observed, at which time the American Psychoanalytic Association passed a resolution opposing "public or private discrimination" against homosexuals. It stopped short, however, of agreeing to open its training institutes to these individuals.
In April 1992, "after a long history of denials and rationalizations," the psychoanalytic association finally extended the provisions of its 1991 resolution to training candidates at its affiliated institutes, she said. Even at that point, Miller added, the organization's president was denying that any discriminatory policies ever existed or that psychoanalysis had an "official" viewpoint on homosexuality.
In the last six years, there have been several additional signs that the psychoanalytic organization is more open to rethinking its stance on homosexuality and on gay and lesbian analysts, Miller pointed out. It has formed the Committee on Issues of Homosexuality, for example, whose chair, Ralph Roughton, M.D., is the first openly gay training analyst at an institute affiliated with the American Psychoanalytic Association. And at the association's annual meeting, in an event unthinkable not many years ago, a gay analyst presented a gay patient.
A few months ago the American Psychoanalytic Association startled many observers by endorsing a resolution that calls on state legislators to enact statutes granting same-gender couples the legal right to marry.
In the next 25 years Miller hopes to see psychoanalytic training programs revise their curricula to reflect the updated thinking on homosexuality. She also hopes to see educators rewrite the analytic literature to remove "stereotyped, pathologizing views," which are still prevalent. She also called on the American Psychoanalytic Association to write an accurate account of "the story of its own family history" regarding its stance on this subject.