In 1957, psychologist Evelyn Hooker published findings that directly challenged psychiatry's prevailing view of homosexuality. Using standard psychological tests on thirty homosexual men and thirty heterosexual men, all non-clinical subjects, she asked expert clinicians working blind to distinguish the two groups. They could not. The homosexual men showed no greater psychopathology than the heterosexual men.
That result cut against the clinical consensus embedded in the American Psychiatric Association's diagnostic manuals. The DSM-I in 1952 had listed homosexuality under "Sociopathic Personality Disturbances," and the DSM-II in 1968 retained it as a "sexual deviation." Because psychiatrists encountered homosexuality mainly in clinical settings, they often treated its presence as evidence of pathology rather than recognizing that stigma, criminalization, and social punishment were driving many patients into treatment.
By the early 1970s, both research and activism were forcing the issue. Gay activists, including Frank Kameny, confronted the American Psychiatric Association directly, arguing that its diagnosis reflected cultural prejudice rather than science. In 1972, psychiatrist John Fryer appeared before the APA disguised as "Dr. Henry Anonymous" and described the contradiction of a profession labeling gay psychiatrists and patients as disordered without valid evidence. Robert Spitzer, who helped lead the review process, found the emerging empirical case persuasive: homosexuality did not meet the APA's own criteria for mental disorder, since many gay people experienced neither intrinsic distress nor generalized impairment.
In December 1973, the APA's Board of Trustees voted to remove homosexuality from the DSM. In 1974, the full membership upheld that decision by referendum. A new category, "Sexual Orientation Disturbance," applied only to people distressed by their orientation, shifting the focus from homosexuality itself to the conflict imposed by social stigma.
The older classification had justified a range of treatments, from psychoanalysis to aversion therapy and other coercive interventions. Those practices did not disappear immediately, but the diagnostic change marked the collapse of the medical claim that homosexuality was inherently pathological. Later reviews of conversion therapy found no demonstrated benefit and substantial evidence of harm, including depression, anxiety, and suicidality.