Homosexuality is a mental illness or psychological disorder that can and should be treated.
Homosexuality is a normal variation of human sexuality. The American Psychiatric Association removed it from the DSM in 1973. 'Conversion therapy' has since been shown to cause harm with no demonstrated benefit.
What changed?
In 1956, psychologist Evelyn Hooker walked into a conference room at the National Institute of Mental Health and presented data that should have been unremarkable but was, in its context, explosive. She had administered a standard battery of psychological tests, including the Rorschach inkblot test and the Thematic Apperception Test, to thirty homosexual men and thirty heterosexual men, all non-clinical subjects, none of whom had sought psychiatric help. She then asked expert clinicians, working blind, to distinguish the two groups by their test results. The clinicians could not do it. The psychological profiles of the homosexual men were indistinguishable from those of the heterosexual men.
The finding struck at the foundation of the prevailing clinical model. American psychiatry in the postwar era had inherited from Freudian theory the idea that homosexuality was a developmental arrest, an incomplete movement through the stages of psychosexual development, producing a fixated personality marked by pathology, narcissism, and an inability to form mature relationships. This was not fringe thinking. The American Psychiatric Association's first Diagnostic and Statistical Manual, published in 1952, listed homosexuality under "Sociopathic Personality Disturbances." The DSM-II, in 1968, retained it, categorizing homosexuality as a "sexual deviation", the same category that included pedophilia and fetishism.
Psychiatrists who accepted these diagnostic categories treated homosexual patients accordingly. The treatments ranged from psychoanalysis aimed at uncovering the childhood trauma presumed to underlie the deviation to more aggressive interventions: chemical castration, aversion therapy using electrical shock paired with homoerotic imagery, and in some institutions, lobotomy. These techniques were employed in state hospitals, Veterans Administration facilities, and private practices. The reasoning was circular in a way that proved difficult to dislodge: if homosexuality caused distress and impairment, it must be a disorder; if it was a disorder, distress and impairment were what the clinician should expect to find and treat.
Hooker's data challenged the first premise. If non-clinical homosexual men, men who had never sought psychiatric care, showed no measurable psychological differences from heterosexual men, then homosexuality was not, in itself, a source of dysfunction. The distress that clinical patients reported was consistent with the consequences of living as a stigmatized minority in a society that criminalized their behavior, not with an intrinsic disorder the DSM had codified.
Hooker's research appeared in 1957 in the Journal of Projective Techniques. It was largely ignored by mainstream psychiatry for fifteen years.
The shift came through a combination of scientific accumulation and political disruption. By the early 1970s, sociologist Laud Humphreys had published research documenting the ordinary, socially integrated lives of gay men outside clinical populations. Alfred Kinsey's surveys had already suggested that same-sex behavior was far more common than the pathological model implied. And gay activists, emboldened by the Stonewall uprising of 1969, began appearing directly at psychiatric conferences, first to protest, then to present data and arguments.
In December 1973, the American Psychiatric Association's Board of Trustees voted to remove homosexuality from the DSM. Robert Spitzer, the psychiatrist who had managed the revision process, proposed replacing it with a category called "Sexual Orientation Disturbance," applying only to individuals who were distressed by their orientation, a formulation that located the disorder in the conflict with social stigma, not in the orientation itself. The full APA membership ratified the board's decision by referendum in 1974, with 58 percent in favor.
What Hooker had demonstrated in 1956 with a blind test that expert clinicians failed took seventeen years to reach a formal diagnostic conclusion. The treatments employed in the interval, aversion therapy, hormone injections, surgical interventions, left records in medical charts across the country.
