Modern attitudes toward homosexuality have religious, legal, and medical underpinnings. Before the High Middle Ages, homosexual acts appear to have been tolerated or ignored by the Christian church throughout Europe. Beginning in the latter twelfth century, however, hostility toward homosexuality began to take root, and eventually spread throughout European religious and secular institutions. Condemnation of homosexual acts (and other nonprocreative sexual behavior) as "unnatural," which received official expression in the writings of Thomas Aquinas and others, became widespread and has continued through the present day (Boswell, 1980). [Bibliographic references are on a different web page ]
Religious teachings soon were incorporated into legal sanctions. Many of the early American colonies, for example, enacted stiff criminal penalties for sodomy, an umbrella term that encompassed a wide variety of sexual acts that were nonprocreative (including homosexual behavior), occurred outside of marriage (e.g. sex between a man and woman who were not married), or violated traditions (e.g. sex between husband and wife with the woman on top). The statutes often described such conduct only in Latin or with oblique phrases such as "wickedness not to be named"). In some places, such as the New Haven colony, male and female homosexual acts were punishable by death (e.g. Katz, 1976).
By the end of the 19th century, medicine and psychiatry were effectively competing with religion and the law for jurisdiction over sexuality. As a consequence, discourse about homosexuality expanded from the realms of sin and crime to include that of pathology. This historical shift was generally considered progressive because a sick person was less blameful than a sinner or criminal (e.g. Chauncey, 1982/1983; D'Emilio & Freedman, 1988; Duberman, Vicinus, & Chauncey, 1989).
Even within medicine and psychiatry, however, homosexuality was not universally viewed as a pathology. Richard von Krafft-Ebing described it as a degenerative sickness in his Psychopathia Sexualis. but Sigmund Freud and Havelock Ellis both adopted more accepting stances. Early in the twentieth century, Ellis (1901) argued that homosexuality was inborn and therefore not immoral, that it was not a disease, and that many homosexuals made outstanding contributions to society (Robinson, 1976).
Although dispassionate scientific research on whether homosexuality should be viewed as an illness was largely absent from the fields of psychiatry, psychology, and medicine during the first half of the twentieth century, some researchers remained unconvinced that all homosexual individuals were mentally ill or socially misfit. Berube (1990) reported the results of previously unpublished studies conducted by military physicians and researchers during World War II. These studies challenged the equation of homosexuality with psychopathology, as well as the stereotype that homosexual recruits could not be good soldiers.
A common conclusion in their wartime studies was that, in the words of Maj. Carl H. Jonas, who studied fifty-three white and seven black men at Camp Haan, California, "overt homosexuality occurs in a heterogeneous group of individuals." Dr. Clements Fry, director of the Yale University student clinic, and Edna Rostow, a social worker, who together studied the service records of 183 servicemen, discovered that there was no evidence to support the common belief that "homosexuality is uniformly correlated with specific personality traits" and concluded that generalizations about the homosexual personality "are not yet reliable."
Today. a large body of published empirical research clearly refutes the notion that homosexuality per se is indicative of or correlated with psychopathology. One of the first and most famous published studies in this area was conducted by psychologist Evelyn Hooker.
Hooker administered three projective tests (the Rorschach, Thematic Apperception Test [TAT], and Make-A-Picture-Story [MAPS] Test) to 30 homosexual males and 30 heterosexual males recruited through community organizations. The two groups were matched for age, IQ, and education. None of the men were in therapy at the time of the study.
Unaware of each subject's sexual orientation, two independent Rorschach experts evaluated the men's overall adjustment using a 5-point scale.
They classified two-thirds of the heterosexuals and two-thirds of the homosexuals in the three highest categories of adjustment. When asked to identify which Rorschach protocols were obtained from homosexuals, the experts could not distinguish respondents' sexual orientation at a level better than chance.
A third expert used the TAT and MAPS protocols to evaluate the psychological adjustment of the men. As with the Rorschach responses, the adjustment ratings of the homosexuals and heterosexuals did not differ significantly.
Hooker concluded from her data that homosexuality is not a clinical entity and that homosexuality is not inherently associated with psychopathology.
Hooker's findings have since been replicated by many other investigators using a variety of research methods. Freedman (1971), for example, used Hooker's basic design to study lesbian and heterosexual women. Instead of projective tests, he administered objectively-scored personality tests to the women. His conclusions were similar to those of Hooker.
Although some investigations published since Hooker's study have claimed to support the view of homosexuality as pathological, they have been methodologically weak. Many used only clinical or incarcerated samples, for example, from which generalizations to the population at large are not possible. Others failed to safeguard the data collection procedures from possible biases by the investigators for example, a man's psychological functioning would be evaluated by his own psychoanalyst, who was simultaneously treating him for his homosexuality.
Some studies found differences between homosexual and heterosexual respondents, and then assumed that those differences indicated pathology in the homosexuals. For example, heterosexual and homosexual respondents might report different kinds of childhood experiences or family relationships. It would then be assumed that the patterns reported by the homosexuals indicated pathology, even though there were no differences in psychological functioning between the two groups.
The weight of evidence
Removal from the DSM
In 1973. the weight of empirical data, coupled with changing social norms and the development of a politically active gay community in the United States, led the Board of Directors of the American Psychiatric Association to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Some psychiatrists who fiercely opposed their action subsequently circulated a petition calling for a vote on the issue by the Association's membership. That vote was held in 1974, and the Board's decision was ratified.
Subsequently, a new diagnosis, ego-dystonic homosexuality. was created for the DSM's third edition in 1980. Ego dystonic homosexuality was indicated by: (1) a persistent lack of heterosexual arousal, which the patient experienced as interfering with initiation or maintenance of wanted heterosexual relationships, and (2) persistent distress from a sustained pattern of unwanted homosexual arousal.
This new diagnostic category, however, was criticized by mental health professionals on numerous grounds. It was viewed by many as a political compromise to appease those psychiatrists mainly psychoanalysts who still considered homosexuality a pathology. Others questioned the appropriateness of having a separate diagnosis that described the content of an individual's dysphoria. They argued that the psychological problems related to ego-dystonic homosexuality could be treated as well by other general diagnostic categories, and that the existence of the diagnosis perpetuated antigay stigma.
Moreover, widespread prejudice against homosexuality in the United States meant that many people who are homosexual go through an initial phase in which their homosexuality could be considered ego dystonic. According to the American Psychiatric Association. "Fears and misunderstandings about homosexuality are widespread. [and] present daunting challenges to the development and maintenance of a positive self-image in gay, lesbian and bisexual persons and often to their families as well."
In 1986, the diagnosis was removed entirely from the DSM. The only vestige of ego dystonic homosexuality in the revised DSM-III occurred under Sexual Disorders Not Otherwise Specified, which included persistent and marked distress about one's sexual orientation (American Psychiatric Association, 1987; see Bayer, 1987, for an account of the events leading up to the 1973 and 1986 decisions).
Text of APA resolutions