The A.P.A. Normalization of Homosexuality, and the Research Study of Irving Bieber
"Dr. Bieber was one of the key participants in the historical debate which culminated in the 1973 decision to remove homosexuality from the psychiatric manual.
His paper describes psychiatry's attempt to adopt a new "adaptational" perspective of normality. During this time, the profession was beginning to sever itself from established clinical theory--particularly psychoanalytic theories of unconscious motivation--claiming that if we do not readily see "distress, disability and disadvantage" in a particular psychological condition, then the condition is not disordered.
On first consideration, such a theory sounds plausible. However we see its startling consequences when we apply it to a condition such as pedophilia. Is the happy and otherwise well-functioning pedophile "normal"? As Dr. Bieber argues in this article, psychopathology can be ego-syntonic and not cause distress; and social effectiveness-‹that is, the ability to maintain positive social relations and perform work effectively--"may coexist with psychopathology, in some cases even of a psychotic order."...
Dr. Bieber describes the deletion of homosexuality from the American Psychiatric Association's diagnostic and statistical manual as "the climax of a sociopolitical struggle involving what were deemed to be the rights of homosexuals."
Gay activist groups believed that prejudice against homosexuals could be extinguished only if, as homosexuals, they were accepted as normal. "They claimed that homosexuality is a preference, an orientation, a propensity; that it is neither a defect, a disturbance, a sickness, nor a malfunction of any sort." To promote this aim, Dr. Bieber reports, "Gay activists impugned the motives and ridiculed the work of those psychiatrists who asserted that homosexuality is other than normal."
A task force was set up to study homosexuality, but the members chosen included not a single psychiatrist who held the view that homosexuality was not a normal adaptation. There followed riots at scientific meetings by gay activists who increased the pressure on the Psychiatric Association.
Will preventive therapy for homosexuality be prohibited, Dr. Bieber wondered, when homosexuality is normalized?
Furthermmore-‹is it the proper domain of psychiatry to remove diagnoses to eliminate prejudice?
Dr. Bieber pointed out that there were several other conditions in the DSM-II that did not fulfill the "distress and social disability" criteria: voyeurism, fetishism, sexual sadism, and masochism. A.P.A.'s Dr. Spitzer replied that these conditions should perhaps also be removed from the DSM-II -- and that if the sadists and fetishists were to organize as did the gay activists, they, too, might find their conditions normalized.
Summary
The factors that determined the decision of the APA to delete homosexuality from DSM-II were summarized as follows:
- Gay activists had a profound influence on psychiatric thinking.
- A sincere belief was held by liberal-minded and compassionate psychiatrists that listing homosexuality as a psychiatric disorder supported and reinforced prejudice against homosexuals. Removal of the term from the diagnostic manual was viewed as a humane, progressive act.
- There was an acceptance of new criteria to define psychiatric conditions. Only those disorders that caused a patient to suffer or that resulted in adjustment problems were thought to be appropriate for inclusion in the Diagnostic and Statistical Manual.
So under the criteria accepted for DSM-3, an otherwise well-adjusted pyromaniac could not be ethically treated against his will.
Sounds good to me.