On The Medicalization of Homosexuality Identity throughout the 20th Century

Throughout history, there have been various views on the nature of homosexuality[1] as a lifestyle, sexual orientation, psychosexual disorder, form of deviance, and more. What is quite peculiar, however, is how homosexuality’s conceptual fluidity appears to halt some time before the modern day. As medical debates continually went by, the understood nature of sexuality became increasingly turbulent. This era of turbulence mostly, but not exclusively, occurred in the twentieth century- a time which, among other things, contained the Civil Rights Movement, the creation of the Gay Liberation Front, the AIDS Crisis, and the creation (and subsequent revision) of the Diagnostic and Statistical Manual. These components in harmony created a perfect storm of confusion for those attempting to medicalize “gayness” in various ways. To accurately understand the how the medicalization of homosexuality arrived where it did by the 1990s, it is important for one to examine the larger picture, as no historical moment exists in solitude.

Towards the earliest phase of the twentieth century, America was escaping the Victorian era. The horrendous sexual repression and homophobia drew to a close as Queen Victoria passed away in 1901- or so one would think had they merely been educated by hearsay rather than acquired through readings from and about the era. Michel Foucault, a renowned philosopher, historian, and social theorist once wrote that “It will be said that if so many people today affirm this repression, the reason is that it is historically evident…[has] the critical discourse that addresses itself to repression come to act as a roadblock to a power mechanism that had operated unchallenged up to that point, or is it not in fact part of the same historical network as the thing it denounces (and doubtless misrepresents) by calling it ‘repression’?” (“We Other Victorians” 9). He believed that sexuality was so heavily policed that it was impossible for it to have been repressed. Sexuality was enveloping society through the various odd guidelines and customs surrounding it. Furthermore, he believed that the narratives surrounding the Victorian era were developed as a means of easing society towards that very repression. One might see the fact that sexuality was not repressed during the nineteenth century as irrelevant to the medicalization of homosexuality in the twentieth century priorly discussed, however, it is important to first address this in order to fully encompass in what manner the medicalization occurred.

Remaining in the nineteenth century, in 1886, German psychiatrist Richard Freiherr von Krafft-Ebing published the Psychopathia Sexualis. This book was centered- among other things- around an attempt to finally medicalize homosexuality in a way which, plausibly, never had been done before. Krafft-Ebing believed homosexuality to be a hereditary disease which impeded natural male[2] development. Once again it would be natural to inquire as to why time is being spent elaborating upon nineteenth century medicalization when the core topic at hand specifies a historical recounting and analysis of the twentieth century. Well, simply put, the ideas about sexuality put forth in the late nineteenth century were the basis upon which medicalization of homosexuality began to take root in the twentieth. These base assumptions about the clinicality of homosexuality were furthered not only by cultural ideas which had been given several decades to spread amongst the Western world[3], but also due to a translation of Krafft-Ebing’s German work being published in English in the year 1892, which was cusping between the nineteenth and twentieth centuries.

With those histories established, analysis may now begin to diverge from a simple restatement of in-class lectures. In Krafft-Ebing’s work exists free use of the word “homosexual,” however, this word has not always existed. With some debate as to the word’s origin, it is estimated to have developed around the same time as the English translation of Psychopathia Sexualis was published. Before the word existed, gay people were simply thought of as “deviants” in the same vein as those engaging in sadomasochism[4], sodomy, extramarital affairs, and so forth. As such, the development of a stagnant label to apply to an individual’s sexual and romantic actions began to hone medical research into homosexuality to an extent perceived as less than welcome. Relative to the early twentieth century, first had come the discussion of how one could psychological be homosexual, and next came the intermingling of medical ideas with those more closely associated with religion and morality. “In this way, sin and crime, far from being disconnected, were bound as tightly together as they had been when natives first sighted European ships, and sexual ‘degeneracies’ topped the list of illegal acts. It only remained for scientists to help define those acts, associate them with types of people, and add ‘illness’ to the list of synonyms for the newly defined condition of homosexuality.” (Eaklor 31) And so, much of the dominating discourse throughout the Edwardian era was specific to a subjective moral debate as to whether or not homosexuality was a punishable offense. Of course, as many who study the histories of marginalized groups frequently find, the discourse settled upon the idea that one could and should be punished for being homosexual. While Krafft-Ebing’s idea that homosexuality was an illness to be cured was repulsive enough as it was, it somehow grew worse.

After the Edwardian era began the world wars. While development in clinical research surround homosexuality did, on a technical basis, progress, in order to simply by painting in broad strokes, it may be most important to forego the detailed explanations of changes to the medical model of homosexuality until the 1930s. To summarize concisely, Sigmund Freud had begun pursuing homosexuality as his next research topic and began to theorize that homosexuality could potentially be a stage in adolescent development caused by phobia of the opposite sex[5]. His theory gained traction, but bore no change upon the psycho-sexological view of homosexuality as an illness.

Uproar surrounding the medical model finally became widely dealt as in 1952, the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual (DSM) I. A manual which ideally would be a universal standard upon which psychologists could refer for diagnoses. Please excuse the sarcastic tonality, but there was a single minuscule, unnoticeable, inconsequential problem which was that homosexuality was now labelled officially as a sociopathic personality disturbance. While the second edition of the manual clarified this to refer to mere sexual deviance rather than sociopathy or disturbance, it still had not quite removed all stigmatization from the label. Additionally, the second edition of the DSM contained a diagnosis which may seem familiar to modern day asexual people. The diagnosis was “sexual orientation disturbance” which was explicitly defined by homosexuality being exhibited by people do not desire to be homosexual. This diagnosis, in essence allowed plausible deniability on behalf of the APA for claims that they wished to cure all homosexuals of their supposed deviance. Now, they could easily claim to only treat clinically significant cases.

Moving on from medical jargon and talks of precise labels, in the 1980s began the AIDS crisis, in which the gay community was plagued by Auto Immune Deficiency Syndrome, a disease which, as one could assume, depletes the auto-immune system. As the disease was most common in gay communities, it was vastly and negligently under-researched, leading to a feedback loop in which gay communities[6] simply did not know how to prevent themselves from getting AIDS. Slowly, over time, more and more information began to spread, but by then it had been too little and too late. In the powerful words of AIDS victim Vito Russo “If I’m dying from anything — I’m dying from the fact that not enough rich, white, heterosexual men have gotten AIDS for anybody to give a shit” (Russo). At this point it was common to see gay people unaffected by AIDS claiming that the crisis was giving negative coverage to the relatively recently formed gay rights movement. Especially considering that, as seen with the DSM volumes, there was still a continual push to demedicalize gay identity. As such, claiming that being gay was not medically significant but that gay people just happen to be getting infected with a life-threatening disease was not exactly an improved perception of the community to thrust upon a straight audience. However, it is important to note that the reason why this crisis is as significant as it is towards the establishment of homosexuality as a medical and social identity was its function in helping people realize that gay people needed activism desperately. Alongside this, barely before the AIDS crisis began, the third edition of the DSM was released, completely removing homosexuality from the text. At this point in time, cisgender heterosexuals were forced to address that their dismissal of homosexuality as a disease was solely based in hate. However, mere addressing does not mean they had completely accepted that they were wrong, the arguments just began to shift towards pure moral discourse. After this, many cisgender heterosexuals began engaging in LGBTQ+ civil rights. While it goes without saying that the AIDS crisis was a terrible tragedy, there is no doubt that the 80s were monumental- for various reasons- in heightening the LGBTQ+ civil rights discussion to an all-time high.

It would not be unprecedented for one to wonder what the point of the reception of all that information was (aside from pure acquisition of knowledge for knowledge’s sake). The answer is simple. Issues like these are never over. As Foucault discussed, whenever we think of the past as worse than now, it gives our leaders an excuse to reenact historical mistreatment of people while in power, as the public is less likely to question it if it seems “better”. Alongside this, as was hinted at earlier, Asexuality is facing the exact same issue currently as homosexuality had faced back in DSM II. Currently there is a diagnosis for Hypo-Sexual Desire Disorder, in which the disorder‘s diagnosis is simply based on the lack of sexual attraction. The very same plausible deniability is also pursued through a disclaimer that asexuals who desire to be asexuals are not a target of the diagnosis and treatment. Those are just two examples, in the information provided in this paper alone, one could potentially find hundreds of comparisons to make between history and the modern day. The takeaway is this: understand how history taks shape, because history does not end.

[1] as labelled in the present day

[2] Do note the explicit differentiation between male and female development. At this point in time it was believed that only males- a word which is here being used to refer to those assigned male at birth- could be homosexual in a clinical sense.

[3] The term “Western world” is fraught with insensitivities and assumptions. While it would be possible to fully problematize the creation of the term, it would quite significantly digress from the current topic. Please acknowledge that the term is being used solely as shorthand for what white Americans commonly understand the Western world to be.

[4] This term was coined by Krafft-Ebing

[5] as with the “Western world,” the term ‘opposite sex” is quite loaded with inaccuracies and assumptions about biology while simultaneously erasing intersex identities. In this context, assume the opposite sex of a male to be a female and likewise vice versa.

[6]other communities were also affected, notably there were 4 “H”s, heroin users, homosexuals, hemophiliacs, and Haitians. The other groups, while having intense and historically significant struggles, are not going to be addressed for lack of relation to the central thesis.

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