from Clinical/Therapeutic Issues
In our April 1999 NARTH Bulletin, we reprinted "On Arriving at the American Psychiatric Association Decision on Homosexuality," by Irving Bieber, M.D. The full-length article is available by contacting NARTH and requesting our April back issue. We will summarize it here.
The article first appeared in Scientific Controversies: Case Studies in the Resolution and Closure of Disputes in Science and Technology, edited by H. Tristam Engelhardt Jr., and Arthur Caplan, Cambridge U. Press, 1987.
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."
NARTH President Charles Socarides argued the same point in a review he wrote of gender researcher Robert Stoller's Pain And Passion: A Psychoanalyst Explores The World Of S & M. In that book, Dr. Stoller acknowledged the psychodynamic causes of sadomasochism, and then described practices, utensils, and bodily parts used in sadomasochistic performances. He offered a six-page listing of the various methods used to inflict pain and humiliation on willing victims, including the different hanging techniques used to achieve orgastic ecstasy. But then Stoller claimed sadomasochism was no more abnormal than "dislike of zucchini"--asserting that only our "deep prejudices" about perversion lead us to label it abnormal.
Indeed, as some prominent cultural observers have noted, the political drive toward ever-greater equality has turned Americans against any conclusion which entails values and consequences - resulting in our culture's trend toward rejection of all evaluative conclusions as unkind and "undemocratic." Legal scholar Robert Bork sees this as a natural consequence of democracy untethered from its Judeo-Christian roots of self-restraint and responsibility, after which it began to be dominated by the philosophy of radical egalitarianism.
Reading the account by the eminent Irving Bieber, the reader is reminded of the historic role played by both Dr. Bieber, and NARTH President Charles Socarides. Both influential and courageous men stood, we believe, for truth in a profession that has increasingly set itself adrift from its theoretical and philosophical roots.
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."
"It is my aim here," he wrote, "to separate out the psychiatric and conceptual issues from the sociopolitical issues; to document my own theoretical and clinical position; and to describe the events that I participated in and observed--all of which I trust will bring into focus the elements that went into the American Psychiatric Association's decision."
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."
He describes in detail the well-known research study he conducted in 1962, involving a 500-item questionnaire and 106 male homosexuals, with a comparison group of 100 male heterosexuals.
"The father-son relationship, however, revealed uniformly an absence of loving, warm, constructive paternal attitudes and behavior. In my long experience, I have not found a single case where, in the developing years, a father had a kind, affectionate, and constructive relationship with the son who becomes homosexual. This has been an unvarying finding. It is my view, and I have so stated and written, that if a father has a kind, affectionate, and constructive relationship with his son, he will not produce a homosexual son, no matter what the mother is like."
Dr. Bieber's study in fact found a continuity of poor relationships with males, beginning with the father, older brothers, and same-sex peers in childhood. He concludes,
"The consistent history of unremitting fear of and hostility to other males throughout childhood has led me to conclude that male homosexuality is basically an adaptation to a disorder of a man's relationship with other men."
Of the 106 homosexuals who started psychoanalytic therapy, 29 changed to exclusively heterosexuality, which represented 27 percent of the total sample.
Dr. Bieber discussed the issue of the definition of normality. Because homosexual fantasies and behavior are fear-based, he concluded, we cannot call them normal.
The Psychiatric Association pointed to the excellent occupational performance and good social adjustment of many homosexuals as evidence of the normalcy of homosexuality. But such factors do not, Dr. Bieber countered, exclude the presence of psychopathology. Psychopathology is not always accompanied by adjustment problems; therefore, the criteria are in reality, inadequate to identify a psychological disorder.
Dr. Bieber stated that psychopathology can be ego-syntonic and not cause distress; that social effectiveness--that is, the ability to maintain positive social relations and perform work effectively--may in fact coexist with psychopathology.
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.