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from Clinical/Therapeutic Issues
The A.P.A. Normalization of Homosexuality, and
the Research Study of Irving Bieber
To keep the record straight against the threat of psychological revisionism, from
time to time, NARTH publishes important historical articles.
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."
What is Homosexuality?
He describes the difficulty of putting homosexuality in an appropriate category:
Is it a developmental arrest, or an illness? Is it a constitutional disorder, a
genetic misprint, a habit? Through his longterm research on the subject, Dr.
Bieber concludes that homosexuality is not a normal sexual adaptation.
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.
Mother of Homosexuals
He found a close-binding, intimate mother who tended to interfere with her son's
assertiveness, and who tended to dislocate his relationship with the father,
siblings, and peers. However, Dr. Bieber found that homosexuality can develop
without the frequently occurring close-binding-intimate, mother-son bond.
Fathers
But the most significant finding was that of the detached father. "The father-son
relationship was almost the diametrical opposite of that between mother and son.
The paternal portrait was one of a father who was either detached or covertly or
overtly hostile," he reported. While there was some variance in the mother-son
relationship, Dr. Bieber reported,
"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 New Diagnostic Criteria
The A.P.A. at that time had adopted a new set of criteria for defining
psychological disorder. To be disordered, a condition must:
- regularly cause distress, or
- interfere with social effectiveness.
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.
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.
Updated: 13 March 2008
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