From ‘illness’ to identity: how psychology contributed to the suppression of the LGBTQ+ community
Before we begin, two important points to clarify.
Firstly, a historical perspective on psychology and homosexuality is a journey into the darkness: there is little that is joyful, and even more that is horrifying, to be said about how medicine, psychiatry and psychology, without any support from empirical research, contributed to the oppression, persecution and suffering of gays and lesbians.
Since the dark aspects of this chapter in the history of psychology are well known to many readers, the focus below will be primarily on the absurdity of it all. This should not be taken to mean that we are forgetting the suffering of the victims of this kind of ‘science’.
Secondly, although we write above ‘gays and lesbians’, the relevant research concerned almost exclusively homosexual men. It remains an open question whether lesbians appeared less conspicuous or threatening, or whether researchers overlooked the fact that women have an independent sexuality. The few articles known to us that touched upon the subject of lesbians are included in the following account.
Introduction
Whilst same-sex love has been a source of immense joy for many over the millennia, the term ‘homosexuality’ emerged in 19th-century Germany (cf. Bullough, 1989). It is only since then that homosexual people have come to be regarded in our culture as a distinct category — separate from heterosexuals, who were ‘invented’ much later.
With urbanisation, a critical mass of people possessing the ‘homosexual’ attribute had accumulated, so that the medical community began to address the question of which sexual behaviour was normative and which was not. Karl Heinrich Ulrichs described this phenomenon from the perspective of the ‘self’.
The scientific examination of homosexuality began with Carl Westphal’s book (1869), in which he described ‘contrary sexual feeling’ (conträre Sexualempfindung) in feminine men and previously boyish girl. Although he emphasised that this different predisposition should not always be regarded as pathological, in the decades that followed the main question was how homosexuality arises and how it can be ‘cured’.
For this purpose, medicine, psychiatry and psychology employed methods that were in favour at the time, such as the universally beneficial ‘exercise in the fresh air’ (Murphy, 1992): ‘Since nothing counteracts sexual appetite like physical exhaustion, I have found nothing more suitable than the bicycle, ...’ (Hammond, 1892).
Hammond reported that regular cycling did indeed curb his patient’s libido to such an extent that the patient no longer felt the need to act on his sexual desires. Other doctors attempted to restore their patients to heterosexual equilibrium through rest.
Whilst some advised their patients to visit sex workers, others were critical of this approach. ‘The therapy seems to me worse than the disease,’ Havelock Ellis aptly put it (Ellis & Symonds, 1897). He feared that this might lead to an aversion to women.
Homosexuals were offered marriage as an alternative therapy—a form of self-therapy which, according to empirical studies, a significant proportion of gays and lesbians later tried (according to Bell & Weinberg, 1978, for example, 20% of gays and as many as 35% of lesbians).
Psychodynamic approaches
From the beginning of the twentieth century, psychodynamic approaches emerged in psychology and psychiatry, focusing on the psychosexual development of children. Homosexuality was immediately recognised as a disruption of this development.
Male homosexuality was explained by the presence of an overly caring, excessively close relationship with the mother and, at the same time, a severely disrupted relationship between father and son: the father is perceived by the young boy as hostile or ‘always absent’ (‘nie da’, Bieber, 1976). This supposedly gives rise to an excessive fear of women, and in this neurotic conflict, a man is chosen as a substitute love object.
Many experts appear to have overlooked the fact that in a traditional marriage with a housewife (Hausfrauenehe), such a dynamic—in which the primary emotional attachment lies with the mother, whilst the father is notable mainly for his absence, is so likely that the proportion of gays should be closer to 80% rather than 10% (cf. also Stone, 2000).
However, this short-sightedness cannot be attributed to Freud, the father of psychoanalysis; he had already raised the point that false conclusions might arise if one were to draw inferences about the causal effect of certain relationships observed in clinical cases, and that such configurations are often found without any observable homosexuality. Popular psychoanalysis has shifted the blame for ‘incorrect’ development onto mothers.
If homosexuality were an ‘incorrect adaptation of children’ to certain life circumstances, then it should also be possible to ‘cure’ it through therapy — by working through that conflict. Although there are psychoanalysts who report having ‘cured’ numerous gays in the course of their analyses, such claims do not stand up to critical scrutiny (cf. Haldeman, 1994).
The hypothesis of neurotic maladjustment is testable empirically. However, empirical scientific work is not very common within psychodynamic thinking. Credit for the empirical investigation of this issue goes to the pioneer Evelyn Hooker (Evelyn Hooker, 1957).
Her reasoning was as follows: if gays were neurotics, their unconscious conflicts and motives could be identified by specialists using projective methods, such as the Rorschach test (‘What do you see in this inkblot?’) . Accordingly, specialists should have been able to distinguish (dysfunctional) gays from (mature) heterosexuals.
The specialists tested were unable to do so. Psychoanalytic methods, such as the Rorschach method, therefore do not provide support for psychoanalytic theories of the origins of homosexuality. To date, there is no empirical support for the ‘abnormal development’ hypothesis.
Given the vast differences between all cultures in which homosexual behaviour exists, an explanatory model in which the typical Western, white, heterosexual nuclear family plays such a decisive role also seems implausible.
Is it not paradoxical that psychoanalysis, once the embodiment of progressive thought, has changed so little over the past hundred years that today it ranks among the most conservative forces in psychology? However, there have been further developments in this field; for example, the pathologisation of homosexuality is discussed as countertransference in psychotherapy (e.g., Herron, Kinter, Sollinger, & Trubowitz, 1982), and there are newer non-deficit theories that account for the emergence of homosexuality within psychoanalytic models of thought (e.g., Gissrau, 1993, explains lesbianism through the mother’s ‘erotic gaze’).
Behavioural-therapeutic approaches
Behavioural approaches in the history of psychology, from which behavioural therapy was developed, have existed for almost as long as psychodynamic ones. According to these theories, children are born as a Tabula Rasa (blank slate), and their behaviour is determined by their learning history. Stimuli are associated with other stimuli that predict them, and behaviour is determined by its (previous) consequences.
From the perspective of sexual orientation, to put it scientifically: according to social learning theory, positive reinforcement channels constitutionally polymorphous-perverse, undirected sexuality (Churchill, 1967, as cited in Mitchell, 1978/2002). This means that sexual orientation is not fixed from the very beginning.
Reinforcement and punishment lead to sexual satisfaction being expected from certain objects of pleasure, and not expected from others. Thus, homosexuality arises through a learning experience, following which sexual satisfaction is associated with same-sex, but not opposite-sex, individuals. It was assumed that such a learning experience could be counteracted by a repeated, opposite experience.
Two such ‘conditioning variants’ will be presented here as examples.
Aversive Therapy
Disclaimer: Today, these methods are recognised by the international community as torture and a violation of human rights.
Firstly, ‘aversive therapy’ — aversive counter-conditioning using electric shock (Feldman & MacCulloch, 1965). The patients were homosexual men, mainly from psychiatric institutions, who voluntarily agreed to treatment because they suffered from their ‘inclination’.
Patients were asked to bring a set of images of men that they liked and to rank them in order of attractiveness. They were advised to do the same with images of women. The first of the approximately 30-minute sessions began with the least attractive image of a man. The patient was to look at it for as long as he liked. At an unpredictable moment, an electric shock would follow.
Sometimes it was possible to avoid this by switching off the image in time. The moment the male image disappeared and relief set in because the unpleasant shock had not occurred, the most attractive of the female images would appear.
The experimental procedure was derived from experiments in learning psychology, for example, with dogs, where avoidance learning (Vermeidungslernen) proved to be a very effective and stable form of learning. The experimenters’ hope was that the repeated pairing of an unpleasant electric shock with male images and a pleasant sense of relief with female images would lead to the conditioning of negative emotions towards men and positive emotions towards women. If the first male image ceased to be perceived as attractive, the treatment continued with the second, and so on.
Orgasmic Reconditioning
A procedure more pleasant for patients was used in attempts at orgasmic reconditioning. Here, it was assumed that homosexuality arises through incorrect conditioning via ‘incorrect’ masturbatory fantasies. The therapy involved masturbating frequently whilst imagining one’s favourite sexual fantasies, but immediately before climax, shifting one’s attention to desired sexual objects — that is, to women (or images of women).
Effectiveness and Attitudes
There is no convincing evidence that any behavioural therapy programme leads to changes in sexual orientation (see below). Nevertheless, it was used in practice. According to a 1973 survey (Davison & Wilson, 1973), British and American behavioural therapists had, on average, treated around 15 homosexuals. They mainly used aversion therapy. 90% of them believed that homosexuality is not always pathological and that homosexuals can live happily. Nevertheless, 13% would attempt to heterosexualise homosexuals even against their will. On average, they all considered heterosexuality to be better and more positive than homosexuality.
Medicines, Hormones and Genes
Doctors have repeatedly attempted to treat homosexuality with medication.
Denslow Lewis (1899–1983, p. 224) devoted himself to eradicating lesbianism, ‘a disease of the wealthy classes... A poor, hard-working girl is not prone to this vice. ... It is the idle woman who has fallen into this destructive practice. A girl ‘raised in luxury’ develops an oversensitive and abnormally large clitoris; ‘she enjoys these perverse and harmful practices, perhaps for years, and when she takes on the duties of a wife, normal sexual intercourse cannot satisfy her’ (authors’ translation). The author reports that cocaine, saline solutions, bromides, cannabis and strychnine have proven effective as therapies.
Other doctors found their attempts at pharmacological treatment of homosexual men disappointing (Oberndorf, 1929). The sole exception is a report of a single case of the therapeutic effect of LSD.
‘Perceptual-cognitive-behavioural reorganisation of the psychedelic experience’ can be used to encourage a man towards heterosexual intercourse — but only with the help of specialists who are themselves highly experienced with LSD (Alpert, 1969). The patient was required to bring images of women to the second session; the third session was tantric with a female companion; during the fourth session, sexual intercourse took place with the companion, after which the patient became heterosexual. Reports of attempts to replicate this therapy have not been published.
With the discovery of the role of hormones in human behaviour, attempts began to use this knowledge to ‘cure’ homosexuality. Initially, attempts were made to administer testosterone to homosexual men. As expected, this sharply increased sexual desire. However, to the disappointment of the treating doctors, the orientation of desire remained unchanged.
They then tried using oestrogens to at least minimise abnormal sexual expression. The most famous patient was the British mathematician Alan Turing, who — like many others — voluntarily underwent ‘therapy’. Like the cycling described at the beginning, oestrogen therapy also led to a decline in libido. However, it had such significant side effects — primarily weight gain and breast growth — that attempts at therapy were soon discontinued (Stone, 2000).
Conclusion on Changing Sexual Orientation
As regards all the ethically dubious efforts outlined to change sexual orientation using a wide variety of methods, the main point to note in conclusion is this: there is no convincing evidence that sexual orientation can be changed (cf. also Haldeman, 1994). In the words of one honest expert: ‘We—that is, we psychoanalysts, and everyone else, whether specialists or not—do not understand homosexuality’ (Moor, 1990) .
Even therapists hostile to homosexuals, who claim to have successfully ‘cured’ homosexuality, report low success rates; for example, Irving Bieber (1976) estimates only a third and therefore emphasises that prevention must come first.
It is not surprising that some ‘patients’ report, after therapy, at least a temporarily more successful suppression of their homosexual impulses than before. Firstly, placebo effects are likely to occur; secondly, the therapy is likely to reinforce ‘internalised homophobia’, which has already driven patients into the arms of irresponsible therapists.
Finally, we would like to note that sometimes people who have identified as lesbians or gays throughout their lives rediscover heterosexual aspects within themselves. Such ‘spontaneous remissions’ are likely to be regarded as successes of the therapy in the respective treatment attempts.
Later proponents of so-called conversion therapies (e.g. Masters and Johnson) emphasised that, whilst they regarded homosexuality as equal to heterosexuality, individuals’ desire to change their sexual orientation should also be accommodated by offering appropriate therapeutic services. — Theoretically, this makes it possible to provide therapy for heterosexuality as well, for example, if a person, after many fruitless attempts, finally desires an equal partnership...
Incidentally, Masters and Johnson’s proposal for gays is a mixture of conversation skills training, similar to lessons at a dance school, to reduce fears of women, and saturation (Sättigung), in which preferred masturbatory fantasies are acted out so frequently that they become boring.
Criticism of the argument that everyone should be afforded individual heterosexual development is levelled on the grounds that, in a heterosexist, oppressive society, a decision against homosexuality is not a ‘free’ one (Murphy, 1991; Haldeman, 1994). Therefore, heterosexism manifests itself even in approaches that appear egalitarian, such as that of Masters and Johnson.
Furthermore, practitioners should use effective, promising methods, rather than those whose ‘success’ has not been proven. However, the majority of those who underwent conversion therapy did not become heterosexual in the long term (Murphy, 1991); that is, therapists cannot fulfil clients’ desire to change their sexual orientation.
Masters and Johnson emphasised that such an outcome of therapy should not necessarily be regarded as ‘unsuccessful’, since many of their clients were happier in their homosexuality following a failed attempt at therapy.
Furthermore, hormonal influences during pregnancy are discussed as causal factors in sexual orientation, as well as a genetic basis (Stone, 2000): sexual orientation concordance is higher in identical twins than in fraternal twins.
In this context, it is important to note that even in identical twins, the concordance rate is not 100%; that is to say: although the relevant studies have been interpreted as proving the decisive role of genes, they simultaneously demonstrate that, in addition to genetic factors, other factors are also significant.
In addition to twin studies, there are studies suggesting that gays have a noticeable number of gay uncles and male cousins on their mother’s side (cf. Stone, 2000) — note that here, ultimately, the ‘axis of blame’ once again runs through the mothers.
A Turning Point
In 1973–1974, a small ray of light pierced the darkness in which the field of psychology had contributed to the oppression of homosexuals, when the American Psychiatric Association (DSM) removed homosexuality from its classification of disorders, retaining only ‘ego-dystonic homosexuality’.
As succinctly put in an introductory psychology textbook: ‘On 14 December 1973, homosexuals were mentally ill, sexual deviants. On 15 December 1973, homosexuals ceased to be ill’ (Zimbardo, 1983). In the more recent 1984 edition of the DSM, the diagnosis was politically correctly changed to ‘sexual orientation distress’ — implying that heterosexuals might well suffer from it too.
One might have hoped that, as a result of research such as that conducted by Evelyn Hooker, which showed that homosexuals are not psychologically disturbed, an initiative to remove homosexuality from the list of illnesses would eventually emerge from within the research community itself.
However, the realisation of the 1970s did not originate within the professional associations themselves, but came about under pressure from American gay and lesbian organisations. Homosexuality was only removed from the International Classification of Diseases (ICD) as a disorder in 1987. This means that, prior to this, the need for therapy could be derived solely from a person’s homosexuality.
A similar time lag was observed in the establishment of interest groups for lesbian and gay psychologists. These emerged in the US in the early 1970s, and in Europe in the early 1990s. At the American Psychological Association’s congress in Honolulu in the early 1970s, there was a symposium on ‘Psychology and Homosexuality’. When asked from the floor why there were no gay psychologists on the podium, the reply was: ‘Because there aren’t any!’ Those who were ‘not there’ in the hall decided immediately afterwards to found the Association of Gay Psychologists.
The Association of Lesbian and Gay Psychologists (ALGP) Europe (see Steffens & Eschmann, 1995; Steffens & Ise, 2000, for a more detailed account) also faced difficulties at its inception, even though it was already the final decade of the 20th century. Dutch psychologist Jan Schippers attempted to draw attention to lesbian and gay psychologists and find like-minded individuals by presenting a poster on the subject at the European Congress of Psychology in Hungary. The only response was a question as to whether he was representing patients in this study.
Disappointed, he returned home to Amsterdam with the idea of abandoning his plan for a European association. Despite his gloomy mood, he noticed that not only next to him, but throughout the entire aeroplane, there were remarkably handsome men. When his seatmate sympathetically asked what was wrong, he was cheered up by a serenade high above the clouds. The Los Angeles Gay Choir, returning home after a concert tour, sang ‘California Here I Come’ to him.
Since the 1970s, a new branch of psychological research has existed in the US — gay affirmative psychology — and since then, relevant studies have been conducted in at least many parts of Europe and in Australia. From the process of coming out and identity development, topics ranging right up to life in ‘rainbow families’ are raised and scientifically investigated here.
Persisting Shortcomings
Nevertheless, the relationship between psychology and homosexuality is still not entirely untroubled. Several examples are given below.
The Disease Model and Training
Psychiatrists and psychologists in many countries still adopt a disease model with regard to homosexuality. Openly lesbian and gay people are still not accepted by all psychoanalytic training institutions.
It would be consistent if no lesbian or gay person had ever successfully completed this training, since this would require them to work through a severe disturbance in their psychosexual development (and change their sexual orientation). There are numerous living counterexamples.
This implies that although gay men and lesbians were often officially denied access to psychoanalytic training, if they behaved discreetly and did not publicise their sexual orientation, they could well have successfully completed the training.
Negative Perception
Experiments show that gay and lesbian people are still perceived more negatively than heterosexuals. For example, analysts were asked to assess the mental health of a person about whom they had received only a written medical history, from which it was implied in passing that the person had a partner.
If there were no psychological problems, gay and heterosexual men were considered equally healthy. However, if abnormalities were detected, the gay man was perceived as more ‘disturbed’ than the heterosexual man (Lilling & Friedman, 1995).
Dissatisfaction with Therapy
Consequently, gay men and lesbians also belong to those groups of people who are least satisfied with psychotherapy and counselling provided by heterosexuals (Rudolph, 1988; Nuehring, Beck Fein & Tyler, 1975). Gay or lesbian therapists are perceived by them as far more helpful.
Therapists’ attitudes towards homosexuality are inconsistent (there are significant differences between individuals) and contradictory (individual practitioners make internally inconsistent statements) (reviewed by Rudolph, 1988). A significant proportion of lesbians (50%) and gays do not disclose their sexual orientation during psychotherapy (MacEwan, 1994). They fear, for example, that otherwise therapists and group members will view them solely as homosexuals.
As a result, they do not receive adequate treatment. For instance, 30% of heterosexuals, but only 6% of openly lesbian and gay individuals, were offered the opportunity to include their partner in therapy. Even humanistically oriented therapists, despite the best of intentions, often behave incompetently (Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991), for example, by relying on clients to provide information about homosexual lifestyles; by assuming that homosexuality is no longer an issue these days; or, conversely, by assuming that it is an issue that needs to be discussed with clients.
Meanwhile, there are texts through which heterosexual therapists can undergo further training (e.g., Nuehring et al., 1975). From these, they learn such things as: ‘Homosexual couples, in their homes and in their activities, are remarkable only in that they are completely unremarkable...’ (p. 67) and ‘There is far more platonic physical closeness and warmth among close friends than in typical heterosexual friendship groups’ (p. 68, authors’ translation).
But information alone is not enough. Heterosexual professionals often experience difficulties when lesbian or gay clients discuss sensitive topics such as sexuality (Coyle, Milton & Annesley, 2001). There is undoubtedly a need here for peer supervision, professional supervision or other professional development.
Conclusion
Gays and lesbians are different. Psychological research has long been paralysed by the futile question of why this is so and, unfortunately, has not yielded many fruitful results.
Thus, we still know little about why people fall in love with each other and how we can help a person in therapy to fall in love with someone they like — someone with a ‘gentle’ nature, with whom they get on so well — instead of falling in love time and again with the same egocentric macho types who only make them unhappy.
The discrimination that lesbians, gays, and bisexuals face in psychology today is more subtle than before, but still palpable. They receive little open support and a great deal of incompetent help from ‘specialists’ (cf. Ohms & Müller, 2001).
On the other hand, there has been a move towards the comprehensive inclusion of gay and lesbian issues in research. Projecting this trend into the future, one can only hope that in ten years’ time all major institutions will fly the ‘rainbow flag’, so that gay, lesbian and bisexual people receive the same high-quality psychosocial care as heterosexuals as a matter of course.
Authors: Melanie Caroline Steffens and Erin Marie Thompson
