39 - LGBT Issues

Question 1

Define “sodomy”

Answer 1

The term “sodomy” (referring to the decadent behavior that occurred in the biblical city of Sodom) was first used in the 11th century to denote any form of prohibited sexual activity, including masturbation, bestiality, and oral or anal sex (regardless of heterosexual or homosexual)

Question 2

Describe homosexuality as a “crime against nature”

Answer 2

Christian basis

• Sex between- men was further condemned based on the passage in Leviticus that ordered the death penalty for a man who “lies with man as with woman.”
• A faith-based law and crime rather than a civic law

Question 3

When the American Colonies developed, what laws did they adopt?

Answer 3

Kept the same Christian based laws as the English

Question 4

When did a “crime against nature” start to be abolished?

Answer 4

• In post-revolutionary France, they tried to get away from Catholic influence in society
• Sodomy was “decriminalized” at this point
• If you do it in private and it is between adults, it is not illegal

Question 5

Describe the investigation into homosexuality in the 19th century

Answer 5

Revolved primarily around the context of the criminal justice system

Question 6

What did physicians begin studying in the 19th century

Answer 6

Physicians began studying possible etiologies of “chronic masturbation,” bestiality, “nymphomania” (sexual drive in females”, exhibitionism and male homosexuality

Question 7

Describe the idea of “sexual inversion”

Answer 7

By finding a medical cause, the hope was to find treatments that might reduce recidivism

Question 8

Were lesbians investigated?

Answer 8

Since sexual drive within women was itself considered abnormal (hence the term “nymphomania,”) sex between women was considered a particularly rare phenomenon and was rarely investigated

Question 9

What happened toward the end of the 1800s in terms of sexual inversion

Answer 9

• Homosexuality was coined as a term - supported the idea that same-sex attraction was innate to the patient, not developed
• Advocated for decriminalization of of same-sex
• Referred to it as “contrary sexual sensation” - a congenital condition, not needing legal intervention

Question 10

Describe the view of homosexuality as a degenerative neuropsychiatric condition

Answer 10

• Neurosurgeon said that it was a serious mental illness
• “Inversion of the genital sense”
• A severe heritable degenerative condition
• No degeneration of the brain actually occurs (we know now)

Question 11

How was the science of homosexuality studied?

Answer 11

• As advances were made in the study of neuroanatomy and endocrinology, there were increased attempts to find biological evidence of “inversion” within homosexuals (i.e. female traits within gay men and male traits within lesbians.)
• The concept of “sexual inversion” continues to be influential in the study of homosexuality.

Question 12

Describe Freud’s point of view on homosexuality

Answer 12

In the course of his career, Sigmund Freud suggested multiple possible etiologies for homosexual attraction

• Overattachment of a son to his mother leads to overidentification with her. This results in his seeking love objects like himself to replicate the love his mother had for him.
• As part of the Oedipal conflict, a boy’s discovery that his mother is “castrated” leads to intense castration anxiety within himself. He relieves his anxiety in the sexual pursuit of women who have a penis (i.e. effeminate men.)

Question 13

Describe Freud and internal conflict theory

Answer 13

• With the hypothesis that homosexuality involved developmental arrest, Freud suggested that psychoanalysis could treat it through insight and resolution of the internal conflict.
• Freud, however, did not believe that homosexuality unto itself prevented a person from living a happy and fulfilling life.

Question 14

Describe Freud’s theory of “embryonic hermaphroditism”?

Answer 14

• Freud’s theories had some basis in the 19th Century belief in “embryonic hermaphroditism” – that an embryo initially carried the potential to be either male or female.
• From this, he theorized that all individuals were born with a bisexual capacity.
• He believed normal, non-traumatic development resulted in a sexual orientation appropriate to a person’s anatomical sex.

Question 15

Describe Freud and psychoanalysis

Answer 15

• In his later life, Freud expressed the belief that even the resolution of internal conflicts and resultant developmental maturation would only rarely result in a change of the person’s sexual orientation.
• “Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness; we consider it to be a variation of the sexual function, produced by a certain arrest of sexual development.”

Correct transition

Question 16

Describe psychoanalysis after Freud

Answer 16

• In rejecting the idea that the psyche has a bisexual origin, Rado claimed that all people are born intrinsically heterosexual.
• There was thus no possibility of homosexuality imprinting itself upon the psyche due to developmental experience.
• Homosexuality is pathological and reversibel

Question 17

Describe Rash Treatment

Answer 17

• Behavior modification (commonly known as aversion therapy) was achieved through administering an aversive stimulus in conjunction with the inappropriate sexual stimulus.
• Chemical emetics were initially used, though electrical shock became the more standard practice as its administration was more easily controlled.
• Subjects would typically be shown photographs of conventionally attractive men (patients would even be encouraged to bring in pictures of their lovers) and then be administered the electrical shock
• Since homosexuals were presumed to be heterosexuals who had suppressed their natural desires, extinguishing the inappropriate sexual desires would presumably allow their “natural” state to emerge.

Question 18

What were the claims of the effectiveness of aversion therapy or rash treatment?

Answer 18

• Practitioners of aversion therapy made claims of up to 50% success.
• Their results have since been largely discounted as documentation of success could rarely be supplied.
• Their methodology was also questioned – a patient who became entirely asexual was generally considered a success.
• There were no significant follow-up studies assessing long-term effects.

Question 19

What were the effects of rash treatment or aversion therapy

Answer 19

• Anecdotally, however, patients commonly experienced worsened depression, anxiety, post-traumatic responses and suicidality
• As homosexuality was both illegal and socially unacceptable, the ethics of such treatment was generally not taken into consideration
• Such treatment was often part of criminal sentences. Patients had little recourse for abuses that stemmed from practitioners’ bias and hostility towards homosexuality.

Question 20

Describe the decrease in aversion therapy over time

Answer 20

• Since sodomy laws often were specific to male homosexuality, lesbians were far less likely to be prosecuted due to their sexual orientation. For them, aversion therapy occurred more commonly in medical practice.
• Aversion therapy remained common in America, Britain and the Soviet Union through the 1950’s and 60’s.
• The practice waned over time as it proved largely unsuccessful.

Question 21

What are some of the extreme attempts to treat homosexuality?

Answer 21

• Forced hysterectomy and estrogen treatment in lesbians.
• Castration (chemical and physical) of gay men.
• Lobotomy
• ECT (as distinct from electrical shock as aversion – though the difference was slim in its early use)

Question 22

What were some of the methodological problems associated with research regarding homosexuality?

Answer 22

• Psychoanalysis, dependent as it was on interpretation, intrinsically involved observer bias.
• Study samples were commonly taken from individuals already in mental health treatment and/or incarcerated.
• Even when questioned anonymously, individuals were more likely to deny homosexuality.

Question 23

What different perspectives were available regarding homosexuality in the mid 1900s?

Answer 23

Alfred Kinsey

• His data showed homosexual behavior or fantasy occurred far more commonly than was previously presumed.
• It presented the “Kinsey Scale” that rated sexual orientation on a seven-point continuum, from exclusively heterosexual (0) to exclusively homosexual (6)
• It was the most notable American work to date supporting the view of homosexuality as a normal variant among humans.

Question 24

Who conducted the lecturer’s “favorite study”?

Answer 24

In 1957, Evelyn Hooker published an innovative study

Question 25

Describe the Evelyn Hooker study

Answer 25

• Three projective tests (Rorschach, Thematic Apperception Test, and Make-A-Picture-Story) were administered to 30 homosexual men and 30 heterosexual men.
• All had been recruited through community organizations and were not engaged in mental health treatment. The two groups were matched for age, IQ, and education.
• When blind to the subjects, experienced psychologists could not distinguish between the two groups.
• It countered the common belief that homosexuality was intrinsically linked to psychopathology.

MAIN POINTS:

• Could not find any differences between the groups
• So this means homosexuality is NOT always paired with psychiatric disturbance

Question 26

Describe the epidemiological information regarding homosexuality that circulated in the 1950s

Answer 26

• It showed that homosexual behavior was widespread among various nonhuman species.
• Similarly, it was evident within a large number of human societies regardless of its level of social acceptance
• It also detailed a surprising number of societies where male and/or female homosexuality was accepted as a normal variant, including in some native American cultures.

Question 27

What did the DSM-1 say about homosexuality (1952)?

Answer 27

Homosexuality was classified as a “sociopathic personality disturbance”

Question 28

What did the DSM-2 say about homosexuality (1968)?

Answer 28

Separated “sexual deviations,” including homosexuality, from sociopathic personality disturbance. It remained, however, a mental illness that merited treatment.

Question 29

What did gay and lesbian rights begin to heavily lobby for in the 1970s?

Answer 29

Activists supporting gay and lesbian rights began to heavily lobby the APA to review its position on homosexuality. There were heated encounters on the subject at the APA annual meetings from 1970-1972.

Question 30

What happened after this lobbying?

Answer 30

• After reviewing the existing data, the Nomenclature Committee proposed eliminating homosexuality from the DSM.
• The measure went on to be approved by the Council on Research and Development, the Reference Committee and the Assembly of District Branches before receiving final approval from the APA Board of Trustees in December, 1973.
• Led primarily by traditional psychoanalysts, a group of APA members asked for a general referendum by all voting APA members. It passed by 58% majority

Question 31

What was the overall result?

Answer 31

In recognition of the controversy, a compromise was made within DSM-II in creating a diagnosis of “Sexual Orientation Disturbance.”

It declared that homosexuality was only a mental illness within those who experienced significant conflict with their sexual orientation.

Remember sexual orientation disturbance ***

Question 32

What did the DSM-III say about homosexuality (1980)?

Answer 32

• DSM-III (1980) replaced the SOD diagnosis with “Ego Dystonic Homosexuality,” which maintained the same basic premise while clarifying diagnostic criteria.
• SOD and EDH were both criticized as diagnoses based solely on the individual’s subjective attitude about their condition. ***
• Ongoing stigma regarding homosexuality meant that many gays and lesbians experienced an initial period of distress, which was later alleviated by finding a supportive environment and developing positive relationships as a homosexual.

Question 33

What question was then raised? What was the result in the DSM-III-R (1987)

Answer 33

• The question was raised as to whether external attitudes (i.e. “homophobia”) should lead to a diagnosis of mental illness in someone distressed by the fear of stigma and prejudice.
• In the DSM-III-R (1987), the APA Nomenclature Committee removed the diagnosis of EDH.

Question 34

What does the DSM-IV-TR say about homosexuality?

DSM-IV-TR - the most recent before what we use now (DSM V)

Answer 34

• The DSM-IV-TR listed “Persistent and marked distress about sexual orientation” as a Sexual Disorder NOS.
• Used as a descriptive/billing code.
• Regarded as a “disturbance” experienced by the individual, but not a disorder resultant of sexual orientation.
• The description is not limited to homo- or bi-sexuality

Question 35

What are the contemporary views of homosexuality?

Answer 35

Since the 1973 removal of homosexuality from the DSM list of disorders, the American Psychological Association has consistently taken positions against homosexuality as pathology and against discrimination of non-heterosexuals.

Question 36

Describe credible association views on homosexuality?

Answer 36

• At this point, all credible medical associations say that homosexuality is not an illness and does not need treatment
• But if there is significant anxiety regarding their identity of being homosexuality

Question 37

What is NARTH?

Answer 37

The National Association for Research and Therapy of Homosexuality is a professional organization for psychiatrists, psychologists, other therapists, social workers, and behavioral scientists. They alone among professional mental health organizations promote reparative therapy for gays and lesbians. Their Statement of Policy and Right to Treatment contradicts statements by all other professional mental health organizations, mirroring the beliefs of religious conservatives . Their total membership is somewhat over 1,000 (compared to the over 132,000 members of the American Psychological Association.) Non-therapists may join as a “Friend of NARTH;” many conservative Christian ministries have done this.

**NARTH teaches that homosexuality is a sexual disorder which can be cured.