"The History of the Medical Treatment of Homosexuality"

I heard an interesting talk from Dr. Alice Dreger this spring about how homosexuality has been approached in the medical sphere over the past century or so.  Dr. Dreger's research focuses on what she refers to as "norm-challenging bodies", including disorders of sexual development (e.g. intersex), conjoinment, dwarfism, and cleft lip.  


Her talk at MSU touched on the issues related to medicalizing homosexuality, and how LGBT advocacy has led to more progressive attitudes in the medical field towards sexual minorities.



Dr. Dreger explained a general shift in societal views of homosexuality over the centuries:
Sin (pre-19th century) → Crime (19th century) → Disease (20th century) → Identity (21st century)


She described some horrifying measures that have been taken over the years in an attempt to rehabilitate same-sex attracted individuals, including:

• Castration (1929) & Clitoridectomies (1950s)
  If they’re sexually “deviant”, might as well take away their libido, right??  Geez..
• Gonadal transplant of cadaveric testes (1940)
  Maybe they just need more testosterone!  Send in the testes!
• Psychoanalysis (1950s+)It was thought in the past that homosexuality stemmed from a home environment consisting of overbearing mothers and distant fathers.  I’m sure it couldn’t possibly be that a gay teenager might be smothered by an overly protective mother concerned for his welfare and estranged from his father who doesn’t approve of or understand his child’s sexuality…
• Aversion therapy (1960s)
  Shock therapy associated with gay porn-- a positive punishment technique.
• Focused masturbation (1970s)
  Having the subject focus on sexual ideas related to the opposite sex at the point of orgasm - an attempt at conditioning.
• Sexual reassignment surgery (1960s-1980s)
  This was a not uncommon practice for biological males born with micropenis.  It was thought that simply changing their genital presentation to a female phenotype would solve the problem.  John Money (a psychologist) proposed a Theory of Gender Neutrality, suggesting that one's gender identity is more influenced by "nurture" than "nature".  Those who know the case of David Reimer know that theory has been debunked, and that gender identity is not just a matter of how your caregivers raise you.
• Prenatal "prevention" (1980s+)
  Potent doses of dexamethasone have been used prenatally in an attempt to prevent ambiguous genitalia as well as homosexuality, especially in girls.  Need I get into the ethical issues of this?
• Conversion therapy
  Ah yes, the age-old fallacy that homosexuality is pathological, and clearly a perverse choice that can be cured with some good ol' psychoanalysis and reparative therapy.  The folks at NARTH (National Association for the Research and Treatment of Homosexuality) are a minority group that continues to see homosexuality as a mental disorder to be treated.

Get with the program, NARTH!  Homosexuality was removed from the DSM (Diagnostic and Statistical Manual of Mental Disorders, the ultimate diagnostic guide for psychiatrists) back in 1973.  For NPR's telling of this story, see 81 Words.  One piece of research that helped to contribute to this change in perception of homosexuality in the mental health field was a study administered by Evelyn Hooker, who matched gay men with straight men (none with any prior history of mental illness) , performed a series of psychological tests, and demonstrated no significant evidence of any difference between the groups with respect to mental adjustment.  In other words, gay men aren't crazy!

So where does that leave us now?

The official medical perspective at present is that homosexuality is a normal variant.  Well-respected organizations such as the American Academy of Pediatrics support same-sex co-parenting, and mainstream society as a whole is realizing that being gay is okay.  Thank goodness.  But that doesn't mean that remnants of homophobia aren't interweaved in the medical community.  I've talked in other posts about the negative experiences LGBT folks have reported with health care providers.  And even simple things like using heteronormative language - assuming patients are straight, assuming that one's marital status is an accurate representation of their partnership status, etc. - can be problematic and alienate providers from their LGBT patients.

The first step has been to help society realize that homosexuality is NOT pathological.  The next goal  that we should all strive for (in my mind) is to help LGB individuals feel supported in their sexual identity.  Avoid assumptions, use inclusive language, and connect them with extra resources/support when necessary.