New book describes the hassle

Gays vs. psychiatry, psychiatrist vs. psychiatrist

Homosexuality and American Psychiatry, the politics of diagnosis, by Ronald Rayer. Published by Basic Books, Inc., New York, $12.95.

By R. Woodward Between the psychiatric establishment in the United States and the American gay liberation movement there has been a major clash of assumptions.

American psychiatry has traditionally argued that homosexuality per se is a mental illness and that "homosexuals" are sick people that American psychiatrists should be taking care of.

Those involved in gay liberation since the 1960s have insisted that homosexuality per se is no illness and that gay people in general are capable of taking care of themselves.

The question of whether or not homosexuality is to be regarded as a mental illness has been as much a political issue as a medical one. It has been a question not only of how ill any particular "homosexuals" actually look or feel, but also a question of who

should control how "homo-

sexuals" think and behave.

Saying that people are mentally ill implies that their judgment is impaired and that they

are likely to need looking after. Saying that particular people are mentally ill usually goes hand in hand with insisting that they themselves are not the ones who know what is best for them.

The clash between gays and psychiatry is depictec in detail in a new book by Ronald Bayer entitled Homosexuality and American Psychiatry, The Poiltics of Diagnosis. Bayer, an Associate for Policy Studies at the Hastings Center, Institute of Society. Ethics, and the Life Sciences, has written a book which is well-researched, well written, and also extremely exciting.

that the American Psychiatric Association was just about torn. in half.

Deleting homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, the Psychiatric Association's official list of mental disorders, was effected by a vote of the Board of Trustees of the American Psychiatric Association after the proposed deletion had been inspected and approved by the Nomenclature Committee, the Council of Research and Development, the Assembly

of District Branches, and the

Reference Committee.

Trustees was upheld by a vote of The decision of the Board of 5,844 psychiatrists for and 3.810 against, a clear majority but not an overwhelming one.

Says Bayer in his book, "It was a struggle in which neither side would ledge the merits of its opponents' acknow case.

"Those who opposed the nomenclature change believed that the psychiatrists who voted to reverse the board's decision had rallied to the banner.of

Mailbag

TO THE EDITOR:

Unaware that they were being paradoxical, or too angry to care. If R. Woodward knows as psychiatrists opposed to the much about other subjects as he "diagnostic shift" decided to try espouses to know about psychia to restore the American Psychitry, then he should be FOREVER atric Association to its "scientifiBANNED FROM PUBLISHING cally objective" senses and keep ANYTHING at least in High it from succumbing to "political Gear, ever again. FURTHERpressure" by resorting to a stra-MORE, it should be YOUR duty tegy that is unmistakably as editor (even interim) TO SEE political. THAT SOURCE MATERIAL HAS They formed an Ad Hoc Com-AT LEAST SOME VALIDITY!!! mittee Against the Deletion of i.e.: let the people who KNOW Homosexuality and forced the about psychiatry do the writing board's decision to a referendum not some flagrant, hack, amateur by the entire membership of the journalist!!! association.

(Name withheld by request)

those who voted to affirm the science and objectivity while December 15 action were guilty of attempting to impose their own social values under the hand, those who supported the guise of science. On the other affirmative votes as indicating change portrayed their own their commitment to the scientific tradition of psychiatry, and they excoriated those who supported the Socarides position for their value-laden attachment to an unscientific perspective on homosexuality."

(The Socarides referred to by Bayer is Charles Socarides, the leader of the ad hoc committee. Socarides is widely noted for his

JULY 1981-HIGH GEAR Page 7

als." about half of them, who are opinion that those "homosexunot simply neurotic are psychotic or on the verge of becoming psychotic).

moral assumptions usually influScientific views, politics, and slowly and gradually and in ways ence and define each other which ar enot readily apparent to the general public.

As Bayer points out, as the psychiatrists struggled with each. other, in response to the demand by gay activists that homosexuality be redefined, the interacting between science, politics, and morality was speeded up and glaringly illuminated.

Friends and allies

Vehement rejection by gays has been a major trauma for many psychiatrists because many psychiatrists did not realize what their power over gays was based on.

Many psychiatrists have overlooked what is an obvious practical consideration for anyone who wants to wield a great deal of power: Being an ally is not the same thing as being a friend.

A friend is someone you associate with because you happen to like that individual. An ally is someone you associate with because that individual happens to be useful to you.

· Friendship involves love and pleasure. Having an ally involves necessity and expediency.

For gays, being involved with psychiatrists has mostly been a mat-

From the introduction in Ronald Bayer's book HOMOSEXUALI-ter of necessity and expediency. TYAND AMERICAN PSYCHIATRY, THE POLITICS OF DIAGNOSIS:

"Because concepts of disease and health take form within cultural contexts in ways that often remain hidden from view, the process of change through which certain deviations become labeled as normal or abnormal remains difficult to discern, becoming clear only when ¿torical or social conditions potuit the piercing of the veil of "the natural."

The decision on the part of the American Psychiatric Association to remove homosexuality from its list of disorders was startling to many observers precisely because it diverged so dramatically from the more hidden and gradual pattern.

Between. 1970 and 1973, in a period of only three years, what had been n article of orthodoxy in psychopathology was reversed. Because the change occurred so rapidly, the factors that are always at play were placed in stark relief, allowing us to observe some features that are often obscure.

The struggle over the status of homosexuality also provides an extraordinary opportunity to examine the complex relationship' The book includes a history of between psychiatry and contemporary society. It has become a matpsychiatric attitudes in the Uni-ter of conventional wisdom to note that psychiatry is affected by the ted States towards homosexualcultural milieu within which it is embedded, tending to reflect the ity and a history of gay liberation dominant values of the time. But psychiatry as a social institution is not so limited. It is not simply an agency of social control, autonomous only to the extent that it can develop its own explanatory schemes and modes of therapeutic intervention. Psychiatry may, under special circumstances, act upon society, using its cultural influences to challenge social values and practices. The APA's decision on homosexuality provides an instance of such an effort. Society's response reveals the limits of that reformist capacity.

in the United States.

Bayer's text of 195 pages contains so much information that many readers will not feel that they have absorbed it adequately • until they have read the book through about three times. Most people who read the book through once, however, will be eager to read it through a couple of more times.

Clear, very concise, and very well organized, the book is very readable (even though you might have to look up a few words). The author leaves you entirely convinced that his subject matter is not only relevant to you, but vital. Three hectic years

In December of 1973, when homosexuality was deleted from the official list of mental diseases issued by the American Psychiatric Association, the deletion was largely the result of three years of vigorous and frequently -disruptive lobbying by gay activists. Psychiatrists argued so vehemently among themselves

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The psychiatric notion that homosexuality is an illness, which means that you should be seeing a doctor, seemed better than the notion that homosexuality is a sin, which means that you are going to hell, or the notion that it is a crime, which means that you should be locked away in prison.

Many psychiatrists harbor the romantic and flattering notion that psychiatric patients always fall in love with their doctors at some time during treatment.

Many psychiatrists "treating" gays have not distinguished between being loved and being regarded as the least of a small selection of R. Woodward

evils.

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