GLR November-December 2022

OPEN LETTER

Inside the APA’s Decision to Delist L AWRENCE H ARTMANN

E DITOR ’ S N OTE : This “Open Letter” started as a lengthy ketter to the editor, but it was too long for that format and warranted more prominent placement. The author was so kind as to adapt the letter to this format. I WISH TO RESPOND to an article that appeared in the May-June 2022 issue of this magazine titled “How Three Activists Stopped the Madness.” While the arti cle is a creditable take on the more public and flamboy ant side of the story, it leaves out the behind-the-scenes deliberations and actions that led to the APA’s momen tous decision. In December 1973, the American Psychiatric Association decided to remove “Homosexuality” per se as a mental illness diagnosis from the Diagnostic and Statistical Manual (Volume 2). That decision turned out to be widely important. Not only did many major national and international mental health groups soon support the change, but many laws in many countries changed as well. Many customs and policies and arrangements changed; much social understanding changed; and a great deal more art and sensible popular and scientific writing about ho mosexuality was published than had ap peared before 1973. the many quieter, cooperative steps that were essential to the change. The headline to the piece, with its reference to “stop ping the madness,” is a typically oversimplified summary. The three people on that panel helped the cause, to be sure, but a lot of other work, by a good many other people—as well as some good luck and timing—were essential to success. Part of the G&LR article was probably familiar to many peo ple, as the protesters’ activism has been much written about and was the topic of a 2021 PBS “Independent Lens” documentary. Frank Kameny did good, energetic, tenacious, and courageous work to help end homosexuality as a diagnosis, and he deserves a lot of credit. And he has received some from many supporters both gay and straight, including from President Obama. So does Barbara Gittings, who played a crucial organizing role. And so does John E. Fryer, the mask-wearing APA member who came out as gay on the panel and made a passionate plea for toler Lawrence Hartmann, MD, a past president of the American Psychiatric Association, is a child psychiatrist and activist who played a critical role in the APA’s declassification of homosexuality as a mental illness. Some reports of what led up to that deci sion, including the G&LR piece on that sub ject to which I referred, stress the picturesque moments—such as the 1972 panel featuring Barbara Gittings, Frank Kameny, and a masked John Fryer—which were powerful and useful, but often they don’t do justice to

ance. However, the article ignored some crucial areas of history and hard work that were essential to the 1973 decision, and which would by now have been relatively easy to mention or document. The author [Malcolm Lazin], like many who have commented on the 1973 decision, seems to know little about psychiatry or about the APA as an organization, and he seems to imply that making a loud noise over time did the whole job. As a now elderly psychiatrist who was an active part of the American Psychiatric Association’s diagnostic rethinking and change in 1972-73, and who went on to teach at Harvard for fifty years and eventually to become president of the APA, I want to bring to the attention of G&LR readers some of the is sues slighted by the May-June article. Some questions that were not addressed are these: What is a psychiatric diagnosis? How and why does that matter? What was the standing of the Amer ican Psychiatric Association in the early 1970s? of the Board of Trustees of the APA? of the APAAssembly? of the DSM itself? How could a major change affecting a huge category of people happen in the large and then rather conservative APA? What were the discussions, the obstacles, the possibilities? The APA was at the time by far the largest and most influ Civil Rights movement, and the Women’s Rights movement all helped to stimulate reconsideration and an openness to change, both inside and outside the APA. On the LGBT front, Stonewall helped a lot, as did the sep arate research of Alfred Kinsey and Evelyn Hooker, both of whom studied non-institutionalized, non-incarcerated gay peo ple. The status of homosexuality had evolved from sin to crime to mental illness over a period of several centuries. Now chang ing the concept from “mental illness” to mere “difference” was a difficult and major shift. However, there was a history of thought spanning at least two centuries that was very support ive of change, with precedents that included the philosophy of Diderot, the Code Napoleon, Jeremy Bentham’s utilitarianism, the science of Karl Heinrich Ulrichs, Karl Maria Kertbeny, and Magnus Hirschfeld, and the scholarship of John Addington Symonds and Edward Carpenter. In the 20th century, Sigmund Freud with his immense influence was partly supportive of nor malizing homosexuality, though the next generation of Freudi ans was not. Some studies by historians, anthropologists, sociologists, ethologists, and animal studies scientists, while ential psychiatric organization in the world. It was far more influential, for instance, than was the relatively small World Psychiatric Association. This was partly because of sci ence and partly because of the international standing of the U.S. in the postwar world. The DSM mattered, and it was internation ally debated and approved. Could the APA be changed? The Vietnam War protests, the

The G&LR article ignored some crucial areas of history and hard work that were essential to the APA’s 1973 decision.

November–December 2022

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