GLR November-December 2022

supporting LGBT acceptance, were not widely known, though their work was slowly beginning to accumulate by the mid-20th century. In 1970, after the APA’s non-response to the invasion of Cambodia and the Kent State massacre, a small group of youngish members of the APA calling themselves the Commit tee for Concerned Psychiatrists (CFCP) met and actively set out to reform the rather conservative and guild-oriented APA of the time. Fuller Torrey and I and a few others took the lead in this endeavor. By petition, we repeatedly proposed changes to APA bylaws, which eventually were adopted, leading to competitive elections and a more diverse slate of nominees. For several years in the early 1970s, the CFCP nominated, and was suc cessful in electing, several distinguished psychiatrists from major cities and psychiatric centers (e.g., New York, Chicago, L.A., Boston) who were open to the social aspects of psychia try and patients, and not just “guild” and financial aspects of the practice. With lots of membership backing and enthusiasm, we got a remarkable number of such people onto the APABoard and as president and vice president of the organization (such as Al Freedman, John Spiegel, Judd Marmor, Jack Weinberg, Viola Bernard, Mildred Mitchell Bateman, and Alan Stone). That change was absolutely key to getting any change on homosex uality passed by the larger body of the APA. It would not have happened without them. The APABoard had and has the power to set rules and poli cies for the organization, but structurally it sat on two large pil lars, both of which were important in influencing the Board on major policy. One pillar was the Council and Committee Sys tem, leading up to the Reference Committee, which was made up of the council chairs and headed by the APA president-elect. Councils working on a range of issues—Women, Children, Ed ucation, Research, Government, International Affairs—and their committees tended to be staffed by national experts cho sen by successive APA presidents. The other pillar was the APA Assembly of District Branches, comprised of about 140 people largely based on local and state psychiatric societies, organized into regional Area Councils. The Assembly tended to over-rep resent rural and private practice psychiatrists and to be firmly conservative on social and financial issues. The APA Board usually tried to reconcile differences and create cooperation between its two pillars on large policy is sues. On the December 1973 decision to end homosexuality as a diagnosis, both pillars were essential, and the publicity gen erated by Robert Spitzer, MD, who chaired the Committee on Nomenclature of the Council on Research (which tended, and still tends, to overshadow the Assembly pillar), was indispen sable. How was the Assembly brought to be comfortable with the December 1973 change? In 1972, well ahead of the Committee on Nomenclature— which did most of its widespread consultation with other APA

councils and committees in 1973—an APA District Branch (Northern New England) and its Social Issues Committee took the lead in creating and articulating psychiatric positions on so cial issues such as women, children, Blacks, racism, drugs, His panics, the elderly, and poverty. That committee, which I chaired at the time, discussed psychiatric diagnoses and possi ble abuses of such diagnoses, and in late 1972 we wrote up a two-page argument for opposing discrimination against homo sexuals and ending homosexuality as a psychiatric diagnosis. The document outlined much of the evidence, arguments, and material that would be more widely discussed by the APACom mittee on Nomenclature, and several APA Councils, in the fol lowing year. This paper, with a bit of minor editing, was passed by the NNEPS (made up of Massachusetts and New Hampshire at that time), and then by Area I of the Assembly (New England plus Eastern Canada), and finally, to the pleasure of its writers, by the APA Assembly. Without the usually conservative APA Assembly taking up and furthering the cause, the APA would almost certainly not have voted to accept the resolutions put forth in our paper. Thus in December 1973, the APA Board, which now in cluded a good many social-psychiatrically aware psychiatrists, was faced with a closely watched, noisy, and risky-seeming de cision, with largely overlapping positions from its two pillars, the Council and Committee structure and the Assembly. The APA Board adopted some of the Assembly language and voted 13 to 0, with 3 abstentions, to pass the removal of homosexual ity per se as a psychiatric diagnosis. That was decisive. Other major mental health organizations in the U.S. and abroad—psy chologists, social workers, psychoanalysts—soon followed the APA, and a remarkable number of laws, regulations, and social policies were reformed. Two well-known blips followed the December 1973 deci sion. First, as a sop to some conservatives and some vocally prominent psychoanalysts, a provisional diagnosis was created for those homosexuals who thought or felt deeply damaged by their homosexuality, labeled as “Ego-Dystonic Homosexuality.” That was clearly a stopgap for a minority of dissenters, and it was predictably deleted after a few years. Second, some con servatives in the APA, led by some psychoanalysts who claimed to be able to “cure” homosexuals, instigated a referendum of all APA members in an effort to overturn the Board’s December 1973 decision. That effort failed decisively, but it did muddy the waters a bit, enough so that many—perhaps half or more— of the journalists writing about the event since then have stated incorrectly that the APA “cured millions” of mental illness in a referendum. In fact, the Board’s decision was the result of a con scientious study of the science, which was carefully and widely discussed. While the media have sometimes overdramatized the events of 1972-73, the APA’s decision would prove to have widespread consequences.

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