LGBTQ living and mental health: From DSM to queer care

LGBTQ living and mental health: From DSM to queer care

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First in a three-part series. Some names have been changed to protect privacy.

For centuries, being LGBTQ has been associated with mental illness, criminality and sociopathology. Laws against sodomy were established in the 17th century in the U.S. and only overturned fully in 2003 by the Supreme Court. Committing sodomy was often used as an example of mental illness, so the connection between homosexuality as both mental illness and criminality was constantly being made and reinforced.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is the handbook used by healthcare professionals in much of the world as the authoritative guide to diagnosing mental disorders. The DSM categorized homosexuality as a mental disorder until 1973 and being transgender until 2013.

For generations, lesbians and gay men in the U.S. were also often imprisoned in mental hospitals for their same-sex attractions, at a time when families decided to have their sons and daughters committed rather than risk the social stigma of discovery. In Philadelphia, the Friends Hospital in the Northeast was one of those mental hospitals.

In the late 19th century, the pathologization of same-sex desire by doctors and psychiatrists began in earnest. Labeling homosexuality a mental disorder inevitably led to attempts to “fix” same-sex attraction into a heterosexual attraction. The development of conversion therapy began in 1899, and over the next century, a range of procedures were utilized to attempt to turn gay men and lesbians heterosexual. A survey by The Williams Institute of UCLA Law School showed that nearly half a million Americans had undergone conversion therapy as minors.

Conversion therapy remains legal in 34 states in the U.S. and all but five countries worldwide.

The most common technique for conversion was electroconvulsive therapy, but more extreme treatments such as lobotomy and chemical and surgical castration were also used. One German psychiatrist and another in New Orleans transplanted testicles of heterosexual men into gay men. Some psychiatrists had surgeons do direct brain stimulation with electrodes on gay and lesbian patients. Many of these patients died from these treatments.

Aversion therapy was also employed to “de-gay” people. In this process, people are given medications that will make them nauseous and then shown photographs and films depicting same-sex romantic and sexual encounters, so that the association with those images becomes linked to feeling ill.

Sometimes electroshocks to the genitalia were also used in this type of therapy. These procedures were used on both men and women in mental hospitals throughout the U.S. well into the 1980s.

Philadelphia gay activist Barbara Gittings was instrumental in getting the mental illness designation lifted from the DSM. At an APA convention in Philadelphia in 1972, she bought a booth from which she distributed material explaining that same-sex attraction was normative. She also set up a kissing booth, where gay men and women kissed publically to disrupt the stigma narrative.

But it was the panel she set up with herself, another gay activist and a masked gay Philadelphia psychiatrist, Dr. John Fryer, to dispute the theories of same-sex attraction as mental illness that had the most impact. Fryer said there were many other gay psychiatrists and said, “When fellow homosexuals come to you for treatment…develop creative ways to let the patient[s] know that they’re all right.”

Iconic, award-winning, Black science fiction author and Temple University professor Samuel Delany, 77, checked himself into a mental hospital in the 1960s. Fearing the homophobia of fellow patients, he was slow to reveal his homosexuality. Writing about his own experience, Delaney said what stunned him was his own self-loathing that he’d been unaware of. Delany wrote, “There in the hospital, I had not been dwelling on the physical pleasure of homosexuality, the fear and power at the beginnings of a political awareness, or the moments of community and communion with people from over an astonishing social range,” he wrote. Instead, Delany had described his gayness as sickness and pain that he wanted to escape. “Where, then,” he queried, “had all the things I’d said that morning come from?”

Delany had an epiphany which many men of his era were slow to address: the literature and models they had access to were limited and many had negative messaging which led to these negative feelings. These were the very issues that Gittings had wanted to disrupt at the APA convention with her kissing booth.

Delany wrote that his feelings about gayness being not affirming, but damaging, had come from various books he had read, including one by Dr. Edmund Bergler that “explained how homosexuals were psychically retarded,” as well as novels such as The City and the Pillar by Gore Vidal and Giovanni’s Room by James Baldwin.

In an interview at the University of Pennsylvania’s Kelly Writers House, those thoughts were reiterated as Delany read from his novel Dhalgren: “As I walked home, I thought about the hospital again. … It was so easy to tell your story and not mention you were homosexual. It was so simple to write about yourself, and just not to say you were Black.”

Marginalization is a difficult path to traverse.

Trauma therapist and social worker Dr. Jennie Goldenberg has worked with LGBTQ clients for nearly two decades. She says the complexity of the history of stigmatizing LGBTQ people and incorrectly demonizing them as mentally ill has made accessing care for actual mental illness much more difficult and fraught. “The interconnectedness of social stigma for being LGBTQ and the social stigma for being mentally ill makes seeking help for depression or other mental illness far more difficult than for a non-LGBTQ person,” she explained.

“The mental health field has not addressed adequately the need for interventions designed specifically for the challenges LGBTQ folks face in a still homophobic society,” Goldenberg told PGN. “The stressors and stigma continue to be crushing, despite high-profile celebrities and political figures like Ellen or Pete Buttigieg.”

Goldenberg addresses what Delany was unaware of at the time he spent three weeks in Mt. Sinai Hospital decades ago. “Because LGBT folks have significantly higher levels of anxiety and depression due to their minority status, harassment, and so forth, the challenge is for mental health providers.”

Goldenberg said these providers must “help clients recognize that a lot of their stress is due to environmental/large scale homophobia and transphobia.” She said professionals must help clients target these issues “rather than internalize the negative and hurtful messages of society as personal failure and self-blame.”

Self-blame is the reason many LGBTQ people still seek out conversion therapy, even though it has been widely debunked.

While 16 states (Pennsylvania is not one of them, but New Jersey and Delaware are) have banned conversion therapy for minors, as has the District of Columbia, no state has banned it for adults. In addition, the statewide bans are limited in their purview, focusing mainly on psychiatrists and other mental health professionals, but allowing religion-based conversion therapy programs to continue. Philadelphia banned conversion therapy in 2017, joining several other Pennsylvania locales including Doylestown, Pittsburgh, Reading, State College, Bethlehem and Yardley Borough.

Despite the ban, a quick Google search finds conversion therapy is readily accessible throughout Philadelphia and the suburbs, and its existence puts LGBTQ people at risk as much as they’ve ever been.  

Next week: Finding help for mental illness as an LGBTQ person, the rise in mentally-ill LGBTQ people experiencing homeless and the threats mentally-ill LGBTQ people face from law enforcement and the mental health system.


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