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\title{166-460B Paper Proposal}
\author{Rich Lafferty}

\hyphenation{theo-ries stun-ted emo-tio-nal par-en-tal}

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{\LARGE {\bf {\it Queerly Ill}}}

{\Large The Rise and Fall of the Illness of Homosexuality}

\vspace{0.5in}

{\large
Rich Lafferty\\
October 20, 2000\\
\vspace{0.2in}
\href{http://www.lafferty.ca/writings/}{http://www.lafferty.ca/writings/}
}

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\begin{center}
{\bf Abstract}
\end{center}
This article traces the development of the illness of homosexuality
from its legal origins through its political demise within a framework
of social control exerted by the medical profession. The rise of
an authoritative medical profession and the stigmatizing effects of
its positivist ideology are examined in the context of Goffman's theory
of stigmatization, and the development of positive homosexual identity
from within a negative illness model is explained using David Matza's
naturalist theory of deviance. Recent developments suggesting
remedicalization of homosexuality by the gay community are explored.



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% =====================================================================
% Introduction
% =====================================================================

\begin{quote}
\textit{The mental processes of the man with whom one disagrees are always
wrong. Where is the line between wrong mind and insane mind?}\begin{flushright}
\small{Jack London in \cite{Elrich78}: 64}\end{flushright}
\end{quote}

The history of homosexuality---particularly that of sanctions against
homosexuality---is a curious one from the point of view of the theory
of social problems and social control. For thousands of years,
same-sex sexual behaviour has been considered, in one way or another,
to be unacceptable; the historical universality of the homosexuality
taboo has been compared to that against clan incest in staying power and
mythology (\cite{Plummer81}). Yet for all this, the actual enforcement
of the norm has seen tremendous variation, as new institutions of
social control gain authority and power at the expense of that of
their predecessor.

In particular, homosexuality has, for a little more than a century,
found itself in the domain of the medical profession; exceptionally,
it has toward the second part of the century found itself able to
escape, to an extent which will be discussed below, from the control
of that domain. This paper examines the genesis of the medical
conception of homosexuality,\footnote{This paper concerns itself
almost entirely with male homosexuality. For reasons documented
elsewhere, historical prohibitions against same-sex behavior have been
targeted primarily at men. For more on this, see \cite{Miller95}.}  its
effect on the identity of those engaging in homosexual behaviour, and
the political effects of that identity on freeing homosexuality from
institutional control.

% =====================================================================
% Premedicalization
% =====================================================================
\subsection{The Church and State}
Prohibitions against same-sex sexual behaviour have a long and
established history in Western society, although the form of those
prohibitions has changed over time, especially in the last century or
so. Institutionalized limits on homosexual behaviour originated,
predictably, with the Christian church. While there have been
occasional disputes over its proper interpretation, the historical
Christian approach to homosexual behaviour finds itself rooted in the
Biblical tale of Sodom, in which two (male) angels take residence in the
house of Lot, and are called upon by the townspeople:

\begin{quotation}
\noindent But before they lay down, the men of the city, even the men
of Sodom, compassed the house round, both old and young, all the
people from every quarter: and they called unto Lot, and said unto
him, Where are the men which came in to thee this night? Bring them
out unto us, that we may know them.

And Lot went out at the door unto them, and shut the door after him,
and said, I pray you, brethren, do not so wickedly.  Behold now, I
have two daughters which have not known man; let me, I pray you, bring
them out unto you, and do ye to them as is good in your eyes: only
unto these men do nothing; for therefore came they under the shadow of
my roof.
\begin{flushright}
\small{(Genesis 19:4--8, KJV)}
\end{flushright}
\end{quotation}

For their desire to ``know'' (\textit{i.e.}, to have sexual relations
with) the visitors, God destroyed the cities (Genesis 19:24). The
religious prohibition of homosexual behaviour found itself codified in
law as early as the 16th century, when it was thus incorporated in the
ecclesiastic sanctions of 1530 (\cite{Weeks81}).  The rise of the
State and corresponding decline of the Church brought on by the
transition from feudalism served to an extent to divorce the letter of
the law from the moral code upon which it was based (\cite{Kutchins97});
one result of this secularization was that by 1885, the only law
in the United Kingdom to deal directly with homosexual acts was that
which made buggery a capital crime (\cite{Weeks81}), but even that
made no distinction of gender or even species. While buggery was no
longer a capital crime by 1861, the late 1800s would find increased
legal sanctions against homosexual behaviour; the 1885 Labouchere
Amendment made all male homosexual activity illegal under the label
``Gross Indecency'', punishable with two years hard labour (\cite{Weeks81}).

The legal approach to homosexuality was to send a strong message that
homosexual \textit{acts} were not to be tolerated. Homosexual behaviour was
considered abominable, and what was originally considered a grave sin
was later considered a grave crime (\cite{Kutchins97}).  However,
there was until this point no corresponding category for the
perpetrator himself; a man convicted of committing homosexual acts was
an undesirable, a criminal, even a sinner, but nothing more specific
than that (\cite{Miller95}). Homosexual acts were by their nature
committed in privacy; while failing to keep a secret probably had
reputation effects, it was the commission of the act, and not the
character of the offender, with which the courts were concerned, and
because of the private nature of the offense prosecution rates tended to
remain low (\cite{Weeks81}: 82).

By the turn of the century, that had begun to change. An
anti-homosexual crackdown in the mid-1890s found many leading citizens
at the heart of scandal, including Oscar Wilde, of whom the London
Telegraph of 25 May 1895 (in \cite{Weeks81}) wrote, ``We venture to
hope that the conviction of Wilde for these abominable vices, which
were the natural outcome of his diseased intellectual condition, will
be a salutary warning to the unhealthy boys who posed as sharers of
his culture.'' The paper's use of medical metaphor provides a first
glance into the reconceptualization of homosexual behaviour which was
beginning to establish itself.

% =====================================================================
% Medicalization
% =====================================================================
\subsection{The Medical Institution}

With the beginning of the 20th century came a shift in emphasis. The
sinner was no longer only the criminal; instead, therapeutic
intervention had begun to compete with criminal punishment, and
undesirable behaviour was beginning to be cast in medical, rather than
criminal, terms. In order to properly understand the implications of
this shift, it is first necessary to jump back slightly in time and
examine the origin of the roots of medical ideology. Historically, the
Christian church had objected to the physician's practice of charging
a fee for his work; healing was a Christian charity, and
if laymen were to practice it, they should be doing so without
obliging their patients (\cite{Turner87}). Predictably, this met
objections from the physicians. Their work was science, not religion,
and they intended to pursue their livelihood. Medicine adapted by
developing their own set of professional standards; by maintaining
these standards, medicine could become not only an occupation but a
\textit{calling}, in the same manner as but distinct from the
Church. While it was not clear that the Church agreed to such a
distinction, the structural differentiation which occurred between it
and other institutions with the Industrial Revolution solidified the
division between it and competing institutions, at the same time
compartmentalizing categories of Sin, Deviance, and Crime, although
not necessarily defining what would fall in which category.

In the 19th century, the medical fraternity was far from a single
united body. While licensing of medical practitioners began as early
as 1800 in the United States, it had since been repealed due to its
elitist nature (\cite{Conrad85}). The field was divided between
``regular'' practitioners practicing surgery, bleeding and similar
invasive practices, and ``medical cults'' practicing noninvasive
techniques such as homeopathy and botanical medicine. In 1847, a group
of American regular physicians formed the American Medical Association
(AMA) in order to promote what they termed the ``science of medicine''
which excluded the medical cults (\cite{Conrad85}: 10). As with most
professional organizations, the intention of the group was to exert
control over the profession itself; after an anti-abortion crusade in
the middle of the century, the AMA found itself with some authority
over the medical cults, who continued to practice now-criminalized
abortions. A number of convenient advances followed: the discovery of
scientific medicine (based on, but not limited to, germ theory), a
general decline in disease mostly attributable to improved living
conditions arising from improved sanitation and nutrition, and a
perception of vastly variant conditions of medical practice across the
United States led to the state granting in 1910 of medical licenses
(\cite{Conrad85}). The medical profession, via the AMA,
became functionally autonomous, being regulated internally---what
\cite{Conrad85}) referred to as a ``legally enforced monopoly
of practice'' which ``[had] won the almost exclusive right to reign
over the kingdom of health and sickness, no matter where it may
extend.''

The discipline of psychiatry soon took advantage of the gains of the
physicians. The discovery in 1913 of a physiological basis to general
paresis, or syphilitic madness, solidified the contested theory of a
physical etiology of what was then termed insanity, bringing
psychiatry firmly under the umbrella of medicine. In 1921, the
Association of Medical Superintendents of American Institutions of the
Insane---originally a group of institution managers and caretakers,
not doctors---changed its name to the American Psychiatric Association
(APA) (\cite{Conrad85}). The APA resembled the AMA in more than name;
the group quickly became authoritative on insanity, legitimizing
psychiatry by excluding those without formal training.  The
implications of the formation of such organizations are crucial to
understanding the conceptions of homosexuality which were to
follow. The establishment of medicine as a ``calling'' and the medical
profession's monopoly of practice combined to create an institution
with absolute authority over things medical.

The ideology of the medical profession is primarily one of
positivist science. \cite{Parsons51} described the basis of
medical ideology as ``the application of scientific knowledge to the
resolution of problems of illness and health.'' The scientific
knowledge to which he refers is that of specific etiology. Doctors are
trained to see illness as an individual phenomenon; diseases result
from physiological, biological, and organic abnormalities inside the
body and cures are those techniques which remove or return to normal
those abnormalities (\cite{Turner87}: 17, \cite{Conrad85}: 35,
\cite{Parsons51}: 431). If sickness brings with it social effects, they
are considered secondary, and traditionally not addressed in treating
the disease itself; the doctor's job is to neutrally
apply the scientific method to physiological problems, and the
assumption of neutrality is maintained even when social effects might
be present (\cite{Parsons51}).

Combining the monopoly power of the medical profession with its
professional ideology results in an institution with tremendous social
and regulatory power. The collegiate nature of the profession gives it
absolute authority to define sickness and health. Especially within
psychiatry, this provides the means to label certain attributes or
behaviours as abnormal. One behaviour which psychiatry labeled
abnormal was that of homosexuality.

% =====================================================================
% creation of homosexual
% =====================================================================
\subsection{Birth of the Homosexual}

While the psychological origins of homosexuality had been considered
since the early 1900s, it was Sigmund Freud (1856--1939) whose
theories of stunted emotional growth and parental attachment firmly
planted same-sex attraction and sexual behaviour in the domain of
psychiatry.  Unfortunately, while Freud for the most part refrained
from taking a moral stance on homosexual behaviour---often refusing to
treat patients who were ``only'' homosexual but did not suffer from
other psychological ailments (\cite{Miller95})---psychiatrists
following Freud quickly determined that an inclination toward members
of one's own sex was a sign of sickness which needed to be
treated. Sandor Rado (1890--1972) started the ball rolling immediately
following Freud with a theory of homosexuality based on an
incapacitating fear of the same sex (\cite{Miller95}); his theories
proved influential, and by the 1950s, a psychiatric explanation for
homosexual behavior was dogmatic within the profession. The leaders of
that school of thought were Irving Bieber (1908--~) and Charles
Socarides (1922--~). Bieber claimed a 25\% cure rate among homosexuals
he had treated, claiming that ``every homosexual is a latent
heterosexual'' (\cite{Miller95}: 248); Socarides declared that
``heterosexual object choice is determined by two and a half billion
years of evolution'' and claimed that half of those engaged in
homosexual practices were paranoid or schizophrenic, while the other
half were merely neurotic.  The homosexual was sick; homosexual acts
and desire became not just undesirable but a disease, something in
need of a cure, the basis of which would have to originate in the
afflicted individual (\cite{Matza69}, \cite{Scheff99}).

These theories of homosexuality---treated by the profession, as are
many medical theories, as undeniable fact---had a curious if
predictable effect. As homosexuality became an illness, homosexual
acts became essentializing. It was no longer what someone
\textit{does}, but rather what one \textit{is}. As with most
psychiatric conditions, homosexuality became a diagnostic category, a
means of separating out (\cite{Plummer81}), into which fell the Homosexual.
By declaring a medical basis for homosexual behaviour, the psychiatric
profession created the concept of an individual, with psychological
abnormality, suffering from a disease, with specific causes outside of
the individual's control. In other words, by committing homosexual
acts one exhibited a symptom of a mental illness, and as one thus
inflicted, became a homosexual.

There exists an incongruity between the professional and public
conceptions of mental disorder: while professionals explain away
behaviour by considering it as having resulted from the disorder, the
public, while accepting of the \textit{existence} of the disorder, is
considerably less willing to ignore behaviour which conflicts with its
norms (\cite{Conrad85}). In other words, deviance remains deviance
even when given a medical explanation. From the point of view of the
psychiatrist, social aspects of sickness are side-effects, and are all
but ignored in determining the cause of a psychiatric illness.  For
the layman, though, in the case of homosexuality, the initial
pre-medical taboo lingers. On one hand, the layman knows that the
medical profession has stated that homosexuality is a mental illness,
and that homosexuals are sick, but at the same time he also knows from
his socialization and myths that homosexual acts are sins and crimes
and willful behaviour. To those outside the medical profession, the
homosexual is no longer just bad---rather, he is now sick \textit{and}
bad. Matters are made worse by the particular sort of badness
homosexuality implies: the homosexual, engaging in forbidden acts in
secret, becomes not only immoral but subversive, doubly so since the
idea of a nonreproductive male is at odds with the family structure
upon which the society is built.

Further, ``sick'' in this case does not imply a medical, morally
neutral state. \cite{Parsons51} details four aspects of what he
termed the ``sick role'': (1) an exemption from normal social
responsibility relative to the nature and severity of the illness; (2)
an expectation that the sick person cannot be expected to get better
by decision or will; (3) definition of the state of sickness as
undesirable; (4) an obligation to seek technically-competent help.
Homosexuality does not fit well with the sick role; assuming that
same-sex sexual relations are engaged in in private for (at least)
positive physical sensations, the homosexual implicitly disagrees with
the third and fourth aspect of the sick role. As such, his sickness
may fail to generate a sympathetic response as would, for instance, a
broken leg. Since homosexuality is chronic, the exemption of the first
aspect of the sick role is minimal. Lastly, viewed as the layman as
the commission of unnatural acts, the second aspect of the sick role
also fails to hold; there remains a suspicion that the homosexual
could simply \textit{stop}, and in refraining from any sexual
behaviour fit into convention as well as someone not thus branded could. 
The homosexual fails to play the sickness role as expected and is thus
disallowed the exemptions usually made for the sick.

All of this combines to create a popular image of the homosexual as
inherently and irreparably if imperceptibly \textit{different}
(\cite{Scheff99}). The medical profession provides the basis for the
distinction, which the layman believes because of the doctor's
position of authority and alleged neutrality. The distinction recalls
traditional taboos on same-sex relations as well as stereotypes of
mental illness.  The homosexual's behaviour suggests a subversive
refusal to comply with the expectations following
self-diagnosis. While the medical profession creates the
\textit{category} of the homosexual, the popular imagination creates
the archetype. The homosexual, judged evil but from ascribed
characteristics, finds himself as one of a long tradition of diabolic
Others in Western history/mythology, like the Vampire, the Gypsy, and
the Witch (\cite{Young95}: 11), a deviant near-human with the capacity to
bring himself under control but refusing to do so.

% =====================================================================
% Being Homosexual
% =====================================================================
\subsection{Being Homosexual}

The fate of the homosexual himself, between the efforts of the medical
establishment and the perspective of the layman, at first seems
sealed. First, he lives with the threat of treatment from the medical
establishment. Treatments for homosexuality varied, but at one time or
another included surgical interventions from vasectomy to lobotomy,
chemical treatments from hormones to pharmacological shock,
electroshock and aversion therapy, and incarceration
(\cite{Kutchins97}).  As it turns out, homosexuality was relatively
easy to conceal from medical authorities. Incarceration was falling
out of favour due to budgetary problems and ensuing
deinstitutionalization starting in about 1950
(\cite{Turner87}). Keeping away from treatment meant keeping one's
homosexuality a secret---staying `closeted'. Staying away from doctors
was a common approach, but occasionally a visit would be necessary, as
\cite{Young95} notes: ``Gay people hid their sexual orientation from
their doctors, knowing that if it was discovered, their real illnesses
would take second place to the pressing need to `cure' their
affections''. Nonetheless, the homosexual undergoing involuntary
treatment became the exception, and the violent
nature of the treatment kept the rest away from all but
psychotherapy. Those that did end up in psychotherapy, claimed
psychoanalyst Judd Marmor, had bought the majority line that
``\ldots{} it was bad to be gay, and that if they possibly could, they
ought to try to be heterosexual'' (\cite{Kutchins97}: 63).

The effects of popular opinion were not so easily avoided, and are
most easily explained from the viewpoint of Goffman: the homosexual
was constantly forced to conceal his homosexuality from the public and
to place himself at risk when revealing himself to other homosexuals
or homophiles. The unexposed homosexual was stigmatized. He became
\textit{discreditable} (\cite{Goffman63}); while no-one would have to
know about his homosexual status, he would feel transparent in mixed
encounters even though his stigma was easy to conceal. \cite {Goffman63}
quotes an unnamed homosexual from 1960:
\begin{quote}
[T]he strain of deceiving my family and
friends often became intolerable. It was necessary for me to watch
every word I spoke, and every gesture that I made, in case I gave
myself away. (90)
\end{quote}
It was not necessary for anyone to actually censure him; the imagined
censure and fear of being `outed' was enough to exert control over his
actions. `Normal' society labeled those that were
like him as `homosexuals', and since he found himself attracted to, in
the company of, and having sex with other homosexuals, he soon began
to consider himself a homosexual as well (\cite{Gerhardt85}).

The homosexual label differs slightly from the conventional labeling
theory in one respect: while it tends to behave as a master status in
terms of risk of exposure and dominance over one's life, it does so in
an adjectival, rather than a nounal sense (\cite{Gerhardt85a}); where
a banker caught stealing is labeled a thief, a banker caught in a
homosexual act is labeled a \textit{homosexual
banker}. Unfortunately, Gerhardt only acknowledges that behaviour,
without explaining why it might be the case. I suspect that `banker'
plays as much of a role in that example as does `homosexual'; that is,
that high-prestige occupation isn't completely crowded out by the
homosexual label, or that retaining the high-prestige occupation in
the label serves the purpose of the labelers better through irony or
shock.

The nature of the homosexual label was pervasive. It was not
immediate; \cite{Plummer81} observed that a single homosexual
encounter was only sufficient for four of thirty men to consider
themselves homosexual. But men attracted to men with the means to have
one encounter also had the means to have more, and these repeated
encounters would more and more encourage the as yet unlabeled
neophyte to consider himself a homosexual. \cite{Matza69} following
Becker separates affinity from affiliation in the factors which lead
to the adoption of a role; as the neophyte meets more self-identified
homosexuals (affinity) and engages in homosexual practices with them
(affiliation) he mediates the process of becoming, the whole time
feeling as though he was, or could at any moment be, under the eye of
the authority supplying the label. Engaging apparently willingly in a
forbidden act and finding himself at constant risk of being discovered
and branded homosexual, he begins to adopt the label for himself,
making it easier to repeat the behaviour. Knowing that it is
prohibited, he finds himself attempting to stay safe by avoiding
situations in which it is necessary to work at concealing his
invisible secret, favouring instead the company of others similarly
identified. He is, in Becker's terminology, ``turned on'' (in \cite{Matza69}).

% =====================================================================
% community
% =====================================================================
\subsection{Forming a Community}
Having been signified as a homosexual and then self-identifying as
same, the homosexual could be expected to organize his life to
minimize opportunity for being ``outed''---\textit{i.e.}, discredited
by having his deviant identity revealed to those from whom he had kept
it secret---while at the same time attempting to maintain the
associations and activities by which he found himself becoming a
homosexual, and by which he may satisfy his sexual
needs. 

Goffman observed the tendency for stigmatized individuals to form
local and wider networks of those ``acquainted or
acquainted-once-removed'' who share the stigma (\cite{Goffman63}). For
homosexuals, the advantages of such a network were many. Amongst other
homosexuals and the occasional homosexual-friendly heterosexuals, it would
not be necessary to engage in impression-management techniques to
prevent being discredited; since the norm would be homosexuality,
finding sexual partners did not involve risk of further
stigmatization; and the simple awareness of others in the same
situation would reduce the anxiety of being fundamentally different
from the heterosexual majority.  At the same time, it was unnecessary
to completely abandon the mainstream; as mentioned previously,
homosexuality was private enough that avoiding discrediting was
possible. The homosexual led something of a double life: able to
maintain a normal role in the public sphere, he could keep a job and
use public resources, while assuming a homosexual role in his private
life.

As more and more homosexuals found themselves in this situation, the
ad-hoc means by which they would associate started to
institutionalize; what started as convenient associations with others
known to be homosexual turned into what \cite{Plummer81} refers to
as a ``life-sustaining `hero system' around which [they] could
organize their lives''. With little need to spend time with
`straights' in their private lives, a community developed in which
``members of one's own sex are defined as the most desirable sexual
objects, and sociability is energetically organized around the pursuit
and entertainment of these objects'' (\cite{Goffman63}: 143). Nearly fully
immersed in their homosexuality, the community established a culture
of outrageousness and camp which at every bend found itself distancing
itself further and further from the mainstream. The nascent
homosexual culture rested in part upon the immasculine homosexual
stereotype conferred by the mainstream and the homosexual community's
simultaneous acceptance and rejection of the stereotype, as
well as a seemingly universal appreciation for irony which led to a
system of feedback in which developments of homosexual culture would
once established be taken to an extreme through self-parody, only to
be established and parodied in their new form.. As the
foundations of the homosexual community stabilized, means to establish
a solid subcultural identity became explicit. On one cornerstone of
the subculture, admiration of Hollywood `divas', an unnamed man
notes, ``It was as if the fact that we had gathered to see [Judy
Garland in concert] gave us permission to be gay in public for once''
(\cite{Harris97}: 17). Magazines, fiction and film catering to the community
began to appear, and by the midpoint of the
century it would be common knowledge which nightclubs in major North
American cities catered to a homosexual client\`ele.

% =====================================================================
% organizing
% =====================================================================
\subsection{Getting Political}
The establishment and institutionalization of a homosexual community
and subculture created a contradictory situation. On one hand, for
members of the community, its existence and its shared values and
culture served to solidify homosexual identity, create a certain
amount of solidarity among homosexuals, and remove some of the
stigmatization of being a homosexual. For the mainstream public,
however, it was more evidence that there was something inherently
different about homosexuals, and the fear that, despite what the
medical profession told them, that there was something politically
subversive about homosexuality (\cite{Miller95}). To an extent they were
correct---with the solidarity and increasing numbers, the homosexual
community for the first time began to realize that homosexuality
didn't \textit{have} to be unacceptable.

The homosexual community found its first opportunity to organize after
the 1948 release of Alfred Kinsey's (1854--1956) \textit{Sexual
Behavior in the Human Male}, popularly referred to as the Kinsey
Report. Kinsey's findings on homosexual behaviour were startling. Over
a third of men had had a homosexual experience to orgasm since
adolescence; nearly a tenth were exclusively homosexual for more than
three years, and four percent were exclusively homosexual for life
(in \cite{Miller95}: 249--251). Kinsey had shown to be invalid the `species'
hypothesis of homosexuality; it would be near impossible from here to
scientifically claim that homosexuals were subhuman when homosexual
behaviour was ``neither deviant nor exceptional'' (in
\cite{Miller95}: 252). In light of such an influential and popular study---the
report spent weeks on the New York Times bestseller list---parts of
the homosexual community began to organize.

The first major homosexual political organization following Kinsey was
the Mattachine Society, whose purpose according to founder Harry Hay
was to ``rock the boat of American conformity'' (\cite{Young95}: 49) and
legitimize homosexuality through decriminalization. There was little
discussion of whether homosexuality should be considered deviance,
only that it was not worthy of legal sanctions (\cite{Kutchins97}).
That the Mattachine never once drew attention to the medical
status of homosexuality says something of the extent to which medical
ideology stands as fact; despite active work in the field---both Bieber
and Socarides were active at this time, and German physicians were
working to establish which part of the hypothalamus needed to be
removed to get rid of the `female part' of the brain (\cite{Kutchins97})---
the Mattachine's stance was that of requesting permission to
engage in homosexual activity, and not for legitimation.

Unfortunately, there was more than one way to read Kinsey's
figures. In 1954, Senator Joseph McCarthy began his campaign to rid
the United States of what he called ``the Communist menace''. McCarthy
equated that which his committees found subversive with Communists,
and used the numbers from the Kinsey report to support his claim that
homosexuals were also a subversive group of which America should free
itself; in the words of Kenneth Wherry, a McCarthy
subordinate, ``You can hardly separate the homosexuals from the
subversives'' (in \cite{Miller95}: 261). McCarthyism and the Communist panic
conflated sexual heresies and political ones; the Mattachine and
similar groups which had appeared quickly moved back
underground. What was left of homosexual politics was a quiet,
conservative, and anti-Communist movement which, where the Mattachine
asserted rights, meekly acknowledged its own existence (Kutchins 1997: 60).

With the fall of McCarthy's crusade in the mid-1950s, the homosexual
community found itself without the momentum that the building of its
institutions had conferred on the early activists. McCarthy had
reaffirmed the inherent differentness of the homosexual, adding
anti-Americanism to the mythology on which claims of differentness
rested. While the 1960s found a generation concerned with social
change, homosexuality was seldom included; however, the civil-rights
protests of the 1960s did, in all probability, provide an example for
what was to become the coming-of-age of American homosexuality.  It
was common in the big cities for bars and clubs catering to
homosexuals to have made an arrangement with the police, often via
organized-crime syndicates, to be able to operate
(\cite{Miller95}). Despite this---or possibly because of it---police
would occasionally stage raids on these establishments, in which the
proprietor would be charged with some alcohol-related offense such as
serving without a license, the client\`ele would be ushered into the
street and dispersed, and the bar would open days later, after the
proper payoffs had been made. 

When the police raided the Stonewall Inn
in New York's Greenwich Village on June 17, 1969, however, the usual
scenario didn't play out. For reasons mostly unknown (although
\cite{Young95} notes that the then-recent death of Judy Garland has
been alleged to have been an aggravating factor) the patrons of the
Stonewall Inn decided not to submissively file out of the bar. Once
out in the street, they began throwing rocks, shoes, and cans at
police; in a short while, a full-fledged riot was underway. By the
climax of the evening, the police had barricaded themselves in the bar
awaiting reinforcements and the homosexual
community had found itself a new militant voice and a new
label---`gay' (\cite{Miller95}). Demonstrations and protests
occurred for the next few nights outside the Stonewall Inn, and
otherwise-inactive gay activists began to organize and mobilize. The
Stonewall Riots, as gay cultural history labeled the night, effected
no social change in themselves, but reminded the gay community that
they had numbers, and that they had voice. But there was no target;
gay liberation had begun, but no-one was sure who was holding the
chains in the first place.

% =====================================================================
% Claimsmaking
% =====================================================================
\subsection{Fighting the APA}

Before examining the efforts of gay activists, we need a framework by
which their efforts can be analyzed. \cite{Spector77} suggest a
framework for the study of social problems in which the sociologist
identifies and analyzes the \textit{claimsmaking behavior}; that is,
that social problems are `` the activities of individuals or groups
making assertions of grievances and claims with respect to some
putative conditions'' (75). In such an analysis, the nature and
genesis of a social problem is determined by ``identify[ing] the
causes and antecedents of the \textit{definition} of the social
problem'' (41); that is, by examining what is being claimed, who is
making the claims, who the claims are being made against, and the
interests and values driving the claim. As it turns out, the efforts
of the new gay liberation movement lend themselves to this sort of
analysis.

The work of psychiatrists on homosexuality---in particular, that of
Socarides---was not unknown to activists; there had been a protest in
1968 of a talk he gave to the AMA at their annual convention, by a
pre-Stonewall ``homophile'' group demanding bias-free research into
homosexuality (\cite{Kutchins97}). With their new voice, gay activists
decided to take on the APA at their own convention; their goal was the
removal of homosexuality from the Diagnostic and Statistical Manual
(DSM), the diagnostic bible of psychiatry and psychology. Organized
protests first arose at the 1970 APA convention, which was disrupted
repeatedly by confrontational gay protesters threatening violence
(\cite{Kutchins97}). While the protesters certainly caught the
attention of the psychiatrists attending, their demands went unheeded;
when they took the microphone at a meeting demanding to be heard, many
of the attending psychiatrists were enraged, and one asked the police
to shoot the protesters (\cite{Kutchins97}: 67). While the activists were
making their claims of bias and abuse known, they were doing so in
such a way that the psychiatric profession needn't take notice of
them; if nothing else, their behaviour was a manifestation of their
mental illness.

The failures of 1970 led to the protesters' reevaluation of their
methods. In 1971, while there were no meetings on the convention
schedule worthy of protest, gay activists maintained a booth on the
convention floor, a practice they would continue for the next few years, 
and arranged for a discussion
panel on homosexuality at which they would present their point of
view. While they had tried this the year before, this session was
substantially different---the panel featured psychiatrists as well as
protesters. One was Judd Marmor, who had
previously attacked Charles Socarides' most recent findings; the other
was a cloaked, hooded and anonymous psychiatrist who declared that he
was gay, and told the attendees of the Gay Psychiatrists' Association,
a social group which secretly met during the APA conventions. The Gay
Psychiatrists' Association, claimed the anonymous speaker, comprised
over two hundred APA members. It is not clear
whether or not this revelation was a surprise to the average APA
member or a confirmation of a suspicion. In either case, the
recognition of a large number of gay psychiatrists reportedly opened
the ears of some of the APA membership to the complaints of the
protesters. It was no longer a bunch of perverts
protesting; now the claims of bias were coming from psychiatrists
themselves. With this collapse of distance between doctor and subject
and between claimsmaker and recipient came increased difficulty in
maintaining that homosexuality was a sickness and that the claims were
not worthy of attention.

The 1972 convention was a watershed for the activists' cause. After a
hundred gay demonstrators interrupted a meeting on behaviour
therapists, psychiatrist Robert Spitzer found himself talking with the
leader of the disruption, Ron Gold. Gold described the exchange
(in \cite{Kutchins97}: 68):
\begin{quote}
[Spitzer] said he believed in the illness theory. I said, alright, who
do you believe? And he hadn't read any of it. \ldots{} But he happened
to know Socarides and thought he was a nut. Whom do you believe?
Bieber? I don't know. Have you read it? No. But they all believed it.
\end{quote}
Spitzer, as a result of this conversation, arranged a meeting between
gay activists and the APA's Committee on Nomenclature, which organizes
the diagnostic manual. While the initial interpretation of this event
would be a simple matter of the activists' claims being acknowledged
by the psychiatric establishment in light of the newly-recognized gay
psychiatric contingent and Spitzer's own discovery of prejudice in the
area, there were further details involved. Spitzer knew that the
committee to revise the Manual was going to be appointed during the
next year (\cite{Kutchins97}); having orchestrated such a meeting
would almost certainly merit consideration when it came time to choose
the new committee. Unfortunately, missed deadlines meant that any
change to the DSM regarding homosexuality would have to wait.

In 1973, another panel was organized in the same manner as in 1972,
and the audience of over one thousand psychiatrists responded
positively to the idea of depathologizing homosexuality; the
proceedings were then published in the \textit{American Journal of
Psychiatry}. The question of the nature of homosexuality was no longer
being raised by claims from gay activists; rather, it had become a
matter of competing claims within the association. For the most part
the discussion was taking place in terms of what Spector and Kitsuse
would term `value groups' (\cite{Spector77}: 88), who took
positions based on their beliefs on the illness theory of
homosexuality; the previous `interest group' (\cite{Spector77}:
88) organizing which found homosexuals looking out for
homosexuals and psychiatrists looking out for psychiatry had
faded. The question of values was driven further home when Spitzer
found himself invited to a meeting of the Gay Psychiatrists'
Association; the emotional exchanges at that meeting ``helped to
persuade Spitzer that many homosexuals \ldots{} function at a high
level'' (\cite{Kutchins97}: 69); he immediately prepared a proposal to
change the DSM. In his proposal, he suggested that while homosexuality
\textit{per se} was not worthy of psychiatric diagnosis, there should
remain a diagnosis for homosexuals unhappy with their orientation.

The Committee on Nomenclature refused to adopt the proposal, choosing
instead to adopt a resolution calling for recognition of the civil
rights of homosexuals. Nonetheless, Spitzer's presentation
was referred by the committee to the Council on Research and
Development along with the suggestion that the Council hold a survey
of the APA membership to determine the outcome. The Council rejected
the suggestion of a survey as ridiculous; a survey was
not compatible with the positivist, scientific basis of medicine. The
Council itself had no reservations, though; it voted unanimously to
adopt the proposal, as did the rest of the committees involved in the
process. Further, the proposal was modified at one stage to
be even more inclusive; Spitzer had, in his new diagnosis for those
unhappy with their sexuality, referred to homosexuality as
`irregular', which was removed from the final product.
Homosexuality was no longer an illness, according to the American
Psychiatric Association; the Washington Post ran the headline,
\textit{Doctors Rule Homosexuals Not Abnormal}. 

Shortly thereafter, Socarides organized a referendum on the change;
his efforts to reinstate the diagnosis failed (\cite{Kutchins97}). The
DSM was not completely free of references to homosexuality, however;
there was still Spitzer's diagnosis for those troubled by their
homosexual orientation, but no corresponding diagnosis for
heterosexuals. It would not be until 1987 until homosexuality would be
completely expunged from the DSM; then, while Spitzer and the
Nomenclature Committee was undergoing a battle with feminists
reminiscent of the early battles with gay liberation activists, the
gay activists found themselves with an unbeatable opportunity. They
threatened to raise the homosexuality issue and the APA immediately
removed the remaining diagnosis. By this point, what had originally
been a scientific diagnosis of the medical profession was reduced to a
political token.

% =====================================================================
% Analysis, with some Ominous Leanings
% =====================================================================
\subsection{Analysis: the post-psychiatric homosexual} 

The medical history of homosexuality is not without irony. It was,
after all, the diagnosis of the medical profession which created the
discreditable Homosexual. The public opinion of the homosexual, based
on medical `fact' combined with the inevitable myth surrounding an
invisible enemy, served to push the homosexual underground, but
without cutting him off entirely from mainstream society. The
homosexual, thus partially cut off from the world, turns to the
company of other homosexuals, both for sexual and social purposes;
without such severe stigma, the homosexual community may not have been
so large and institutionalized to start off the chain of events which
started the APA talking about homosexuality in the early 1970s. On the
other hand, the ease by which homosexuality could be concealed, living
a conventional public and homosexual private life, resulted in large
numbers of homosexuals establishing careers in psychiatry (although I
make no claims as to whether this is only a matter of percentages or
something specific to psychiatry and homosexuals), while still
maintaining a homosexual identity in the adjectival sense discussed
previously---``gay psychiatrist'', not just ``gay''.

Both of these factors---the stigmatization of homosexuals and
resulting community, and the ability for homosexuals to maintain
professional careers, in our case as psychiatrists---were
\textit{necessary} causes for psychiatric reform on the homosexual
issue. As demonstrated by the confrontations at the 1970 and 1972
conference, the APA was not prepared to listen to unqualified
homosexual activists; it was necessary for the
professionally-qualified gays within the organization to effect real
change. But without the urgings of the homosexual community, the
insiders wouldn't have had the prompting to do anything in the first
place. However, not even the combination of gay psychiatrists and
angry activists were \textit{sufficient} causes for reform; starting
the bureaucratic gears in motion took the political motivation of
Spitzer, whose decision to make a proposal for the removal of
homosexuality as a diagnostic criteria and eventual concession to
completely purge the DSM of homosexual diagnoses were motivated by
internal APA politics, and not by science as would befit the medical
profession's own ideology.

Unfortunately, homosexuality since the DSM revision has not been
happily free of medicalization. 1984 found the gay community facing a
medical stigma of a much larger scope than the psychiatric diagnoses
it had fought off previously---real life-threatening disease. The
medical establishment was initially baffled by an epidemic of gay men
coming down with diseases which had previously only been thought to
affect livestock (\cite{Young95}). The condition was traced to a
sexually-transmitted deficiency of the immune system, and Gay-Related
Immune Disorder (GRID) was born. Socarides blamed the APA decision of
the previous decade, claiming that the decriminalization of homosexual
behaviour that followed the demedicalization of homosexuality led to a
rise in gay bathhouse culture that allowed the epidemic to
spread. This ``gay disease'' was fodder for those opposed to
homosexuality, referred to by the Christian right as the ``ultimate
wage of sinners'' (\cite{Young95}), and reestablishing the myth that
there is something different and dangerous about gays. It was not
until the epidemic began showing up in the straight population that
extensive research began, and it was at that point that the disease,
no longer confined to gay men as originally supposed, was relabeled to
Acquired Immunodeficiency Syndrome, or AIDS. But the damage had
already been done; the old homosexual myths, which had never entirely
left the popular imagination, had been strengthened further, and
stereotypes reaffirmed. As late as 1990, the World Health Organization
still listed homosexuality in its classification of diseases
(\cite{Young95}: 13).

But the ultimate post-psychiatric irony is to be found in a debate
currently raging within the gay community. In a 1995 experiment on
twins, researcher Richard Pillard---gay himself---found preliminary
evidence of a genetic explanation of homosexuality
(\cite{Kutchins97}). Homosexual activists immediately picked up the
news, their reasoning being that a biological explanation removes the
question of intent and choice from homosexual behaviour. After all,
they argue, if homosexuals are born that way, then there exists no
excuse to discriminate against them. Whether this is because
homosexuality is like a race or like a disability is not immediately
clear from the arguments, but in either case, history has shown us
that medical explanations of homosexuality need not be in the interest
of homosexuals. Kutchins suggests that a genetic causation for
homosexuality could be read by Christian fundamentalists as a mark of
the Devil (Kutchins 1997: 97). After a century-long battle to be no
different from straights, an astounding lack of historical
appreciation and foresight threatens to drag homosexuality back to its
turn-of-the-century not-quite-human status.  And we put our faith back
to the objective science of the medical profession for hope; according
to \cite{Scheff99}, the claim of genetic causation ``seems
premature''. The status of homosexuality remains, again, firmly under
medical power.


\bibliography{lafferty_queerly_ill}

\end{document}
