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The APA Vote On Same-Sex Marriage:

The Inside Story
By Joseph Berger, M.D.
In the mid-1970's, the Board of Trustees of the American Psychiatric Association (APA) voted to remove the diagnostic category of "Homosexuality"
from its Diagnostic and Statistical Manual, generally known as DSM and now in its fourth edition.
The vote at the time was highly controversial and divisive, and was widely understood as being political. The protocols, or reasons for the proposal,
made it clear at the time that the intention was to reduce stigma and discrimination, and that the vote was not intended to indicate any final scientific
determination regarding homosexuality.
Unfortunately, as is often the case, what is done by one generation with the best of intentions to improve social relationships becomes interpreted by
the next generation as representing a solidly-based scientific conclusion.
Following the American Psychiatric Association's move, a number of other professional mental health organizations also took various positions
declaring in one way or another, their support for the notion that homosexuality was not a disease or disorder, and that homosexuals were normal
and psychologically healthy.
Within the American Psychiatric Association itself, over the next thirty years a very active Gay-Lesbian Caucus proceeded to instigate a number of
other official position statements, which included the declaration that a particular form of psychotherapy intended to offer interested self-identified
homosexuals the possibility of becoming comfortably heterosexual was unacceptable, potentially harmful, and should be banned.
Indeed, in more recent years the APA--pushed by this Gay-Lesbian Caucus--came very near to issuing a ban on any form of psychotherapy with
self-identified homosexuals-- even if they wished for such psychotherapy themselves and came to a therapist purely voluntarily-on the grounds that
as homosexuality was not an illness or a disease there cannot be any treatment.
Fortunately, this aroused considerable opposition-especially from outside the organization-and soon after was followed by the intervention of Dr.
Robert Spitzer who is often looked upon as the "father" of DSM 3 and 4 and who was a major figure in the original effort to de-list homosexuality
from the DSM.
Dr. Spitzer made the extraordinary gesture of saying "I'm a scientist, I'm prepared to re-examine the data," and then he conducted a review of a
number of patients whose names were given to him by different psychotherapists.
Dr. Spitzer concluded that contrary to extremist gay activist claims, some people who had identified themselves as homosexual before therapy had
in fact become comfortably heterosexual during the course of long-term psychotherapy. Did this mean that they never again experienced a
homosexual fantasy or thought or desire? Of course, not. But just as the ex-alcoholic or the ex-drug addict has to recognize the factors that may
precipitate a craving for the substance, and then use the tools learned to combat the craving, so too, do some formerly homosexual patients have to
learn what may precipitate such fantasies and desires and how to deal with those when they arise.
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Dr. Spitzer's conclusions, not surprisingly, came under vicious attack and reference has been made in the NARTH Bulletin to some of the criticisms
of Spitzer, and the very weak foundations upon which those attacks are based.
But the APA Gay-Lesbian Caucus has moved on from fighting Spitzer to campaigning for support for same-sex marriage, and won an initial vote on
this topic at the May 2006 meeting of the Assembly of the APA.
What Happened?
It is unlikely that most NARTH members are aware of how that vote came about and what steps will follow. As I am a member of the Assembly of the
APA, I am taking this opportunity to share how this particular vote was achieved.
The APA is a large organization; it has 35,000 members, and as is true of most organizations of that size, and even larger, it has a professional staff
to carry out its numerous and complicated daily activities. That professional staff is accountable to and overseen by a lay board and executive
elected from the general membership.
The lay leadership is mainly made up of about 300 members of the parliament or "Assembly" of the APA. These are representatives from each state
or district branch over the U.S. and Canada, plus representatives from various allied and affiliated groups.
But a 300-member group cannot supervise the professional staff on a close and immediate basis, therefore, from the Assembly is elected a much
smaller Executive group in the APA, which is called the "Board of Trustees." It usually makes the final decisions for or against any new initiatives.
Early in 2006, the Gay-Lesbian Caucus had been proposing a motion that the APA support same-sex marriage.
The Board asked some of its sub-committees to examine the proposal, and to some people's surprise, those committees emerged quite divided, and
in some cases rather strongly negative to the proposal.
The Gay-Lesbian Caucus nevertheless wanted to push on with its proposal and to take that to the next meeting of the larger Assembly, which was
being held at the time of the general business meeting of the APA. This is held just before the much broader annual academic meeting of the
organization, which in May 2006 was in Atlanta, Georgia.
When we, the members of the Assembly, gathered in Atlanta at the opening of the conference on a Friday afternoon, we were told that debate and
discussion on the proposal would take place on the following Sunday before the conclusion of the Assembly, and that the press would be in
Various plenary and caucus group meetings take place on Friday and Saturday, and in at least one of these, one of the largest groups within the
APA, psychiatrists from Massachusetts, indicated their intention to offer an alternative proposal, a proposal that they claimed was more scientifically
based rather than the political proposal put forth by the Gay-Lesbian Caucus.
On the Sunday morning when the great debate was supposed to take place, a representative speaking on behalf of the Gay-Lesbian caucus
introduced their proposal, and then the chairpersons of the main geographical areas into which the assembly is divided-there are seven of them-was
asked to indicate how their particular area viewed this proposal. Most indicated that their area had been in favour, though in some cases, there was
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considerable division and the margin in favor was very small.

At that point though, the area that contains Massachusetts (Area 1 in the Assembly) announced its intention to offer its alternative proposal.
This threw the meeting into its first chaos, as a number of assembly members protested that they hadn't been given notice of this alternative proposal
or had a chance to read and study it.
Those proposing it indicated that it had been available at a reference table from the beginning of the plenary session and was available to anyone to
Debate came to a stop while many members read the alternative proposal.
When it was deemed that sufficient time had been given to enable members to read and consider the alternative proposal, a request for a vote on it
was made. But instead of the more usual vote by voice first--yes or no--then followed, if necessary, by counting heads, this vote request was then
modified into a particular type of vote that requires filling out a ballot form, which has to be handed in and counted.
This obviously takes up a lot of time because there are close to 300 people voting. In addition, each of their votes is not a single vote but is actually
representative of a much larger official number of members whom they are representing, which according to the area they live in or the organization
they represent, may be hundreds of people. This made the final vote even more complicated.
So, while the vote was performed, and then collected and counted, the meeting continued with completely different business. Actually, much of the
intervening business was various farewells and gifts to people completing their terms of office as representatives or officials.
What is very important to understand is that all debate/discussion had been stopped, and that, in fact, up to this point there had been no discussion.
There has just been the presentation of the original proposal; the brief indication from each area of their caucus preference; and the presentation of
an alternative proposal.
There had been no actual debate or discussion in the usual sense, of people speaking for and against the proposal, other than the original
presenter. Nor, were any individuals free to challenge, question or refute many of the false and/or distorted claims made by the proposers.
Eventually, the counters came back with the result that the alternative Massachusetts proposal had been defeated by approximately a 55-44 majority
At this point, we had reached the time when the debate was supposed to end, and the hall was to be cleared for the next event.
So, without any further debate or discussion, a quick hand vote was taken on the original Gay-Lesbian proposal. Perhaps half the members had
already left, many to catch planes, while others went off to other meetings.
The motion won on a hand vote.
This is how the APA Assembly voted to support same-sex marriage. There was no real debate and no real discussion. There was nothing remotely
"scientific" about this vote by the APA.
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From the Assembly, the matter went to the Board of Trustees. The Board is aware that there are a number of members very much opposed to the
motion. It is seen as highly divisive, as going against the current trend in American society, and as dragging what should be a professional scientific
organization into supporting a controversial political social issue and thus harming the reputation and credibility of the organization.
But on the other hand, the Gay-Lesbian caucus has been very successful in its endeavors in recent years. Many of its members are individually nice
and decent people and many of their colleagues don't want to upset or offend them in any way. Therefore, they are willing to grant Gay-Lesbian
members what they demand because they are nice people - without really thinking through the possible consequences of such a move.
Dr. Joseph Berger is a Psychiatrist in Toronto. He is a Past President of the Ontario District Branch of the American Psychiatric Association and an
Assembly Representative to the APA. He has contributed a number of articles to the NARTH Bulletin.

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