Medicalized Identities

M Jordan

Throughout history, there have been various views on the nature of homosexuality[1] as a
lifestyle, sexual orientation, psychosexual disorder, form of deviance, and more. What is quite
peculiar, however, is how homosexuality's conceptual fluidity appears to halt some time before
the modern day. As medical debates continually went by, the understood nature of sexuality
became increasingly turbulent. This era of turbulence mostly, but not exclusively, occurred in the
twentieth century- a time which, among other things, contained the Civil Rights Movement, the
creation of the Gay Liberation Front, the AIDS Crisis, and the creation (and subsequent revision)
of the Diagnostic and Statistical Manual. These components in harmony created a perfect storm
of confusion for those attempting to medicalize "gayness" in various ways. To accurately
understand the how the medicalization of homosexuality arrived where it did by the 1990s, it is
important for one to examine the larger picture, as no historical moment exists in solitude.

Towards the earliest phase of the twentieth century, America was escaping the Victorian
era. The horrendous sexual repression and homophobia drew to a close as Queen Victoria passed
away in 1901- or so one would think had they merely been educated by hearsay rather than
acquired through readings from and about the era. Michel Foucault, a renowned philosopher,
historian, and social theorist once wrote that "It will be said that if so many people today affirm
this repression, the reason is that it is historically evident...[has] the critical discourse that
addresses itself to repression come to act as a roadblock to a power mechanism that had operated
unchallenged up to that point, or is it not in fact part of the same historical network as the thing it
denounces (and doubtless misrepresents) by calling it 'repression'?" ("We Other Victorians" 9).
He believed that sexuality was so heavily policed that it was impossible for it to have been
repressed. Sexuality was enveloping society through the various odd guidelines and customs
surrounding it. Furthermore, he believed that the narratives surrounding the Victorian era were
developed as a means of easing society towards that very repression. One might see the fact that
sexuality was not repressed during the nineteenth century as irrelevant to the medicalization of
homosexuality in the twentieth century priorly discussed, however, it is important to first address
this in order to fully encompass in what manner the medicalization occurred.

Remaining in the nineteenth century, in 1886, German psychiatrist Richard Freiherr von
Krafft-Ebing published the Psychopathia Sexualis. This book was centered- among other things-
around an attempt to finally medicalize homosexuality in a way which, plausibly, never had been
done before. Krafft-Ebing believed homosexuality to be a hereditary disease which impeded
natural male[2] development. Once again it would be natural to inquire as to why time is being
spent elaborating upon nineteenth century medicalization when the core topic at hand specifies a
historical recounting and analysis of the twentieth century. Well, simply put, the ideas about
sexuality put forth in the late nineteenth century were the basis upon which medicalization of
homosexuality began to take root in the twentieth. These base assumptions about the clinicality
of homosexuality were furthered not only by cultural ideas which had been given several decades
to spread amongst the Western world[3], but also due to a translation of Krafft-Ebing's German
work being published in English in the year 1892, which was cusping between the nineteenth and
twentieth centuries.

With those histories established, analysis may now begin to diverge from a simple
restatement of in-class lectures. In Krafft-Ebing's work exists free use of the word "homosexual,"
however, this word has not always existed. With some debate as to the word's origin, it is
estimated to have developed around the same time as the English translation of Psychopathia
Sexualis was published. Before the word existed, gay people were simply thought of as
"deviants" in the same vein as those engaging in sadomasochism[4], sodomy, extramarital
affairs, and so forth. As such, the development of a stagnant label to apply to an individual's
sexual and romantic actions began to hone medical research into homosexuality to an extent
perceived as less than welcome. Relative to the early twentieth century, first had come the
discussion of how one could psychological be homosexual, and next came the intermingling of
medical ideas with those more closely associated with religion and morality. "In this way, sin
and crime, far from being disconnected, were bound as tightly together as they had been when
natives first sighted European ships, and sexual 'degeneracies' topped the list of illegal acts. It
only remained for scientists to help define those acts, associate them with types of people, and
add 'illness' to the list of synonyms for the newly defined condition of homosexuality." (Eaklor
31) And so, much of the dominating discourse throughout the Edwardian era was specific to a
subjective moral debate as to whether or not homosexuality was a punishable offense. Of course,
as many who study the histories of marginalized groups frequently find, the discourse settled
upon the idea that one could and should be punished for being homosexual. While Krafft-Ebing's
idea that homosexuality was an illness to be cured was repulsive enough as it was, it somehow
grew worse.

After the Edwardian era began the world wars. While development in clinical research
surround homosexuality did, on a technical basis, progress, in order to simply by painting in
broad strokes, it may be most important to forego the detailed explanations of changes to the
medical model of homosexuality until the 1930s. To summarize concisely, Sigmund Freud had
begun pursuing homosexuality as his next research topic and began to theorize that
homosexuality could potentially be a stage in adolescent development caused by phobia of the
opposite sex[5]. His theory gained traction, but bore no change upon the psycho-sexological
view of homosexuality as an illness.

Uproar surrounding the medical model finally became widely dealt as in 1952, the
American Psychiatric Association (APA) published the Diagnostic and Statistical Manual (DSM)
I. A manual which ideally would be a universal standard upon which psychologists could refer
for diagnoses. Please excuse the sarcastic tonality, but there was a single minuscule,
unnoticeable, inconsequential problem which was that homosexuality was now labelled officially
as a sociopathic personality disturbance. While the second edition of the manual clarified this to
refer to mere sexual deviance rather than sociopathy or disturbance, it still had not quite removed
all stigmatization from the label. Additionally, the second edition of the DSM contained a
diagnosis which may seem familiar to modern day asexual people. The diagnosis was "sexual
orientation disturbance" which was explicitly defined by homosexuality being exhibited by
people do not desire to be homosexual. This diagnosis, in essence allowed plausible deniability
on behalf of the APA for claims that they wished to cure all homosexuals of their supposed
deviance. Now, they could easily claim to only treat clinically significant cases.

Moving on from medical jargon and talks of precise labels, in the 1980s began the AIDS
crisis, in which the gay community was plagued by Auto Immune Deficiency Syndrome, a
disease which, as one could assume, depletes the auto-immune system. As the disease was most
common in gay communities, it was vastly and negligently under-researched, leading to a
feedback loop in which gay communities[6] simply did not know how to prevent themselves
from getting AIDS. Slowly, over time, more and more information began to spread, but by then
it had been too little and too late. In the powerful words of AIDS victim Vito Russo "If I'm dying
from anything -- I'm dying from the fact that not enough rich, white, heterosexual men have
gotten AIDS for anybody to give a shit" (Russo). At this point it was common to see gay people
unaffected by AIDS claiming that the crisis was giving negative coverage to the relatively
recently formed gay rights movement. Especially considering that, as seen with the DSM
volumes, there was still a continual push to demedicalize gay identity. As such, claiming that
being gay was not medically significant but that gay people just happen to be getting infected
with a life-threatening disease was not exactly an improved perception of the community to
thrust upon a straight audience. However, it is important to note that the reason why this crisis is
as significant as it is towards the establishment of homosexuality as a medical and social identity
was its function in helping people realize that gay people needed activism desperately. Alongside
this, barely before the AIDS crisis began, the third edition of the DSM was released, completely
removing homosexuality from the text. At this point in time, cisgender heterosexuals were forced
to address that their dismissal of homosexuality as a disease was solely based in hate. However,
mere addressing does not mean they had completely accepted that they were wrong, the
arguments just began to shift towards pure moral discourse. After this, many cisgender
heterosexuals began engaging in LGBTQ+ civil rights. While it goes without saying that the
AIDS crisis was a terrible tragedy, there is no doubt that the 80s were monumental- for various
reasons- in heightening the LGBTQ+ civil rights discussion to an all-time high.
 It would not be unprecedented for one to wonder what the point of the reception of all
that information was (aside from pure acquisition of knowledge for knowledge's sake). The
answer is simple. Issues like these are never over. As Foucault discussed, whenever we think of
the past as worse than now, it gives our leaders an excuse to reenact historical mistreatment of
people while in power, as the public is less likely to question it if it seems "better". Alongside
this, as was hinted at earlier, Asexuality is facing the exact same issue currently as
homosexuality had faced back in DSM II. Currently there is a diagnosis for Hypo-Sexual Desire
Disorder, in which the disorder's diagnosis is simply based on the lack of sexual attraction. The
very same plausible deniability is also pursued through a disclaimer that asexuals who desire to
be asexuals are not a target of the diagnosis and treatment. Those are just two examples, in the
information provided in this paper alone, one could potentially find hundreds of comparisons to
make between history and the modern day. The takeaway is this: understand how history taks
shape, because history does not end.

[1] as labelled in the present day

[2] Do note the explicit differentiation between male and female development. At this point in time it was believed
that only males- a word which is here being used to refer to those assigned male at birth- could be homosexual in a
clinical sense.
[3] The term "Western world" is fraught with insensitivities and assumptions. While it would be possible to fully
problematize the creation of the term, it would quite significantly digress from the current topic. Please acknowledge
that the term is being used solely as shorthand for what white Americans commonly understand the Western world
to be.
[4] This term was coined by Krafft-Ebing
[5] as with the "Western world," the term 'opposite sex" is quite loaded with inaccuracies and assumptions about
biology while simultaneously erasing intersex identities. In this context, assume the opposite sex of a male to be a
female and likewise vice versa.
[6] other communities were also affected, notably there were 4 "H"s, heroin users, homosexuals, hemophiliacs, and
Haitians. The other groups, while having intense and historically significant struggles, are not going to be addressed
for lack of relation to the central thesis