PSYCHOLOGY AND THE LGBTQIA+ ISSUE

by Deepshikha Jena

The journey of the field of psychology, with regard to the LGBTQIA+ issue has been far
from idealistic. From the classification of homosexuality as a mental pathology to its
unacceptance as a normal phenomenon despite being dispelled as a mental illness decades
later, the orientation towards the queer issue had not been in the least bit progressive until
recently. For this article, we are going to take a look at some key points in the history of
psychology to trace back the emergence of queer-affirmative practices in our field.
The view of homosexuality as a pathological abnormality has been present since the time
homosexuality began to be studied formally, and even before that. Until the 19th century,
homosexuality was viewed as an unnatural phenomenon and was punishable under the
Buggery Act by even death. There are close to 71 nations today which still have laws against
same-sex relationships. Many psychologists were interested to find out the causes of
homosexuality and believed that it was a disease which could be cured with therapy. Despite
some opposing claims, the American Psychological Association listed homosexuality in the
Diagnostic Statistical Manual (DSM I) in 1952 as a psychiatric disorder. Some notable
oppositions to the idea of pathologizing homosexuality were those of Sigmund Freud and
Alfred Kinsey. However, with all due credits given, these views could still be characterised
more as tolerant than accepting of the normalcy of homosexuality as they did not consider
homosexuality as a disease but still as an abnormal development.
Freud’s views on homosexuality were quite complex as demonstrated in his essay “Three
Essays on the Theory of Sexuality”. Freud attempted to understand the causes of
homosexuality and came up with the explanation that bisexuality was the “original libido”
orientation. Freud believed that every individual was born bisexual with a homosexual and
heterosexual portion of libido. Over the course of development, one side emerges as a
dominant over the other. He believed that treatment of homosexuality was a futile device as
the individual, as a pleasure-seeking entity, would not be willing to give up the sexual
identity which gives them pleasure. He had tried to “cure” homosexuality through
psychoanalysis and hypnotic suggestion, but it yielded no effect, which led him to claim with
conviction that homosexuality was “nothing to be ashamed of, no vice, no degradation, it
cannot be classified as an illness, but a variation of sexual function”.
Alfred Kinsey, a prominent sexologist of his time, explored the mating practices in many
species and found that there were a variety of sexual orientations. His books on human
sexuality refuted the prevailing trends of pathologizing homosexuality by demonstrating that
homosexual behaviour was much more common than assumed, insinuating that it was normal
and a part of the spectrum of sexual behaviours exhibited by humans.
The inclusion of homosexuality in the Diagnostic Statistical Manual as amental disorder
added to the stigma and influenced the socio-cultural perception of homosexuality. It sparked
many debates in academia as well as in public. However, with the evolution of scientific
study, more and more empirical support from the likes of Kinsey led to the confrontation of
the existing notions on homosexuality. By the 1970s many psychologists had altered their
stances on homosexuality being a disorder. The previous assumptions of homosexuality
stemming from family dynamics, traumatic sexual experiences, etc. were brought to question
when many psychological tests such as the Rorschach Thematic Apperception Test and
Minnesota Multiphasic Personality Inventory failed to distinguish between heterosexuals and
homosexuals in their functioning. The lack of evidence supporting the pathological nature of
homosexuality, changing beliefs among psychologists, and increased pressure from queer
activists led to the vote in the American Psychological Association for the removal of
homosexuality as a mental disorder from the DSM in 1973. However, this was not a moment
of true progress as it was still listed in the DSM, only under a different category of “sexual
orientation disturbance”, which was still problematic as it did not remove the negative
psychological connotation attached to homosexuality. The following is an excerpt from an
article in New York Times released after the APA vote dated December 23, 1973. The article
was titled “The A.P.A. Ruling on Homosexuality” and included a debate on the APA ruling
between two psychiatrists Robert L. Spitzer, member of the nomenclature committee of APA,
and Irving Bieber, chairman of the research committee on male homosexuality at New York
Medical College:
Dr Bieber: I want first to define terms and not use illness and disorder interchangeably. The
popular connotation of mental illness is psychotic illness. Now I don't believe homosexuality
is a mental illness in that connotation. As far as civil rights go, I am in complete favor of all
civil rights for homosexuals: No matter how a particular sexual adaptation is arrived at in
an adult, sexual behavior between consenting adults is a private matter.
The central question is: Is homosexuality a normal sexual variant, that develops like left‐
handedness does in some people, or does it represent some kind of disturbance in sexual
development? There is no question in my mind: Every male homosexual goes through an
initial stage of heterosexual development, and in all homosexuals, there has been a
disturbance of normal heterosexual development, as a result of fears which produce anxieties
and inhibitions of sexual function. His sexual adaptation is a substitutive adaptation.
I'd like to give you an analogy. In polio, you get a range of reactions of injuries. Some kids
are totally paralyzed. Their walking function is gone. Others are able to walk with braces,
others have enough muscle left so that they can be rehabilitated and can actually gel to walk
by themselves. The analogy falls down only in that the injury of polio is irreversible. But
what you have in a homosexual adult is a person whose heterosexual function is crippled like
the legs of a polio victim. What are we going to call this? Are you going to say this is
normal? That a person who has legs that have been actually paralyzed by polio is a normal
person even though the polio is no longer active? The fears that have created the
homosexuality, and the psychological inhibitions, belong in some kind of psychiatric
representation.
Editor’s note: Much of the language that Dr Bieber uses (homosexuals are crippled, there is
an injury) represents precisely the definitions that homosexuals now refuse to accept.
Homosexuals are insisting they no longer want to view themselves this way.
…
Dr Bieber: I say homosexuality is a psychiatric injury to function and belongs in any
psychiatric manual. Now that doesn't mean I consider it an illness any more than I consider
frigidity an illness. As long as something like frigidity will be in the manual, disorders of
sexual functioning and homosexuality belong there. And to differentiate two types, to take
what is really the most injured homosexual and say he shouldn't be in the DSM, and that the
least injured, the one who has the potential left for restoring his heterosexuality, should be
diagnosed as a sexual orientation disorder, to me seems wild.
Value Judgments?
Dr Spitzer: It seems wild to you because you have as your value system, that everybody
should be heterosexual.
Dr Bieber: You think it's a value system? Do I think all homosexuals today should become
heterosexuals? Definitely not. There are many homosexuals, maybe two‐thirds of them, for
whom heterosexuality is no longer possible.
Dr Spitzer: But should they feel that their heterosexuality is injured or crippled?
Dr Bieber: If they want to be accurate, they can view that their heterosexuality has been
irreparably injured.
Dr Spitzer: Injury is already a value.
Dr Bieber: Injury is not a value. A broken leg is not a value.
Dr Spitzer: I cannot function homosexually but I would not regard it as an injury. You
wouldn't either.
Dr Bieber was one of the many psychologists who viewed homosexuality as a
deviant/abnormal sexual development even after discarding it as mental illness. Only after
considerable backlash, controversies, and pressure did the DSM-III finally drop
homosexuality as a listed psychological disorder in 1987. Queer affirmative psychology
emerged in the 1970s to challenge the DSM classification of homosexuality as a disorder and
combat the oppression faced by the LGBTQIA+ community due to social stigma and hate
towards them. Although the field has tried to be more inclusive of people from all sexual
spectrums and gender identities, it lacks rigour and still might be backwards in terms of the
quality of therapy as being queer-sensitive is not a requisite to practice therapy. Therefore,
therapists might still hold prejudices and provide ineffective therapy in a space which might
exploit the vulnerabilities of the queer community.
It is extremely important for psychologists to have proper knowledge and skill training to
deal with LGBTQIA+ issues as the stigma, oppression, and discrimination by the people in
the community takes a huge toll on their mental health. Queer people can be subjects of
various traumatic events such as sexual harassment, physical and verbal abuse, hate crimes,
etc. which might lead to extreme mental distress and even result in anxiety, depression,
dysmorphia, substance abuse, self-harm, and suicidal tendencies. They have to struggle to
maintain and accept their queer identity in a societal space which is mostly anti-LGBTQIA+.
Suicidal tendencies and suicide are major concerns for LGBTQIA+ youth. Studies show that
queer youth are 3-4 times more likely to attempt suicide than cis-het youth. In academic
spaces, they experience verbal, physical, and even sexual abuse due to their sexual
orientations or gender identities. They also receive negative judgements and social rejections
more than cis-het people. There is also systemic prejudice and discrimination against
LGBTQIA+ community in many countries. The constant isolation, rejection, violence, and
hatred is often internalised resulting in self-hatred and suppression of the queer identities in
individuals. They experience guilt and shame regarding their identities and this often adds to
the pressure and fear experienced during the whole process of “coming out”. This also
becomes a major source of anxiety for LGBTQIA+ people. There is a lot of inhibition when
it comes to the free and open expression of queer identities as they fear social exclusion,
reduced family and peer support, even extreme brutality and legal persecution in some cases.
Therefore, it is extremely important to build a safe, inclusive, and queer-sensitive space for
the LGBTQIA+ people who seek psychological help.
The American Psychological Association has since issued practice guidelines on how to
effectively treat people from the LGBTQIA+ community. Some of the guidelines from the
updated version from 2011 are listed below:
- Psychologists strive to understand the effects of stigma (i.e., prejudice, discrimination,
and violence) and its various contextual manifestations in the lives of LGBTQIA+.
- Psychologists understand that lesbian, gay, and bisexual orientations are not mental
illnesses.
- Psychologists are encouraged to recognise how their attitudes and knowledge about
lesbian, gay, and bisexual issues may be relevant to assessment and treatment and seek
consultation or make appropriate referrals when indicated.
- Psychologists strive to distinguish issues of sexual orientation from those of gender
identity when working with lesbian, gay, and bisexual clients.
There were detailed guidelines for the various issues of distress in LGBTQIA+ community,
such as relationships and family, issues of diversity, economic and workplace issues,
education and training, etc.
This issue is of personal importance to me as I identify as a bisexual woman. Although I can
only talk about my queer experiences from an extremely privileged lens, I have been subject
of stereotyping and bias in social spaces. Even I have heard the stereotypical “you are just
confused” and been in a position where cis-het women have hesitated to share a physical
space with me so as to not “encourage” me in a wrong way. However, I am extremely
privileged to have an accepting support system in my friends and family. I have not come out
to all my family members but those who know have been extremely supportive. My friends
have never made me uncomfortable and have shown active interest to understand my queer
identity well. All this makes me reflect on how many people in the LGBTQIA+ community
are deprived of this sense of support. Acceptance is a luxury for some queer people who
struggle to fulfil even basic needs of proper food, clothes, and shelter. Queer people are in a
much larger disadvantage when we look at their issues from an intersectional lens. Race,
caste, class, religion, all of it might add to their struggles, especially in such a divisive
country like India where homosexuality was a criminal offence until very recently. Adding to
that is the taboo surrounding mental health in our country which already makes psychological
help inaccessible to most people in our country. Therefore, it is essential to develop queer-
affirmative therapeutic settings to effectively treat queer people. It is not just a question about
the ethics and morale of our discipline but also being equipped to acknowledge and respect
the basic human rights to self-identification and sustenance of an overwhelming size of the
population which identifies under the LGBTQIA+ umbrella.
A humorous account on the many struggles of the LGBTQIA+ community

(not in any way trivialising or invalidating the distress associated with it)
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