On Saturday I took part in the LGBT History Project NE public day, speaking on the changing theraputic attitudes to LGBTQ+ people. This is the talk I gave.

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I am a therapist, studying for a therapeutic post grad diploma specialising in gender, sexuality and relationship diversity. Part of the process of therapeutic training is to look honestly at yourself, including your mistakes, because only then can we move past them. So it is perhaps unsurprising that the diploma starts by looking at the history of how therapy has treated lgbtq+ people.

Before the 19th century in some ways things were very simple, there was no such thing as heterosexual, or homosexual, there were just sex acts which were a sin, and punishable by law. Of course, as always, who you were, very often mattered much more than what you did, James 1 springs to mind as an example of how privildge protected people.

As we entered the 19th century various theorists wanted to move away from the idea of sin as an explanation for behaviours. Cesare Lombroso developed the theory of criminal tendencies, as in the idea that some people were born destined to be criminal. It is important to point out that this was felt to be a better thing than being a sinner. Various psychiatrists (or their antecedents) were saying to the world that these people are not irredeemable sinners, but ill, and so in need of support and treatment. They are not bad, but mad.

Into this change in attitudes came Richard von Krafft-Ebing  An Austro–German psychiatrist Kraft Ebbing was the father of sexology, and his seminal work Sexual Psychopathy: A Clinical-Forensic Study), which was first published in 1886 cannot be underestimated in importance. Krafft-Ebing’s believed that homosexuality was not normal, it is listed in his perversions, alongside masturbation and sadism However, he also argued that it was caused by an abnormality in fetal development, and so, in many ways invented the born this way argument as well as the “born in the wrong body” narrative which has dominated the medical treatment of trans people.

So, inverts not only could not help how they were, but there was no treatment, no cure. IN the english speaking world the theory was popularised by Havelock Ellis, and was influential in the Well of loneliness. At this point there was almost no distinction between gender identity and sexuality, indeed sexuality was seen as an indicator of gender, or of an inversion in your gender.

It is easy today to see only the pathologization, and heteronormativity of Kraft Ebbing, but, his work was vitally important in moving away from the idea of homosexuality being a sinful behaviour, and into viewing it as an identity, and an immutable one

However, one figure loomed over the world of psychiatry, and what would come to be known as psychotherapy, and that figure was not Kraft Ebing

Any guesses?

Of course, I am talking about Sigmund Freud. Unlike Ebing he saw newborns as blank slates, malleable, and curiously, bisexual, as in everyone had the capacity to be heterosexual or homosexual. Sadly he did not end there, but it is important we look at what Freud actually said, rather than what is so often said in his name

Freud did believe that homosexuality was a result of remaining in an immature state of sexual development, oral for lesbians and anal for gay men, according to his psycho sexual model of development. However, here is the kicker, Freud pretty much believed everyone, except himself of course, was in a state of less than perfect development. Everyone could benefit from psychoanalysis to work on their neuroses, gay men and lesbians were no exception.

However Freudian analysis took up the idea of the talking cure being able to “treat” homosexuality, despite the very words of Freud showing he did not believe it was practical, or desirable.

This is a pattern we see again and again, society which as whole is homophobic, biphobic cis sexist and transphobic takes what it needs from psychological theories to give its own prejudices the veneer of respectability. Kraft-Ebbing said LGBTQ people were not bad, but born this way, Freud said, they were not bad, but developed this way, and the wider psychotherapeutic community interpreted this as “bad and needs to be cured”

There were a few brave souls who stood out against this, and one of the bravest was Magnus Hirschfeld. Hirschfeld was a doctor and sexologist, who like Kraft -Ebing believed that sexuality was innate, and that some people were born as “sexual intermediaries” between fully heterosexual men and woman. In many ways he was the grandfather of Queer studies, and the Institute of Sexology in Berlin studied thousands of people who we would now put into the categories of trans, gay, lesbian and non binary.

It is important to note Hirschfeld was not perfect, he believed for example that treating gay men with hormones would make them heterosexual, he did not believe however that such treatment was justified. crucially he was the first therapist to highlight the high suicide rates of LGBTQ+ people, and campaigned vigorously for the legalisation of homosexuality.

The Institute of Sexology was the world’s foremost research institute into all kinds of sex, and sexual behaviours, its library was invaluable, and its destruction by the Nazis was one of the many horrors they perpetrated. Many of you may have seen this  picture of Nazis burning books, few people are aware that the most famous picture is of the books of the Institute of Sexology.

Hirschfeld, was compassionate, gay himself (a rarity in this field) and fighting to make the world a better place for LGBTQ+ people, Sadly his work was an almost complete dead-end, so total was the destruction. However, it was carried on by the people who met him, among them Harry Benjamin who introduced gender affirmative surgery to the US.

After the 2nd world war Freud was out of favour, or debased to the idea if you found the right lever you could wipe away someone’s neuroses. Instead the behaviorists were in ascendancy. No longer believing being LGBTQ (or anything else) was innate, and rejecting the idea that we should accept LGBTQ identities they instead proposed treatments which would cure homosexuality.

Oddly many of them used Freudian underpinnings for their tortures, and I will call it torture, despite Freud himself rejecting the idea you should try to make gay people straight.

This was the era of mad and bad. LGBTQ people were not only mentally ill, but were failing morally by resisting being cured.

With the introduction of homosexuality into the DSM the field was clear for all therapists to try to cure homosexuality. It was a mental illness, and should be treated as such. Many even claimed compassion for their victims, asserting they were only trying to help, the idea of born this way, or compassionate acceptance was replaced with ECT and chemical castration.

However, not everyone subscribed to the DSM definitions, and one of the unsung heroes of the therapeutic, and LGBTQ world is Evelyn Hooker.

Hooker used the very methods and beliefs of the psychiatric and psychotherapeutic world of her time against those arguing being gay was a mental illness. Her research was simple. She got gay men, with no diagnoses of a mental illness (other than being gay of course) to fill in some standard psychological tests. She also got cishet people to fill in the same tests. She then sent blind copies of the tests to a number of therapists, with the simple question “Since homoosexuality is a mental illness, spot the pathology, and identity the gay results”

Spoiler, they couldn’t.

A slight digression, part of the justification for the classification of homosexuality as a mental illness is they had lots of data on mentally ill gay people. In fact this was pretty much the only data they had, since criminalization meant the only easy to study group was those who had been committed to mental institutions. Other than this research focused on bars, sex workers, and those who came for treatment voluntary to cure themselves. With such skewed research it is no surprise many psychiatrists and psychotherapists believe being gay its self was something that anyone would want to be cured of. Remember what I said up there about society using theory to cover its own prejudices. In many ways the ghost of Kraft Ebings still haunted the therapeutic world, with homosexuality being seen as a brain degeneracy, but one which now could be treated.

Things came to ahead in 1973 in the APA conference, in Hawaii, because if you are going to have one of the most controversial debates the therapeutic world have seen, you need nice beaches. One of the vital contributors to this debate was Dr H, a psychiatrist who gave evidence anonymously of being a gay man. Here was someone who, shock horror, was not one of Kraft Ebbings degenerates, nor unable to “try hard enough” to be straight. He spoke to the APA as an equal.
The debate was heated  but in the end homosexuality was removed, although it was not until 1987 that “sexual orientation disturbance” for people “in conflict with” their sexual orientation was removed. This is one of the reasons conversion therapy has been allowed to flourish.

Perhaps most shockingly homosexuality was not removed from the ICD until 1992, the ICD is the worldwide version of the DSM, and the diagnostic manual used in the UK.

So, 25 years after homosexuality was decriminalised in the UK, it was still seen as a mental disorder.

So, where are we now? The memorandum of understanding has finally protected LGBTQ people from conversion therapy, although lack of training still means many queer people receive poor and prejudiced therapy. Bisexuals particularly report many therapists who still believe they are in an arrested stage of development (sound familiar) and is in the diagnostic criteria for BPD.

However I am going to leave the last words to Stuart Lorimer from the Tavistock Clinic

In the US the DSM having dropped its sexual orientation category adopted a slew of trans related categories instead. Suddenly there were labels to apply and treatment pathways to follow. In practice many of these labels and pathways mimicked the previous abandoned approach to homosexuality in tending to pathologise that which made mainstream “straight” society uncomfortable.

Dr Stuart Lorminer Trans Britain 2018