History of Mental Health Responses to LGBTQIA+ Issues
Celebrating Pride and LGBTQ Mental Health
With Pride Month just behind us, we reflect on the progress in queer culture, safety, and identity. Mental health professionals continue to advocate for LGBTQIA+ affirming approaches, and the spirit of pride remains vibrant in business windows, websites, clothing, and countless other places.
While there is a great deal to be celebrated about queer love and identity, acceptance is by no means widespread or universal. Many people still live in cultures and communities where embracing queer identity is dangerous and finding support feels like a losing game. Sadly, the mental health profession is one of those areas where people have historically struggled to find safety and support from providers.
Despite important milestones of improvement in care and treatment of queer people, there is still a tragic history of marginalization and harm which has come from therapists, counselors, psychologists, psychiatrists, and social workers. Some try to shy away from this dark history, but it is times like Pride where it is imperative to look back at the way mental health professionals have gotten it wrong in the past.
Without acknowledging the hurt that has been caused and taking accountability for past actions, mental health professionals will not make the progress needed to continue improving standards of care for LGBTQIA+ communities or recognize the barriers of stigmatization still holding many in the community back from seeking mental health support.
Ancient History of LGBTQIA+ Identities
Homosexuality and transgender identities are by no means new concepts. While some of the specific terms used today may be new, there is evidence of same-sex love in almost all ancient civilizations, including mythology from ancient Greece, India, China, and Japan championing these relationships. Just as examples of same-sex relationships can be found in ancient life, so too can discrimination.
As Christianity began spreading and condemning queer relationships, attitudes changed, leading to the late Roman Empire passing a law prohibiting same-sex marriage in 342 CE. Harmful laws continued to grow in number throughout the following centuries with events like sodomy being declared a crime punishable by death in 1522, amping up the stakes for queer expression.
As colonialism began, condemnation of homosexuality spread alongside disease and genocide. Native American communities, which once embraced Two Spirit spiritual leaders, were persecuted by horrified European settlers until the practice was largely wiped out by the 1800s. Although the last hangings for homosexuality in Britain were in 1835 and death was removed as a consequence of same-sex relationships in the following decades for several countries, discrimination and criminalization were by no means eradicated.
Mental Health & LGBTQIA+
Stigmatization
APA and the DSM's Role in LGBTQIA+ Mental Health
In 1844, the American Psychiatric Association (APA) was founded by 13 superintendents of US institutions for people with mental illnesses. The APA published the first Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 in an effort to codify and differentiate “natural” or “healthy” behavior from “unnatural” and “unhealthy” behavior.
Homosexuality was included in this first publication, officially classifying same-sex interest as a mental illness. This resulted in further stigmatization of LGBTQIA+ people and drew a dividing line between “normal” sexual and gender expressions and “others.” Members of the organization argued that homosexual behavior should be classified as unnatural because non-procreative sex could not result in a child.
Once classified as a mental illness, people could be institutionalized, fired from employment, denied mortgages, lose custody of children, and more all from reports of homosexual desire or behavior. Through the next decades, the language used for homosexuality in the DSM changed from paraphilia to sexual orientation disturbance to ego-dystonic homosexuality, though the message that homosexuality was a problem to be eradicated remained consistent.
Harmful Conversion Therapies
Beyond social consequences of the DSM classifying homosexuality or “sexual inversion” as a mental illness, scientific attempts to scrutinize and understand queer identity and practices led to a variety of inhumane treatment approaches.
Therapists, religious leaders, and medical professionals were known to utilize chemical castration, electroconvulsive therapy, and lobotomies in an effort to “cure” people of their homosexuality and transgender identity expressions. These are only a few methods that were used in the wider umbrella of conversion therapy.
From physical harm to psychological trauma, the impacts of these efforts were deeply damaging to the individuals forced to undergo these so-called “treatments.” Naturally, many members of the LGBTQIA+ community became fearful of the medical and psychological fields. Those who could not avoid these harms were left with high rates of depression and suicidality.
Declassification of Homosexuality
The Fight for Declassification in the 1960s
Given these numerous horrors, the campaign to remove homosexuality as a diagnosis from the DSM began picking up in the 1960s. These campaigns grew alongside other civil rights movements including Black rights marches, women’s movements, and the wider gay rights campaign.
One huge barrier to gaining support was of course that queer and transgender people advocating for their rights were immediately labeled mentally ill and therefore unqualified to speak about their own experiences, many even being called manic or schizophrenic.
Despite all the obstacles in place, activists were finally successful in their efforts with the culmination of declassification occurring in 1973. That year the APA board of trustees voted to remove homosexuality from the DSM, severing the official link between homosexuality and mental illness. Unsurprisingly, however, the declassification did not mean the end of discrimination.
Additionally, the campaigns for declassification also had unintended consequences of further stigmatizing other non-neurotypical behaviors and characteristics as the APA was pressured to more explicitly define mental illness and create more distinct diagnoses.
While the DSM dropped homosexuality as a classification, the World Health Organization’s (WHO) International Classification of Diseases (ICD) did not remove homosexuality until 1990. Conversion therapy was still legal everywhere in the United States until 2013, and despite total bans existing today in 26 states, a 2023 report from The Trevor Project found over 1,300 active conversion therapists practicing in all U.S. states with the exception of Vermont and Hawaii.
The Transgender Community and Mental Health
The wins for better mental health recognition for gay, lesbian, bisexual, and pansexual people were not felt by the transgender community until significantly later. It wasn’t until 2022 that the ICD stopped classifying transgender people as mentally ill, and the debate about the classification of gender dysphoria in the DSM continues today. Ongoing legal battles and discrimination in the mental health field against transgender people is still an imminent problem and threat to mental well-being and safety for so many.
Current Challenges in LGBTQIA+ Mental Health Care
The incredibly recent history and still occurring incidents of these horrors from the mental health community hopefully shed light on why so many from the LGBTQIA+ community are still hesitant to seek care. High rates of depression and suicide make this a deeply concerning combination which must be actively discussed and righted by the mental health community.
All therapists must work to receive education around queer issues, ask clients about any past traumatic experiences with therapists, speak up against any unethical behavior, and communicate loudly and clearly that they are a safe space for clients of all queer identities. I am personally proud to be a member of the queer community myself, and I hope all clients find a therapist who makes them feel safe and listened to for their unique therapeutic journey.
Meet The Author: Brittany Trexler
Brittany is an individual and couples therapist who offers individual and couples therapy sessions for adults (18+) who live in Baltimore, Virginia, and Florida.
Brittany is an eclectic sex therapist specializing in kink, LGBTQIA+ issues, couples therapy, and relationship counseling for non-monogamous groups, polycules, and individuals. She employs a variety of evidence-based therapeutic techniques, believing that therapy should be tailored to each person's unique needs rather than following a one-size-fits-all approach. She holds her Master’s degree in Mental Health Counseling and is currently pursuing a PhD in Sex Therapy at Widener University.
Brittany loves board games, competing in pole dancing competitions, and snuggling with her cat. She also enjoys listening to mental health podcasts and ballroom dancing. As a bisexual, polyamorous, and kinky therapist, she is deeply committed to LGBTQIA+ education, advocating for polyamory acceptance, and the destigmatization of BDSM.