Initial classification The
DSM-II, published in 1968, expanded the "sexual deviation" diagnostic category (now located within the larger category of "personality disorders and certain other nonpsychotic mental disorders") so that different "sexual deviations" were listed under ten individual diagnostic codes: homosexuality, fetishism, pedophilia, transvestitism,
exhibitionism,
voyeurism, sadism, masochism, other sexual deviation, and unspecified sexual deviation. and added descriptive text that noted that homosexuality "by itself does not constitute a psychiatric disorder" and that the renamed code should be used for "individuals whose sexual interests are directed primarily toward people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation." This was considered a major victory by gay activists, because it clearly articulated a shift from considering homosexuality a mental disorder to only characterizing people as unwell if their sexual orientation caused them distress. The change was a compromise between competing schools of thought within the psychiatry field: the view that homosexuality was a pathological condition and the view that homosexuality is a normal variation of sexuality. Specific protests by gay rights activists against the APA began in 1970, when the organization held its convention in San Francisco. At the 1972 conference, gay psychiatrist
John E. Fryer spoke to the audience about what it was like for the many gay psychiatrists in the APA who had to hide their sexuality due to anti-gay prejudice within the field; he wore a mask and a wig and used a voice distorter to conceal his identity. This activism occurred in the context of a broader
anti-psychiatry movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at the same APA conventions, with some shared slogans and intellectual foundations. Psychiatrist
Robert Spitzer, who served as technical consultant to the DSM-II Committee on Nomenclature and Statistics, became a go-between in the dispute. Spitzer originally believed that homosexuality belonged in the DSM, but after meeting with gay activists, including a secret group of gay APA members later known as the
Association of Gay and Lesbian Psychiatrists, and faced with data from researchers such as Kinsey and Hooker, he drafted the compromise of removing homosexuality itself from the DSM and replacing it with "sexual orientation disturbance". After a vote by the APA board of trustees in December 1973, and confirmed by the wider APA membership in 1974, this change was made. Psychiatrist Richard Green, who had argued forcefully in favor of declassifying homosexuality as a mental disorder, viewed Spitzer's insistence on including a diagnosis for homosexuals who were distressed by their sexuality as a poorly disguised attempt to maintain homophobic bias in the DSM, and publicly resigned from the APA nomenclature committee over it. Meanwhile, critics argued that declassifying homosexuality was a result of pressure from gay activists and demanded a referendum among voting members of the APA. The referendum was held in 1974 and the APA's decision was upheld by a 58% majority. The APA published a position statement that urged an end to anti-homosexual discrimination and called for decriminalizing private sexual acts between consenting adults. However, the APA also made it clear that it did not endorse the view that homosexuality was a normal variant of sexuality. ==DSM-III==