The most dangerous assertions that the medical profession has been responsible for have been attempts to see homosexuality as inherently self-destructive and to probe the psyches of lesbians and gay men for the root motivation that causes their 'illness.' Rofes, 1983.

Research into the etiology of homosexuality must be placed within an historical context, which is the purpose of this introduction paper.

Pre 19th Century

The term sodomy, which came into use in the Netherlands in the mid 16th century and which meant anal sex but in practice was used to mean every sexual act disapproved of, was regarded as a sin and a crime, punishable in some places by death. The term used for lesbians was 'tribady.' Sodomy (or tribady which was more rarely used) was thought of as an activity someone might indulge in occasionally. (Dekker and van de Pol, 1989)

In the 18th century sexuality became an increasing concern to the medical profession; medical ideas about sexual deviation came to enforce traditional religious concepts which were under attack. (Minton, 1986)

Tissot, 1758

Masturbation included everything that had previously been included in the 'sin against nature' by churchmen, namely all nonprocreative sex. Loss of semen resulted in, or would lead to,

- cloudiness of ideas even to the point of madness,

- decay of bodily powers eventually resulting in coughs, fevers, and consumption (i.e. tuberculosis),

- acute pain in the head, rheumatic pains, and an aching numbness,

- pimples on the face, suppurating blisters upon the nose, breast, and thighs as well as painful itching,

- eventual weakness of the power of generation as indicated by impotence, premature ejaculation, gonorrhea, priapism, and tumors in the bladder, and

- disorder of the intestines, constipation, hemorrhoids, and so forth.

Masturbation in females meant that they suffered much the same ills as men, plus:

- hysterical fits,

- incurable jaundice,

- violent cramps in the stomach,

- pains in the nose,

- ulceration of the cervix and to the uterine, and

- tremors that deprived them of decency and reason.

Masturbation lowered women to the levels of the most lascivious brutes, and caused them to love women more than men.

Onanism (masturbation) was considered far more pernicious than an excess in marital or premarital fornication and, if engaged in by young people, would tend to destroy the mental faculties by putting much strain upon the nervous system. (Bullough, 1974).

19th Century

It was not until the late 19th century that the term homosexuality began to be used when it came to be accepted as part of a person's character/nature. Many theories were expounded by doctors, psychologists and sexologists from England, Germany, Italy and the U.S.A. Most said that homosexuality was innate, therefore it could not be a sin but was a sickness which should be cured. (Rofes, 1984) These 'experts' came up with ideas about what homosexuality is, how to recognise homosexuals, what the causes of homosexuality were and how to 'cure' it. These theories are the origins of many of the negative myths and stereotypes about homosexuality which are still believed today. For example,

Ulrichs, 1860's

Homosexuality is an inborn condition. Ulrichs coined the term urning for male and urninging for female homosexuals.

Homosexuals were part of a third sex born with the characteristics of one sex and the sexual and emotional responses of the other.

This forms the basis for the belief that lesbians are men trapped in women's bodies and gay men are men trapped in women's bodies.

Moreau, 1887

Homosexuality is a sixth sense; it is a genital sense which is inborn and which could mean psychic and physical injury.

Such injury resulted from a hereditary taint, a sort of predisposition to perversion.

However, it might be further invoked by certain environmental conditions.

In any case, it is pathological.

Puberty and senility are times of particular genetic trauma for those predisposed to homosexuality.

Moll, 1893

Many urnings come from nervous or pathologically disposed families ...when the love of a homosexual woman is not responded to, serious disturbances of the nerve-system may ensue, leading even to paroxysms of fury.

Krafft-Ebing, 1894

Created two categories for homosexuals:

"sexual inversion as an acquired morbid phenomenon" and

"sexual inversion as an innate morbid phenomenon."

That is, some are born that way, others become that way.

He said "mental abnormalities and real disturbances of the intellect are commoner with urnings than in the case of other men."

and that lesbianism was a cerebral anomaly indicative of an inherited diseased condition of the central nervous system.

Krafft-Ebing looked upon masturbation as a causal factor for most things he regarded as deviant or unpleasant. He grouped together different 'disorders.' In one group he included lust murderers and cannibals along with harmless phenonema like people who collect violet-striped handkerchiefs, a man who loved to smell roses, and a girl who longed to kiss and embrace other girls. (Bullough, 1974).

Tarnovsky, 1886

Made a distinction between inherited and acquired homosexuality. Inherited homosexuality, like hysteria, epilepsy, alcoholism, anemia and typhus, is a pathological sign. Acquired homosexuality, although also influenced by heridity, could be enhanced by reading dirty books, keeping bad company, or living in too great a luxury. However, the first step to both types was masturbation. (Bullough, 1974; Rofes, 1984).

Ellis, 1897

Supposedly treated homosexuality as neither a disease nor a crime. He wrote that female inversion was more common than male inversion and female inverts were boyish, nervy, having deep voices and the ability to whistle.

Male inverts resisted stereotyping but were prone to mild neurosis.

20th Century

Carpenter, 1908

Characterised male homosexuals as having "defects in the direction of subtlety, evasiveness, timidity, vanity etc. while the female is just the opposite, fiery, active, bold and truthful, with defects running to brusqueness and coarseness."

Adler, 1917

Lesbianism is a form of 'masculine protest' whereby lesbians refuse to submit to being a sexual object for men.

The development of a lesbian lifestyle is based on the resentment of men rather than affirmation of women.


Concluded that lesbianism represented a way for women to avoid the responsibilities of marriage and motherhood.

Said there were two types of lesbians: predatory (not married) and women who are or have been married.

Predatory lesbians posed a potential threat to family life and hence were a danger to society.

Freud, 1920's

Said everyone was born bisexual, as a result, all people experience a homoerotic phase of psychosexual development.

Homosexual tendencies reside in every individual because repression or sublimation of homosexual desire is never totally achieved. Hence the search for a sexual object can take two paths leading to heterosexuality or homosexuality as a choice but homosexuality was an immature form of sexuality.

Homosexuality caused by mother fixation, penis envy, maternal indifference.

Whilst Freud said the patient was not ill, he nevertheless described lesbianism as an 'abnormality' caused by inadequate resolution of the Oedipus complex.

Freud said the essential feature of a 'normal' female sexual development was to transfer the site of orgasm from the clitoris to the vagina in order to accommodate heterosexual functioning. Those unable to do this are at a less mature state of sexual development.

(n.b. Kinsey, Masters and Johnson said that all orgasms are an extension of sensations originating from the clitoris. This exploded the myth of the vaginal orgasm which had far-reaching implications for heterosexual female sexuality.)

Deutsch, 1932

Homosexuality is a 'perversion' developed in a setting of sadistic mothering and inadequate fathering.

Terman, Miles and Kelly, 1936

Said that passive female homosexuals were 'perverts.' Perverts were homosexuals whose gender characteristics were 'appropriate' but by chance - possibly flavoured with curiosity - turned to a form of sexuality that went against his or her natural gender adjustment, implying that a 'pervert' was not a bona fide homosexual.

Active female homosexuals, on the other hand, were called 'inverts.' Inverts had inappropriate gender identity, mentality and emotionality,

Perverts and inverts were psychologically conditioned by parents from early childhood.

Ellis, 1936

Lesbianism caused through:

living in sex-segregated environments,

seduction by other women,

experiencing disappointment in heterosexual love, or

engaging in masturbation.

All these could interact with a genetic disposition to produce lesbianism.

Hirschfield, 1936

Homosexuals born with faulty genes, thus suffering from an incurable disease.

Schmidt (1984) tells us that as a result of Hirschfield's untiring campaigning to change the German penal code which outlawed homosexual acts, several researchers, including Krafft-Ebing, changed their views about homosexuality. A year before he died, Krafft-Ebing revoked his previously held opinion that homosexuality was a pathological mental state and said that one "cannot insist on the term 'illness'" since "homosexuality is compatible with normal mental functioning."

Henry, 1941

Involved with many other medical professionals in American study entitled "Sex Variants: A Study of Homosexual Patterns." The purpose of the study was to assist doctors in identifying and treating patients who suffered from "sexual maladjustment." It was hoped the findings would go towards preventing the spread of 'sex variance' among the general population.

The experts recommended the family as the site for prevention of homosexuality. On the assumption that all male homosexuals were feminine and all female homosexuals were masculine, parents were warned to reinforce proper gender behaviours:

The sex variant is a person who has failed to achieve and maintain adult heterosexual modes of sexual expression ... [and is unable] to meet the responsibility of establishing and maintaining a home which involves the rearing of children....

Thompson, 1947

Lesbianism is a symptom of other underlying disorders; it is a behaviour that occurs when there are no available men.

Caprio, 1954

Saw lesbianism as a narcissitic extension of autoeroticism.

Said lesbianism was caused by various environmental traumatic influences during childhood and adolescence e.g.

- broken homes,

- sexually maladjusted parents,

- a sadistic feeling toward the opposite sex,

- death of a parent,

- predisposition to masculinity and precocious sexuality,

- homosexual seduction in childhood,

- excessive use of alcohol.

Caprio believed that lesbians were insanely jealous, exhibited sadomasochistic tendencies and had strong feelings of guilt and insecurity.

Lombroso, (1958, 1972)

Studied criminal temperaments and included homosexuals as a type of criminal suffering from a form of insanity that should be treated in asylums rather than prisons.

Socarides, 1963, Romm, 1965, Wilbur, 1976

Suggested the following contributed towards development of lesbianism:

- clitoral fixation,

- fear of men,

- fear of rejection,

- sexual abuse (including rape and incest),

- ambivalence toward both parents,

- masochistic debased life of the mother interferes with the girl's identification.

Khan, 1964

Lesbianism caused by a premature genital awareness.

Kaye, et al 1967

Viewed lesbianism as a "massive adaptational response to a crippling inhibition of normal heterosexual development."

McDougall, 1970

Lesbianism is an identification with the father in order to prevent psychotic symbiosis with mother; it is a body-ego disturbance.

These 'experts' significantly contributed to the belief that lesbians are sick, degenerate, and controlled by excessive sexual desires.

As a result of such research, various treatments were developed to 'change' homosexual behaviour to heterosexual behaviour or to extinguish homosexual behaviour. These included:

- castration,

- vivisection,

- cliterodectomy,

- lobotomy,

- electroshock treatment,

- pharmacologic and hormonal injections, and

- aversion therapies.

Alongside these researchers others, e.g. Davis, 1929, Kinsey, and Hooker, 1957, were conducting research with non-institutionalised homosexuals which contradicted previously held assumptions: they found that homosexuals were remarkably similar to heterosexuals with the exception of sexual preference.

Kinsey asserted that homosexuality was a variation of sexual expression. He suggested that there was only a small percentage of the adult population who were exclusively heterosexual or homosexual and that most had both heterosexual and homosexual experiences.

Ford & Beach, 1951 discovered that there was some form of homosexual behaviour found in almost all species across all cultures.

These studies led the way to research in the early 1960's which saw the earlier theories being subjected to rigorous scientific scrutiny. The validity of the early research was seriously challenged for various reasons, not least because the authors based their understanding on people interviewed mainly in asylums, hospitals or prisons but also because they were influenced by prevailing religious values and limited by cultural biases. As Suppe (1984) notes:

The historical record clearly shows that in issues such as masturbation, abortion and contraception, veneral disease, and the inferiority of women and blacks, physicians have generally supported the prevailing mores, presenting research that gave credence and medico-scientific legitimacy to social prejudices (Bullough, 1963; Duffy, 1963, 1982; Englehardt, 1974; Haller & Haller, 1974).

A series of studies (Armon, 1960; Hopkins, 1969; Siegelman, 1972; Freedman, 1971; Obison & Wilson, 1974; Thompson et al 1971; Wilson & Green, 1971; Saghir & Robins, 1973; Oberstone & Sukoneck, 1976; Adelman, 1977; Bell & Weinberg, 1978; Hart et al 1978) proved that lesbians were no different in maturity or psychological adjustment to heterosexual women. Many of these studies, along with the actions of the gay rights movement, led the way to the American Psychiatric Association voting, in 1973, to remove homosexuality from the Diagnostic and Statistical Manual as a diagnostic category.

The decision to remove homosexuality from DSM II was challenged by a group of psychiatrists led by Irving Bieber and Charles Socarides. Whilst the category homosexuality per se was no longer classed as a mental disorder, it was replaced by ego-dystonic homosexuality, or Sexual Orientation Disturbance, the term applied to homosexuals who were "disturbed by, in conflict with, or wish to change their sexual orientation." (Suppe, 1984)

In 1974 the American Psychological Association recommended that psychologists "take the lead in removing the stigma of mental illness that has long been associated with homosexual orientations." (Conger, 1975, cited in Rothblum, 1994).

'Modern' Research

There has been substantial progress in the U.S.A. In the mid 1970s gay social scientists formed associations which encouraged networking. (Furnell, 1986) There can be no doubt that these groups, together with the publication of the Journal of Homosexuality in 1974, significantly helped to encourage research. Hundreds of articles and research papers have been written, primarily by homosexuals as compared to earlier work which was mainly conducted by heterosexuals, with a heterosexual bias. Morin (1977) defines heterosexual bias as "a belief system that values heterosexuality as superior to and/or more 'natural' than homosexuality". By examining researcher's questions Morin showed that research reflects the researcher's values as well as those of society at the time of writing. For an investigation as to how U.S. psychological research into homosexuality became less heterosexual biased see Morin, 1977, for the period 1967 to 1974; MacDonald, 1981, for the period 1975-1978, and Watters, 1986, for 1979 to 1983.

Modern research challenges the stigma of homosexuality and develops knowledge about lesbian and gay issues. The focus of this has been on the coming out process and identity development; discrimination and homophobia (developing ways of measuring and challenging negative attitudes towards homosexuals); mothers; mental health and therapy; adolescents; education; alcohol misuse; relationships; health; social services; parents of lesbians and gays; old lesbians and gays; black and minority ethnic lesbians and gays; AIDS; bisexuality; butch/femme; communities; employment; law; religion; sex; as well as culture (history, literature, music, theatre, media) and politics/theory.

Despite the level of information now available, many psychiatrists and psychologists still consider homosexuality a perversion of normal psychosexual development and continue to put forward theories and attempt to change the sexual orientation of individuals.

Socarides, 1978

Lesbianism is caused by a disturbance of early object relations characterised by masochism.

It is a disturbance of separation-individuation (1968).

It is a disturbance with constitutional contributions (1963, 1968).

Siegel, 1988

Lesbianism is caused by a narcissistic mother interfering with her daughter's identification.

It is a narcissistic disturbance.

It is a disturbance arising out of pathogenic family constellations.

Quinodoz, 1989

Lesbianism is a borderline phenomenon characterised by defences against both psychotic and oedipal anxieties.

There has been a significant upsurge in religious sexual re-orientation therapy, both in the USA and in Britain. In a highly critical essay about this phenomenon, Haldeman (1994) quotes the Washington State Psychological Association policy of 1991:

Psychologists do not provide or sanction cures for that which has been judged not to be an illness. Individuals seeking to change their sexual orientation do so as the result of internalized stigma and homphobia, given the consistent scientific demonstration that there is nothing about homosexuality per se that undermines psycholgical adjustment. It is therefore our objective as psychologists to educate and change the intolerant social context, not the individual who is victimized by it. Conversion treatments, by their very existence, exacerbate the homophobia which psychology seeks to combat.


The situation in Britain is that we are between 15 and 20 years behind the U.S.A. Furnell (1986) conducted a survey of British writings and research on homosexuality over the period 1965-1985. In his introduction Furnell stated, "British psychology appears not to have moved beyond the position which characterized the psychological literature as a whole in the late 1960's and early 1970's (Morin, 1977)." Noting the proliferation of material from the U.S.A. Furnell concluded, "As yet, however, very little sophisticated psychological research has been undertaken in these areas in Britain."

Furnell discusses several British authors including the following:

Papatheophilou et al, 1975

Homosexual behaviour, common in adolescence, is recognized as a phase of normal development and our findings indicate that the EEG of the majority of treatment seeking homosexuals is similar to that of adolescents. So that a degree of cerebral immaturity (Grades II and III) must be considered as predisposing to homosexuality as well as Silverman and Rosanoff's pathologically functioning brain; presumably these entities relate to either retardation or failure of psychosexual development with increased susceptibility to sexual trauma or seduction.

Limentani, 1977

The homosexuality which occurs on the background of hysterical, obsessional and other neurotic personality types and related psychiatric conditions, tends to be linked with latent heterosexuality and responds well to all forms of psychotherapy. On the other hand, true homosexuality is often the major presenting symptom of borderline states, narcissistic disorders, psychopathy and the schizo-affective psychoses and carries an unfavourable prognosis with any form of treatment. Cases of actual bisexuality form the third group with its own specific psychopathology.

In his paper "Behavioural Approaches to the Management of Sexual Deviations" Hawton (1983) discusses techniques for psychiatrists to deal with patients who have a 'deviant' sexual behaviour, specifically homosexuality. Only a small proportion of the paper deals with "Methods used to provide help in adjusting to deviant sexuality" i.e. helping homosexuals accept their sexual orientation. Hawton recommends that practitioners give a thorough assessment of their patient to ascertain whether s/he wants deviant interests removed, heterosexual adjustment improved or adaptation to a deviant role.

The situation has hardly changed since 1985. Several searches on different databases suggest that we are only beginning to conduct research into areas concerned with the effects of homophobia in Britain.

The tenth revised edition of the World Health Organisation's "International Statistical Classification of Diseases and Related Health Problems" dropped the inclusion of homosexuality as a disease under Mental Disorders, subsection Sexual Deviation and Disorders. Homosexuals were described as "Sufferers" and had to endure "exclusive or predominant sexual attractions for persons of the same sex with or without physical relationship." The new edition, published in January 1993, states that "Sexual orientation by itself is not to be regarded as a disorder." As a result of this, in January 1993, the British Government declared that homosexuality was to be struck off its central computer list of mental illnesses in April 1994 when the new guidelines came into force. (Capital Gay, 8th January 1993).

In 1993 a group of British lesbian psychologists proposed the establishment of a Lesbian Section of the British Psychological Society (BPS). The proposal was rejected on the basis of insufficient resources and the existance of too many Sections already, yet not long after further Sections were accepted. When the idea was first suggested, the executive secretary, Dr. Colin Newman, wrote a letter stating "By accepting a Section devoted to the study of lesbianism, the Society will be giving a public signal that it endorses behaviour which, by the biblical standards they personally seek to follow, is incompatible with their own standards of morality." (The Guardian, 6/1/94). A proposal for a Lesbian and Gay Section has been put before the BPS twice since then; both met with refusals.

Charles Socarides, who has propounded the theory that homosexuals are 'disordered' for over thirty years, was invited to Britain to give a lecture by the Association for Psychoanalytic Psychotherapy. His lecture was cancelled due to demonstrations but the chairman of the APP, Rob Hale, planned to invite Socarides for a series of private meetings. (Capital Gay, 28th Aapril 1995)

At the MIND Conference "Prejudice and Pride: Exploring Lesbian, Gay & Bisexual Mental Health" held on June 21st 1995, John Bowis, Under Secretary of State for Health, said: "There is no doubt that sexual orientation itself is not, should not and never again will be a mental health issue. As with all members of our society gay men, lesbians and bisexual people should be treated with respect and equality."

Essentialism v Constructionism

The academic debate about essentialism (biological origins) and constructionism (sociological origins) continues to rage among modern researchers. In 1987 the conference "Homosexuality, Which Homosexuality?" held in Amsterdam discussed the issues and recent medical research (Le Vay, 1991; Bailey & Pillard, 1992; and Hamer, 1993), is coming up with evidence that some people - in particular male homosexuals - are pre-disposed to homosexuality. This has prompted a response by constuctionists (Kitzinger & Wilkinson, 1995).

It is worth noting that constructionism is particularly strong in Britain where it is propounded by most of the few British lesbian and gay academics who write about homosexuality/lesbianism (chiefly Kitzinger, 1987; McIntosh, 1968/1992; Plummer, 1981, 1992; Weeks, 1977; cited in Kitzinger & Wilkinson, 1995). Many (most) feminist academics who are writing about homosexuality are constructionists.

One final point worthy of note is that of definitions. As Harry (1984) argues: "... social constructionists are referring to labels applied to sexual orientation while essentialists are discussing sexual orientation itself."


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© Jan Bridget 1995