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June 28th, 2007

Beware The Hidden Assumptions

That’s something I was taught to consider in a structured analysis and design class I attended once and it’s the kind of thinking that we should all practice.  You really need sometimes to look critically at the obvious, the taken-for-granted, those "everyone knows such-and-such is true" truths.  They can be delicate, nearly invisible curtains hiding from your eyes the reality that’s staring you back in the face.

Via aTypical Joe, comes this story of 81 words that were once in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and how they were there in the first place, simply because everyone just assumed they were true.  And this particular assumption got its first really critical looking at, when Evelyn Hooker, a psychologist at UCLA, met Sam From, a student…

Evelyn was a psychologist at UCLA and Sam was her student. He was also a homosexual. They started spending time together in the mid 1940s and Sam introduced Evelyn to his group of friends most of whom, like Sam, were gay.

Now, as I said, everyone in this group was homosexual but curiously, none was in therapy. They were all well-adjusted young men who utterly failed to conform to the traditional psychiatric image of the tortured, disturbed homosexual.

This, naturally, got Evelyn thinking.

Now, prior to Evelyn Hooker, all of the research on homosexuality – all of it – was done on people who were already under serious psychiatric treatment. Let me repeat that: In the history of psychiatric research, no one had ever conducted a study on a homosexual population that wasn’t either in therapy, in prison, a mental hospital, or the disciplinary barracks of the armed services.

Evelyn thought about this and decided that this kind of research was distorting psychiatry’s conclusions about homosexual populations. To test her theory, Evelyn came up with an experiment. Through her former student she located 30 homosexuals who had never sought therapy in their lives and matched those homosexuals with a group of heterosexuals of comparable age, IQ and education.

Evelyn then put both groups through a battery of psychological tests including a Rorschach Test, the famous ink-blot test. After disguising her subjects, Evelyn gave the results to three experienced psychiatrists and asked them to identify the homosexuals. She figured that if homosexuals were inherently pathological, the psychiatrists would be able to pick them out easily. But the judges were completely unable to distinguish the homos from the hets.

Equally important was the fact that the judges categorized two thirds of the homosexuals and the heterosexuals as perfectly well-adjusted normally functioning human beings. 

Hooker’s study challenged the idea that homosexuality was a pathology in the first place, and in doing this it not only called into question an entire generation of research on homosexuality, it also challenged psychiatry’s basic concept of disease. If you believed Hooker’s data the only conclusion you could come to was that psychiatry was deciding that certain behaviors were diseases, not out of any sort of scientific proof, but based on their own prejudices.

Beside Evelyn Hooker, psychiatrists who wanted to change the DSM really had only one other scientific study on their side: Alfred Kinsey’s famous 1948 sex survey which found that a whopping 37% of all men had had physical contact to the point of orgasm with other men, a finding which – besides shocking the hell out of 63% of the American public – seemed to suggest that homosexual acts were too common to be considered a disease.

In spite of all this work, psychiatry continued to maintain that the homos were sick and steadfastly refused to reevaluate the DSM. And then luck, or maybe fate, intervened.

This is but a small excerpt from a really good This American Life broadcast, which originally aired in January 2002.  It’s available for listening at the link above.  If you have iTunes it can also be purchased for ninty-five cents.  I highly recommend it.  The broadcast is the story of the DSM change as told by Alix Spiegel, the granddaughter of the man who was the president elect of the APA when the change occurred.  Like many profound historical events, this one is something more, and something less, then the mythologies that have grown up around it.  It involved political theater, and behind the scenes activism.  It involved many diverse people from many diverse backgrounds…most of them heterosexual, some of them gay.  Most of the gays in the APA at that time were in fact, deeply, deeply closeted, and what is probably a striking thing for modern ears to hear is how many of them accepted the prevailing assumptions about the pathology of homosexuality.

But if the internal behind the scenes politics, and the external pressure of gay activists accomplished anything, it was to hasten what the science would eventually compel them to do anyway.  That is not to ether dismiss, nor exaggerate the impact of the activism.  There is a scene near the end of Alix Spiegel’s story that needs to be in any film or TV recreation of these events, and it is that moment when Robert Spitzer is brought by one of the activists who had been protesting the APA’s categorizing of homosexuality as an illness, uninvited, to a gathering of the closeted gay professionals, and he sees how many distinguished and successful people of his profession are homosexual, people he would never have suspected, people whose accomplishments were considerable, people who would, every one of them, have been drummed out of their profession had their sexual orientation become known then.  For Spitzer, it is a profound revelation.  And then…a young man in uniform walks in the door.

You should listen to this episode.  It’s nearly an hour long but well worth it, to get to that scene.  There is a historian toward the end who says that questions of disease and pathology ultimately resolve down to moral questions, not scientific ones.  I disagree.  Science can certainly tell us whether or not something is or is not harmful to us mentally and physically.  And the moral question was answered millenia ago: First Do No Harm…  But there is a profound moral question at the bottom of every scientific one and that is the question of truthfulness and letting the evidence speak for itself.  Even if means you have to discard a cherished assumption you’ve held on to for years.  Even if that assumption has given you the recognition of your peers, fame, and made you a pretty good living. 

Robert Spitzer has taken a lot of justly deserved criticism for his so-called study of clients of ex-gay ministries, but you have to give the man credit for that one dazzling moment near the end of this report, when he let the evidence he could clearly see with his own two eyes, finally, speak for itself.  Charles Socrades comes off by contrast, as a man so blinded by dogma that he’s even willing to regard himself as a parental failure to his own gay son.  But as he says, his business was booming.  He speaks with pride toward the end about some parents who took their 16 year old gay son to one psychiatrist after another, only to be told there was nothing wrong with the boy…until they met him.

And now you know what happens to a soul that stops asking questions.

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