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204: 81 Words

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Prologue

Ira Glass

So for weeks and months and years, people write to their legislators, and lobbyists make massive campaign contributions to try to swing the votes. And there are stories on the TV and editorials in the newspapers. And people talk about it, and then they ignore it. Then they talk about it some more. And then there are votes, and there are compromises and more votes. And finally, the president signs the bill into law. And when he does it, there are special pens that he uses.

It's the pens that I want to talk about. He uses more than one, then he gives the pens away. And people save these pens for years. Pens. They didn't do anything. You know what I'm talking about here? The pen that Lyndon Johnson used to sign the Voting Rights Act-- that pen did not give anybody the right to vote. It took the entire political machinery of a huge country to do that.

But, OK. Let's say that you end up with one of these pens. I'm guessing that, from time to time, what you do is that you take out the pen and you stare at it, and you think a thought that goes along the lines of-- this pen was right there. This pen has done something more important than I will ever do, which is, of course, a distressing thought because, after all, it is just a pen, and you are a human being. But put that aside.

It's just uncanny. I think that's the word. It's uncanny when something so small, for a moment, for the length of time that it takes to sign a name, can carry the entire weight of history of a nation. Today's radio program is about something small like that that was at the epicenter of a massive social change in our country for a brief moment. From WBEZ Chicago, it's This American Life. I'm Ira Glass.

Today, we are devoting our entire show to this one killer story about something very small, something small that helped change something very, very large. It's a story of doctors, of science, of homosexuals, of lucky coincidence and political action, and of the sheer power of good old-fashioned face-to-face schmoozing. Alix Spiegel tells the story.

Act One: Act One

Alix Spiegel

This is the story of a definition, three single sentences composed of 81 words. It's the story of how this particular definition became another definition, nine sentences, composed of 237 words.

Now according to some parties, this change from 81 words to 237 words liberated an entire category of humanity. According to other parties, it undermined the basic family unit, compromised the scientific authority of psychiatry, and quote, "tampered with the basic code and concept of life."

Now, I should tell you that I know this story not because I read it in a book or learned it in any class, but because it's one of those stories that my family uses to explain itself. Like most family stories-- anyway, like most stories told in my family-- the version I heard growing up was an exaggeration, the relevant family member cast as a conquering hero. The actual story, the story I hope to tell you is, of course, much more complicated. But I'm getting ahead of myself.

John P. Spiegel

June 23rd, 1980, at the home of the seagulls in Woodstock, New York.

Alix Spiegel

My grandfather, John P. Spiegel, used to say that he was a fish. It's true. Most of my memories of him are memories of a body floating face down in the water, slack, communing with his brothers and sisters of the sea. He was a strange man-- a doctor of psychiatry who spent months in the desert studying exotic tribes, smoking their drugs, sleeping under the stars, living, he said, like a native.

This tape, the tape that you hear running under my voice, was recorded for my cousin Zoe's 12th birthday. She'd gotten a tape recorder as a present and had asked my grandfather if she could interview him. Zoe was a smart kid, but still only a graduate of the seventh grade, and so my grandfather politely declined. He decided there was only one person present with the intelligence and experience necessary to interview Dr. John P. Siegel. That person? Dr. John P. Siegel.

John P. Spiegel

All right, Grandpa, would you mind telling us what you're doing here?

All right, John, I'll tell you. I'm here to help celebrate Zoe's 12th birthday. True, her birthday was on Thursday, but I wasn't able to be here on Thursday, so I came on Friday. And I've been here all weekend, and we're having a marvelous time.

Alix Spiegel

My grandfather interrogates himself about the difficulty of travel from Boston to upstate New York and the movie the family saw the night before, Urban Cowboy, which included an actor that my grandfather refers to as John Revolta. Then he moves on to other topics of potential interest to posterity.

John P. Spiegel

And what are your plans from here on out, grandpa?

Well, John, I'm going to go to Ireland. I've been asked to testify in a trial being conducted by a gay activist who happens to be a professor of English at Trinity College and who is bringing a suit against the state of Ireland to change the constitution, which has several extremely repressive provisions forbidding, and condemning, and devaluing homosexuality. And I've been asked to testify as an expert in mental health.

Alix Spiegel

My grandfather was a psychiatrist, but not in any sense an expert on what was then called sexual deviance. Still, he was asked to testify about the mental health of homosexuals and the mental health effects of discrimination against homosexuals in Ireland, in Texas, in Maine, in front of Congress, and too many places to mention.

He was asked because, in 1973, he happened to be president-elect of the American Psychiatric Association when the organization decided that homosexuality was not a mental disease. Up until that time, psychiatrists had always thought of homosexuality as a pathology-- a problem so profound it affected, as one psychiatrist told me, the total personality.

Now, because psychiatrists believed that homosexuals were pathological, it gave scientific sanction for the rest of the country to see it the same way. Gays were routinely fired from teaching jobs, denied security clearances and US citizenship. For that matter, they were barred from practicing psychiatry, because you don't let someone who's pathological practice medicine on other people who are pathological. Or anyway, that's what the psychiatrists thought.

That's what it said in the bible of their profession, what the psychiatrists called the DSM, or the Diagnostic and Statistics Manual, a book which listed in clear, clinical language every possible permutation of psychosis, every variant of paranoia, every deviant mental tick that the children of Freud had ever encountered, all nicely bound together under an industrial yellow cover with an authoritative OED staid font.

There it was, diagnosis number 302.0, 3 sentences, composed of 81 words, which certified homosexuality as sick.

John P. Spiegel

Do you look forward, Grandpa, to this engagement that you're going to have in Ireland?

Well, John, I have mixed feelings about it. It's going to be fun to spend a few days in Dublin. But it's also kind of anxiety-making because the trial is going to be held in the high court, and I'm going to be cross-examined, which I don't particularly look forward to.

If you have anxiety about doing it, Grandpa, then how come you're going?

Well, you see, John, it isn't so often that a person has an opportunity to help to change the constitution of an entire nation.

Alix Spiegel

To hear my family tell it, it was my grandfather alone who banished those 81 words from the DSM. When I was young, the family legend was that my grandfather, president of the American Psychiatric Association, single-handedly changed the DSM because he was a big hearted visionary, a man unfettered by prejudice who worked on behalf of the downtrodden.

This story was wrong on two counts. A, my grandfather was not president of the American Psychiatric Association in 1973-- he was president-elect. B, he didn't single-handedly change anything.

But never mind, because this version of events was discarded, anyway-- discarded after the family went on vacation to the Bahamas to celebrate my grandfather's 70th birthday. I remember it well, remember the plane, and the drive from the airport, and arriving and discovering that the hotel had a swimming pool installed about 50 feet away from the beach. I remember thinking that a pool so close to the water was both ridiculously decadent and somehow incredibly exciting.

I also remember my grandfather stepping out of his beachfront bungalow on that first day, followed by a small, well-built man, a man that later, during dinner, my grandfather introduced to a shocked family as his lover, David.

David was the first of a long line of very young men that my grandfather took up with after my grandmother's death. It turned out that my grandfather had had gay lovers throughout his life, had even told his wife-to-be that he was homosexual two weeks before their wedding.

And so, in 1981, the story that my family told about the definition in the DSM changed dramatically. My grandfather was no longer seen as a purely enlightened visionary, but as a closeted homosexual with a very particular agenda.

In actual fact, this version of the story also bears only a passing resemblance to the truth. The real story is, as I said, much more complicated. And though it ends in the same place as my family's version, with a world in which it's just a little bit easier for men like my grandfather to come out to their families and friends before they're, say, 70 years old, it's a story in which my grandfather really plays a pretty minor role.

John P. Spiegel

Well, Grandpa, why don't you tell us a little bit about the past?

Now, John, you know that that's an extremely broad area. As an expert interviewer, you should know better than to ask me a question like that. Would you mind making it more specific?

You're right, Grandpa. That was a very pertinent observation. Why don't you begin talking about your past and pick up--

Alix Spiegel

Let's begin with a little background so the full meaning of what transpired can be properly understood. Throughout the '40s, '50s, and early '60s, the American Psychiatric Association was a very conservative place, an organization run by what were described to me by a former APA president as businessmen psychiatrists-- well-meaning, gray-haired, '50s-style professionals.

Now, when the '60s arrived, these men weren't particularly interested in weighing in on the issues of the day-- on Kent State, or civil rights, Vietnam. Then a relatively small group of homosexual activists started making noise about their designation in the DSM. Specifically, the activists rejected the idea that they needed to be cured of their desire. They said that they only needed the stigma of insanity to be removed from homosexuality so that they could get jobs teaching children or practicing psychiatry-- basically, so that they could finally achieve equal rights.

Now at the time, these protests didn't make much of an impression on the doctors at the APA. They saw themselves as scientists. And scientifically, there was near universal agreement that homosexuals were at least one donut short of a dozen.

I spoke to 10 different psychiatrists who were members of the APA during the time of the redefinition, and I began each of my interviews with the same question-- what percentage of the APA believed that homosexuality was pathology in 1970 when this story begins?

Psychiatrist

Oh, well over 90%.

Alix Spiegel

In 1970?

Psychiatrist

Oh, I think so. Sure.

John Fryer

95. 98. 99, even the ones of us who were gay.

Alix Spiegel

This is John Fryer. John lives in Pennsylvania now in an aging Philadelphia mansion with two enormous dogs and rooms filled with elaborately scrolled furniture. This house is a very great distance, both psychologically and physically, from the Kentucky farm where John grew up.

John graduated from his Kentucky high school when he was only 15 years old. And by 19, he'd been accepted to Vanderbilt University Medical School. He was one of the youngest students to be trained in psychiatry in the school's history. He was also a homosexual.

Now, technically, it was forbidden for homosexuals to practice psychiatry, and John knew that. He had, after all, read the literature. He'd seen the research. And he had certainly sat through the lectures.

John Fryer

So from the very beginning, I learned that it was pathology. And it was very difficult to get over that.

Alix Spiegel

Difficult to get over, even years later, after he became a practicing psychiatrist. Difficult to get over, even after he joined the APA and met a number of other gay psychiatrists. So many, in fact, that informally they began to meet each year during APA conventions-- a loose underground group which they jokingly titled the GAYPA.

These were men who, like John, had made it through medical school without detection and continued to hide their sexual preference, except to one another. These were men who, despite their association with the GAYPA, never thought to question, even among themselves, traditional psychiatric ideas about homosexuality.

John Fryer

No way.

Alix Spiegel

No way?

John Fryer

Didn't come up, to my knowledge, because of our own internalized homophobia. Most of us probably agreed that it was OK to be a disease.

Alix Spiegel

The idea that homosexuality was a form of insanity began in the 19th century. And at least at the time, its designation as a mental illness was actually seen by homosexuals as a step forward.

For the previous 2000 or so years, the Christian world saw being gay as a crime against the will of God. The book of Leviticus declares, "If a man lies with another man, as he would a woman, both have committed an abomination. They shall be put to death. Their blood shall be upon them."

Then along came the head doctors and suddenly it wasn't the homosexual's fault. He was just another victim of faulty wiring, or possibly an overbearing mother. The shrinks weren't sure exactly what the problem was, but there was research-- a whole bunch of research-- from Freud on down.

But by the late '60s when the status of homosexuals became an issue of public debate, the field was really dominated by two New York psychoanalysts. The first was a man named Charles Socarides. I'll talk about him later. The second was Dr. Irving Bieber, an analyst in New York who, at least originally, had no interest in the problem of homosexuality. Only became interested after he went to work as a psychiatrist in the Second World War. Irving Bieber is now deceased, but his wife, Dr. Toby Bieber, agreed to talk to me.

Toby Bieber

They would arrest homosexuals in the army. This was in India and in Egypt where he was in the CBI theater. They would arrest them and discharge them dishonorably. And the others would be hospitalized, something like that. So he got interested in the problem because he would be the psychiatrist who would examine these people.

Alix Spiegel

Toby Bieber says that during the war her husband defended homosexuals-- protested whenever a gay soldier was arrested or discharged, arguing he deserved treatment, not dishonor.

Toby Bieber

He got into trouble-- actually, a bit-- in the army. My husband went in as a captain, and he came out after four years-- he was in the Army for four years-- he came out as a captain. And he wasn't promoted, largely because of his defense of homosexuals in the army.

Alix Spiegel

So he saw himself as somebody who was helping homosexuals.

Toby Bieber

No question about it.

Alix Spiegel

After the war, Dr. Bieber returned to the States and began research into the homosexual question in earnest. He assembled a crew of psychiatrists and undertook the single largest survey of homosexual behavior ever attempted. The project involved 77 doctors who contributed information on over 100 gay men and concluded that the cause of homosexuality was a combination of what they termed close-binding mothers, which is overprotective women who made their children weak and feminine, and detached, rejecting fathers.

The work was published in 1962 and immediately attracted the attention of the psychiatric world. It received the Hofheimer Award for original work. It also attracted the attention of another very different group of people-- homosexual activists.

A handful of homosexual organizations had begun in the early '50s and had grown slowly, both learning from and, in some ways, shadowing the progress of the civil rights and feminist movements. From its earliest days, one of the main goals of the gay groups, alongside civil rights, which was really number one, was removal from the DSM. So naturally, Bieber's study, which billed itself as definitive proof that homosexuality was a pathology, kind of rubbed them the wrong way.

In 1970, the American Psychiatric Association made the mistake of holding its annual convention in San Francisco, which then, as now, had a large gay community. And the gay activists decided to protest. Irving Bieber was their very first target.

The Washington Post, May 14th, 1970-- The gay liberation and the women allies out-shrinked the head shrinkers today and took over an American Psychiatric Association session on sex. Before the morning was over, the 500 psychiatrists who gathered to hear scientific studies on sexual problems demonstrated that they're just as prone to anti-social behavior as anyone else. "This lack of discipline is disgusting," said Dr. Leo Alexander, a psychiatrist at the meeting. Then he diagnosed the problem of one of the lesbian protesters. "She's a paranoid fool," the doctor said, "and a stupid bitch."

Gary Allender

As I recall, there were evidently closeted gay and lesbian people who were inside the APA who kind of wanted something to happen. And I think they just passed along information to us. And somebody got us press passes, I guess, so that we could get through the front door.

Alix Spiegel

This is Gary Allender, one of the gay activists who infiltrated the APA convention. He says that while one group of activists stormed a session on behavioral therapy, another combed the halls, looking for Bieber. They found him at a panel on transsexuals and homosexuality. Bieber, who was sitting in the front of the room, had just settled in for a nice long chat about close-binding mothers when, according to his wife, Toby, there was a loud noise from outside the auditorium.

Toby Bieber

And a group came storming in, dressed rather fantastically with feathers in their hats, as though they were going to attend some costume ball, making noise and broke up the meeting. They broke it up.

Gary Allender

We were not polite. We were not quiet. We were not asking for favors. We were just trying to delegitimize their authority. And we felt that they were oppressing us. And here was finally a chance to talk back to them.

Alix Spiegel

The protesters yelled at the psychiatrists. They called them sadists. They called them oppressors. But the protesters had an entirely different word for Irving Bieber, a word which, in the accounts that circulated after the event, got a disproportionate amount of attention. To the protesters, Dr. Bieber was not just your run of the mill sadist oppressor. No, sir. Irving Bieber was a mother [BLEEP].

Toby Bieber

This is not how you conduct a discourse, if you want to disagree with the people. Certainly, Darwin wasn't-- not that I'm comparing my husband to Darwin. But his work wasn't accepted either, but nobody called him a mother [BLEEP].

Alix Spiegel

By all accounts, this episode greatly disturbed and hurt Irving Bieber. Like most psychiatrists at the APA, he saw himself as someone who was helping, someone who had devoted his life to helping.

Charles Socarides

All of us did. All of us felt the same way.

Alix Spiegel

Which was how?

Charles Socarides

It was dismal to be accused of something that you're innocent of.

Alix Spiegel

This is Charles Socarides. Like Bieber, Socarides was one of the most lauded psychoanalysts in the profession-- a man who claims to have treated over 75 homosexuals in analysis and consulted with literally 1,000 more.

Invariably, the goal of therapy with Socarides was to cure homosexual desire, to transform the patient into a heterosexual through analysis. At the time, this was common practice. There were all kinds of methods, from traditional talking treatment, to hormonal enhancement, to aversion therapy where patients were attached to electric shock machines, given gay pornography, and zapped if they demonstrated any kind of arousal.

Needless to say, the gay activists considered this treatment, even this goal, barbaric and sadistic-- an accusation which simply didn't make sense to Socarides.

Charles Socarides

We only treat people who come to us, seek our help, and beg for our help. And we treat them with dignity, and with tact, and with loyalty, the same way we'd treat any other patient. So in the first place, to say, you are harming the homosexual was untrue. They even brought up that there are more suicides of people in treatment. That's not true.

Alix Spiegel

But it wasn't just Socarides and Bieber who were uncomfortable with the accusations and demands of the gay activists. Most of the closeted psychiatrists of the GAYPA, like John Fryer, the gay psychiatrist you heard from earlier, were also disturbed.

John Fryer

I frankly, at the beginning, remember the sense that I was embarrassed by it and that I wished they'd shut up. None of us were there.

Alix Spiegel

None of the GAYPA were?

John Fryer

No. And I would say that all of us avoided that whole thing.

Alix Spiegel

It's not that they wanted to be seen as sick, it's just that they knew their colleagues-- or, anyway, they thought they knew their colleagues-- and believed that the psychiatrists of the APA would never change the definition.

John Fryer

Most of us didn't think this would happen.

Alix Spiegel

Didn't think what would happen?

John Fryer

That the nomenclature would be changed.

Alix Spiegel

Right.

John Fryer

And I thought that it was just a fool's errand.

Alix Spiegel

What John didn't fully appreciate was that there were forces at work, forces at work deep inside the APA.

Adam Spiegel

They met at our house. And that's how I came to know them and to know what they were trying to achieve.

Alix Spiegel

This is Adam Spiegel, better known to this reporter, at least, as Dad. Adam Spiegel / Dad grew up with John P. Spiegel / Grandpa in a boxy Victorian off Brattle Street in Cambridge, Massachusetts.

By the early 70s, Dad had moved out of this house to his own house in Baltimore, Maryland. But he still came back regularly for holidays. And often during these visits, he would find gathered around the kitchen table of his childhood home a group of men that my Aunt Mamie dubbed the "Young Turks."

The Young Turks were all psychiatrists, all members of the APA, and all liberal-minded Easterners who had decided to reform the American Psychiatric Association from the inside. Specifically, they had decided to replace all the gray-haired conservatives who ran the organization with a new breed of psychiatrist, more sensitive to the social issues of the day, with liberal opinions on Kent State, Vietnam, feminism.

They figured that once they got this new breed into office, they could fundamentally transform American psychiatry. And one of the things this group was keen to transform was American psychiatry's approach to homosexuality.

And so they gathered around my grandfather's kitchen table, over the delicate graven flowers of my grandmother's china, they'd discuss offenses and defenses-- map strategy.

Adam Spiegel

The meetings, I thought, were all in great, good spirits. They all sat around rollicking with laughter about what they were planning to do. And they were serious, but they were also able to take a look at themselves. And it was just a small kind of cohort group that seized the moment to put across a huge-- what? Something on the 18,000 American shrinks of the APA.

Alix Spiegel

As active members in an APA subcommittee, called the Committee for Concerned Psychiatry, the Young Turks proposed candidates for office, politicked for internal change.

Now, I should point out that the group that gathered around my grandfather's kitchen table, and really around kitchen tables all over the East Coast, was not by any stretch of the imagination a homosexual cabal. But several of the key players were gay-- people like Dr. Larry Hartmann, who was a founding member of the Committee for Concerned Psychiatry, and later, like my grandfather, became president of the APA.

Of course, none of these men were out at the time. They weren't even members of the GAYPA. They were too buried-- buried even to friends and family. Adam Spiegel.

Adam Spiegel

It was not clear to me. In fact, when I learned that Larry was gay, I almost fell out of my chair because he was so not gay in his affect-- impossible to discern.

Alix Spiegel

Although the gay activists who were protesting the APA from the outside didn't know it, it was this group of men, these Young Turks and their allies, who laid the groundwork for the change in the DSM.

Without moving liberal-minded psychiatrists into positions of power in the APA, without changing the organization's internal infrastructure, there would have been an immediate veto of any attempt to change those extremely troublesome 81 words.

Ira Glass

Coming up, the scientific evidence that homosexuals might not be sick and how a party in a Hawaiian bar can change everything. Alix Spiegel's story continues in a minute, from Chicago Public Radio, when our program continues.

Act Two: Act Two

Ira Glass

This American Life. I'm Ira Glass. Today, we're devoting our whole program to the story of how and why the American Psychiatric Association decided, in 1973, that homosexuality is not a disease.

This weekend in December is the 45th anniversary of that milestone. Today's program was first broadcast back when way more of the people involved in this story were still alive, back in 2002. Alix Spiegel continues her story.

Alix Spiegel

While the Young Turks worked from the inside, the gay activists continued their assault from the outside. They showed up at the American Psychiatric Association convention again in 1971, broke into the auditorium through a stage door during the opening ceremony, and stormed the podium.

But it wasn't until the next year, at the '72 convention, that the gay activists hit upon a piece of political theater so outlandish that it actually managed to shake the dinosaurs at the APA. The spectacle was organized by Barbara Gittings, a librarian turned lesbian activist, who decided that it was time for the psychiatrists to hear from one of their own-- to hear from someone like John Fryer.

John Fryer

I got a call from Barbara Gittings about November of '71. She said, John, I'm looking for a psychiatrist to come and testify, a gay psychiatrist, to testify what it is like to be a good psychiatrist.

Alix Spiegel

The call from Barbara Gittings came at a particularly awkward moment in the life of John Fryer. He had recently been dismissed from his position as a resident in psychiatry at the University of Pennsylvania because his boss suspected he was gay. He was fired from another hospital in Philadelphia for the same reason.

John had applied for other positions and professorships at a variety of universities, but the rumors of his sexual preference followed him, and so he was turned away. More than anything, John wanted to teach. And he definitely didn't want to do anything that might jeopardize his ability to get a faculty position.

John Fryer

My first reaction was, no way. But she planted in my mind the possibility that I could do something and that I could do something that would be helpful, without ruining my career.

Alix Spiegel

John told Barbara to find someone else. But four months later, Barbara called back. She had tried, she said, to find another gay psychiatrist, but no one would take the chance.

And so, Barbara Gittings offered John Fryer a compromise. They-- she and John-- would create an alternate personality, a disguise so fantastical that John's own mother wouldn't know him if he sat in her lap. They would call this creation Dr. Anonymous. And as Dr. Anonymous, John would address the members of the APA at the '72 convention in Dallas.

He would be given a hotel room to change in and a microphone to disguise his voice. All his expenses would be paid for. John told Barbara he would do it, then he called a friend.

John Fryer

My friend, who was in drama, and I talked about what would be the most effective disguise. And you may or may not know this, but if you wear clothes that are much too large for you, you look much smaller than you are. So we made arrangements to rent a large and very flamboyant tuxedo.

We then decided that the best way to do my head was an over the head rubber mask. It was a Nixon mask that we distorted, so that you couldn't even see it was Nixon.

Alix Spiegel

And so, in May of 1972, standing on stage in front of an audience of his peers in a wig, a Nixon mask, and a multicolored tuxedo three times his size, John Fryer made his case against 81 words.

He explained to his fellow psychiatrists how these words had harmed him and others like him. As he did this, he glanced occasionally at a man sitting just a few feet away from him in the front row. It was the man who had fired John from his hospital position several years before.

John Fryer

I received a standing ovation. And I felt-- I felt very empowered at that moment.

Alix Spiegel

It was around this time, fall of 1972, that the Young Turks saw the first fruits of their labor. One of their candidates for office, a man named Alfred Freedman, was elected president of the APA.

My grandfather, John Spiegel, was installed on the board of trustees. And another man, Judd Marmor, one of my grandfather's best friends and an outspoken critic of the idea that homosexuality should be categorized as a disease, was selected as vice president. This turn of events was naturally distressing to the opponents of the change, Irving Bieber and his friend, Dr. Charles Socarides.

Charles Socarides

I know. I talked to the outgoing president at the time. He shook his head. He said, I don't know what's going to happen now. They've got gays galore. They're running for office. One of them may be president.

Alix Spiegel

Suddenly, Bieber and Socarides found themselves in a position that, just two years before, they could not have conjured in their most outlandish nightmares. They were becoming professional renegades. And the work that established their reputations was under fire. Again, Charles Socarides.

Charles Socarides

Papers that we wanted to give at various places, it was suddenly said, well, we don't think that would be a good thing to do right now in the current environment and the atmosphere.

Alix Spiegel

It wasn't just professional rejection. Personally, Bieber and Socarides had become targets. Angry gay activists followed them around, protesting every paper. There were threatening phone calls late at night and obscene messages scratched into the paint of department bathroom stalls.

Charles Socarides

All kinds of things-- that you're killing the gay men, that you're persecuting us, you ought to be dead. I mean, things like that-- all kinds of death threats.

I went to Kansas City one day, Topeka. And one of my friends said I have a gift for you. And so he gave me a package. It was a gun. He says, Charles-- he says, you're really going to have to defend yourself. Of course, I never used it, but you felt like carrying it around as people followed you to a meeting and raising terrible threat calls.

Alix Spiegel

Socarides never took the professional criticism of his work seriously. A true believer in the psychoanalytic method, Socarides felt his research was sound and that he was, as he told me, doing God's work.

Charles Socarides

My views were the most solid clinical and theoretical studies on homosexuality, describing its origin, its course, its therapy, its symptoms. Most of the guys had never seen a homosexual. They'd never dealt with his unconscious material, or his dream material, or his transference. They don't know what goes on in the mind of a homosexual. All they see is the homosexual, who appears quite normal. But underneath, they don't know the dynamics and the meaning of his inability to approach a woman-- the pathology behind it.

Alix Spiegel

Now, we need to take a moment to talk about the science. As I've said, for most of its history, psychiatry took for granted the idea that homosexuality was a pathology-- a grave distortion of normal development which demanded some kind of explanation.

The question that concerned the psychiatrists then was what exactly had gone wrong with these people? Was it the mother? Was it the father? Was it frustration in the Oedipal phase? Or simply an excessive preoccupation with one's own genitalia? A lot of very intelligent men with years of university education and walls full of calligraphy certificates spent countless hours trying to pin down exactly who or what was to blame, which was pretty much the state of affairs until Evelyn Hooker met Sam Fromm.

Evelyn was a psychologist at UCLA, and Sam was her student. He's also a homosexual. They started spending time together in the mid-40s. And Sam introduced everyone to his group of friends, most of whom, like Sam, are gay.

Now, as I said, everyone in this particular group was homosexual, but curiously, none in the group was in therapy. They were all very 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 in 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, or 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 inkblot 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 2/3 of both 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, then the only conclusion you could come to was that psychiatry was declaring certain behaviors were diseases not out of any sort of scientific proof, but based on their own prejudices. This was something that psychiatrists had been accused of before, most famously by a psychoanalyst named Thomas Szasz, who argued in the 1950s and '60s that certain dangerous psychiatric treatments, like electroshock therapy, were prescribed with no scientific basis and that psychiatrists were essentially in the business of enforcing social norms.

But Szasz didn't provide the gay activists any hard data to use in their fight with the psychiatrists. Aside from Hooker, the most useful scientific studies supporting their side was 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 re-evaluate the DSM. And then luck, or maybe fate, intervened, intervened in the form of a chance meeting between a gay activist on the outside and an open-minded insider. That open-minded insider? Dr. Robert L. Spitzer.

Robert L. Spitzer

My view was no different, I think, from the standard view. I totally accepted it.

Alix Spiegel

Totally accepted what?

Robert L. Spitzer

The idea that homosexuality was an illness.

Alix Spiegel

In the fall of 1972, Robert Spitzer was only loosely aware of the controversy. He knew about the protests, he knew about Dr. Anonymous, of course, Socarides and Bieber, but he hadn't really taken a professional interest in the issue. At the time, Robert Spitzer was a relatively young, but very ambitious man, and most importantly, at least to this story, a junior member of the APA's Committee on Nomenclature.

For those of you who didn't spend four years in medical school, the Committee on Nomenclature is the group which decides which mental disorders will appear in the DSM. In other words, these were the people who actually decided what was and what was not a mental illness-- the people with the most direct, unmediated control over those extremely troublesome 81 words.

If Robert Spitzer chose to get involved, he would have been in a great position to help the activists. But like I said, he hadn't really taken an interest, not until one day in the fall of '72, when he showed up at a behavioral therapy conference in New York City. Now, it just so happened that this particular behavioral therapy conference had been infiltrated by a group called the Gay Activists Alliance. Among them was a man named Ronald Gold.

Ronald Gold

We went to this meeting, and we're all sitting there like everybody else. And at a particular time, the idea was for somebody to get up and say, sorry, we're taking you over. And he didn't show up. And so they all sort of looked at me and said, you've got to do it.

Alix Spiegel

At the time, Ronald Gold, like Robert Spitzer, was a minor figure in this battle. He had recently quit his job as a reporter for Variety to become media director of the Gay Activists Alliance, but he almost never made speeches. He was strictly a backstage kind of guy.

But at this conference, when the usual speech maker didn't show, Ron got up and railed against the psychiatrist himself. Apparently made enough of a spectacle to tick off Robert Spitzer who, after the meeting, decided to tell Ron off. Ronald Gold.

Ronald Gold

When it was all over, this woman, who was a friend of mine, came by to say hi, and good job, or words to that effect. And she introduced me to this man, who happened to be with her, who was Dr. Robert Spitzer.

Robert Spitzer

I complained to him, you know? You've broken up a meeting. You're not letting-- you know, it's one thing to talk, but it's another thing to break up a meeting. And we started to have a discussion. And at some point in that discussion, well, he learned that I was on this committee.

Ronald Gold

And I said to him, do two things for us. Set up a meeting for us with the Nomenclature Committee, and set up some kind of a panel discussion at the next convention and allow us to participate.

Robert Spitzer

Ron asked formally for permission to speak to our committee.

Ronald Gold

He was interested. I think he was intrigued by the-- you'd have to talk to him exactly about what his feelings at the time were.

Robert Spitzer

I started off by feeling they're wrong, but they're interesting. And something I wanted to understand-- their viewpoint. That's how it started.

Alix Spiegel

Robert Spitzer arranged for an appearance in front of the Nomenclature Committee, as promised. Several months later, three gay activists presented their case to the Nomenclature doctors, who listened, and nodded, and, after their presentation was done and the room was cleared, had absolutely no idea what to do about it. Even Robert Spitzer wasn't sure where he stood on the issue, and so he came up with a plan.

Spitzer decided that the two sides, who had been shouting at one another for over two years, but incredibly, hadn't officially met face to face, should have an organized debate-- a final meeting between the two sides.

And so, for the 1973 APA convention in Honolulu, Spitzer organized a forum where both sides could directly argue the merits of the case with each other. The old guard, Charles Socarides and Irving Bieber, publicly met the new school, Ronald Gold, Judd Marmor, and several other psychiatrists, in front of a room filled to capacity. Ronald Gold.

Ronald Gold

The title of my speech was "Stop It, You're Making Me Sick." And essentially, I said that the diagnosis of the illness of homosexuality is the greatest tool of oppression imaginable. And that they've got to take us out of the nomenclature and in order to prevent this from being the kind of sick that you get when people are repressing you.

Charles Socarides

Gold says you're all rats, and you're all inhuman, and you're a disgrace to the profession.

Ronald Gold

Socarides did his "they're betraying their mammalian heritage" number during the thing. They all just hooted. I mean, they just thought that was ridiculous.

Charles Socarides

I presented those findings at the national meeting in Hawaii. A lot of people booed. Some people clapped.

Ronald Gold

One of the things he said in that panel was that there are no homosexuals in kibbutzes in Israel. And I had just come back from Israel, and had had a thing with somebody who was raised in a kibbutz. And I said so in their panel, and they all laughed hysterically. But it made him seem to be a perfect jackass, which, of course, he was.

Alix Spiegel

But an equally important performance that day-- the performance which, at least according to Ronald Gold, finally convinced Robert Spitzer to sit down and redraft the 81 words in the Diagnostic and Statistics Manual-- was not the exchange between Ron and Charles Socarides in front of the psychiatrists of the APA.

It didn't even take place in the upscale, beachfront hotel in which the conference was stationed. No. It took place in a bar later that night, in one of those campy Hawaiian lounges with bamboo furniture, grass skirted waitresses, and a three-page menu of exotically-colored drinks. This is where the GAYPA had decided to hold its annual party. Naturally, after his speech at the conference, Ron Gold got an invitation.

Ronald Gold

I got invited to this party, but I was told keep it all very quiet and don't say anything. And just come to this bar, and we'll all be there. So I decided to invite Spitzer to come to this because he had told me, essentially, that he didn't know any gay psychiatrists and wasn't quite sure there were any. And I said, you just come along.

Alix Spiegel

Ron warned Spitzer not to say anything. He was instructed not to speak, or stare, or indicate in any way that he was anything other than a closeted gay man.

Ronald Gold

But once he got there and saw that the head of the Transactional Analysis Association and the guy who handed out all the training money in the United States, and the heads of various prestigious psychiatry departments at various universities were all there, he couldn't believe it. And he started asking all these absolutely dim-witted questions.

Alix Spiegel

Like what?

Ronald Gold

Oh, I can't even remember, but questions that no gay person would ask.

Alix Spiegel

At the time, the members of the GAYPA were still completely hidden. They hadn't been active in the struggle to change the DSM. They were too fearful of losing their jobs to identify themselves publicly. So when Robert Spitzer, an obviously straight man in a position of power at the APA, appeared at the bar, the men of the GAYPA were completely unnerved.

Ronald Gold

So the Grand Dragon of the GAYPA, whoever he was, I can't remember now-- came up to me and said, get rid of him. Get him out of here. You got to get rid of him. And I said, I'm doing nothing of the kind. He's here to help us, and you are not doing anything.

Alix Spiegel

And that's when it happened. There, in front of Robert Spitzer and the Grand Dragon of the GAYPA, there in the midst of neon-colored drinks and grass-skirted waitresses, a young man in full Army uniform walked into the bar. He looked at Robert Spitzer. He looked at Ronald Gold. He looked at the Grand Dragon of the GAYPA. And then the young man in uniform burst into tears. He threw himself into Ron's arms and remained there, sobbing.

Ronald Gold

Well, I had no idea who he was. It turned out he was a psychiatrist, an Army psychiatrist based in Hawaii, who was so moved by my speech, he told me, that he decided that he had to go to a gay bar for the first time in his life. And somehow or other, he got directed to this particular bar and saw me and all these gay psychiatrists. And it was too much for him. He just cracked up.

And it was a very moving event. I mean, this man was awash in tears. And I believe that that was what decided Spitzer right then and there, let's go. And of course, it was right after that that he said, let's go write the resolution. And so we went back to Spitzer's hotel room and wrote the resolution.

Alix Spiegel

Right then? That night?

Ronald Gold

Right, that night.

Alix Spiegel

Robert Spitzer's resolution didn't call for a flat-out elimination of homosexuality from the APA nomenclature. He didn't think that the psychiatrists of the APA would approve an outright deletion. Instead, it argued that in order for a behavior to be categorized as pathological, the behavior must cause, quote, "subjective distress." In other words, if you were gay and it didn't bother you, you weren't sick.

For those homosexuals who were troubled by their orientation, Spitzer created a new category-- ego dystonic homosexuality. And it was the 237 words which followed this heading, which were eventually submitted to the reference committee, which was then headed by the president-elect of the APA-- my grandfather, Dr. John P Spiegel.

Once the reference committee endorsed the change, it was sent to the board of trustees and the president of the APA, Dr. Alfred Freedman, one of the newly elected APA officials whose candidacy for office had been contrived and supported by the Committee for Concerned Psychiatry and the Young Turks, who sat around my grandfather's kitchen table.

On December 15, 1973, this president and this board called a press conference where they announced to the world that they had approved the deletion of homosexuality from the American Psychiatric Association's Diagnostic and Statistics Manual. Charles Socarides, naturally, was appalled.

Charles Socarides

I said, holy [BLEEP]. They're changing the rules. If there's anything you couldn't change in this world would be the relationship between a male and a female. They go together. They go together through all of evolution, right up the animal kingdom, right to man. And now they're saying it's just as natural to mate with the same sex as it is with the opposite sex. What will psychiatry think? What will medicine think? What will pediatric think? They think we've gone insane.

Ronald Gold

The headline in our newsletter at the National Gay Task Force was, "The Earth is round." And that's what it was to us. They finally got around to having a grain of sanity.

Alix Spiegel

So that's the story of how 81 words became 237 words. That's the story of a definition. Today, there's no entry in the DSM on homosexuality, no entry at all. In 1987, the 237 words that Robert Spitzer wrote about ego dystonic homosexuality were quietly removed.

Meanwhile, the APA turned itself upside down. In 1970, 90% of the American Psychiatric Association believed that homosexuality was a pathology. Today, 90% believe that it's a normal variant of sexual behavior, no more pathological than something like left-handedness.

In fact, it's now considered unethical to treat homosexuality. And any psychiatrist who attempts to change the sexual orientation of his patient can face professional censure. If a gay person finds his sexual preference disturbing, if he's interested in becoming heterosexual-- and there are many people who fit this description-- the APA guidelines suggest that the therapist counsel his patient that change is impossible.

My family always told me that my grandfather single-handedly changed the DSM. But what's striking is all the different forces that had to be in place in order to make this happen. It took both Evelyn Hooker and Dr. Anonymous, John P. Spiegel and Ronald Gold-- people on the outside, people on the inside, and people at every point in between. The change happened partly through scientific debate and partly simply because psychiatrists got to know gay men.

There are a couple of interesting postscripts to this story. Dr. Irving Bieber died in 1991, and the New York Times published an obituary which focused on his work and homosexuality in a way that his wife, Toby, found hostile and insulting. Most of the quotes were from people who never agreed with him.

Worse, the newspaper mistakenly printed a picture of Robert Spitzer, Dr. Bieber's longtime opponent, in Dr. Bieber's place. This misprint so infuriated his wife, Toby, that she canceled her subscription to the New York Times and never bought the newspaper again. When she wants to find out what's going on in the world, she says she watches television.

And then there's Charles Socarides. Dr. Socarides continues to teach and practice psychiatry, but his views on homosexuality have damaged his position in his profession. He's been violently criticized by his peers. And his book on homosexuality, called A Freedom Too Far, was refused by over 40 publishers. In the end, he had to print the book himself. But Socarides remains convinced that he has chosen the right path and claims that, far from destroying his career, his views on homosexuality have actually helped his practice.

Charles Socarides

Oh, it's made it boom.

Alix Spiegel

It made it boom?

Charles Socarides

Boom, sure. Sure. I'm known both as the devil of the radical gay movement, and I'm also known as the savior of many homosexual's lives.

Last week, I saw somebody with his son of 16 who said they've taken the boy to six psychiatrists in New Jersey, and everyone of them said, get out of here, or told him that he can't be helped. And that's happened over and over again.

I've heard a lot of terrible words against me, but my patients would tell you differently-- any one of them.

Alix Spiegel

One of the homosexuals who does not speak against Socarides is his eldest son, Richard Socarides, a lawyer who served as an advisor to the Clinton administration on lesbian and gay issues, and who helped to organize, among other things, a White House Conference on HIV and AIDS.

Dr. Charles Socarides has told reporters that he wonders if he failed his son, Richard. That's the word he used, "failed." Dr. Socarides believes his own theories, and therefore believes that he is in some way responsible for his son's sexual orientation. A few years ago, his son, Richard, told the press, quote, "Our relationship is quite strained, but is a relationship, nonetheless."

Finally, there's my grandfather, Dr. John P. Siegel, whose postscript was written that day in the Bahamas in 1981 when he stepped out of his beachfront bungalow into the Caribbean sun, his new lover, David, on his arm.

John P. Spiegel

Thank you very much, Grandpa. That was very interesting. I hope it's as interesting to listen to as it was to conduct the interview with you. End of interview. Bye-bye.

Ira Glass

Alix Siegel, who put that story together, these days is the co-host of the NPR show, Invisabilia, which is about the things that shape our ideas, and beliefs, and assumptions, very much along the lines of the story you just heard. It's available wherever you get your podcasts. And I know we say that all the time. If you don't actually have a place that you get podcasts, just type Invisabilia into Google search, and you will find it.

As I said earlier, we first aired today's program in 2002. In the years since then, so many people in the story have died-- Charles Socarides, John Fryer, Toby Bieber, who's Irving Bieber's wife, Gary Allender, who was one of the gay activists who infiltrated the APA convention, and Robert Spitzer and Ronald Gold, the unlikely pair who drafted the resolution after that fateful night in the Hawaiian tiki bar.

Credits

Ira Glass

Special thanks to [INAUDIBLE] Martin Duberman, whose memoir Cures details what it was like to be a gay man undergoing therapy for homosexuality for a decade. Coincidentally, Radiolab just did a spectacularly good series of shows on this same period of history where psychiatry was rethinking homosexuality. I cannot recommend this enough. They've just been killing it lately. It's a few episodes that they call "Un-erased." Again, that's Radiolab, wherever you get your-- oh I'm not even going to say all that again.

Thanks to WYPR in Baltimore. Alix Spiegel's story was funded with money from the Corporation for Public Broadcasting.

This American Life is distributed by PRX, the Public Radio Exchange.

Thanks, as always, to our program's co-founder, Mr. Torey Malatia, who was allowed to visit our program this week. If he would just follow some simple rules--

Alix Spiegel

Not to speak, or stare, or indicate, in any way, that he was anything other than a closeted gay man.

Ira Glass

I'm Ira Glass. Back next week with more stories of This American Life.