On May 14, 1970, gay liberation activists stormed the 123^rd annual Meeting of the American Psychiatric Association (APA) at the San Francisco Civic Center, where over 10,000 psychiatrists were in attendance. Over the next three years, members of the gay liberation movement would disrupt APA meetings all over the country to demand that psychiatrists listen to them, and ultimately to get “homosexuality” delisted as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM), aka the psychiatrist’s bible. “Homosexuality” had been classified as a mental disorder since the first edition of the DSM, published in 1952.

The activists wanted the psychiatrists to know that their so-called expertise gave them no real comprehension of gay people’s lives. At a conference in Los Angeles, one person shouted, “We have been listening to you people for years. Now, you listen to us!” The activists’ refrain, “Stop talking about us and start talking to us!” would become the inspiration for the disability rights movement’s slogan, “Nothing about us without us.”

The 2021 documentary film, Cured, tells the story of the LGBTQ+ community’s successful efforts to remove “homosexuality” as a mental illness from the DSM. (Note: I use the inclusive term, LGBTQ+, here although it is anachronistic. It would be more accurate to reference only gay and lesbian people since trans people and other gender and sexual minorities were completely excluded from the depathologization campaign despite playing a large role in the gay liberation movement.)

The film presents a rather simple (albeit fascinating) David vs. Goliath narrative of outsiders breaching the cloistered, staid world of academic psychiatry and winning recognition of their humanity, of science self-correcting, and of reason triumphing over bigotry. The actual history, of course, is a lot more complicated.

Less than a century ago, the entirety of gay people’s lives in the United States was heavily criminalized and stigmatized. LGBTQ+ people lived in the shadows, under constant threat of ostracism, police harassment, and punishment. During the Lavender Scare of the 1940s and 50s, mass paranoia about government infiltration by communists and gay people led to the surveillance and persecution of thousands of gay men and women in government positions. Sodomy was prohibited by law in every state, and only relatively recently were these laws ruled unconstitutional by the Supreme Court’s decision in Lawrence v. Texas in 2003.

Bombarded by pervasive criminalization in their private and public lives, gay people initially viewed psychiatrists as allies and embraced the inclusion of homosexuality in the DSM. Being pathologized was at least a step up from being criminalized.

As the scholar, Ronald Bayer, notes in Homosexuality and American Psychiatry: The Politics of Diagnosis, psychiatry was useful to the gay community insomuch as it transferred the “issue of homosexuality” from the criminal/legal and religious domains to the medical domain. In other words, in the 20^th century, as the authority on morality shifted from clergy to scientists, psychiatry played an increasingly important role in determining standards of behavior, for sorting people into categories of normal or “wrong,” fit or unfit. Where the church said certain behaviors such as sodomy were sinful, psychiatry said such behaviors were deviant, or “sick.” This pathologizaton, in turn, served as legal protection from criminal charges, as gay people claiming mental illness could deny immorality, having no control of their “homosexual” urges.

During the 1960s, gay people began to realize, as did other marginalized groups before them, that their liberation was actually impeded by pathologization. The disability scholar, Douglas C. Baynton, notes that disability was historically attributed to women, Black people, and immigrants to justify their subjugation, enslavement, or exclusion. Every marginalized group in U.S. history has therefore had to disavow any attributions of disability in order to raise their status in society. Hence, before the American Psychiatric Association could be compelled to remove homosexuality from the DSM, gay activists ironically had to demonstrate to psychiatrists that they were “well adapted” to cisheteronormative society. This expectation to deny disability, i.e. to perform ablemindedness, can partly explain why respectability politics has played such an outsize role in LGBTQ+ advocacy. Early on, this work was led by the Mattachine Society and the Daughters of Bilitis in the 1950s, gay and lesbian advocacy groups that “affirmed a deep loyalty to the mores of society” instead of challenging cisheteronormativity.

Among the challenges that the gay rights movement faced in its efforts to remove homosexuality from the DSM were many within the psychiatric profession who were invested in the torture of gay people, including the delivery of aversive therapy, electroshock treatments, and lobotomies. Vested interests in the industry of “therapeutic” intervention and control over the lives of gay people therefore made the profession resistant to change. And to a greater extent, the field of psychiatry, as an institution that partially functions to enforce conformity to the dominant cultural values of society, was invested in the pathologizing paradigm of homosexuality despite a lack of scientific evidence supporting its categorization as a mental illness.

Concurrently, there was a growing body of research suggesting that “the classification of homosexuality as a mental illness represented nothing more than the cloaking of moral judgments in the language of science,” notes Bayer. Scholars like Alfred Kinsey at Indiana University documented a greater than previously acknowledged occurrence of same-sex behavior among white males. Evelyn Hooker’s experiments showed that gay people and heterosexuals performed identically on psychological tests used to measure psychopathology. These studies challenged the pathologizing paradigm of homosexuality, leading a small but growing group of researchers to conclude that “the labeling process was itself the primary pathogenic factor.” According to Bayer, “This evidence was vital to the effort to strip psychiatry of the warrant granted by society to those who spoke as scientists.”

The gay rights movement also owed its existence to Black people’s struggles for civil rights, which awakened other oppressed groups to their own marginalized status in society. The tactics and ideology of the civil rights movement spurred gay liberationists to question their relationship to authority and embrace militancy, to affirm gay identity as Black people had affirmed Black Pride, in rejection of the shame and conformity that had been imposed upon them. By 1972, Frank Kameny, a leader in the gay liberation movement, turned the Mattachine Society away from its conservative roots, and declared psychiatry “the major single obstacle in our society to the advancement of homosexuals and to the achievement of our full rights, our full happiness and our basic human dignity.”

At the 1972 annual meeting of the APA in Dallas, after two years of constant protests and disruptions at APA events, gay liberation activists were invited to join a panel titled, “Psychiatry: Friend or foe to homosexuals? (A dialogue).” One of the panelists, Dr. John Fryer, a gay psychiatrist wearing a mask to conceal his identity, shocked the audience of his peers when he declared, “I am a homosexual. I am a psychiatrist.” The contradiction was untenable; how could homosexuality be a mental illness if some of the APA’s own practicing members were gay?

On December 15, 1973, the APA held a news conference in D.C. where they announced that homosexuality was not a mental disorder. A few months later, the APA voted to remove the diagnosis of homosexuality from the DSM. An article in The Advocate was published with the title, “Gays Leave Psychiatric Sick List.”

This was an important but largely symbolic victory, according to Bayer. In 1978, five years after homosexuality was officially declassified as a mental illness, a survey by the American Association of the Directors of Residency Programs found that 80% of psychiatric residency programs reported no change in their training programs on the treatment of homosexuality. Another survey by a medical journal found almost 70% of psychiatrists agreeing that homosexuality was pathological.

The public, as well, continued to harbor deeply homophobic attitudes based on pathologizing beliefs, reflecting the vague boundaries between folk psychiatry and academic psychiatry. In 1976, Ann Landers wrote, “I fought for the civil rights of homosexuals twenty years ago and argued that they should be regarded as full and equal citizens. However, I do not believe homosexuality is ‘just another life style.’ I believe these people suffer from a severe personality disorder. Granted some are sicker than others, but sick they are and all the fancy rhetoric of the American Psychiatric Association will not change it.” Nevertheless, Bayer writes that, “In removing homosexuality from the Diagnostic and Statistical Manual, the Psychiatric Association symbolically deprived American society of its most important justification for refusing to grant legitimation to homosexuality.”

Even as homosexuality was removed from the DSM II, new diagnoses including “gender identity disorder” (GID) and “ego-dystonic homosexuality” (essentially internalized heterosexism), were created in the DSM III, the subsequent edition of the Diagnostic and Statistical Manual, published in 1980. GID pathologized trans and gender nonconforming people, while “ego-dystonic homosexuality” situated gay people’s distress in the context of society’s predominantly negative attitudes towards homosexuality, and was viewed as a compromise for the vast numbers of clinicians within the APA that still viewed homosexuality as pathology. In the 1980s, in the midst of the AIDS epidemic and returning stigma against LGBTQ+ people, the head of the Association of Gay and Lesbian Psychiatrists, Robert Cabaj, wrote a letter to Robert Spitzer, chair of the DSM III Task Force, urging the workgroup to remove the diagnosis of “ego-dystonic homosexuality” from the DSM III. GID was removed from the DSM in 2013 and replaced by gender dysphoria.

Gender dysphoria is considered a non-stigmatizing diagnosis by the LGBTQ+ community, recognizing that individuals can feel distress when their gender expression does not match their gender identity, and that the diagnosis can provide access to gender-affirming medical care for trans and gender nonconforming people. Therefore, it was not surprising that seventeen conservative states sued the Biden administration in 2024 when gender dysphoria was included as a federally protected disability under Section 504. This event illustrates the increasingly complicated tensions between the LGBTQ+ community and disability/diagnostic labels in the decades following the removal of homosexuality from the DSM.

In the 1980s, the AIDS epidemic would put the LGBTQ+ community once again under a medical lens as AIDS became “a gay disease.” When AIDS increasingly impacted the heterosexual community, it gave license to heterosexuals to discriminate based on their perceptions of LGBTQ+ people as a public health threat. In 1985, separate surveys by the Los Angeles Times and NBC found that 75-79% of people surveyed considered same sex to be “wrong.”

In 1987, disability rights advocates helped to argue in the Supreme Court case of School Board of Nassau County, Florida v. Arline that people with contagious diseases were protected from discrimination under Section 504 of the Rehabilitation Act. Although the case concerned a public school teacher who was fired for testing positive for tuberculosis, the Disability Rights Education & Defense Fund’s lead attorney, Arlene Mayerson, recognized that if Arline lost in the Supreme Court, “anyone who was HIV positive or had AIDS would not be seen as a person with a disability and thus would not be protected under 504.” Disability in this case therefore served not as a source of discrimination for the LGBTQ+ community, but rather as a qualifying identity for protection from discrimination.

In 1990, during the negotiations to pass the Americans with Disabilities Act (ADA) through Congress, Patrisha Wright risked it all to include people with HIV and AIDS under the ADA’s protections. It was not an easy alliance to hold together. With the exceptions of gay people who were disabled, neither the gay community at large, nor the community of people living with HIV/AIDS, identified strongly with disability. The plebeian members of the disability community, as well, struggled at the time to understand AIDS as a disability issue. It would therefore have been easier to get the ADA passed through Congress if the principal ADA negotiators were willing to carve out the most marginalized groups (including people living with AIDS, people living with mental illness, and substance users), and to restrict the ADA’s protections for only the least controversial disabilities in order to placate people like Senator Jesse Helms on the right, who wanted an exclusion for HIV/AIDS.

As Michael Iskowitz, who was serving as Senator Ted Kennedy’s policy advisor on AIDS, explained: “For legislators who always want to make definitions more restrictive and less ‘onerous,’ there would be attempts to chip away at groups that are protected. The community really needed to hold together and push off any attempts to do that.”

Patrisha Wright, a disabled lesbian, and the lead negotiator on the ADA, convinced others in the disability community that they could not throw the LGBTQ+ community under the bus. When a last-minute amendment was introduced by Rep. Jim Chapman, which would have allowed restaurants to discriminate against employees with infectious or communicable diseases, Wright held a press conference at which she stated that the disability community would drop its support for the ADA if the amendment was included in the bill.

The Chapman amendment was dropped from the bill, and on July 13, 1990, the ADA was passed 91-6 in the Senate. Because of the ADA, people living with HIV or AIDS are federally protected from discrimination.

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The removal of homosexuality from the DSM represented not only a narrowing of psychiatry’s authority over gay people’s lives, it also represented conflicting narratives about psychiatry’s scientific foundations. The gay activists were aware that they had utilized political power to pressure the APA to change course, but they also appealed to science in doing so. Meanwhile, psychiatrists in the APA who were opposed to the removal of homosexuality from the DSM viewed declassification as caving to politics over science, not realizing that the initial categorization of homosexuality as a disorder was itself political.

According to Bayer, what really concerned the APA about the campaign to remove homosexuality from the DSM was that it would raise bigger questions about the legitimacy of psychiatry as a science and expose its susceptibility to influence by sociopolitical forces. As Bayer writes, “An unwarranted intrusion of extraprofessional forces was perceived by many as posing a threat to the integrity of the APA.” However, that threat never materialized.

After the gay liberationists won their concessions from the APA, they stopped challenging the validity of the DSM and failed to raise questions about the broader pathologization of other marginalized people, and whether that pathologization justified the exclusion of those other people. Early in the film, Cured, a member of the Gay Activists Alliance, Ron Gold, says, “To be viewed as psychologically disturbed is to be treated as a second-class citizen. And being a second-class citizen is not good for my mental health.” Thus, gay (and predominantly white) liberation activists, negotiating their removal from the DSM, left the field of psychiatry largely intact to continue pathologizing others and relegating others to second-class status. As the scholar, Jonathan M. Metzl, would document in his book, The Protest Psychosis: How Schizophrenia Became a Black Disease, many Black civil rights activists — the very activists who inspired the gay liberation movement — would be diagnosed with schizophrenia and incarcerated in psychiatric hospitals.

Gay liberationists thus sought protection from discrimination by removing themselves from the pathologizing lens of psychiatry, rather than challenging the broader supposition that disability was a valid basis for discrimination. As Baynton notes, “This common strategy for attaining equal rights, which seeks to distance one’s own group from imputations of disability and therefore tacitly accepts the idea that disability is a legitimate reason for inequality, is perhaps one of the factors responsible for making discrimination against people with disabilities so persistent and the struggle for disability rights so difficult.”

In the 1980s, Robert Spitzer, head of the DSM III Task Force, made the unfortunate decision to move away from a narrow definition of mental illness centered on distress and social dysfunction, towards a more expansive definition that pivoted on experiencing inherent disadvantage. As Bayer notes, “Spitzer’s formulation involved little more than an elaborate theoretical justification for his all too obvious normative assumptions.” The failed opportunity to rein in psychiatry in the 1970s resulted in an explosive expansion in the number of diagnoses in each subsequent version of the DSM.

In many ways, psychiatry came out emboldened after 1973 as the decision to remove homosexuality from the DSM further legitimized the process by which medicalization led to discrimination and erosion of other people’s civil rights. In December 1973, on the same day that they declared that homosexuality was no longer a mental illness, the APA released a statement affirming the civil rights of gay people. In their statement, the APA announced: “Whereas homosexuality in and of itself implies no impairment in judgment, stability, reliability, or vocational capabilities, therefore, be it resolved, that the American Psychiatric Association deplores all public and private discrimination against homosexuals in such areas as employment, housing, public accommodation, and licensing, and declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon homosexuals greater than that imposed on any other persons.”

The above statement asserts that a diagnosis of mental illness allows for discrimination on the basis of impairment. It’s notable that the statement was issued the same year that the Rehabilitation Act of 1973 was signed into law, with Section 504 affirming the civil rights of disabled people. The same year that the rights of disabled people were codified in federal law, the right to discriminate based on psychiatric disability was also asserted by the APA.

Edited on May 15, 2026.

For further reading:

Ronald Bayer, Homosexuality and American Psychiatry: The Politics of Diagnosis

Lennard Davis, Enabling Acts: The Hidden Story of How the Americans with Disabilities Act Gave the Largest US Minority Its Rights