The Third Backdoor: How the DSM Casebooks Pathologized Homosexuality

This study argues that institutional psychiatry's pathologizing stance on homosexuality persisted after 1973, when the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. It persisted not only through the well-known diagnoses of "ego-dystonic homosexuality" and "gender identity disorder of childhood," but also through case studies published in four editions of the DSM Casebooks (1981, 1989, 1994, 2002), the APA publications advertised as a "learning companion to the Diagnostic and Statistical Manual." These publications contained harmful and false homosexual stereotypes, associating gay men with child abuse, violence, and sexual sadism; associating homosexuality with mental disturbance while failing to similarly mark heterosexuality or bisexuality; associating psychopathology with gay social contexts while failing to similarly mark non-gay social contexts. This study provides evidence that the DSM Casebooks portrayed homosexual women and bisexuals as invisible, and homosexual men as narcissistic, predatory, and dangerous.