Therapists who do not help their homosexual patients to fully explore the possibility of homosexuality as a legitimate option have not helped to expand those individuals' freedom.

The treatment documents demonstrate that the conflict between Gay people and the psychiatric-psychological profession is of long-standing; it did not begin with the recent Gay liberation movement. Dr. Edmund Bergler's lecture (not excerpted) before the New York Psychoanalytic Society in 1942 provides evidence of those antihomosexual views which have led many Gay people to despise psychiatrists and psychologists— conflict of whose origin Bergler is blithely unaware. Bergler's report indicates no sensitivity on his part to the fact that the "ill-repute enjoyed by our therapy among homosexuals" might be due to those therapists' negative evaluation of homosexuals as "sick" (Bergler's term). Bergler has no awareness that recurring conflicts with his homosexual patients (reported by himself) just might have something to do with his own attitudes toward "perverts" and "perversion" (his terms). His characterization of homosexuals as "injustice" collectors, who provoke trouble upon themselves to justify self-pity, must have struck some homosexuals as a provocative way of blaming the victim—even before the rise of the Gay liberation movement. The great irritation Gay liberationists will no doubt feel while reading Bergler's account today is simply a more conscious, less ambivalent form of that same dislike experienced (according to his own report) by many of Bergler's patients. Even in pre-Gay liberation days some homosexuals must have resented, however ambivalently, Bergler's positive evaluation of their pain—based on his belief that a certain high level of guilt indicated a good prognosis for heterosexual reorientation. In Bergler's report, it is indeed odd to find a man supposedly concerned with the alleviation of mental suffering so positively gleeful about the guilt feelings of homosexuals. If, as Bergler points out, many Gay people in treatment with him displayed masochistic tendencies, then he was undoubtedly the sadist in those partnerships. Bergler's provocative comments do raise serious questions about masochism as a form of socially conditioned Gay self-oppression, and about the often sadistic treatment of Gay people by psychiatrists and psychologists.[1]

Bergler's antihomosexual views are typical of many other doctors, few of whom show any sign of seriously questioning their own motives, feelings, and fundamental assumptions in treating homosexuals. Their basic system of values has remained quite simple and unchanged through the years. America's psychological establishment has quite simplemindedly propagated the absolute virtues of heterosexuality, marriage, monogamy, parenthood, and the most traditional, narrow definitions of femininity, masculinity, and of male and female roles. The doctors' reports are characterized by a complacent, middle-class sensibility, a smug philistinism. This moralizing is most evident in the earliest documents quoted—those from the end of the nineteenth century and the start of the twentieth. At that time, doctors un-self-consciously invoked morality—God, country, family—in describing their treatment of homosexuals. More recent documents usually replace such overt moralizing with quieter, often unspoken, hidden evaluations, expressive of a technocratic consciousness focused on getting a job done, a new heterosexual created. Doctors have increasingly turned to technical language and jargon to disguise and suppress their own emotions and underlying values. Although secularization has transformed the rhetoric, mystification remains.

The focus here is on treatment—actual medical practice—rather than on either of the two other major areas of medical discourse on homosexuality: its alleged nature, its supposed cause. These character assessments and etiological discussions have often been of a highly abstract, theoretical, and speculative character, disassociated from any social reality. The literature on treatment, on the other hand, conveys what was actually done to, and even experienced by, Lesbians and Gay men. The diverse theories of the alleged character and cause of homosexuality, and their relation to particular forms of treatment, do need to be studied in social-historical perspective—an important task for the future. Here, the doctors' causative theories may often be inferred from the type of treatment they prescribe. Aversion therapy, for instance, rests upon the tenets of behavioral psychology holding that homosexuality is a learned response, capable of being unlearned. This concept is only distantly related to the more complex notion of those psychoanalysts who regard sexual orientation as the outcome of early experience, especially within the family, by which social norms and role models come to influence the undefined psyche of a child. Opposed to both these views are various physiological theories of causation, now generally regarded as outmoded, according to which homosexuality is either treatable by biological means, such as hormones, or is an unalterable, hereditary trait. It is now becoming clear that the causation of homosexuality cannot be understood apart from the causation of sexual orientation of every variety (including heterosexuality, bestiality, and object fetishism)—if the subject is to be studied at all. Past interest in the subject was almost always motivated and obscured by either pro- or antihomosexual views: the cause of homosexuality is inborn, it was argued, therefore homosexuals should be free of legal harassment or medical treatment; or homosexuality is a "bad thing," which understanding might make alterable. Contemporary Gay liberationists emphasize that study of the cause and cure of heterosexuals' seemingly obsessive antihomosexuality should have higher priority.