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Some Notes on Psychology, Homosexuality, and Sadomasochism

Two Letters from Sigmund Freud

On October 27, 1903, Die Zeit published a letter from Sigmund Freud arguing that homosexuals must not be treated as sick people.

I advocate the standpoint that the homosexual does not belong before the tribunal of a court of law. I am even of the firm conviction that homosexuals must not be treated as sick people, for a perverse orientation is far from being a sickness. Wouldn't that oblige us to characterize as sick many great thinkers and scholars whom we admire precisely because of their mental health?

SOURCE: Die Zeit, Viena, October 27, 1903, p. 5

In a letter he composed on April 9, 1935 (but which was not published until 1951), Sigmund Freud replied to a concerned American mother about the topic of Homosexuality.

Dear Mrs. X

I gather from your letter that your son is a homosexual. I am most impressed by the fact that you do not mention this term yourself in your information about him. May I question you, why do you avoid it? Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute Homosexuality as a crime, and cruelty too. If you do not believe me, read the books of Havelock Ellis.

By asking me if I a help, you mean, I suppose, if I can abolish Homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of the treatment cannot be predicted.

What analysis can do for your son runs in a different line. If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. If you make up your mind that he should have analysis with me (I don't expect you will!!) he has to come over to Vienna. I have no intention of leaving here. However, don't neglect to give me your answer.

Sincerely yours with kind wishes,


P.S. I did not find it difficult to read your handwriting. Hope you will not find my writing and my English a harder task.

SOURCE: Reply to a mother (published 1951)
CITED IN: Freud, Sigmund, "Letter to an American mother", American Journal of Psychiatry, 107 (1951): p. 787.

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Diagnostic and Statistical Manual of Mental Disorders

VIDEO: A History of the DSM

A History of the DSM
National Institute on the Teaching of Psychology
Jan 1, 2021
Dr. Kenneth E. Carter

This 20 minute video provides an overview of the history of the DSM that is appropriate for both introductory psychology as well as for undergraduate psychopathology courses.

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A Brief History of Homosexuality and Sadomasochism in the DSM

or, You can't spell BDSM without DSM.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook used by psychiatrists and other mental health professionals to diagnose and classify mental disorders. The DSM has gone through several revisions in its publishing history, and the way it has classified and diagnosed certain disorders has evolved. This article will focus on the history of the DSM with regards to the diagnosis of Homosexuality and sadomasochism.

In 1918, the American Psychological Association (known at that time by the name "the American Medico-Psychological Association") published the first edition of Statistical Manual for Use of Institutions for the Insane.

The World Health Organization (WHO) issued the International Classification of Diseases-6 (ICD-6) which contained a section on mental disorders.

In 1952, The APA published the first edition of the DSM (DSM-I.) It was based on the WHO's ICD-6 and the military system. The DSM became the first official manual and glossary of mental disorders with a focus on clinical use. The disorders included in the manual were based on theories of abnormal psychology and psychopathology. The manual classified Homosexualiy and “sexual sadism” (along with transvestism, pedophilia, fetishism) as “sexual deviations” within within within the larger "sociopathic personality disturbance" category of personality disorders.

Critics challenged the DSMs reliability and validity. But it still gained acceptance.

The DSM-II, published in 1968, was even more stronger aligned to psychoanalysis than the first edition. It retained the classification of Homosexuality as "sexual deviation" but changed the label from "sociopathic personality disturbance" to "sexual orientation disturbance." In addition, it is officially listed as mental illness.

The DSM-II also added a new category called "sexual deviation," which included various sexual behaviors such as fetishism, exhibitionism, masochism, and sadism .

With the advent of the Gay Liberation movement, the classification of Homosexuality became controversial and there were growing calls to remove it from the DSM. The National Gay Task Force and other gay rights organizations protested outside the annual meeting of the APA and demanded that Homosexuality be removed from the DSM. The APA responded by appointing a task force to study the issue. The APA board of trustees voted to declassify Homosexuality as a mental disorder in 1973. From then on, homosexuals were no longer considered to be ill acording to the APA. Some professionals --- particularly psychoanalysts --- criticized the decision.

In the seventh printing of DSM-II in 1974, the ADA removed Homosexuality as a disorder and added “sexual orientation disturbance,” a new diagnostic code for individuals distressed by their Homosexuality. The latter code would remain the manual (under different names) until the release of the DSM-5 in 2013.

The ADA published the DSM–III in 1980. In this version, the APA changed the category of “sexual orientation disturbance” to “ego-dystonic Homosexuality.”

Ego-dystonic Homosexuality
the condition of being distressed about an inability to be aroused by the opposite sex. There is a sustained pattern of same-sex arousal that the person explicitly states is unwanted and persistently distressing. The condition is frequently accompanied by feelings of loneliness, shame, anxiety, and depression.

CITE: APA Dictionary of Psychology

DSM-III includes Masochistic Personality Disorder as "a condition needing further study." The disorder's diagnostic criteria were:

  1. A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which they will suffer, and prevent others from helping them, as indicated by at least five of the following:
    1. Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
    2. Rejects or renders ineffective the attempts of others to help them
    3. Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain (e.g., an accident)
    4. Incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provokes an angry retort then feels devastated)
    5. Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying themselves (despite having adequate social skills and the capacity for pleasure)
    6. Fails to accomplish tasks crucial to their personal objectives despite having demonstrated the ability to do so (e.g., helps fellow students write papers, but is unable to write their own)
    7. Is uninterested in or rejects people who consistently treat them well
    8. Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice
  2. The behaviors in A do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused.
  3. The behaviors in A do not occur only when the person is depressed.

In the DSM-III-R, published in 1987, sadomasochism was moved from the paraphilias category to the SDNOS category, reflecting a growing recognition that consensual sadomasochistic behavior did not necessarily constitute a mental disorder.

The DSM-IV, published in 1994, included a new category called "sexual and gender identity disorders," which included disorders related to sexual orientation and gender identity.

Furthermore, the APA completely removed Masochistic Personality Disorder from the DSM.

As explaind in the Leather History Timeline The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition is issued with considerably revised definitions of Masochism and Sadism, which in essence say that it they are not illnesses unless you are bothered by your interest in them and they interfere with your normal functioning in other aspects of your life.

In 2000, the APA releases the DSM-IV-TR, a revision of DSM-IV. It alters the diagnostic criteria for "Sexual Sadism" so that a diagnosis is now only allowed if the impulse or fantasies cause distress. Consensual acts are excluded as diagnostic criteria.

Diagnostic criteria for 302.84 Sexual Sadism
These criteria are obsolete.
DSM Criteria (Paragraphs)
DSM Version: DSM IV - TR
DSM Criteria

  1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
  2. The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

In the same year the APA began work on the DSM-V.

In 2008, Susan Wright, MA of the National Coalition for Sexual Freedom (NCSF) starts a petition calling on the American Psychiatric Association (APA) to require that all diagnoses in DSM be based on empirical research. 3,288 supporters signed the petition out of the 4,000 goal.

We, the undersigned, support the American Psychiatric Association's (APA) own goal of making its Diagnostic and Statistical Manual (DSM) a scientific document, based on empirical research and devoid of cultural bias. A diagnosis of a mental disorder can have a severe adverse impact on employment opportunities, child custody determinations, an individual's well-being, and other areas of functioning. Therefore we urge the APA to remove all diagnoses that are not based upon peer-reviewed, empirical research, demonstrating distress or dysfunction, from the DSM. The APA specifically should not promote current social norms or values as a basis for clinical judgments.

The petition is closed, but it is still possible to view the petition, the signatories, and comments made to it online.

The ADA publishes the DSM-5 in 2013. For the first time, the condition of experiencing "distress over one's sexual orientation" (under whatever name) does not appear.

Also, for whatever it might means, the DSM-5 renames "sexual sadism" as "sexual sadism disorder."

Works Cited

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