Psychiatry, Homosexuality, and U.S. Postwar International Leadership

by Naoko Wake, Ph.D.

The well-known psychiatrist Harry Stack Sullivan received severe criticism of his work on the world stage after World War II. He was known as a founder of an interpersonal theory of mental illness and a leader of the liberal reform of psychiatry between the wars. He defined mental illness not as a biological defect, but as dysfunctional “interpersonal relations” embedded in broader socio-cultural circumstances, helping to remove the stigma from patients. But his approach to an international commission on mental health in 1948 contradicted this liberal view. The goal of the commission was to issue a statement on the worldwide advancement of mental health, but many conferees felt that the commission was “unsuccessful” and they had to leave in “bewilderment.” Moreover, they believed that Sullivan had tenaciously excluded minority opinions, and thus was the person most responsible for the commission’s failure.

In this essay, I examine how Sullivan’s work on an international stage after the war contradicts the well-known image of him as a liberal psychiatrist, in order to shed light on American liberalism’s important limitations. It is at first surprising that many members of the commission found Sullivan intolerant to disagreements, considering that his prewar theory emphasized the ethics of including social minorities. Past studies have stressed how his interpersonal approach helped de-stigmatize mental illness. 1 Also we are now appreciating that he was dedicated to the treatment of homosexuals because, as a gay psychiatrist, he was a strong critic of the social prejudice against them. 2 True as this may be, this view heavily focuses on Sullivan in the 1920s when his liberal agenda was at its peak. Sullivan’s career after the 1930s clearly shows a decline of this agenda. Thus it is misleading to see him as simply bringing the best of American liberalism into a postwar international program. As a vivid way to show the limits of his liberalism, I will first look at Sullivan’s failure to defend homosexual men during the war. Working for Selective Service from 1939 to 1942, he maintained that certain types of mental “problems,” including homosexuality, worked against the nation’s interest. Then, I will suggest how this earlier narrow view, which also ran counter to his prewar ethics of inclusion, played a role in shaping U.S. isolation in international projects after the war. Sullivan, in postwar years, drew a parallel between heterosexuality and homosexuality on the one hand, and “mature” and “immature” nations on the other. In so doing, Sullivan and his professional associates had a significant impact on the shrinking liberalism in the 1930s and 1940s. Psychiatrists’ attitudes toward homosexuality were a crucial component of American liberalism in these decades, and I hope that this essay begins to better integrate the issue of homosexuality into our understanding of the changing liberalism in the interwar period and beyond.

Screening Out Homosexuals

Sullivan attempted and failed to protect gay men from medical and social stigma in wartime. As is well known, the U.S. military during WWII tried to keep gay men out of the armed forces, using psychiatric examination as its device. A fair number of psychiatrists, including Sullivan himself, who created the screening criteria, were conflicted. They understood that exclusion from the army was often considered a disgrace, and that it might cause psychological damage for gay men whom they knew as patients. This was a serious compromise of medical ethics in general and the ethics of inclusion that liberal psychiatrists upheld in particular. But Sullivan and other psychiatrists were unable to discuss their concern persuasively with government and military officials. They lacked an ability to make their opinions heard in discussions of public policy, and this confirmed the military’s bias against gay men as “unfit” for service. How did this happen?

Sullivan’s work on psychiatric screening between 1939 and 1941 helps us understand how liberal psychiatrists failed to make their opinions heard. When he drafted the screening criteria in 1939 and 1940 as a member of a civilian committee advising the military on selection of soldiers, he made a list of major psychiatric problems to be screened out, such as mental retardation, mood disorders, and psychotic personalities. He did not make a direct reference to homosexuality, but instead mentioned “ impression of queerness” that certain psychotic personalities might make on examiners (Sullivan 1940, 625-627 ) . The term “queerness” could mean an unspecific strangeness in a person, but it could also mean homosexuality when it is used in specific contexts (Chauncey 13-14). Psychiatrists during the 1920s and 1930s also used this term in both ways. Sullivan, because he worked intensively with homosexual patients during these decades, surely knew the ambiguous and possibly less-stigmatizing character of the word “queerness” compared to “homosexual.” In 1941, however, the advisory committee revised the screening criteria and spelled out that individuals with “homosexual proclivities” must be rejected. 3

Sullivan’s role in this revision is unclear, but evidence suggests that it was troubling to him. For one thing, Sullivan avoided the word “homosexual” in his professional writing, claiming that the term “has accumulated so great a freight of misunderstanding” that a better term was needed (Sullivan 1935, 1954). He continued to insist on this even as he lectured psychiatric examiners on how to screen out homosexual men. In a 1941 seminar in Chicago, for example, he pointed out that medical examiners must reject homosexuals, because it is so required; but psychiatric examination is not at all dependable in detecting an examinee’s sexual preference, and thus the cause of rejection should remain as unspecified as possible. 4 When he acknowledged the “inadequacy” of examination, he came close to disqualifying the screening that he himself had created. He attempted to keep homosexual men away from medical stigma, without fully challenging the system of stigmatization itself.

He also tried to use screening to benefit individual gay men. Sometime in 1940, for example, he helped a patient of his friend psychoanalyst Clara Thompson out of the army. As this patient recalled, Thompson believed that “it would be disastrous [for the patient] to go in the army.” She talked to Sullivan and he used his “influence” to get the patient a rejection “without saying he was homosexual” (Biele, my emphasis). The apparent intention of Sullivan was to protect the patient without putting a “diagnosis” of homosexuality on him. As in his attempt to keep the language of rejection unspecific, Sullivan tried to obscure the borderline between rejection and admission--or to put it more specifically, the borderline between homosexuality and heterosexuality--in order to minimize the distress of those who were denied military service.

Why didn’t Sullivan resist discrimination based on sexual preference itself, rather than attempting to lessen its adverse consequences? There is no simple answer. Certainly, the prevailing homophobia, particularly in the medical profession and in the military, played a part, as did Sullivan’s fear that if his own sexual preference came to light he would lose both social and professional standings. What needs to be addressed in addition to these reasons is the gradual exclusion of homosexuality as an issue from public debate among scientists, a process beginning in the early 1930s. Well before the war, as historian George Chauncey has argued, “[a] powerful campaign to . . . exclude [homosexuals] from the public sphere . . . gained momentum,” as the economic recession undermined traditional gender and sexual roles (331). There is some evidence suggesting that Sullivan and his associates were influenced by or even contributed to this trend of exclusion.

For one thing, there was a considerable gap between what Sullivan pursued in his treatment of homosexual patients and what he claimed about them in public. Sullivan continued to see homosexual patients in the 1930s, as he had in the 1920s, encouraging them to be more comfortable with their own sexual preference, a rather radical approach at the time. In his public lectures and articles, in contrast, he continued to stress that a certain kind of homosexual men are “immature.” In 1939 at Georgetown University , for example, Sullivan discussed “individuals who have [never] progressed to the stage of pre-adolescence. [These] immature people . . . [or] immature personalities . . . are incapable of love, [because their personalities] have never gotten to the point of developing love” directed toward a person of the opposite sex. Sullivan’s circle of professional associates was careful not to make his radical approach in the clinical setting a public issue or a matter of public policy. When one of his male patients in the 1930s had a doubt about Sullivan’s approach, the patient consulted with the referring psychiatrist. This psychiatrist suggested that the patient discontinue seeing Sullivan, but made it clear that she did not want to openly criticize Sullivan’s approach. Even as she supported Sullivan, then, she contained the issue of homosexuality within the private arena. The discussion never got outside of a small group of doctors and patients, thus it did not challenge the official view of homosexual men as “immature” personalities.

Sullivan’s use of unspecific diagnoses and unspecific reasons for rejection of gay men during wartime, therefore, was of a piece with his and his profession’s propensity in the preceding decade to deal with the issue of homosexuality mostly in the private arena. Psychiatrists created the ethics of inclusion in private, but they were not willing to use it to make a difference in the public sphere. I do not argue that this had only negative consequences. Indeed, there is a fair amount of evidence suggesting that the containment of sex matters in private facilitated psychiatric treatment. But it is also true that the containment contributed to the system that deprived a number of healthy homosexual men of the right to serve the nation. Thus, when the egalitarian view of homosexuality came into conflict with the official view of it as an illness, as it did in wartime, liberal psychiatrists were rather ineffective. Sullivan was aware of this, but he attributed it to the limits of democracy in wartime, as he said in 1941:

[First,] the army of a democracy cannot be democratic . . . There is no conceivable place for an equal voice in the government; and often no freedom of decision but rigid discipline and unquestioning execution of orders. Second, the civilian population of a democracy . . . cannot remain free to question the necessity for maximum . . . effort for the national defense. . . . Painfully banal as these two thoughts may be, I fear they need very much wider acceptance. (1941d, 292-3)

This can be seen as his self-critique. In the years after the war, however, the “painfully banal” thought of sacrificing democratic procedure for national interest became his main tactic. His postwar work for international organizations, such as the aforementioned international commission, was not specifically about homosexuality. But I see a link--a conceptual, even metaphorical link--between his approach to homosexuality and his work in the postwar years for two reasons. First, he divided nations and peoples into “mature” and “immature” groups, building on his distinction between heterosexuality and homosexuality. Second, he tried, privately and even secretively, to absorb disagreements that emerged in international programs, refusing to bring them into open discussion.

An Inner Circle Tactic on the International Stage

Sullivan worked for postwar international organizations UNESCO and the International Congress on Mental Health . He explained what motivated him to do this in 1946, pointing to the human crisis after the war and a psychiatrist’s increasing responsibility to help the world to recover. One of the psychiatrists’ responsibilities, he said, was to identify well-informed “leaders” who would trace and correct dangerous “elements” in society--for example, aggressive political parties--that helped cause the war. Then, psychiatrists should pursue “remedial modification of these elements.” Once these dangerous “elements” were corrected, wars would become “unnecessary for mature people.” The war had happened because “there have never been enough mature people in the right places,” and thus, it was most important to prevent “immature” people from taking charge. His message was clear: psychiatrists should regulate “immature” people, while making sure that “mature” people take leadership (Sullivan 1946, 83). 5

In international politics, he further argued, a “mighty garrison state,” clearly the U.S. , would play the “mature” role. He seemed to have few doubts that such a state would be well accepted by all who were intelligent:

I think that the peoples of the world would be less hesitant to become subjects of a world government . . . if it were evident to the thoughtful among them that . . . this mighty garrison state . . . [ensures that] men of good will would be working out a fully civilized way of life for the people of the earth. (Sullivan 1946, 86)

What is apparent in this statement is his belief that there was a “fully civilized way of life” that should be applied all over the world. What is also apparent is his belief that these “men of good will” must be equipped with scientific knowledge and skill to understand and facilitate human relations. He stressed this connection between goodwill and liberal science elsewhere: “[We have to] mobilize . . . psychiatrists, social psychologists, psychologists, sociologists, cultural anthropologists, political scientists. . . in a world-wide effort to . . . promote enduring peace and social progress around the world” (Sullivan 1947, 239). Thus, it was these scientists who would assist the world to be “mature” or, even become the “mature” leaders themselves. The resemblance this argument carried with his published view of homosexuality is striking. Just as psychiatrists would help patients with “immature” sexuality to grow, “mature” scientists in a garrison state would assist “immature” nations to develop.

The resemblance was not limited to theory and language. Just as wartime psychiatrists coped with the prejudice against homosexuality within a small circle of sympathizers, Sullivan tried to brush off disagreements in international conferences using what might be called an inner circle tactic. The International Preparatory Commission in 1948 brought together twenty-five conferees from ten countries. Sullivan participated as one of seven representatives from the U.S. The conference began in a friendly atmosphere, but the majority of the conferees concluded at the end of two weeks that the conference was a failure and the statement they prepared for the International Congress on Mental Health was useless. This was clearly expressed in a highly critical retrospect they wrote a week after the conference. For example, one of these reports reads:

[The conference was] a leaderless group . . . Gang formation took place. Figures strong enough to gather some members around themselves . . . formed points of crystallization. This was particularly evident around one figure whose chief significance for the group was negative . . . [His group] assumed characteristics of the true gang: it isolated itself in an aura of secrecy, it even separated from the rest of the members by disappearing a whole day, and came back after a prolonged absence surrounded by tales of great deeds done. (Querido 1948, 351-2)

Another conferee said, “no arrangement was made to record the process of group formation and tensions at work. Such a document might have been more valuable than the [commission’s] statement itself” ( William Alanson White Psychiatric Foundation 341). Others pointed out that at the end of the conference, an editor was selected from the “gang” group, and exercised gross influence on the final version of the statement. As Sullivan admitted, “the target-person” in these critiques was Sullivan himself (ibid. 342). 6 His actions had a considerable impact, in particular on non-Westerners. Some of them thought that he was imposing Western values, perhaps in part because his small group did not include those from non-English speaking countries (Querido 350). Not surprisingly, as one of these participants commented, the final statement did “not include, even under a separate heading, any minority opinions, or opinions of circles far removed from Western conceptions. . . [The conference was] the least ‘world-wide’” (ibid.). Despite the lack of diversity, the commission’s statement served as a blueprint for the mission statement of the World Federation for Mental Health and the mental health program of the World Health Organization, building the foundation of the postwar international mental health policy. Sullivan’s tactic of working with a small group of sympathizers had not changed the homophobic policy of screening in the U.S. But when the same tactic was brought to the international stage and was presented as American way to others, it certainly made a public impact.

Sullivan and his professional associates used the model of “mature vs. immature” nations and the inner circle tactic to form American identity as a world leader. This approach made it difficult for others in the postwar international community to converse with the U.S. on open, equal ground. Psychiatrists’ dualistic approach to the issue of homosexuality after the 1930s--in particular, their failure to bring the ethics of inclusion to public policy making--might not have been the sole cause of the difficulty, but it influenced how America was perceived by the rest of the world after the war. The politics of sexuality in the interwar years need further examination in this light.

Notes

1. See Mullahy, Chapman & Chapman, Youniss, Wiggins, Alexander, Chatelaine, Evans, Kiesler, and Strack.

2. See Harned, Allen (1995 and 2000), Hansen, Blechner, and Hegarty.

3. The original criteria did not make it clear that homosexuals needed to be rejected. As seen in the proceedings of a seminar for psychiatric examiners in Chicago in May 1941 (right around the time when the criterion was revised), examiners were not really sure if they should reject homosexuals at this point. In this seminar, Colonel William C. Porter from the U.S. Army commented, “this morning during my talk there was a slip of paper handed to me with the word “homosexuality” on it. . . . We feel that the homosexuals, if they are overt in their manifestations, can do inestimable harm in the Army of the United States by seduction of youths who are not homosexually inclined. That has been our experience . . . Therefore, we feel that if a man is a known homosexual . . . he should be excluded from the military service, not only for his sake, but for the sake of the others with whom he has to associate.” This comment makes it clear that the regulation of homosexual candidates was in flux in the early phase of screening. See Sullivan 1941c, 47-48 and 1941b, 440-464, in particular 451. “After mid-1941, however, homosexuality came to be recognized a definite cause of rejection and the criteria was revised accordingly. See Sullivan 1941a, 265-283 in particular 265. On the change of terms used by the Army criteria, see Hampf 13-20.

4. See Sullivan 1941c 48-49, where Sullivan said “there may be a hesitancy on the part of . . . [psychiatric] examiners to label a selectee as having . . . homosexuality, on the basis of what at best is an inadequate examination . . . we have been urging that causes for rejection shall be answered . . . in term of group so and so” instead of a specific diagnosis.

5. See Sullivan 1948. Also, see Sullivan 1950, in which he repeated his belief that fascist leaders were “immature” people who lacked “the preadolescent and adolescent” maturity and thus could not create “intimate give-and-take relations of equality” with others.

6. Lawrence K. Frank, in his interview with Helen Swick Perry, “expressed a great deal of exhaustion about Roffey Park [where the IPC took place]. Sullivan apparently acted somewhat like a spoiled child.” See Frank interview (1962). Margaret Mead, one of the participants at the IPC, also remembered “he [Sullivan] started out attacking me and baiting me in every conceivable way… he behaved as if he was being nasty to a previous sweetheart. . . . So the whole group was pretty disoriented by his behavior because he could be incredibly nasty” (Mead interview 1970).

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