Five Questions with Regina Kunzel, author of “In the Shadow of Diagnosis: Psychiatric Power and Queer Life”

In celebration of Pride Month, we’d like to highlight one of our authors whose work thoughtfully examines the history of psychiatry’s impact on the lives of queer and gender-nonconforming people. In the mid-twentieth century, American psychiatrists proclaimed homosexuality a mental disorder, one that was treatable and amenable to cure. Drawing on a collection of previously unexamined case files from St. Elizabeths Hospital, Regina Kunzel’s In the Shadow of Diagnosis examines psychiatrists’ investments in understanding homosexuality as a dire psychiatric condition, a judgment that garnered them tremendous power and authority at a time historians have characterized as psychiatry’s “golden age.” That stigmatizing diagnosis made a deep and lasting impact, too, on queer people, shaping gay life and politics in indelible ways. In this post, we chat with Regina about her book and how it offers a new perspective on psychiatry’s influence on queer people.

In your new book, In the Shadow of Diagnosis, you explore the history of psychiatry’s impact on the lives of queer and gender-nonconforming people. How did you first become interested in this topic, and why did you decide to pursue it?

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My interest in the topic was surely kindled by having grown up at a time when the mental health of gay men and lesbians was actively and publicly debated and, until 1974, determined by American psychiatrists to be disordered. Psychiatrists were very good at getting the word out, and so those ideas were part of the air and water of American life in those years.

Mid-century psychiatry’s pathologizing stance toward homosexuality and gender variance is not news to historians.  What allowed me to approach that history in a new way was my luck in gaining access to a remarkable archival collection: the papers of psychiatrist Benjamin Karpman. Early in his career, Karpman developed the unusual and perhaps unique practice of asking his patients to write.  At his urging, they wrote autobiographies, recorded their dreams, reviewed psychiatric texts, responded to questionnaires, and kept diaries.  Those sources allowed me to move beyond psychiatrists’ published writing to consider how people themselves engaged with psychiatric thinking, diagnosis, and treatment. 

What did you learn that surprised you the most?

Truly, there are surprises on nearly every page. One was discovering that Karpman plagiarized from one of his patients’ writing in his own published review of a psychiatric text. That act of uncredited borrowing laid bare the intellectual labor performed by patients and the reliance of psychiatry on their expertise, as well as the exploitative nature of psychiatric knowledge production about queerness and gender variance. At the same time, it’s clear that Karpman and his patient conceived their work together as collaborative, complicating any expectation of an inevitably antagonistic relationship between queer patient and psychiatrist.

In the book, you argue that psychiatric power depends upon psychiatrists’ claims of expertise regarding homosexuality and gender variance. Could you discuss how psychiatrists used those claims to broker some of their most strategic collaborations with the state?

American psychiatrists formed a symbiotic relationship with the US state at mid-century at a time when homosexuality was understood to constitute a threat to national security, linked to communism and, for some, surpassing it in menace. At the beginning of the Second World War, psychiatrists partnered with the federal government to establish guidelines for the psychological screening of military inductees to weed out those deemed “unfit” for service, homosexuals among them. Psychiatrists also made themselves useful to the state, expanding their own influence in the process, first by helping legitimize a national wave of sexual psychopath laws and then by agreeing to treat people who were carcerally committed under those laws. On a much wider scale, psychiatrists established themselves as key participants in the criminal legal system, staffing psychiatric clinics attached to the courts and building clinical practices by accepting people ordered by judges to undertake psychiatric treatment as patients.  That means that a story typically told as an episode in the history of medicine, or the history of the oppression of gay men and lesbians, is also a story about the role of psychiatry in American state and carceral power.

What do you most hope readers will take away from your book?

The history of psychiatry’s impact on queer and gender-nonconforming people has been told as a relatively straightforward allegory, one with villains, heroes, a linear timeline, and a gratifying and triumphant narrative arc: psychiatrists participated in the pathologizing and abusive treatment of gay men and lesbians; gay activists resisted and ultimately prevailed.  I aim to shift the register of that story—from an oppression-to-liberation or pathology-to-politics telos to one more open to surprise and contradiction and more alert to unexpected consequences.

More important, I hope that readers come away with an understanding of the deep effects of stigma on queer and trans life. Historians have tended to downplay the profound unease that many queer and gender-variant people felt under the weight of pathologizing diagnoses. Emphasizing queer defiance and celebrating the flouting of norms, though, requires that we read the historical record very selectively. The history of the encounter of queer and trans people with psychiatry offers up stories of resistance, to be sure. But it should not surprise us that for many, psychiatric thinking and treatment instilled, compounded, and consolidated a sense of shame.

Where will your research and writing take you next?

One of the things that completely stymied me in my work with Karpman’s case files was the dream journals that he asked his patients to keep.  To the psychoanalyst, dreams were the key to the unconscious. But what are dreams to the historian?  What do people living under the burden of pathologizing diagnosis, psychiatric scrutiny, stigma, and often criminalization dream of? And how might a reading of dreams shed new light on this history? I’m considering returning to those dream journals with those questions in mind.

I’m also inspired by the present moment—one marked by the resurgence of pathologizing ideas about queerness (witness narratives of “grooming” and censorship of curricula) and a war on trans life (witness the 550 anti-trans bills introduced so far in 2024)—to think historically about perceived gendered and sexualized threats to children and the strategic use of those threats to promote hetero- and gender-normativity. That project returns me to the decades of my own childhood, the 1960s and 1970s, and the investment in those years in sexual and gender normativity that we can see in the use of behavior modification to normalize the gender expression of children, purges of gay teachers, contests over custody of children, and more. Decades ago, feminist poet and writer Adrienne Rich theorized what she termed “compulsory heterosexuality.” I envision this project as an investigation into a key moment in that history.

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Regina Kunzel is the Larned Professor of History and Professor of Women’s, Gender, and Sexuality Studies at Yale University. Kunzel is the author of Criminal Intimacy: Prison and the Uneven History of Modern American Sexuality, also published by the University of Chicago Press.

In the Shadow of Diagnosis is available now from our website or your favorite bookseller.