Lesbians are frequently treated with insensitivity, antagonism, and discrimination in health care encounters. The authors argue that contemporary health care experiences of lesbian clients cannot be understood apart from a critical examination of the historical construction of medical ideologies that pathologized lesbianism. An excavation of historical data about medical conceptualizations of lesbian women is undertaken to demonstrate how cultural and medical ideologies throughout the century have reinforced each other to shape lesbians' health care experiences and influence public policies. By illuminating both the prejudicial content of medical theories as well as the emancipatory actions of lesbian and gay communities to change stigmatizing diagnostic and treatment situations, the authors attempt to demystify ideologies about lesbians that motivate clinicians, administrators, educators, researchers, and theorists in the delivery of health services.
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References
1.
DardickL.GradyK. E.Openness between gay persons and health professionals. Ann. Intern. Med.93: 115–119, 1980.
2.
JohnsonS. R.Factors influencing lesbian gynecological care: A preliminary study. Am. J. Obstet. Gynecol.140: 20–28, 1981.
3.
McGheeR. D.OwenW. F.Medical aspects of homosexuality. N. Engl. J. Med.303: 50–51, 1980.
4.
ParoskiP. A.Health care delivery and the concerns of gay and lesbian adolescents. J. Adolesc. Health Care8: 188–192, 1987.
5.
SmithE. M.JohnsonS. R.GuentherS. M.Health care attitudes and experiences during gynecological care among lesbians and bisexuals. Am. J. Public Health. 75: 1085–1087, 1985.
6.
StevensP. E.HallJ. M.Stigma, health beliefs and experiences with health care in lesbian women. Image: J. Nurs. Scholarship20: 69–73, 1988.
7.
HarveyS. M.CarrC.BernheineS.Lesbian mothers: Health care experiences. J. Nurse Midwifery34: 115–119, 1989.
8.
LevyT.The Lesbian: As Perceived by Mental Health Workers. Doctoral dissertation, California School of Professional Psychology, San Diego, 1978.
9.
MathewsW. C.Physicians' attitudes toward homosexuality: Survey of a California county medical society. West. J. Med.144: 106–110, 1986.
10.
RandallC. E.Lesbian phobia among BSN educators: A survey. J. Nurs. Educ.28: 302–306, 1989.
11.
WhiteT. A.Attitudes of psychiatric nurses toward same sex orientations. Nurs. Res.28: 276–281, 1979.
12.
YoungE. W.Nurses' attitudes toward homosexuality: Analysis of change in AIDS workshops. J. Continuing Educ. Nurs.19: 9–12, 1988.
13.
FriendR. A.Sexual identity and human diversity: Implications for nursing practice. Holistic Nurs. Pract.1(4): 21–41, 1987.
14.
GonsiorekJ. C.Mental health issues of gay and lesbian adolescents. J. Adolesc. Health Care9: 114–122, 1988.
15.
GoodR. S.The gynecologist and the lesbian. Clin. Obstet. Gynecol.19: 473–482, 1976.
16.
JonesR.With respect to lesbians. Nurs. Times84(20): 48–49, 1988.
17.
RaymondC. A.Lesbians call for greater physician awareness, sensitivity to improve patient care. JAMA259: 18, 1988.
18.
WhyteJ.CapaldiniL.Treating the lesbian or gay patient. Del. Med. J.52: 271–280, 1980.
19.
CoreaG.The Hidden Malpractice: How American Medicine Mistreats Women. Harper & Row, New York, 1985.
20.
DuttonD. B.Explaining the low use of health services by the poor: Costs, attitudes, or delivery systems?Am. Sociol. Rev.43: 348–368, 1978.
21.
FisherS.GroceS. B.Doctor-patient negotiation of cultural assumptions. Sociol. Health Illness7: 342–374, 1985.
22.
HaywardR. A.Inequities in health services among insured Americans. N. Engl. J. Med.318: 1507–1512, 1988.
23.
PendeltonD.BochnerS.The communication of medical information in general practice consultations as a function of patients' social class. Soc. Sci. Med.14A: 669–673, 1980.
24.
RothJ. A.The treatment of the sick. In Poverty and Health: A Sociological Analysis, edited by KosaJ.ZolaI. K., pp. 274–302. Harvard University Press, Cambridge, Mass., 1975.
25.
ToddA. D.Intimate Adversaries: Cultural Conflict between Doctors and Women Patients. University of Pennsylvania Press, Philadelphia, 1989.
26.
WallenJ.WaitzkinH.StoeckleJ. D.Physician stereotypes about female health and illness: A study of patient's sex and the information process during medical interviews. Women Health4: 135–146, 1979.
27.
PortilloC. T.Poverty, self-concept, and health: Experience of Latinas. Women Health12: 229–242, 1987.
28.
SmithA.StewartA. J.Approaches to studying racism and sexism in Black women's lives. J. Soc. Issues36(3): 1–15, 1983.
29.
ZajacD. L.Women's health: Problems and options. An overview. Issues Health Care Women4: 287–310, 1983.
30.
ZambranaR. E.A research agenda on issues affecting poor and minority women: A model for understanding their health needs. Women Health12: 137–160, 1987.
31.
AblonJ.Stigmatized health conditions. Soc. Sci. Med.15B: 5–9, 1981.
32.
BeckerG.ArnoldR.Stigma as a social and cultural construct. In The Dilemma of Difference: A Multidisciplinary View of Stigma, edited by AinlayS. C.BeckerG.ColemanL. M., pp. 39–58. Plenum Press, New York, 1986.
33.
PlasekJ. W.AllardJ.Misconceptions of homophobia. J. Homosex.10(1/2): 23–37, 1984.
34.
KlaichD.Woman Plus Woman: Attitudes toward Lesbians. Simon & Schuster, New York, 1974.
35.
PonseB.Identities in the Lesbian World: The Social Construction of Self. Greenwood Press, Westport, Conn., 1978.
36.
PonseB.Lesbians and their worlds. In Homosexual Behavior: A Modern Reappraisal, edited by MarmorJ., pp. 157–175. Basic Books, New York, 1980.
37.
BulloughV. L.BulloughB.Sin, Sickness, and Sanity: A History of Sexual Attitudes. Garland, New York, 1977.
38.
D'EmilioJ.FreedmanE. S.Intimate Matters: A History of Sexuality in America. Harper & Row, New York, 1988.
39.
FoucaultM.The History of Sexuality, Vol. 1: An Introduction (trans. HurleyR.). Random House, New York, 1978.
40.
BarnardM.Sappho: A New Translation. University of California Press, Berkeley, 1958.
41.
SteinerB. W.From Sappho to Sand: Historical perspectives on cross-dressing and cross gender. Can. J. Psychiatry26: 502–506, 1981.
42.
WysorB.The Lesbian Myth. Random House, New York, 1974.
43.
BlackwoodE.Breaking the mirror: The construction of lesbianism and the anthropological discourse on homosexuality. J. Homosex.11(3/4): 1–17, 1985.
44.
CavinS.Lesbian Origins. Ism Press, San Francisco, 1985.
KatzJ.Gay American History: Lesbians and Gay Men in the U.S.A.Avon Books, New York, 1976.
47.
FeinsonM. C.Where are the women in the history of aging?Soc. Sci. Hist.9: 429–452, 1985.
48.
GordonA. D.BuhleM. J.DyeN. S.The problem of women's history. In Liberating Women's History, edited by CarrollB., pp. 75–92. University of Illinois Press, Urbana, 1976.
49.
Wiesen-CookB.The historical denial of lesbianism. Radical Hist. Rev.20: 60–65, 1979.
50.
DavisK. B.Factors in the Sex Life of Twenty-two Hundred Women. Harper and Brothers, New York, 1929.
51.
KinseyA. C.Sexual Behavior in the Human Female. W. B. Saunders, Philadelphia, 1953.
52.
HiteS.The Hite Report: A Nationwide Study on Female Sexuality. Macmillan, New York, 1976.
53.
CromptonL.The myth of lesbian impunity: Capital laws from 1270 to 1791. J. Homosex.6(1/2): 11–25, 1980/81.
54.
ErikssonB.A lesbian execution in Germany, 1721: The trial records. J. Homosex.6(1/2): 27–40, 1980/81.
55.
EvansA.Witchcraft and the Gay Counterculture: A Radical View of Western Civilization and Some of the People It Has Tried to Destroy. Fag Rag Books, Boston, 1978.
56.
BulloughV. L.Heresy, witchcraft, and sexuality. J. Homosex.1(2): 183–201, 1974.
57.
KarlenA.Sexuality and Homosexuality: A New View. W. W. Norton, New York, 1971.
58.
KarlenA.Homosexuality in history. In Homosexual Behavior: A Modern Reappraisal, edited by MarmorJ., pp. 75–99. Basic Books, New York, 1980.
59.
DaviesC.Sexual taboos and social boundaries. Am. J. Sociol.87: 1032–1063, 1982.
60.
AbramsonH. A.The historical and cultural spectra of homosexuality and their relationship to the fear of being lesbian. J. Asthma Res. 17: 177–188, 1980.
61.
BulloughV. L.Homosexuality and its confusion with the ‘secret sin’ in pre-Freudian America. In Sex, Society, and History, edited by BulloughV. L., pp. 112–124. Science History, New York, 1976.
62.
FadermanL.Surpassing the Love of Men: Romantic Friendship and Love between Women from the Renaissance to the Present. William Morrow, New York, 1981.
63.
Smith-RosenbergC.The female world of love and ritual: Relations between women in nineteenth century America. Signs: J. Women Culture Society1: 1–24, 1975.
64.
FadermanL.The morbidification of love between women by 19th–century sexologists. J. Homosex.4(1): 73–90, 1978.
65.
FadermanL.Love between women in 1928: Why progressivism is not always progress. J. Homosex.12(3/4): 23–42, 1986.
66.
BulloughV. L.Homosexuality and the medical model. J. Homosex. 1(1): 99–110, 1974.
67.
ChurchillW.Homosexual Behavior among Males: A Cross-cultural and Cross-species Investigation. Hawthorn, New York, 1967.
68.
ZolaI. K.Medicine as an institution of social control. Social. Rev.20: 487–504, 1972.
69.
BayerR.Homosexuality and American Psychiatry: The Politics of Diagnosis. Princeton University Press, Princeton, N.J., 1987.
70.
ConradP.SchneiderJ. W.Deviance and Medicalization: From Badness to Sickness. C. V. Mosby, St. Louis, Mo., 1980.
71.
Krafft-EbingR. V.Psychopathia Sexualis. F. A. Davis, Philadelphia, 1894.
72.
SchmidtG.Allies and persecutors: Science and medicine in the homosexuality issue. J. Homosex.10(3/4): 127–140, 1984.
73.
KennedyH. C.The third sex theory of Karl Heinrich Ulrichs. J. Homosex.6(1/2): 103–111, 1980/81.
74.
AdamB. D.The Rise of the Gay and Lesbian Movement. Twayne, Boston, 1987.
75.
LewesK.The Psychoanalytic Theory of Male Homosexuality. Simon & Schuster, New York, 1988.
76.
MercerJ. D.They Walk in Shadow: A Study of Sexual Variations with Emphasis on the Ambisexual and Homosexual Components and Our Contemporary Sex Laws. Comet Press Books, New York, 1959.
77.
EllisH.Studies in the Psychology of Sex: Sexual Inversion. F. A. Davis, Philadelphia, 1901.
78.
KatzJ. N.Gay/Lesbian Almanac: A New Documentary. Harper & Row, New York, 1983.
79.
RobinsonP.The Modernization of Sex. Harper & Row, New York, 1976.
80.
FreudS.The psychogenesis of a case of homosexuality in a woman. In Standard Edition of the Complete Psychological Works of Sigmund Freud, edited by StracheyJ., pp. 147–172. Hogarth Press, London, 1920.
81.
KinseyA. C.Historical notes: A letter from Freud. Am. J. Psychiatry107: 786–787, 1951.
82.
MurphyT. F.Freud reconsidered: Bisexuality, homosexuality and moral judgment. J. Homosex.9(2/3): 65–77, 1983/84.
83.
BergC.AllenC.The Problem of Homosexuality. Citadel, New York, 1958.
84.
BerglerE.Homosexuality: Disease or Way of Life. Hill & Wang, New York, 1957.
85.
BieberI.Homosexuality: A Psychoanalytic Study of Male Homosexuals. Basic Books, New York, 1962.
86.
BychowskiG.The ego of homosexuals. Int. J. Psychoanal.26: 114–127, 1945.
RadoS.Fear of castration in women. Psychoanal. Q.2: 425–475, 1933.
91.
RobertielloR. C.Voyage from Lesbos: The Psychoanalysis of a Female Homosexual. Citadel, New York, 1969.
92.
RofesE. E.“I Thought People Like That Killed Themselves:” Lesbians, Gay Men and Suicide. Grey Fox Press, San Francisco, 1983.
93.
SocaridesC. W.The Overt Homosexual. Grune & Stratton, New York, 1968.
94.
StekelW.Bisexual Love. Physicians and Surgeons Books, New York, 1933.
95.
StekelW.The Homosexual Neurosis. Emerson Books, New York, 1946.
96.
HenryG. W.GalbraithH. M.Constitutional factors in homosexuality. Am. J. Psychiatry14: 1249–1270, 1934.
97.
CaprioF. S.Female Homosexuality: A Psychodynamic Study of Lesbianism. Citadel, New York, 1954.
98.
ChideckelM.Female Sex Perversion: The Sexually Aberrated Woman As She Is. Eugenics, New York, 1935.
99.
HenryG. W.Sex Variants: A Study of Homosexual Patterns. Paul B. Hoeber, New York, 1948.
100.
MorseB.The Lesbian: A Frank Study of Women Who Turn to Their Own Sex for Love. Monarch, Derby, Conn., 1961.
101.
IllichI.Medical Nemesis: The Expropriation of Health. Random House, New York, 1976.
102.
ShackleE. M.Psychiatric diagnosis as an ethical problem. J. Med. Ethics11: 132–134, 1985.
103.
SzaszT. S.The Manufacture of Madness. Dell, New York, 1970.
104.
BellA. P.WeinbergM. S.Homosexualities: A Study of Diversity among Men and Women. Simon & Schuster, New York, 1978.
105.
ChafetzJ.A study of homosexual women. Soc. Work19: 714–723, 1974.
106.
LevineM. P.LeonardR.Descrimination against lesbians in the work force. Signs: J. Women Culture Society9: 700–710, 1984.
107.
BerubeA.Coming Out under Fire: The History of Gay Men and Women in World War II. Macmillan, New York, 1990.
108.
BerubeA.D'EmilioJ.The military and lesbians during the McCarthy years. Signs: J. Women Culture Society9: 759–775, 1984.
109.
WilliamsC. J.WeinbergM. S.Homosexuals and the Military. Harper & Row, New York, 1971.
110.
HumphreysL.Out of the Closets: The Sociology of Homosexual Liberation. Prentice-Hall, Englewood Cliffs, N.J., 1972.
111.
McCraryJ.GutierrezL.The homosexual person in the military and in national security employment. J. Homosex.5(1/2): 115–146, 1979/80.
112.
BrowningC.Changing theories of lesbianism: Challenging the stereotypes. In Women-identified Women, edited by DartyT.PotterS., pp. 11–30. Mayfield, Palo Alto, Calif., 1984.
113.
HitchensD.Social attitudes, legal standards and personal trauma in child custody cases. J. Homosex.5(1/2): 89–95, 1979/80.
114.
ReynoldsW. T.The immigration and national act and the rights of homosexual aliens. J. Homosex.5(1/2): 79–87, 1979/80.
115.
SolomonD. M.The emergence of associational rights for homosexual persons. J. Homosex.5(1/2): 147–155, 1979/80.
116.
VetriD.The legal arena: Progress for gay civil rights. J. Homosex.5(1/2): 25–34, 1979/80.
117.
van den AardwegG. J. M.On the Origins and Treatment of Homosexuality: A Psychoanalytic Reinterpretation. Praeger, New York, 1986.
118.
KinseyA. C.PomeroyW. B.MartinC. E.Sexual Behavior in the Human Male. W. B. Saunders, Philadelphia, 1948.
119.
JonesE.The early development of female sexuality. Int. J. Psychoanal.8: 459–472, 1927.
120.
FenichelO.The Psychoanalytic Theory of Neurosis. W. W. Norton, New York, 1945.
121.
BeneE.On the genesis of female sexuality. Br. J. Psychiatry111: 815–821, 1965.
122.
RosenD. H.Lesbianism: A Study of Female Homosexuality. Charles C Thomas, Springfield, Ill., 1974.
123.
WolffC.Love between Women. Harper & Row, New York, 1971.
124.
SimpsonR.From the Closets to the Courts: The Lesbian Transition. Viking Press, New York, 1976.
125.
CoryD. W. [pseudonym]. The Lesbian in America. Citadel, New York, 1964.
126.
FergusonA.Lesbian Identity: Beauvoir and History. Women's Stud. Int. Forum8: 203–208, 1985.
127.
MarmorJ.Overview: The multiple roots of homosexual behavior. In Homosexual Behavior: A Modern Reappraisal, edited by MarmorJ., pp. 3–22. Basic Books, New York, 1980.
128.
DickinsonR. L.The gynecology of homosexuality. In Sex Variants: A Study of Homosexual Patterns, edited by HenryG. W., pp. 1069–1130. Paul B. Hoeber, New York, 1948.
129.
DickinsonR. L.BeamL.The Single Woman. Williams & Wilkins, New York, 1934.
130.
GriffithP. D.Homosexual women: An endocrine and psychological study. J. Endocrinol.63: 549–556, 1974.
131.
KenyonF. E.Physique and physical health of female homosexuals. J. Neurol. Neurosurg. Psychiatry.31: 487–89, 1968.
132.
ShohamS. G.RahavG.The Mark of Cain: The Stigma Theory of Crime and Social Deviance. St. Martin's Press, New York, 1982.
133.
TrippC. A.The Homosexual Matrix. McGraw-Hill, New York, 1975.
134.
LauritsenJ.ThorstadD.The Early Homosexual Rights Movement (1864–1935). Times Change Press, New York, 1974.
135.
D'EmilioJ.Sexual Politics, Sexual Communities. University of Chicago Press, Chicago, 1983.
136.
BronskiM.Culture Clash: The Making of Gay Sensibility. South End Press, Boston, 1984.
137.
LicataS. J.The homosexual rights movement in the United States: A traditionally overlooked area of American history. J. Homosex.6(1/2): 161–189, 1980/81.
138.
MartinD.LyonP.Lesbian Woman. Bantam Books, New York, 1972.
139.
MastersR. E. L.The Homosexual Revolution: A Challenging Expose of the Social and Political Directions of a Minority Group. Julian Press, New York, 1962.
140.
WeissA.Before Stonewall: The Making of a Gay and Lesbian Community. Naiad Press, New York, 1988.
141.
AbbottS.LoveB.Sappho Was a Right-on Woman: A Liberated View of Lesbianism. Stein & Day, New York, 1972.
142.
AltmanD.Homosexual Oppression and Liberation. Avon Books, New York, 1971.
143.
AltmanD.The Homosexualization of America: The Americanization of the Homosexual. St. Martin's Press, New York, 1982.
144.
AdamB. D.The Survival of Domination: Inferiorization and Everyday Life. Elsevier, New York, 1978.
SilversteinC.Even psychiatry can profit from its past mistakes. J. Homosex.2(2): 153–158, 1976/77.
147.
SilversteinC.The ethical and moral implications of sexual classification: A commentary. J. Homosex.9(4): 29–38, 1984.
148.
FordC. S.BeachF. A.Patterns of Sexual Behavior. Harper and Brothers, New York, 1951.
149.
FreedmanM.Homosexuality and Psychological Functioning. Wadsworth, Belmont, Calif., 1971.
150.
HookerE.The adjustment of the male overt homosexual. J. Projective Techniques21: 18–31, 1957.
151.
HookerE.Male homosexuality in the Rorschach. J. Projective Techniques22: 33–54, 1958.
152.
SaghirM. T.RobinsE.Male and Female Homosexuality: A Comprehensive Investigation. Williams & Wilkins, Baltimore, 1973.
153.
GreenR.Homosexuality as a mental illness. Int. J. Psychiatry10: 77–128, 1972.
154.
BayerR.SpitzerR. L.Edited correspondence on the status of homosexuality in DSM III. J. Hist. Behav. Sci.18: 32–52, 1982.
155.
GoodmanG.No Turning Back: Lesbian and Gay Liberation for the '80s. New Society, Philadelphia, 1983.
156.
SuppeF.Classifying sexual disorders: The Diagnostic and Statistical Manual of the American Psychiatric Association. J. Homosex.9(4): 9–28, 1984.
157.
Council on Scientific Affairs. Aversion therapy. JAMA258: 2562–2566, 1987.
158.
BegelmanD. A.Homosexuality and ethics of behavioral intervention: Paper 3. J. Homosex.2(3): 213–219, 1977.
159.
DavisonG. C.Homosexuality and the ethics of behavioral intervention: Paper 1. J. Homosex.2(3): 195–204, 1977.
160.
SilversteinC.Homosexuality and the ethics of behavioral intervention: Paper 2. J. Homosex.2(3): 205–211, 1977.
161.
DavisonG. C.NealeJ. M.Abnormal Psychology: An Experimental Clinical Approach, Ed. 3. Wiley, New York, 1982.
162.
HarrisS. E.Aversion therapy for homosexuality. JAMA259: 3271, 1988.
163.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Revised, Ed. 3. APA, Washington, D.C., 1987.
164.
MorinS. F.Heterosexual bias in psychological research on lesbianism and male homosexuality. Am. Psychol.32: 629–637, 1977.
165.
SchwanbergS. L.Changes in labeling homosexuality in health sciences literature: A preliminary investigation. J. Homosex.12(1): 51–73, 1985.
166.
WattersA. T.Heterosexual bias in psychological research on lesbianism and male homosexuality (1979–1983): Utilizing the bibliographic and taxonomic system of Morin (1977). J. Homosex.13(1): 35–58, 1986.
167.
AdamB. D.The construction of a sociological ‘homosexual’ in Canadian textbooks. Rev. Can. Sociol. Anthropol.23: 399–411, 1986.
168.
NewtonD. E.Representations of homosexuality in health science textbooks. J. Homosex.4(3): 247–254, 1979.
169.
PasnauR. O.The remedicalization of psychiatry. Hosp. Community Psychiatry38: 145–151, 1987.
170.
KitzingerC.The Social Construction of Lesbianism. Sage, Beverly Hills, Calif., 1987.
