Hidden in Plain Sight: The Network for Lesbian,Gay,and Bisexual Concerns in Occupational Therapy (1992–1993)

Abstract

Importance

Documenting the origin of the Network for Lesbian, Gay, and Bisexual (LGB) Concerns in Occupational Therapy (hereinafter the Network) in the United States uncovers previously unknown perspectives and provides lessons for current practice.

Objective

To explain why and how the first formal occupational therapy organization addressing LGB issues formed during 1992–1993.

Design

A qualitative historical design guided our review of key informants’ organizational documents and oral histories.

Setting

Library archives and community-based interviews.

Data

Primary documents associated with the formation of the Network, publications when the Network formed, and oral history interviews with eight key informants.

Outcomes and Measures

Data review was conducted by multiple researchers, triangulation of findings was ensured, and constant comparative interpretations of results were conducted until thematic saturation was reached.

Results

Three core themes emerged: (1) informal beginnings (when LGB practitioners sought safe connections), (2) formal beginnings (establishment of the Network), and (3) points of tension (professional resistance, fear of disclosure, and sociopolitical constraints). The Network’s emergence challenged norms separating personal identity from professional roles.

Conclusions and Relevance

The foundation of the Network promoted visibility, safety, and advocacy for LGB occupational therapy practitioners. The Network unveiled the need for professional spaces to support individuals with marginalized identities. This historical lesson is an example of how hidden groups can spur change.

Plain-Language Summary

This study investigated how and why the first organization supporting lesbian, gay, and bisexual (LGB) issues in occupational therapy formed in the United States in 1992–1993. Researchers reviewed historical documents and interviewed key individuals involved in the Network for LGB Concerns in Occupational Therapy. The formation of this organization highlighted tensions between personal and professional lives given that LGB practitioners did not feel safe being open about their identities. This research uncovers the hidden history of LGB issues in occupational therapy and shows how professional and societal cultures interact to bring unmet needs to light.

This study investigated how and why the first organization supporting lesbian, gay, and bisexual (LGB) issues in occupational therapy formed in the United States in 1992–1993.

Social professional networks offer more than social or professional connections; they serve as platforms for advocacy, collective identity, and systems change, in particular for people who have historically been excluded or marginalized within mainstream institutions. In U.S. occupational therapy, however, the histories of such networks—especially those formed around issues of equity and identity—have often gone undocumented or unrecognized. This research contributes to that gap by discovering the hidden history of the Network for Lesbian, Gay, and Bisexual (LGB) Concerns in Occupational Therapy (hereinafter the Network). Formed in the early 1990s, the Network was the first national effort within U.S. occupational therapy to advocate for the inclusion, safety, and visibility of LGB practitioners. Documenting its origins provides vital insight into how professional and societal cultures intersect—and how occupational therapists have organized to transform their profession from within.

Documenting hidden histories, such as the founding of the Network, relies on public and archived records and brings to light previously unknown information. This article provides a record of the Network’s hidden history using language associated with the time of study. Significant linguistic evolution has since occurred as terms like homosexual and transsexual (1990s) shifted to umbrella terms like queer and transgender (2000s), reflecting an increased recognition of gender and sexual fluidity (Velasco & Paxton, 2022). These subgroups were not excluded from this study; instead, their unique stories remain hidden.

When the Network formed, the 75th anniversary of occupational therapy was being celebrated, and World War I–era, White, middle- and upper class people were honored as founders. Occupational therapy has a long-standing tradition of upholding privacy and proper etiquette, a practice rooted in its upper class, philanthropic history (Peters et al., 2023; Quiroga, 1995). Throughout the history of the field, occupational therapy practitioners and other professionals did not discuss sexuality, gender identity, and other aspects of personal life in their work. Throughout the United States, disclosure about a lesbian or gay sexual orientation had legal ramifications, including incarceration, leading to limited openness about sexuality and gender identity, even in personal settings (Bronski, 2011; D’Emilio & Freedman, 2012).

In the 1970s, national shifts, built on a long history of LGB activism in the United States, occurred. Until this point, words describing gender and sexual fluidity had rarely been used (Velasco & Paxton, 2022). Homosexuality was removed as a mental illness from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1973), and the federal ban on gay and lesbian civil servants was lifted (Faderman, 2016). By the late 1970s, certain states and regions included sexual orientation in their nondiscrimination policies (Bronski, 2011), beginning a pattern of rights protections and associated backlash that continues today (Velasco & Paxton, 2022). Some of these policies were later repealed. The AIDS epidemic of the 1980s and 1990s, and its disproportionate impact on gay men, led to increased activism among the lesbian, gay, bisexual, and transgender (LGBT) community, especially with respect to health and health care (Bronski, 2011). Gay and lesbian people increasingly called on each other to come out of the closet and proclaim their sexual orientation; the first National Coming Out Day in the United States was in 1988 (Faderman, 2016). Organizing at the national level often focused on forming a collective identity based on sexual orientation to support civil rights, and there was dissent within the movement about the inclusion of gender identity (Stryker, 2008; Velasco & Paxton, 2022). Transgender identity was often excluded from the public discussions, even though transgender people were among the activists (Stryker, 2008).

Gay and lesbian issues were increasingly present within mainstream U.S. politics in the early 1990s (Faderman, 2016). Like the 1970s, increased visibility led to backlash. One example was Colorado Amendment 2, a 1992 state constitutional amendment that prohibited protection from discrimination on the basis of sexual orientation (Alexander, 2001). Activists called for a boycott of Colorado, prompting multiple organizations to relocate planned conferences. More states drafted similar legislation, and some municipalities removed sexual orientation from their nondiscrimination policy (see Figure 1).

Figure 1.

1993 advertisement from the Colorado Legal Initiatives Project.

Within this national context, including the passage of the Americans With Disabilities Act of 1990 (Pub. L. 101-336), the American Occupational Therapy Association (AOTA) began to study recruitment and retention of practitioners from underrepresented minority groups, culminating in a newly created Minority Affairs Program in 1991 (Black, 2002). This program focused on recruiting people from racial or ethnic minority groups, men, and people with disabilities, but did not include sexual orientation. In this article, we describe how and why the Network formed within the sociopolitical context of 1992–1993. Like most LGB groups of the time, it did not address transgender concerns because of the homonormative culture at that time (Stryker, 2008).

Method

We used qualitative historical methods to describe the Network’s development as part of a larger study. Historical research involves interpreting documents and events in the context of the time to understand past experiences (Dunne et al., 2015; Peters, 2013). Using sources created at the time of a study enhances historical veracity.

Data Selection

We prioritized sources related to the Network’s development and occupational therapy in the early 1990s. Data included archived early Network documents, AOTA Representative Assembly (RA) minutes and other association documents, published articles, and artifacts from personal collections (Table 1). Two universities’ institutional review boards approved the study before data were collected. We used secure online repositories to store shared data.

Table 1.

Network Data Analyses

Data Source	Data Description	Analyses	Contribution to Findings
Network archives for 1992–1994	676 files, including newsletters, letters, notes, and magazine and newspaper clippings	• Documents were indexed in a shared spreadsheet. • 2–3 researchers reviewed and identified key meanings within and across files. • Themes were iteratively determined in regular researcher meetings.	• Core evidence themes • Contextual support (e.g., timeline)
Oral history interviews collected 2015–2023	Oral histories of 8 Network founders and 1 AOTA representative	• Interviews were conducted by researchers in person or via Zoom. • Recordings and transcripts were reviewed by 3 researchers to determine key meanings. • Interviews were summarized and key quotes were selected.	• Illustrative narratives • Theme verification
AOTA	1992–1994 documents	• Verified most events with AOTA archival documents.	• Theme verification • Contextual support
External archives	• Lesbian Herstory Archives • New York Public Library	• 1–2 researchers reviewed files and determined key events and their sequence.	• Contextual support

Note. AOTA = American Occupational Therapy Association.

We used email and word of mouth to recruit participants associated with the Network for oral histories. Eight Network founders and one AOTA staff member, named in historical documents, were interviewed. Attempts to reach additional key informants were unsuccessful. The consent process required participants to select a level of name identification. Interviews began by asking the interviewee to provide a broad statement describing early experiences with the Network, and follow-up questions were asked to elicit stories about the Network and participants’ experiences. Interviews typically lasted about 1 hr and were recorded and transcribed verbatim. Participants could review their words for accuracy. For this article, oral history data supplemented archival documents.

Data Analysis

Extensive data analysis occurred over the course of 10 yr. At least two researchers independently reviewed all data to identify meaning units, triangulate information across different data sources, bracket personal experiences, and connect information to the historical context of events within occupational therapy. Analysis and data collection occurred iteratively as new data emerged. We maintained shared spreadsheets that included key meaning units and shared documents with categories and themes. We presented the ongoing historical research at several conferences over multiple years and refined the findings as new perspectives emerged.

Trustworthiness of Findings

To enhance the trustworthiness of the research, we used multiple strategies, in particular the collective process we followed when conducting the study. Continuous, intentional questioning during bimonthly researcher meetings ensured open minds and addressed bias. This was particularly critical given the ethical dilemmas frequently presented by sensitive data. At least two researchers independently reviewed all data, triangulating multiple documents and interviews (Table 1).

Researchers’ Positionality

We as researchers/authors represent insider and outsider perspectives. Two of us are internal to the Network, though not founding members; have served as past officers; and continued as members throughout the study. This insider status facilitated the team’s data access. The third researcher brings historical and outsider expertise and served as a bias monitor, which strengthened our open stance. All of us have backgrounds in qualitative and historical research. Uncovering the anonymous or hidden takes time. This was a personal history for us as occupational therapists, with the careers of two of us spanning the years of this contemporary history.

Results

The Network emerged between the 1992 AOTA Annual Conference (hereinafter conference) and the publication of the Network’s first newsletter after the 1993 AOTA conference. During this time, the Network transformed from a small, informal organization to a formal organization professionally recognized as a “nonaffiliated but related group”¹ to what was then called AOTA’s Minority Affairs Program. Although no notes document the first hotel room meeting, and the memories of the founders we interviewed varied, all remembered the 1992 Houston hotel room as the Network’s beginning when lesbian and gay issues came out in occupational therapy. The results are organized and presented as three themes: (1) informal beginnings, which illuminates the private and personal origins of the Network; (2) formal beginnings, which traces its organizational development and professional recognition; and (3) points of tension, which captures the controversies and resistance surrounding its emergence.

Informal Beginnings

This story unfolds as AOTA planned the 1995 conference in Colorado, a state central to the U.S. gay rights movement (Alexander, 2001). One founder described the time between the 1992 and 1993 AOTA conferences as “a really big year because we were all getting together and networking,” which culminated in the (1993 conference) meeting. “It was hard; it was exciting, but it was hard” (founding member interview, October 2, 2015). Occupational therapy was a “very unsafe profession in which to be out” given the escalating AIDS epidemic and “blatant homophobia in the field” (founding member interview, September 17, 2015). Another founding member and occupational therapy faculty member stated in a published keynote speech to the 1992 Network meeting, “the word ‘gay,’ or any other like it, was never uttered in the classroom or anywhere else. One felt clearly the depth and power of the taboo by the silence surrounding it.”¹

The Colorado political situation weighed heavily on the then-called LGB community in the lead-up to the 1992 Houston AOTA conference. After a conference presentation on lesbian and gay identity, Wendy Wood invited participants to join a continued discussion in her hotel room later that evening. “The hotel room,” which is how interviewed Network members referred to the initial meeting, was likely selected as a safe, secure location to discuss these pertinent issues. Approximately 10 occupational therapy practitioners joined the meeting to discuss the plight of lesbian and gay affairs and occupational therapy (Network, 1990– 2005). In May 1992, Wood reflected,

[Networking] was felt to be a high priority among the initial dozen or so people who organized and felt starved (if I might be so dramatic) for the means to identify one another formally and to provide support and mentoring to therapists who were facing any number of issues in their professional lives pertaining to their sexual orientations. (Network, 1990–2005)

Network founders planned the first official meeting of the Network to occur at the next AOTA conference, to be held in Seattle, in 1993. Network leaders requested that the AOTA Executive Board “[establish] how lesbian and gay concerns [could] be formally addressed within the structure of the AOTA” and “[include the LG Network] within the AOTA Annual Conference” (Network, 1990– 2005). Within 3 mo, the Network changed its name to include bisexual concerns. The AOTA Minority Affairs Office already recognized and supported meeting space for the Hispanic Task Force and the Black Occupational Therapy Caucus, with plans to expand minority groups by 1993 (Gibbs, 1990). The news release of the new lesbian and gay networking group in ADVANCE for Occupational Therapy Practitioners, a private magazine, led to a series of published Letters to the Editor spanning the next several months (Network, 1990– 2005). This public discussion is described in the Points of Tension section.

Formal Beginnings

AOTA’s formal acknowledgment of the Network involved a series of AOTA Executive Board meetings and extensive letter writing between the Network’s founding members and AOTA representatives (Network, 1990– 2005).

Executive Board Actions

These communications led to actions approved within a series of Executive Board meetings from July 1992 to May 1993. First, the AOTA board approved the Network’s initial request for meeting space (Figure 2) and to publish a notice for the new meeting in the conference guide (Network, 1990– 2005). Second, the AOTA board voted to keep the 1995 conference location in Denver, Colorado, despite Network leaders’ requests to boycott this location. A founder recalled a conversation with then-AOTA President Mary Evert about potentially moving the conference location out of Colorado:

Figure 2.

The Network’s 1993 AOTA conference space request form.

[Evert] positioned it as a social issue that had nothing to do with [occupational therapy]. Well, I’m thinking that the social issues have everything to do with [occupational therapy]. … I believed that people’s identity, and sexual orientation as part of that identity, very much influence our everyday occupations, how we spend time, who we affiliate with, our aspirations, our small and large life decisions. (Founding member interview, September 17, 2015)

In a letter dated August 25, 1993, Evert wrote, “There were some references in your letter … that I felt did not reflect the actual rationale of the Board members who constituted the majority vote on the decision not to move the site of the 1995 Conference” (Network, 1990– 2005). This suggests that AOTA’s declination was associated with conference pragmatics and finances.

Colorado Conference Response

After the AOTA Executive Board declined to change the conference venue, Network members drafted a motion to designate the theme of the 1995 conference as “Celebrating Human Diversity” and specifically named sexual orientation as a component of diversity. The 1993 AOTA RA, a decision-making body composed of practitioner state representatives, passed a motion to designate “Celebrating Human Diversity” as the theme of the 1995 conference (Network, 1990– 2005). The minutes also specified that “the Executive Board actively work with the Network for Lesbian, Gay and Bisexual Concerns in Occupational Therapy, the Black [Occupational Therapy] Caucus, the Hispanic Task Force and other pertinent groups to implement the conference theme.”¹

An additional motion, authored by Network members, was passed by the same 1993 RA to include sexual orientation in AOTA’s nondiscrimination policy along with other marginalized groups (Network, 1990– 2005). The rationale for the motion included the current “widespread discrimination” and the fact that other national professional groups for related professions already had such protection in their policies (Network, 1990– 2005). When the Executive Board finalized revisions to AOTA’s Policy 5.4, Equal Rights for Human Beings, which was implemented in July 1994, all specifically listed groups were removed, and instead a statement prohibiting discrimination in general was included (American Occupational Therapy Association, 1994). The speed of change to this policy and its impact across the profession illustrate the Network’s advocacy role.

The first formal meeting of the Network occurred at the 1993 Seattle conference, “with approximately 60 enthusiastic people in attendance.”¹ A meeting summary published in July 1993 in OT Week, an AOTA publication, stated, “Since [1992] the Network’s membership has grown to 130 and the organization’s mailing now contains more than 200 names.”¹ Business conducted at the first official meeting of the Network at the 1993 conference served to formalize this new organization. Officers were elected, a mission and bylaws were approved, and communication pathways were determined (Network, 1990– 2005).

During the meeting, a group of approximately 30 members left the formal meeting to join the RA meeting when representatives were scheduled to vote on the two proposals initiated by Network members, as described previously. Their experience is included in the Points of Tension section.

Ensuring safety was essential. Membership was private, with a sign that read “Network” marking the location (Figure 2). One member explained,

It’s frightening to walk through that door. You know, are you outing yourself by walking through that door. Now, we have people who were not gay and lesbian in there. … [But] by being in there, the chances were high. (Interview, October 15, 2015)

Members were asked to sign in and select their preferred level of anonymity: names distributed internally (nonhidden) or not distributed at all (hidden; Network, 1990–2005). No option for public disclosure of the membership roster existed. Members avoided greeting each other outside of meetings for safety. A founder recalled,

I remember someone saying “Hi” to one person and that almost outed her because she was with someone else that said, “How do you know her?” And then she had to make up a lie and [she got] … a little upset. So, yeah, those were the very, very strict rules that we had so everyone could feel safe in that environment. (Interview, October 2, 2015)

One founding member brought buttons to disseminate at the meeting, consistent with LGB culture (Figure 3). The founder reflected,

Figure 3.

First Network button to show visible support for the group.

It was scary and it was exhilarating to wear the buttons the first years. … It helped us to identify one another and to give us a bit of an identity. But I also remember being … apprehensive having that button on when I interacted with some people, “Oh my god. How are they going to respond?” (Interview, September 17, 2015)

Safety concerns surrounded the first meeting, with new routines having been developed to protect member anonymity individually, within meetings, and the profession.

By the fall of 1993, the Network was a functioning organization with a vision; mission; elected officers; bylaws; and a self-published newsletter, The Networker, which was the primary communication tool from 1993 through early 2000s. An annual business meeting occurred at each AOTA conference with follow-up work completed by committees and communicated through issues of The Networker. Membership remained hidden from the public.

Points of Tension

Tensions, driven by LGB occupational therapy practitioners, the professional culture, and U.S. political controversy over LGB rights, marked the Network’s founding. Multiple sources revealed practitioner pushback to the first public announcement and members’ anxiety about outing themselves.

Initial Backlash

In June 1992, OT Advance, a privately funded magazine for occupational therapy practitioners, announced the Network’s request for AOTA to “endorse” the new networking group (June 29, 1992), resulting in a heated public discussion in the form of letters to the editor between June to August 1992 (Network, 1990– 2005). Headlines from letters illustrate the back-and-forth tension:

▪Let’s Not Let Homophobia Divide Us (July 13, 1992)

▪Is Group Really Necessary? (July 27, 1992)

▪Opening Door Took Courage (August 3, 1992)

▪No One Needs Special Privileges (August 3, 1992)

Change “Tough,” But We Need It (August 17, 1992)

When sharing their letter in a speech to Network members, one member stated in a 1993 Networker article, “It will probably not surprise you, as it did me, that occupational therapists are as prejudiced as the general population. … The idea of my [sexual] orientation being known by people I had not met was threatening.”¹ The announcement of the first meeting led to public discourse among practitioners, uncovering beliefs and stereotypes that informed future discussion about inclusion within the profession.

RA Meeting

The 1993 AOTA RA meeting in Seattle was an emotionally tense experience for Network members yet unmemorable for others in the RA. This was a public outing of the group to the association. One member described the experience: “I cannot describe how affirming and empowering it felt last year in Seattle to walk into the gallery of the Representative Assembly.”¹ When interviewed, that same founding member further reflected,

I remember this kind of tension we all had in this group. And then we walked into the RA, and [the] RA turned stunningly silent while we filed in and took our seats in the gallery [and] there was this sense of unease. (Interview, August 15, 2015)

Another member of the RA also gave a description in the Networker:

I was proud when the galley filled up with members of the Network. They even had to find additional seating. A significant amount of desensitization occurred that afternoon in Seattle, and I realized, as well as many other people, that there was no turning back now. AOTA was going to have to begin to deal with sexual orientation. (Network, 1990– 2005)

Entering the room as a group of Network members was recalled in many interviews as a tense yet exhilarating event.

The Network began to draw like-minded individuals interested in LGB civil rights both within and outside of occupational therapy. Some Network members promoted the Network publicly, some chose anonymity, and others chose not to join the Network. These diverse voices activated policy and emphasized the collective voice of this previously silent group. Tensions among professional values, culture, and fear of discrimination were evident.

Discussion

Our findings describe the Network’s beginning with themes of informal beginnings, formal beginnings, and points of tension. Informal beginnings refers to the internal and external contexts and the ignited discussions with like-minded people in a hotel room. Formal beginnings included AOTA Executive Board actions, the board’s response to members’ request to boycott a particular state for the location of the next conference because of that state’s anti-LGB legislation, a description of the first meeting, and its focus on protecting the anonymity of members. Points of tension described initial backlash to the Network’s formation and tensions associated with its formal outing at an RA meeting.

Interpreting history is complex, especially when evidence is limited. Schwartz (1992) commented that “there is no one right view of history, rather beginnings of dialogues” (p. 9). Network members felt events deeply that others did not remember upon later reflection. Although Network members described an event using phrases like “tension,” “unease,” and “stunningly silent,” others at the same meeting had no memory of the event. The irony of a practitioner protecting the rights and confidentiality of gay patients when not feeling safe themselves in occupational therapy is another example.

When the Network was founded, LGB practitioners felt unsafe in the profession, and Network leaders sought safe environments for both practitioners and clients. Greater LGB visibility and acceptance in the United States in the 1990s provided opportunity for change. Individual decisions regarding sexual orientation were made by LGB occupational therapy practitioners by weighing the safety and risk of staying hidden versus being seen. These individual decisions were shaped, in part, by the belief that private matters did not belong in public or professional forums, consistent with World War I–era cultural mores (Peters et al., 2023). This study revealed iterative relationships among safety, disclosure, and inclusion.

This occupational therapy example is consistent with broader research on network formation in other professions. Martinez et al. (2013) demonstrated that leadership within organizations plays a crucial role in supporting cultural change including policies to incorporate members of sexual minority groups. Workforce retention of LGBT health care professionals continues to be a contemporary issue (Streed et al., 2024). Professional networks can catalyze policy shifts that shape workplace cultural environments, including who enters, stays, and thrives in the profession.

However, such a change is not without conflict. Practitioners frequently face ethical dilemmas when the laws and policies of institutions, communities, or governments conflict with their profession’s values. In such cases, national organizations serve as ethical and professional compasses. In this study, members of a hidden group initiated and supported a change in AOTA’s human rights policy statement to include LGB people within protected groups. AOTA’s 1994 human rights policy revision removed all named groups protected from discrimination (e.g., related to race, ethnicity, gender, and disability) instead of explicitly adding sexual orientation. When groups are unnamed, inclusion becomes subject to cultural interpretation. This remains highly relevant today. AOTA’s (2020) Code of Ethics explicitly protects gender identity whereas U.S. laws continue to restrict access to health care and resources for transgender people, not only placing their safety and occupational participation at risk but also challenging the inclusivity and ethical foundation of the profession as a whole.

These findings raise ongoing questions about the responsibility of professional associations in the face of systemic discrimination: What role should they play when any marginalized group is threatened?

This unrecognized coming-out story of LGB practitioners reports the origin of a larger story about the impact of LGBT identities in occupational therapy. A T for transgender was added to the group’s constitution in 2002,¹ and by 2016 the Network’s formal name expanded to “Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Asexual, and Intersex+.” In this article we report only LGB-pertinent data, excluding later periods when gender identities became part of the Network’s mission.

Limitations

The research reported in this article has some limitations. First, we did not collect information on other forms of diversity beyond sexual orientation, leading to questions of how multiple identities affect occupational therapy practice. Also, this research did not address potential differences between sexual orientation types, so experiences across these groups may differ. Another limitation is that most of the archival data represent the view of Network members. Attempts to uncover alternative views occurred within the data, but the study is weighted heavily toward the contextual history of LGB oral histories and Network documents.

Implications for Occupational Therapy Practice

This research has the following implications for occupational therapy practice:

▪Understanding history is necessary when advocating for personal, group, and population change.

▪Safety is a prerequisite for change, and connecting with others in groups can facilitate safety.

▪Negotiating personal disclosure and professional integration involves individual decisions.

▪The perspectives of individuals and groups hidden in plain sight should be sought.

Conclusion

The Network was formed in 1992–1993 in the United States to advocate for LGB safety, visibility, and inclusion. Documenting its origin provides insight into how professional and societal cultures intersect and how occupational therapy practitioners have organized to transform their profession from within. The focus on one year carefully unraveled the fabric of the creation of a network for change. This historical lesson is an example of how hidden groups can spur change.