A Note Before We Begin: Positionality
This essay is written from a specific location: Western mental health care in the United States. It does not attempt to represent the full global history of LGBTQIA+ people, pride, or mental health. LGBTQIA+ histories are expansive, culturally specific, and shaped by different legal, religious, political, medical, and social systems across the world. This article focuses primarily on the US context, particularly the conditions leading up to 1969, the Stonewall uprising, the first Pride marches, and what this history asks of mental health providers today.
I also write from both a personal and a professional perspective. I am a transgender person, and I am a clinician. Those two facts are inseparable from each other, and they are inseparable from this article. I have sat in rooms where my identity was treated as a subject to be debated, assessed, or explained. I have moved through systems designed to decide whether I was assertive enough, distressed enough, consistent enough, or legible enough to deserve care.
I have also watched Pride, a movement born from survival, resistance, grief, and collective care, be reduced in some contexts to corporate logos, annual statements, and once-a-year gestures that bear little resemblance to its origins. So I write with both a clinical lens and a lived one. This is not a neutral history, because mental health care has never been neutral in the lives of LGBTQIA+ people. It has been a site of harm, gatekeeping, pathologization, survival, repair, and, at its best, liberation. What follows is not a full history of LGBTQIA+ mental health. It is a focused reflection on what Pride’s history can teach those of us who practice in this field today.
Before Pride: Survival under Pressure
Long before Pride parades, LGBTQIA+ people were building ways to survive. In the decades leading up to 1969, queer and trans life in the United States was shaped by criminalization, medical pathologization, police harassment, family rejection, and the near absence of affirming institutions.
In response, people created their own structures of care and connection: hidden bars, chosen family networks, coded language, underground publications, mutual aid, and social clubs. Homophile organizations like the Mattachine Society, Daughters of Bilitis, and ONE, Inc. offered some of the earliest organized spaces for education, community, and advocacy before “Pride” was a public word. At the same time, federal campaigns like the Lavender Scare purged thousands of suspected gay employees from government jobs, showing that stigma and exclusion were embedded in policy, not just personal prejudice.
This history matters because it helps explain why the community itself became such a vital source of protection. When institutions were unsafe or unavailable, LGBTQIA+ people relied on one another for information, recognition, housing leads, emotional support, and strategies for staying alive. In modern terms, many of these community responses served functions we now associate with protective mental health factors: reducing isolation, strengthening identity, and creating spaces where shame could loosen its grip. Research later gave us language for some of these dynamics. In his landmark article on minority stress, Ilan Meyer argues that stigma, prejudice, and discrimination create a hostile social environment that contributes to mental health burdens for lesbian, gay, and bisexual people. Related research by Frost and Meyer on community connectedness shows why belonging to affirming communities has become such an important part of well-being, even when those communities are imperfect or precarious.
How our field saw LGBTQIA+ people in the 1950s and 1960s
Understanding Pride’s origins also means understanding the professional context in which LGBTQIA+ people lived before 1969.
As Jack Drescher traces, homosexuality was listed as a psychiatric disorder in DSM-I (1952) under “sociopathic personality disturbance” and in DSM-II (1968) under “sexual deviations.” These labels reflected a time when same-sex attraction was widely framed as illness, deviance, or moral failure, and when many LGBTQIA+ people encountered mental health settings not as places of refuge, but as sites of stigma, correction, or attempted change.
That context matters because it shaped the emotional meaning of seeking help. Modern mental health care developed alongside fields such as social work, sociology, anthropology, public health, and later global health, all of which sought to understand human suffering in relation to social conditions, institutions, and systems. For many people, disclosure could carry serious consequences: loss of employment, family rejection, legal vulnerability, psychiatric labeling, or referral into treatments aimed at changing identity rather than easing distress. Even when individual providers were compassionate, the broader framework remained pathologizing.
It is also important to be accurate and proportionate here. The point is not that mental health was the only harmful institution, or even the central villain in Pride’s history. Police, employers, families, schools, churches, and lawmakers all played major roles in enforcing stigma. But mental health professionals were part of the social world LGBTQIA+ people had to navigate, and their theories, diagnoses, and treatment models could either reinforce that stigma or challenge it. That history helps explain why community-based support often feels more trustworthy than formal care.
Stonewall: A Turning Point in Public
In the early hours of June 28, 1969, police raided the Stonewall Inn in New York’s Greenwich Village. Raids on gay bars were common at the time, part of a broader pattern of policing queer gathering spaces, as outlined in the Library of Congress overview of the Stonewall era and the National Park Service history of Stonewall National Monument. What was different that night was the response. People resisted. According to the Stonewall 50 Consortium factsheet, roughly 500 to 600 people were out the first night, around 2,000 the second, and hundreds more over several nights of uprising. The Stonewall Inn and the surrounding streets drew a young, racially mixed, mostly working-class crowd: homeless LGBTQ teenagers, trans women of color, drag queens, lesbians, gay and bisexual men, sex workers, and neighbors from the Village.
That social makeup matters. Stonewall was not simply an uprising led by the most publicly respectable members of the community. It was shaped in large part by people already living at the intersections of multiple forms of vulnerability: poverty, homelessness, racism, criminalization, gender nonconformity, and survival-based street economies. Later retellings often flattened that complexity, which is why recent public history efforts have worked to restore it.
The Smithsonian’s article on Marsha P. Johnson and Sylvia Rivera, the NPCA’s Unsung Heroines of Stonewall, and PBS’s Who Was at Stonewall? highlight figures such as Johnson, Rivera, Stormé DeLarverie, and Miss Major Griffin-Gracy, alongside many others. There is no single, definitive story of “who started Stonewall,” and some early myths have been revised by the people involved. What most accounts agree on is that Stonewall marked a visible shift: a community that had long been forced to cope in private took that resistance into public space.
From a mental health perspective, Stonewall can be understood not as therapy, but as a collective rupture in shame and fear. A community that had been required to remain hidden, deferential, and fragmented responded publicly and together. For clinicians, that is worth noticing. The event underscores how strongly dignity, recognition, and group solidarity shape psychological life, especially under chronic threat.
The First Pride: Visibility as Intervention
One year later, on June 28, 1970, activists organized the Christopher Street Liberation Day March from the Stonewall area to Central Park. The NYC LGBT Historic Sites Project notes that thousands of people joined- far more than organizers anticipated. For many who marched, this first Pride was not primarily about celebration. It was about being seen together. Walking in daylight, out and named, directly challenging years of living in the shadows and years of hearing that safety required invisibility. It offered a different experience: safety rooted in community and numbers rather than secrecy.
That is one reason Pride’s history still matters in mental health settings. Pride was never only a parade route or a calendar month. In its earliest form, it created public conditions for belonging. It said, in effect, that isolation was not the only option and that collective visibility could be more than just danger.
Again, later research helps clarify why that mattered. Meyer’s minority stress framework explains how expectations of rejection, concealment, and internalized stigma affect mental health. Research on community connectedness helps explain why spaces of shared identity and belonging can have protective value. Pride was not created as a clinical intervention, but it carried many of the same ingredients we now recognize as psychologically meaningful: community, visibility, validation, and relief from aloneness.
What this History Offers Clinicians
Staying focused on the period up to and including 1969, Pride’s early history offers several useful perspectives for mental health providers. First, it reminds us that LGBTQIA+ communities were never waiting passively to be helped. They were already building networks of care, language, advocacy, and resilience long before institutions caught up. That matters clinically because it can shift how we understand our clients: not as people defined only by harm, but as people shaped by traditions of survival, creativity, and collective care.
Second, this history gives important context for mistrust. When people have inherited personal, familial, or cultural memories of policing, pathologization, and institutional rejection, mistrust is not irrational resistance. It is often an intelligent adaptation to history. Knowing that can help clinicians respond with more humility and less defensiveness.
Third, Pride’s early history reminds us that public rituals and shared meaning can matter psychologically. Marches, commemorations, chosen family gatherings, memorials, and community celebrations may not look like treatment, but they can support identity consolidation, reduce shame, and increase connection. In this sense, pride and other acknowledgment months can also be understood as forms of activism through joy, pleasure, and public declarations that LGBTQIA+ lives are not only to be defended but also celebrated. For some clients, these experiences may be every bit as important as what happens in the consulting room. A parade, a visual, a drag performance, a ballroom event, a queer faith gathering, or a chosen family dinner can become part of how someone remembers that they are real, connected, wanted, and worthy of a life beyond survival.
Finally, this history invites us to situate our field within a broader landscape. Mental health care did not create Pride, and it did not own the solutions LGBTQIA+ communities developed. But clinicians can still learn from that history: from the value of belonging, from the limits of pathologizing frameworks, and from the reality that communities often discover forms of healing before institutions have language for them.
As a transgender clinician who has lived on both sides of this history, I do not see Pride’s early years as an indictment of our field. I see them as an invitation: To understand the conditions out of which pride emerged, to recognize the creativity and resilience communities brought to their own care, and to keep shaping mental health practice that is informed by, accountable to, and worthy of that history.
For therapists, this also means recognizing that affirming care is not a static skill set we acquire once and carry forward unchanged. Our field asks us to keep learning throughout our careers, to pursue professional development, to engage emerging research, and to seek opportunities that deepen our understanding of the communities we serve. LGBTQIA+ clients deserve clinicians who are willing to examine history, update their knowledge, challenge inherited assumptions, and practice with humility and support of their clients’ dignity, safety, and self-determination.
