Thursday marks 43 years since the American Psychiatric Association, the organization that publishes the Diagnostic and Statistical Manual of Mental Disorders, voted to remove homosexuality from its list of mental disorders — a change that, to many, marked a major step forward for what would become the modern LGBTQ rights movement.

However, a week after the decision, the New York Times published a conversation between two doctors, Robert Spitzer, a professor of clinical psychiatry at Columbia and a member of the APA's nomenclature committee and Irving Bieber, a professor of psychiatry at the New York Medical College and the chairman of a research committee on male homosexuality. What that discussion would show was that there would still be a long way to go until gay and lesbian identities would be welcome into the mainstream.

Indeed, the APA's decision wasn't an end to the pathologization of sexual orientation. As Spitzer said in the story, homosexuality did not meet the criteria for a "psychiatric illness" because it did not "regularly cause subjective distress."

"In no longer considering it a psychiatric disorder, we are not saying that it is normal or that it is as valuable as heterosexuality," Spitzer noted.

A gay rights march in New York City, 1974 Anonymous/AP

Bieber said that homosexuality was the result of "a disturbance of normal heterosexual development," and compared the orientation to polio.

"What you have in a homosexual adult is a person whose heterosexual function is crippled like the legs of a polio victim," he said.

And, while the APA voted to remove homosexuality from its list of psychiatric disorders, it created a new disorder, "sexual orientation disturbance." It was a label that applied to, Spitzer said, "those homosexuals who [are] in conflict with their homosexuality."

In other words, being gay and comfortable with it was no longer a disorder — but being gay and unhappy about it was. It was a juxtaposition Bieber said was neglectful of the homosexuals who were most in need of help.

"To differentiate two types, to take what is really the most injured homosexual and say he shouldn't be in the DSM, and that the least injured, the one who has the potential left for restoring his heterosexuality, should be diagnosed as a sexual orientation disorder, to me seems wild," he told the Times.

Anti-gay protestors rally at a hotel in New York, 1977. Ray Stubblebine/AP

APA's declassification of homosexuality as a mental disorder was a step towards equality, but the fight to recognize LGBTQ identities as valid, and valuable, still continues. In most states, "conversion therapy," meant to "cure" people of their sexual orientations, is still legal, despite the fact that it is widely understood to be both ineffective and harmful. And in 32 states, LGBTQ people can be fired from their jobs or denied services because of their sexual orientation or gender.

The fight for transgender equality lags even further behind, and the trans community is still fighting against being attacked with accusations that their identities are an illness. The issue is further complicated by the fact that, for many trans people, a diagnosis of gender dysphoria is necessary to receive gender-affirming medical care.

That doesn't mean that Thursday's anniversary is meaningless. But muddied victories remain a reminder of how hard, how long and how necessary the fight for equality really is.