© 1989 Rich Grzesiak, all rights reserved.
Still Crazy After All These Years - (Our) Gay Mental Health
Talked to your shrink lately? How's that relationship with that difficult boyfriend going - are you ready to pull your (or his) hair out? If you think hard about it, have you ever really hated yourself for being gay, and contemplated the possibility of forever changing your sexual orientation?
If you find yourself wondering about these questions, the sometimes ersatz (if not mentally ill) people you encounter in gay life, and the reasons so many gay relationships fail, then perhaps Doctor Richard Isay's new book Being Homosexual: Gay Men and Their Development [Farrar Straus Giroux; $14.95/hardcover] may sate your curiosity - or even inspire you to seek treatment with the right, gay-positive psychotherapist.
Gay life brings many, many emotional and mental problems, a great portion of which are the responsibility of the larger, homophobic society that engulfs us. Finding a good therapist capable of dealing positively with these issues is often like the quest for the Holy Grail - an impossible journey that can even lead one down the road of homophobic therapy (which Isay warns us to steer clear of), alcoholism, and, simply, a miserable life.
Isay, a clinical associate professor of psychiatry at Cornell Medical College, claims his "book is about the formal developmental passages in a gay man's life. Just as heterosexuals have these passages that go from the early childhood attachment to the father, gay men can be derailed from successfully meeting their normal developmental tasks, by rejection of the father." In talking to me, he makes some interesting points about what you can do to find a good therapist, why homosexual men have the sexual orientation they do, the socio-legal factors that prohibit gay relationships from succeeding, why some self-help groups that regard sex as an addiction may actually be harmful - and perhaps most shockingly of all, he warns gay men to stay away from homophobes in the mental health community.
Ultimately, though, Isay believes that gay men must work on their self-esteem so they can go through the developmental passages in their life in a healthy way. For some of us, tragically, this process is postponed 'til one's middle age.
I reached Isay recently by phone, and we had a very full, if not therapeutic consultation:
Rich Grzesiak (RG): In this day and age, one automatically assumes that psychiatrists are, if not pro-gay, then at least neutral on this subject. How extensive is homophobia among psychiatrists?
Dr. Richard Isay (DR): The American Psychiatric Association (A.P.A.) in 1974 came out with a new diagnostic manual stating that homosexuality was not a disease. Even though within organized psychiatry as a whole there continues to be a diversity of opinion about that, those psychiatrists who continue to believe that homosexuality is a disease and even that gay men should be changed to heterosexuality are psychoanalysts or those influenced by psychoanalytical thinking Among analysts, unlike Freud, since the 1930's there is a feeling that the only normal developmentis a heterosexual one. There is such an investment in this, that it's very difficult to change [it], i.e., any "normal man" has to successfully traverse the oedipal stage of development - an erotic attachment to the mother and identification with the father, which leads to heterosexuality. By definition, anything that interferes with that [represents] some kind of trauma within the family - either the overly possessive mother or the inordinately absent father - which derails the potentially heterosexual son from achieving this end point - therefore he develops, according to them, a deviant or perverse sexuality.
I have attempted to show that, on the basis of my clinical experience, this is not true, there is no difference in the family backgrounds of gay men and straight men. Certainly, the theory can be faulted also because by definition, in psychoanalytic theory there must be some kind of trauma which is hurtful to the child and leads to other kinds of problems. In my and others' experience who treat gay men who do not want their sexual orientation to be changed, there is no more disturbance in gay or straight men seeking treatment.
RG: Let me pose a few questions a general reader of Edge might ask. I suspect that more gay men than ever are entering therapy. How do you make certain your therapist is not homophobic?
DR: You should ask! Anybody who goes to a therapist should try to find out if the therapist feels that a)homosexuality is normal for somebody who is gay, and not a deviant or perverse sexuality - and that can be asked - and b)if I were going to a therapist I would not be satisfied with an answer which is, "I can't treat anybody with neutrality," because that is not true if the theory that guides the treatment is one which by definition suggests that anybody who does not achieve heterosexuality is deviant, no matter how hard clinically he tries to be neutral.
I think any gay man who goes into treatment should be very careful about the kinds of answers a therapist or analyst gives him. Gay men should not go to analysts unless they are very, very careful because of the powerful theory that guides the clinical thinking of most dynamically oriented therapists.
RG: If you were considering therapy, what would you do to find a good instead of the proverbially bad therapist one hears about so often?
DR: You can pursue someone who has a good reputation in the community but often that's not good enough, because working with gay men demands a particular knowledge about the kinds of developmental issues gay men encounter in the normal passages of their lives.
One way of going about this is to ask the AP.A., which maintains a list of people that are particularly interested in gay and lesbian issues. But no therapist is going to be right for everybody. I think a patient who goes should rely on his intuition, on how he relates to his therapist and vice versa.
RG: Have you ever heard of a malpractice suit against a psychiatrist that would route back to any kind of homophobia?
DR: I haven't heard of anybody doing it, but I must get four or five letters a month from people who have previously been [involved in] terrible therapy. I just received a note from somebody who was in analysis for fifteen years and in psychotherapy for another ten. [This man] was finally treated by somebody who was good, someone I knew.
It 's a really tragic story, but I hear these kinds of anecdotes all the time. This man struggled through some twenty odd years of treatment to become straight. He finally got a therapist who said this is ridiculous. At the age of 45, he was finally coming to terms with his sexuality.
These kinds of issues are ethical issues. If you believe, as the A.P.A. does, that malpractice is literally not giving good treatment, I think it falls within the range of malpractice for a gay man to be submitted to that for a number of years.
As far as I know no one has ever sued an analyst or therapist for [homophobic] treatment. Frankly, I hope that someday it might be possible to examine those issues as ethical ones.
RG: Inveterate readers of the gay press might jump to the conclusion that gays never suffer from low self-esteem, that gay is good and wonderful and so terribly proud. But the reality is quite different: many gays hate themselves because of their homosexuality.
DR: There must be some of that in any gay life because of the homophobia that surrounds all gay men in our society.
RG: Internalized homophobia. How do you generally treat someone gay who comes to you with really weak self-esteem? I have a 37 year old friend, for example, who is recovering from alcoholism and suddenly realizing that while he enjoys homosexual acts, he really hates himself for being gay, and is quite uncomfortable being around other gay men.
DR: These are usually men who have suffered from rejection, usually from their fathers and sometimes from their mothers as well These are the kinds of men that Charles Socarides, Irving Bieber and many psychoanalysts see - men who hate themselves, and who then draw the conclusions that all gay men are terribly disturbed Such men with such low self-esteem usually do have parents who have been rejecting in one way or another. An overly involved mother usually uses such kids as narcissistic extensions of herself, and the boy grows to feel that the only way he can be loved by her is by becoming the kind of person she wants him to be - he's her little boy.
They are very often unable to express their attachment to the father, which in my opinion all gay men are imbued with, a primary, very powerful emotional and erotic link. They may become either very injured by the mother, feeling only that they can be loved as they conform to the way the mother wants them to conform, or because of their atypicality, they grow to feel very rejected by their father and develop low self-esteem.
Those are the patients most analysts see, with enormously low self-esteem, above and beyond the kinds of self-esteem problems all gay men have in our society, perhaps even to a limited extent. They may even strive to be straight.
RG: The gay man I referred to, as part of his therapy, daily does affirmations aloud (on the order of "I like and approve of myself").
DR: For him, that is probably very good, really an attempt at behavior modification. The kinds of therapy I am used to doing as a traditionally trained analystis [to help the patient] unravel the entanglements from his early life that have made it difficult for him to recognize he is gay, and to affirm himself as a gay man . [This approach] has longer lasting benefits for many, not for all.
RG: Do you think it is unethical for an analyst to try to change the sexual orientation of a gay man?
DR: Yes, because I think it is harmful. I believe it further causes symptoms by lowering the self-esteem of his patient. My experience in follow-ups with patients where a therapist has attempted to do that is that it inevitably results in depression and/or anxiety or some other symptom due to lowered self-esteem.
Somebody is gay from the time they are born -[being gay] has a powerful constitutional origin. To imply that there is something wrong with their gayness is going to do permanent damage to the self-esteem of the patient. I think it's horrendous.
RG: We both live in very urban, sophisticated parts of the country. Do you think there are many gay men who still want to change their sexual orientation?
DR: Well, even your friend, with his low self-esteem, and possible early injury from familial relationships, could very well, going to the wrong therapist, find himself eagerly hearing that "Well, you're really not gay, you're a latent heterosexual, and if you practice being heterosexual, and understand why you are sick, you will become heterosexual" You can easily gravitate toward that kind of therapy and get hooked into it for years. I not only see this kind of thing in my office, I get letters attesting to it.
RG: I mentioned alcoholism earlier, and I noticed that you don't mention it very often in your book. Some sources suggest that 30 to 40% of gays suffer from chemical dependency.
DR: I would be surprised if it's that high, but certainly there is a statistically higher incidence of alcoholism among gay men than straight men. Where does this come from? Probably a number of factors, including rampant homophobia, [because of] where gays socialize (chiefly in bars).
I blame mainly society. I am sure it is not linked causally to homosexuality in any way [Addiction] becomes a way of reducing anxiety.
RG: What's your attitude toward 12-step groups like Gay Alcoholics Anonymous or Al-Anon? How do you deal with patients who raise that as part of their therapy plan?
DR: You know, I've never had a patient who has.
RG: Really!
DR: If a patient did, I would say fine, but I've never had a patient with that severe an alcohol or drug problem who is gay who was in A.A. at the time I was seeing them. But I would say fine!
RG: Well, they're probably too drunk to get to you to keep their appointment, I guess!
DR: Well, that's likely.
RG: Are you aware of the rise of a very unique 12-step group called Sex and Love Addicts Anonymous (S.L.A.A.)? Their premise, based on the Twelve Steps of A.A., is that they're powerless over their addiction to sex and relationships. These groups seem to be proliferating in various urban gay subcultures.
DR: My feelings about gay men and what you label as an addiction to sex [stems from] the kind of split between sex [on the one hand] and affection and love [on the other hand] that is not unusual among gay men in our society. I feel very strongly this has to do first of all with the fact that gay men are not enabled by the social structures (the laws and practices in our society) to bring sex and affection together in any kind of meaningful way. Gay men have never been allowed to elaborate a system of courtship in our society as they're supposed to.
Secondly, any gay man who grows up feeling his sexuality is perverse or sick will have a very hard time feeling there is anything loving or lovable about him or that somebody who loves him will be anything other than corrupt, sick, sinful and bad like he is! This has led to this split which we see very often. Not that the disparity between affection and sex is absent in heterosexuals, but it is more present [among gay men] because of the social constraints on the expressions of gay male sexuality.
[I feel very strongly, too] that if parents, particularly fathers, were able to be loving and accepting of their gay sons from a very early age, then this [kind of divergence] would not be so prevalent If gay men were not rejected so often as children, especially by their fathers, because they seem atypical, gay men would grow up feeling their sexuality was acceptable and they were capable of being loved and loving.
There are two issues here: society should change, a long range goal, hopefully. Meantime, families should become more knowledgeable about their gay sons -gay sexual orientation is constitutional and families are not responsible and there is nothing to feel guilty about - if their sons are loved, they will develop into loving gay adults capable of sexuality and affection together in a loving relationship.
I strongly believe that to feel loving and loved in a gay relationship has a very healing effect on gay men. [This condition] not only makes you feel good about yourself, but it protects you from our society's rampant homophobia.
RG: Ideally, then, you don't think that a child parented by gays should have any more problems than a child reared by non-gay parents?
DR: If the gay parents are accepting of themselves and their own sexuality, that child, whether he's gay or straight, is going to feel loved and feel capable of being a loving adult. Incidentally, there is no evidence such children will grow up more likely to be gay than straight.
RG: For argument's sake, let's assume that a child has loving gay parents. Those parents don't function in a vacuum, but dwell in a society that is rampantly homophobic. What about the queer hating reactions of that child's peers - teasing about the gayness of one's parents?
DR: If that child is loved, and loves his parents, he is going to be able to withstand that readily, but with pain.
RG: I lunched recently with a twentyish gay man who was very curious about the gay bar scene of the seventies. I fear that I horrified this poor soul with my honest ramble down memory lane. The bars, the cruising areas, the endless bathhouses.
DR: Frankly, I don't think there's anything inherently wrong about baths. It has been a place for gay men to meet each other in our society, where, among gays, sex has been a way, because of the constrictions of our society, to meet. Obviously, every gay man should practice safe sex but I don't think the government has any business interfering in these kinds of issues.
RG: I recently learned that yet another acquaintance was diagnosed with AIDS Having been through this process a number of times already, I know how devastating the emotions one processes can be. I wanted at first, to just cut off ties with them, because I couldn't deal with the potential grief involved. I suspect many gay men do just that.
DR: As someone who has had gay friends who have been sick, and who has seen many patients through an illness to death, I know it is an enormously difficult time. One must struggle against the wish to be self-protective and withdraw, because someone sick with ARC or AIDS needs all the more love and attention There is even a tendency among therapists and doctors generally who deal with a lot of [physically] sick gay men to withdraw.
You have to be very careful because you cannot remain effective dealing with somebody with AIDS unless you yourself are emotionally in tune with that and open to their pain. You cannot seal it over. That applies to friends, too - you must remain very giving.
RG: When I meditated on it, I concluded that death can be a very enriching experience emotionally for all involved. I've matured by dealing with death at an early age.
DR: As a therapist, I've seen how it has affected me in treating gay men who are dealing with death and dying. It sharpened my perceptions in the sensitivities it has honed in me. But it has also necessitated my remaining very open and vulnerable to the pain I was never trained to deal with. To treat a patient as they are dying changes your relationship from being a therapist to that of a supportive friend as a necessary part of the treatment.
RG: Should gay men who engage in illicit sex - men who frequent tearooms or other public places - be prosecuted? Do they have mental health problems?
DR: The late Laud Humphrey's book entitled Tearoom Trade suggested that such men were well ensconced in their heterosexual communities, or married and very much afraid of engaging in any other kind of sexual or emotional activity which would permit them to be more open.
No, such men shouldn't be prosecuted The fact remains that our society does not permit full and loving expressions of gay sexuality. I have absolutely no doubt that if our society changed to legally permit gay marriages one would not find so many gay men engaged in sex in porn theaters, baths and tearooms.
RG: Are gay men who engage in sadomasochistic sex mentally ill?
DR: [I will only say that] what does not cause injury to one's self or other people is not sick.
RG: Like many other gay men, my own experience with relationships has been a troubled one. If gay relationships were legalized by society, would we deal with less problems? Or are we talking about the chicken or the egg here?
DR: No, we would be dealing with less problems.
RG: You really believe that?
DR: I really believe that. I'm not saying that gay relationships are like straight relationships. They are not; they are inherently different Male/male relationships differ from male/female ones, as I discuss in Being Homosexual: Gay Men and Their Development. But I do feel that if there were legally and socially positive sanctions for gay relations, there would be a much easier path for gays to follow in living lives together.
To some extent, this is a chicken-and-egg issue, because the problems gay children have with self-esteem [eventually surface in relationships]. But gay men who do not feel capable of being loving or loved, will encounter problems in relationships. However, society can certainly help in such an inexpensive way.