by David Scasta
page 1-2
by David Scasta
page 3-17
Traditional views on the causes and nature of homosexuality are colored by Western cultural hegemony. However, even within Western traditions, views on homosexuality have ranged from acceptance to rejection, from a non-issue to a moral issue, from a disease to a behavior. This article reviews some of the historical roots which slant current thoughts about homosexuality.
by Judd Marmor
page 19-28
The etiology of sexual orientation can be viewed from a scientific, ethical, or socio-politico-religious perspective. The latter view makes the question of etiology more consequential because of the prejudice and hostility against homosexuals in our society. Societal homophobia rests on four basic assumptions: (1) it is sinful/immoral, (2) it is "unnatural," (3) it is a chosen form of behavior that can therefore be unchosen, and (4) it is potentially contagious. The first assumption is a religious view for which dissemination of current research findings can help to undermine the irrationality of religiously based homophobia. The second assumption that homosexuality is contrary to the biological norm is not based on contemporary zoological research. The third and fourth assumptions that homosexuality is chosen and can be spread to others similarly lacks a scientific basis. If therapists believe homosexuality is an acquired behavior pattern (even if they consider themselves to be neutral with regard to homosexuality), their conscious or unconscious bias in favor of a heterosexual way of life may lead them to exert subtle but significant pressure on the patient towards a heterosexuality which does not come naturally. Such pressures can amplify self-rejection and inferiority. For that reason, the new views on the etiology of homosexuality are indeed important.
by Terry S. Stein
page 29-49
The most fervent academic debate in gay and lesbian studies during the past decade had concerned the extent to which a "social constructionist" in contrast to an "essentialist" approach to conceptualizing human sexuality, and particularly sexual orientation and homosexuality, provides a better understanding of these complex phenomena. Because this debate has occurred primarily within the social sciences and humanities and outside of psychiatry and the other mental health fields, the specific implications for the theory and practice of psychiatry and psychotherapy remain largely unexplored. This chapter describes these two sets of ideas, explains their relevance for psychotherapy, and outlines issues raised by these theories for the clinician working with gay and lesbian patients.
by Jack Drescher
page 51-74
This paper offers a psychoanalytic approach to treating gay men. It addresses some of the historical thinking about homosexuality within medicine, psychiatry and psychoanalysis. It presents clinical theory useful in thinking about psychoanalytic psychotherapy with gay men and also provides clinical material to illustrate its points. The clinical examples are confined to gay men because they are representative of the patient population I treat. Some issues may be similar for gay women but that subject needs to be addressed by someone with greater expertise in that area. Finally, the paper shows how this approach differs from what is currently referred to as "reparative therapy of homosexuality" and discusses theoretical and clinical problems inherent in that approach.
by Richard C. Pillard
page 75-85
A number of biological approaches have been taken to understand the origins of sexual orientation (both homosexual and heterosexual). Studies of hormone levels (both prenatal and postnatal), endocrinopathies, and exogenously administered hormones have failed to demonstrate any consistent effect on sexual orientation. Neuroanatomic studies have found some differences between homosexual and heterosexual men but the evidence is weak, confounded by sampling variation and lacking in consistent replication. The genetic evidence is stronger based on twin studies. Fifty-two percent of identical twins were found to be concordant for homosexuality in one study compared to a 4% incidence of homosexuality in the brothers of non-gay men. Studies by Hamer et al. Found an 82% concordance between gay brothers of the Xq28 site on the X chromosome suggesting a maternally mediated genetic inheritance. The study has yet to be replicated. Even if all the biological factors governing sexual orientation were known, it is possible that accurate predictions about individuals could never be made because of randomness in the neural connections during development.
by David Scasta
page 87-98
All gay people, to one degree or another, travel down the road of "coming out" to themselves and others about their sexual orientation. The journey lasts a lifetime and is profoundly affected by societally inculcated homophobia. Gay people who are able to affirmatively acknowledge their sexual orientation to self and others tend to be happier, healthier and better able to bond and develop a social network than their closeted counterparts. Typically, the journey is in stages. A therapist can smooth the transition through these stages, helping the patient to avoid some of the pitfalls of coming out such as "reparative therapy," "catastrophizing" the perceived risks, "crashing out" (with increased risk of STD's), and premature bonding. For those patients for whom coming out is risky or imprudent, the therapist can help the patient balance the benefits of each degree of disclosure against the risks (which are often exaggerated by the patient). Education -combating myths about gay lifestyles and fostering integration into gay communities - is presented differently, depending upon the therapist's own sexual orientation and degree of personal disclosure to the patient. Education is an important antidote to stigmatization by society, religion, families, and self. Specific issues such as coming out to parents and children, assessing bisexual behavior and addressing religious proscriptions often require additional education and interventions on the part of the therapist.
by David Scasta
page 99-111
Straight adolescents go through a long period of training for intimacy. The developmental steps are well-worn - beginning with mixed gender group activities and school contacts, moving to dating and going steady. A lesbian or gay adolescent, particularly is he or she is aware of being "different," generally does not have such a road map to follow and heterosexual models of dating are ill equipped to manage the special hurdles that a gay or lesbian individual must surmount to gain social/sexual intimacy.
A therapist can pave the path to intimacy by effective therapeutic intervention early in the first phases of moving out of the stage of gay identity formation into gay socialization. The first paving stone can be laid by educating the patient about the process. A variety of myths about one's desirability and suitability for a gay relationship grow out of the fact that the availability of suitable partners is severely curtailed by minority status and closeting. These myths routinely stigmatize lesbian and gay people such that routine interpersonal difficulties are introjected as characterological flaws that will forever exclude true intimacy. The second stone is laid by helping the patient know and understand dysfunctional dating styles. AIDS prevention is an early and integral part of this step. The third stone is the development of effective strategies to find and target potential partners. The fourth stone is converting first dates into second dates. The fifth stone is reconstructing rejection as a necessary process in moving from dating communication to intimacy. The therapist must always keep in mind that heterosexual models, which were derived out of the need to parent children for many years, may not be effective models governing healthy intimacy among gay and lesbian peoples.
page 113-114
Transcribed by Emma McCulloch
19 January 1999