This article appears in the February 2000 edition of the Catholic Medical Quarterly
HOMOSEXUALITY AND PSYCHIATRY
In its August 1999 issue, the British Journal of Psychiatry published a useful article entitled 'British Psychiatry and Homosexuality' by Michael King and Annie Bartlett(1). The authors write from the perspective of psychiatrists who are homosexuals. This paper highlights some of their observations. The American Psychiatric Association published its Diagnostic and Statistical Manual (DSM)-11 in 1968. Until 1973 homosexuality was classified as a sexual deviation. In 1973 the Nomenclature Committee of the Association, responding to pressure from homosexual activist groups, recommended the elimination of the category homosexuality in favour of sexual orientation disturbance. This latter group would include those who are trying to lead chaste lives and resist homosexual temptations. As Davison and Neil, authors favourable to the homosexual movement, have written: The members of the Psychiatric Association voted on the issue, in itself a comment on the conduct of science in the twentieth century. The change was approved but not without vehement protests from a number of renowned psychiatrists (2)
King and Bartlett observe: After considerable social and political lobbying, homosexuality was removed from American diagnostic glossaries.
By 1987, with the publication of DSM-11 IR, even a diagnosis of 'ego_dystonic homosexuality, to describe homosexuals unhappy with their orientation, was rejected. Thus, by a vote of hands, a deviation became a 'lifestyle.
Despite this shift it is interesting to note that psychiatric textbooks written or revised in the last twenty years have continued to discuss homosexuality.
Why do people become homosexual?
Homosexuality is not a unitary or homogeneous condition. As has been written in Understanding Homosexuality: 'It is surely too much to find common aetiological features in, on the one hand, the psychopathic, perverse homosexual and, on the other, the passive exclusive homosexual(3). In other words, the causes of homosexuality in the promiscuous, the dominant and the effeminate are likely to be different.
However, there is a general consensus among psychiatrists that homosexuality is an emotional tendency that is learned. Kendall and Zeally write:
....... exclusive homosexual preference appears to be a uniquely human phenomenon, and one which varies in incidence from one type of society to another. This would suggest that, whereas biological factors may influence whether homo sexual activity occurs, the establishment of an exclusively homosexual orientation is probably the result of social learning.(4)
Another factor in the development of homosexuality is an abnormal family life. It must be emphasised that not all homosexuals come from abnormal families and not all abnormal families give rise to homosexuals.. However, a child needs to identify securely with the parent of his own sex and to have a happy relationship with the parent of the opposite sex.
Lack of confidence may stem from an absent or emasculating father or an overprotective mother, and undermine boys self confidence in relating to girls, so that attempts at heterosexual contact are likely to be unrewarding or even punishing.(4) Thus the homosexual person needs to see in the therapist someone in whom he can confide and who will show compassion towards his disorder.
A study carried out by Kenyon(4a) in 1968 on lesbians showed that poor relationships with either parent was common: twenty per cent thought they had been brought up like boys. Nearly twice as many lesbians, when children, had been frightened or disgusted by the sexual behaviour of men. A quarter of parents had divorced as compared with 5 percent in the control group. Social pathologies thus produce human disorders.
General inadequacies of personality which inhibit the transition from the all-male society of many boys during puberty and adolescence to the hetero sexual groupings of adult life may make a contribution in the causation of homosexuality .(5)
A useful way of uniting these different ideas is to suppose that young people develop with the capacity for both heterosexual and homosexual behaviour, and that various factors determine which behaviour develops more strongly. Heterosexual development might be impeded by repressive (abnormal) family attitudes towards sex or by general lack of self-confidence.(5)
King and Bartlett note that attempts to identify an organic cause for homosexuality have failed. They write: When the search is for a "gay gene" or an alteration in a cerebral "sex centre" rather than for the biological basis of all sexuality, gay and lesbian people become concerned that this really leads to marginalisation.'(1)
They fail to mention that some of those scientists (eg. Le Vay) are well known promoters of homo sexual rights. They rightly point out that these studies are deeply flawed. Furthermore, do the authors seriously contend that all sexuality has a mere biological basis ?Is this not reductionism of the human person? While it is possible that there is a small minority of constitutional homosexuals, social learning remains a crucial factor in its development.
Persistence of homosexual behaviour
It is said that sexual orientation, once established, is immutable. However, there is growing evidence that many individuals change their sexual preference at different stages of their lives. Slater and Roth have written that 'it is unwise to assume that exclusive homosexual behaviour has been established until the age of 25 has been passed(5). This group includes mentally immature adults on whom the final pattern of sexual adjustment is not yet decided. The pro- homosexual author, Michael Ruse, in his book, Homosexuality, has written: At adolescence many people are confused by their sexuality and it takes a number of years to resolve things fully.
Persistence depends on the persons age, the extent to which there has been previous heterosexual interest and the persons wish to change. Research suggests that, while a significant number will develop heterosexual tendencies, the majority remain homosexual.
The psychological problems of practising homosexuals
Hill, Murray and Thorley have written that 'homosexual relationships tend to be impermanent and may be promiscuous. The tendency to depression and suicide shown in a number of studies (eg. Lambert, 1954) may be related to this impermanence of relationship.(7)
According to Slater and Roth, homosexuals tend to be more promiscuous in their relationships with each other than heterosexuals; and the tendency is not confined to those with associated psychiatric disorders. The lack of stability of homosexual relationships, the difficulty of establishing fresh contacts with advancing age and the denial of the roles of parents and grandparents make the plight of the ageing homosexual a pathetic and difficult one. Some of the psychiatric disturbances, particularly alcoholism, depression and suicide (OConnor 1948) which are common in homosexuals may be related to such factors.(5)
Are homosexuals by nature more prone to psychological problems? The best evidence comes from large scale studies by Weinberg (1974) and Bell (1978) from the Kinsey Institute. They found a higher incidence of loneliness, lower self-acceptance and more depression and suicidal ideas in their male and female homosexuals than in their hetero sexual controls.
There is one truly tragic statistic secondary to the fact that a number of physical diseases are linked to homosexual activity: the average male homosexual in the United States will be dead before he reaches the age of forty five. Despite this, writers such as Davison and Neil, who support the homosexual lifestyle, state that clinicians should help them to resist the pressures that are still applied by those directing them to heterosexuality ... mental health professionals could be attempting more vigorously to reduce this widespread fear and abhorrence of homo-eroticism.(2)
King and Bartlett(1) discuss behaviour treatments in the management of homosexuality. From a Christian perspective, techniques such as covert sensitisation are unethical as they involve the use of erotic stimuli, aversive stimuli and masturbation. Besides, as the authors note, the outcome measures are poor. It is a pity that the authors fail to mention other treatment options. These include the excellent contributions of Dr. Gerard van den Aardweg and Father John Harvey who both report success in helping homosexuals towards celibacy and - on occasions - heterosexuality. King and Bartlett are likely to dismiss them as religiously orientated professionals who hold entrenched views that homosexuality can be cured.(1) It may be argued that these authors hold equally entrenched views that the condition cannot be cured.
Having failed to mention ethically sound options in the management of the condition, they observe therapy affirming homosexuality, however, is gaining ground. It is dynamically orientated but answers the needs of clients who are content with their gay or lesbian identities.
If they are so content why do they require therapy? Where do the discontented go?
The authors rightly condemn the unethical aversive therapies of the recent past. They fail to address the needs of those who are unhappy with their orientation. Are they to be condemned to a therapy affirming their homosexuality?
King and Bartlett (1) conclude their article by stating they did not intend to write a bland review. They write with passion, and there is much in what they say. As Christians we too must be aware of the mistakes of the past. Hatred and misunderstanding of homosexual persons have led to much unhappiness a few years ago. The Dominican, Father Gerald Vann related a story of the man who was advised by his confessor to marry a good Catholic woman after he had mentioned his homosexual orientation. One can but hope that this attitude is a thing of the past. The pastoral care offered by the church is more charitable than that offered by gay advocates. The church teaches that homosexual persons have the same dignity as any other human being, not because they are homosexuals but because they are persons.
King M and Bartlett A. British Psychiatry and Homosexuality. The British Journal of Psychiatry vol. 175, 1999 p.106-111.
Davison 0 and Neil J Abnormal Psychology, John Wiley, 1998 p. 358.
JA Understanding Homosexuality, MTP Publications, 1974 p. 21.
Kendell RE and Zealley AK Companion to Psychiatric Studies, Churchill Livingstone 1998 p.615.
4a Kenyon FE, Brit. J. Psychiact., 1968, 114, 1337 -50
Slater E and Roth M Clinical Psychiatry, Balliere-Tindall, 1986 p.1 74.
Gelder M, Gath D and Mayou R Oxford textbook of Psychiatry, OUP, 1989 p. 560.
Hill P, Murray Rand Thorley A Essentials of Postgraduate Psychiatry, Academic Press, 1979 p. 271.
Treatment options from a Christian perspective are found in:
Harvey J The homosexual Person, Ignatius Press 1987 p 119 et sub.
Van Den Aardweg G The Battle for Normality, Ignatius Press 1997 p 91 et sub.
Dr. Pravin Thevathasan is a Consultant Psychiatrist in Shrewsbury.