Exp. Clin. Endocrinol. Vol. 98, No. 2, 1991, pp. 155-161
J. A. Barth, Leipzig
Contemporary Psychoanalysis and Homosexuality
Summary. In this paper, I contrast older, traditional, psychoanalytic ideas about homosexuality, with those put forth at a panel on homosexuality at the American Psychoanalytic Association in 1983 (and subsequently). I focus particularly on relationships between cross-gender behavior during childhood and adulthood homosexuality; sexual orientation and personality functioning; determinants and intrapsychic consequences of homophobia, countertransference issues in working psychoanalytically with gay and bisexual patients; the sexual orientation of the analyst (i.e.
should gay patients be treated only by gay analysts?). Changing psychoanalytic ideas about sexual orientation reflect the increasingly widespread recognition by psychoanalysts of the necessity to integrate psychoanalytic theory with advances in neurobiology, particularly neuroendocrinology.
Key words: Psychoanalysis - Psychodynamic - Gender non-conformity - Freud
Since psychoanalysis was created by Freud, a few introductory remarks about Freud's ideas about homosexuality are in order. His views were complex and inconsistent. In his famous letter to the mother of a homosexual, he argued that homosexuality is neither a vice nor an illness (Freud, 1935). He pointed out that Plato, Michelangelo, and Leonardo were homosexual and spoke out against persecution of homosexual individuals. He also pointed out that it was generally not possible to change sexual orientation with psychoanalysis. In a letter to Ernest Jones, he affirmed the right of homosexual people to become psychoanalysts (Freud, 1921). In other writings, however, he took quite a different stance, which critics have argued resulted from three major biases (Friedman, 1988; Lewes, 1988):
A pathographic bias - this led Freud to discuss so-called "primitive" mental mechanisms found in "inverts" and to suggest that "their compulsive longing for men has turned out to be determined by their ceaseless flight from women". He posited a developmental pathway characterized by identification with a woman - and subsequently searching for a male sexual object resembling the self. The sexual partner could then be loved as the mother had loved the prehomosexual child.
A phallocentric, anti-female bias - Freud felt that women were more "primitive" than men. He spoke of "the greater proneness of women to neuroses, and especially to hysteria". Freud attributed this to a model of female development which is now outdated. A bias resulting from a tendency to look upon psychoanalysis as a microscope of the mind. One could generalize from it as one could from looking at cells under
Downloaded by: Universite Laval. Copyrighted material.
R. C. FRIEDMAN
156
Exp. Clin. Endocrinol. 98(1991) 2
a microscope. I suspect that this tendency may have influenced psychoanalytic psychology away from the necessity to test hypotheses with research. In addition, Freud lacked terminology to express the distinction between genderrelated behavior and erotic behavior in his writings. This condensation reflected a way of thinking; (passive = feminine = homosexual). This, too is outdated. Following Freud, most psychoanalytic writings were also influenced by these biases, however. There were many reasons for this. In a recent review of the history of psychoanalytic ideas about homosexuality, for example, Kenneth Lewes com-
mented that many psychoanalysts "pursued their work for three reasons: to confirm Freud's ideas; to illustrate them with specific case material; and to generalize these ideas to realms other than clinical, such as art, anthropology, or education (Lewes, 1988).
example, of projective tests in homosexual and heterosexual men challenged many psychoanalytic hypotheses of the day. This investigation was carried out outside
of organized psychoanalysis, although it focused on psychodynamics (Hooker, 1967).
In the United States during the post World War II years, most psychoanalytic writings about homosexuality utilized Freud's drive theory, and his model of childhood development. The emphasis in most articles was to put forth a model directed at explaining the etiology of homosexuality and relating this to specific types of psychopathology in homosexual patients (Bayer, 1981; Lewes, 1988).
This line of speculation found in the writings of such analysts as Bergler, and Socarides, (and many others), rested on the notion that so-called "normal" development always resulted in heterosexuality. Derailment from a so-called "normal" developmental track was most serious when it occurred during early childhood years, prior to age 5 or so. Such derailment, due to traumatic experiences of various types, not only produced what Socarides termed "obligatory" homosexuality, but also led to global impairment in personality functioning. Two types of such impairments were stressed: in one, patients experienced severe anxiety, irritability, identity disturbances, and were prone to impulsive-compulsive acitivities and poor judgment. Patients in this group would be called Borderline today. In the other category of pathology, patients were dominated by the pursuit of pleasure, had impaired frustration tolerance, and poor self-esteem regulation. Patients in this group would be called Narcissistic today (Socarides, 1978). This way
of thinking about homosexuality influenced the architects of DSM-I in which homosexuality is listed as a Sociopathic Personality Disorder, and DSM-II in which it is listed as a Sexual Deviation, such as sexual sadism or fetishism. Psychodynamically oriented office practitioners were offered no way of conceptualizing homosexuality except in the framework of developmental derailment, character pathology, and sexual pathology. Three major recent intellectual and social-political developments have influenced clinical psychoanalysis, however, and these influences are continuing to exert powerful effects on the way the field as a whole conceptualizes homosexuality. The three developments to which I refer are the Gay Activist Movement, the movement in psychiatry away from a Freudian psychodynamic frame of reference toward a
Downloaded by: Universite Laval. Copyrighted material.
As I mentioned, psychoanalysis itself tended away from research, and this had consequences for psychoanalytic models of homosexuality. Hooker's study, for
R. C. FRIEDMAN, Psychoanalysis and Homosexuality
157
descriptive, empirical one, and the growth and evolution of sexual differentiation theory. The Gay Activist Movement included a Gay Activist psychiatric component. I feel that this influenced psychiatric thinking in a progressive manner. Although the decision by the American Psychiatric Association to drop homosexuality as a diagnostic category from the DSM occurred in a context in which Gay Activism made its influence felt, this decision was not made in response to political pressure,
numerous scientific issues concerning sexual orientation. Meanwhile, at the same time as Gay Activism was becoming a substantial political movement, extremely far-reaching changes were occurring throughout American psychiatary. The field as a whole was moving rapidly towards a biodescriptive framework and away from a psychodynamic framework. These changes were reflected in the alteration in the format of the DSM. Emphasis was now placed on establishment of diagnostic categories that were reliable and valid. Psychodynamically oriented diagnosticians were increasingly held accountable for their views according to generally accepted criteria of science. Knowledge explosions in psychopharmacology and the neural sciences occurred coincidentally. Huge areas of diagnosis and treatment of psychopathology were completely reframed. Traditional "psychoanalytic" concepts about affective disorders, anxiety, obsessions and
compulsions, phobias, just to name a few, were supplemented, and sometimes replaced, by powerful new models. Modern clinicians, psychodynamic or otherwise, do not attribute compulsions to harsh toilet training. Nor do they attribute female psychosexual and character disturbances to difficulties, in shifting from psychological investment in the clitoris to investment in the vagina. The scientific scrutiny by psychiatry concerning the data base for psychoanalytic judgments about sexual orientation, then, was part of a larger process reflecting the importance of empiricism in clinical disciplines. The third influence on recent psychoanalytic discussions of sexual orientation was sexual differentiation theory. I will limit my observations about this to the following:
1 .Constitutional predisposition was an area that Freud stressed throughout his writings. The psychoanalytic literature had moved away from constitutional predisposition for many years. Sexual differentiation theory is influencing the field to redirect its attention to this area. 2. Sexual differentiation theory has also challenged Freud's model of childhood development. The basic principles of gender identity differentiation, for example, are fundamentally different from anything suggested by Freud. It must be noted that, at least in the United States, the full significance of gender psychology and psychoneuroendocrinology has yet to be felt at the level of psychoanalytic education centers. Indeed, most older psychoanalytic faculty is probably not well informed about these areas. Nonetheless, twenty years ago the same could be said of psychopharmacology. This is no longer true today. I am hopeful that since sexual behavior was at the core of psychoanalytic theory at its outset, the discoveries pertaining to sexual
Downloaded by: Universite Laval. Copyrighted material.
but for scientific reasons. Gay Activists and others directed attention to areas underattended to previously. The reasons for the previous lack of attention were socio-political, as well as the reasons for subsequent focusing of attention on the
158
Exp. Clin. Endocrino!. 98 (1991) 2
differentiation will soon become part of Psychoanalytic Institute curricula - generally.
Be that as it may, the 1980's gave witnessed major changes in the way American psychoanalysis conceptualizes sexual orientation. In 1983, for example, the American Psychoanalytic Association sponsored a panel on homosexuality that was radically different from any that had preceded it. This panel, consisting of Robert Stoller, Stanly Leavey, Richard Isay, and myself, viewed homosexuality as non-pathological, and, in addition, directed attention at sexual differentiation theory, and at limitations of previous psychoanalytic models (Panel,
Subsequently, Richard Isay has written extensively about his experience as an analyst of gay men. Many of Isay's perspectives about homosexuality are similar to those previously put forth by Havelock Ellis. Isay's data base consists of 40 adult gay male patients, well-integrated, and accepting of their sexual orientation. From this sample, he created a "framework for the normal development of gay men". Like Ellis, Isay concluded, "the expression of their sexuality is both normal and growth-enhancing for gay men"; and that homosexuality, like heterosexuality, is constitutional in origin. Attempts to alter sexual orientation are ill-advised. Isay related early developmental differences between homosexual and heterosexual
men to primary erotic attraction towards the father in homosexuals, and toward the mother in heterosexuals. Gross gender behavior disturbances during childhood of prehomosexual boys was seen as reactive to primary erotic attraction toward the father. (Isay, 1989, p. 19): "On the basis of my clinical work, I have come to believe that at ages 3, 4, 5, 6 some homosexual children assume opposite gender characteristics in order to attract and sustain the attention of the father...These are usually such attributes as gentleness, sensitivity, and a lack of interest in aggressive sports. Some homosexual children may also seem noticeably feminine in dress and behavior. I believe that they develop these characteristics for the same reason that heterosexual
boys develop certain of their father's attributes - in order to attract first the mother's interest and then someone like the mother. These identifications in homosexual children appear to follow the manifestation of the sexual orientation and the erotic attachment to the father and not to precede them". He attributed retrospective distortion influenced by anxiety about sexual attraction to the father as the cause of the common clinically expressed poor quality early father-son relationships of gay men. Where do Isay's ideas fit into the clinical and nonclinical literature on homosexuality?
The area he discussed is limited to that of the reasonably healthy homosexual person. Certainly, some of his observations about this specific group are compatible, not only with those of Havelock Ellis, but of other analysts, including myself. Specifically, these observations pertain to the issue of change of sexual orientation, and to the capacities for love, work, and play of men in this group. Isay's developmental theories, however, are based entirely on clinical work with adults. I will return to his gender theories shortly.
Downloaded by: Universite Laval. Copyrighted material.
1983).
159
Subsequently, Isay has emerged as a moral leader in the field. He has attempted to get the American Psychoanalytic Association to adopt a statement condemning discrimination against homosexuals as the APA had adopted in 1973, and to go on record condemning exclusion of homosexual individuals as candidates for psychoanalytic training. Isay linked the reluctance of the American Psychoanalytic to do this (i.e. and to refer the issue to its member local institutes) to a widespread lingering belief by many American analysts that homosexuality is psychopathology. Sadly, this is probably true, but much less so than used to be the case. The American Academy of Psychoanalysis, in contrast to the American Psychoanalytic Association, did at its last meeting in 1990 adopt a strong resolution condemning discrimination against gay individuals. The present state of American psychoanalysis regarding homosexuality is, then, inconsistent. This should come as no surprise since the field is inconsistent about so many other issues these days. There does seem to be a generation gap, with younger people much more welcoming of new ideas, as is often true in general. I now want to discuss some specific clinical and scientific issues in light of recent developments in psychodynamic thinking beginning with the determinants and consequences of homophobia - homoparanoia. It is being increasingly appreciated that irrationally based negative attitudes towards gay people generally contribute to the psychological difficulties of gay and bisexual patients. These negative attitudes are routinely found among family and peers of patients, but may also occur in health professionals and mental health professionals as well - including psychoanalysts. The origins of homophobia/homoparanoia have tended to be the target of psychological research but not of systematic detailed investigation from within the psychoanalytic community. The Group for the Advancement of Psychiatry, however, is at work on a monograph on homophobia/homoparanoia. The subcommittee responsible for this does have a number of analysts on it, and the psychodynamic determinants of homophobia/homoparanoia are a major interest of this group. We are collecting clinical material as present. The leadership in this venture, however, still comes from psychiatry, not organized psychoanalysis. I would like to return now to the topic of childhood cross-gender behavior in relation to adult homosexuality, in order to comment on Isay's recent speculations about this. The topic itself is a provocative one in light of the erroneous belief common in the general culture that gay men are not masculine. The data base confirming the association between childhood cross-gender interests and activity and adult homosexuality requires no review in this article. It is helpful to keep the distinction between gender non-conformity and gender psychopathology in mind. As I have pointed out elsewhere: "Boys whose behavior is different than that of cultural norms tend to be accepted if they live in a tolerant culture, and rejected and scapegoated if they live in an intolerant culture. In America, cultural and subcultural norms for sex role behavior in boys tend to be rigidly prescribed. Youngsters who deviate from such norms are likely to be abused, particularly by males" (Friedman, 1990).
Downloaded by: Universite Laval. Copyrighted material.
R. C. FRIEDMAN, Psychoanalysis and Homosexuality
This unfortunate social dynamic influences many of these boys to develop symptoms and syndromes of psychopathology. Data emerging from Susan Coates' clinic in New York City has not confirmed Richard Isay's speculations about the mechanisms leading to GID. Rather, Coates has noted that children with this syndrome generally have severe separation anxiety, come from families with serious psychopathology, and have experienced focal traumatic stresses generally prior to age 3 (Coates, in press). That having been said, however, other clinically meaningful issues must be given their due. Most gay men have not had a history in very early childhood of Gender Identiy Disorder (GID) in full forms as described in DSM-III. Most boys with GID do go on to become gay, however (Friedman, 1988). As I noted, however, generalizations about this extreme subgroup of very young children should not be extended to gay adults. Psychoanalytic theories derived entirely from retrospective reconstructions of adult patients must be viewed with extreme caution, whether they are put forth by Richard Isay on the one hand, or Charles Socarides on the other. I would like to conclude by noting that there has been much bitterness towards psychoanalysis in America expressed by many people in the gay community. Psychoanalysis, however, like homosexuality, or heterosexuality, is not a unitary entity. In general, throughout psychoanalysis there is a tendency to move away from Freud's instinct-drive theories and towards models pertaining to the mental representation of self and others. Hopefully, this will be supplemented by recognition of the need to integrate sexual differentiation theory into psychoanalytic theory. This will, in my view, return sexology to its unique place of importance in psychoanalytic theory. References FREUD, S.: Letter to an American Mother (1935). In: Homosexuality and American Psychiatry, R. BAYER, New York: Basic Books 1981, p. 27. FREUD, S.: Circular Letter with OTTO RANK (1921). In: Homosexual Behavior. Ed. J. MARMOR, New York: Basic Books 1980, p. 395. FRIEDMAN, R. C.: Male Homosexuality: A Contemporary Psychoana!ytic Perspective. New
Haven and London: Yale University Press 1988. LEWES, K.: The Psychoana!ytic Theory of Ma!e Homosexua!ïty. New York: SIMON and SCHUSTER 1988.
HOOKER, E.: The adjustment of the ma!e over homosexual. J. Psycho!. 31(1967)18-30. BAYER, R.: see [1]! SOCARIDES, C. W.: Homosexua!ity. New York: JASON ARONSON 1978.
PANEL: Toward a Further Understanding of Homosexual Men. Presented at the Meeting of the American Psychoanalytic Association, New York, 18 December 1983. Summary by R. C. FRIEDMAN in: J. Amer. Psychoanalyt. Ass. 34 (1986) 193-206. ISAY R.: Being Homosexual. New York: Farrar Straus Giroux 1989. FRIEDMAN, R. C.: Book Review of the Psychoanalytic Theory of Male Homosexuality by KENNETH LEWES, Arch. Sex. Behav. 19, no. 3 (1990) p. 293-301. FRIEDMAN, R. C.: Ma!e Homosexua!ity: A Contemporary Psychoanalytic Perspective. 1988. COATES, S.: Boyhood Gender Identity Disorder. J. Amer. Acad. Psychoana!ysis (in Press).
Author's address: Prof. R. C. FRIEDMAN, 225 Central Park West, APT. 103, New York, N. Y. 10024, U.S.A.
Downloaded by: Universite Laval. Copyrighted material.
Exp. Clin. Endocrino!. 98 (1991) 2
160
J. A. Barth, Leipzig
Contemporary Psychoanalysis and Homosexuality
Summary. In this paper, I contrast older, traditional, psychoanalytic ideas about homosexuality, with those put forth at a panel on homosexuality at the American Psychoanalytic Association in 1983 (and subsequently). I focus particularly on relationships between cross-gender behavior during childhood and adulthood homosexuality; sexual orientation and personality functioning; determinants and intrapsychic consequences of homophobia, countertransference issues in working psychoanalytically with gay and bisexual patients; the sexual orientation of the analyst (i.e.
should gay patients be treated only by gay analysts?). Changing psychoanalytic ideas about sexual orientation reflect the increasingly widespread recognition by psychoanalysts of the necessity to integrate psychoanalytic theory with advances in neurobiology, particularly neuroendocrinology.
Key words: Psychoanalysis - Psychodynamic - Gender non-conformity - Freud
Since psychoanalysis was created by Freud, a few introductory remarks about Freud's ideas about homosexuality are in order. His views were complex and inconsistent. In his famous letter to the mother of a homosexual, he argued that homosexuality is neither a vice nor an illness (Freud, 1935). He pointed out that Plato, Michelangelo, and Leonardo were homosexual and spoke out against persecution of homosexual individuals. He also pointed out that it was generally not possible to change sexual orientation with psychoanalysis. In a letter to Ernest Jones, he affirmed the right of homosexual people to become psychoanalysts (Freud, 1921). In other writings, however, he took quite a different stance, which critics have argued resulted from three major biases (Friedman, 1988; Lewes, 1988):
A pathographic bias - this led Freud to discuss so-called "primitive" mental mechanisms found in "inverts" and to suggest that "their compulsive longing for men has turned out to be determined by their ceaseless flight from women". He posited a developmental pathway characterized by identification with a woman - and subsequently searching for a male sexual object resembling the self. The sexual partner could then be loved as the mother had loved the prehomosexual child.
A phallocentric, anti-female bias - Freud felt that women were more "primitive" than men. He spoke of "the greater proneness of women to neuroses, and especially to hysteria". Freud attributed this to a model of female development which is now outdated. A bias resulting from a tendency to look upon psychoanalysis as a microscope of the mind. One could generalize from it as one could from looking at cells under
Downloaded by: Universite Laval. Copyrighted material.
R. C. FRIEDMAN
156
Exp. Clin. Endocrinol. 98(1991) 2
a microscope. I suspect that this tendency may have influenced psychoanalytic psychology away from the necessity to test hypotheses with research. In addition, Freud lacked terminology to express the distinction between genderrelated behavior and erotic behavior in his writings. This condensation reflected a way of thinking; (passive = feminine = homosexual). This, too is outdated. Following Freud, most psychoanalytic writings were also influenced by these biases, however. There were many reasons for this. In a recent review of the history of psychoanalytic ideas about homosexuality, for example, Kenneth Lewes com-
mented that many psychoanalysts "pursued their work for three reasons: to confirm Freud's ideas; to illustrate them with specific case material; and to generalize these ideas to realms other than clinical, such as art, anthropology, or education (Lewes, 1988).
example, of projective tests in homosexual and heterosexual men challenged many psychoanalytic hypotheses of the day. This investigation was carried out outside
of organized psychoanalysis, although it focused on psychodynamics (Hooker, 1967).
In the United States during the post World War II years, most psychoanalytic writings about homosexuality utilized Freud's drive theory, and his model of childhood development. The emphasis in most articles was to put forth a model directed at explaining the etiology of homosexuality and relating this to specific types of psychopathology in homosexual patients (Bayer, 1981; Lewes, 1988).
This line of speculation found in the writings of such analysts as Bergler, and Socarides, (and many others), rested on the notion that so-called "normal" development always resulted in heterosexuality. Derailment from a so-called "normal" developmental track was most serious when it occurred during early childhood years, prior to age 5 or so. Such derailment, due to traumatic experiences of various types, not only produced what Socarides termed "obligatory" homosexuality, but also led to global impairment in personality functioning. Two types of such impairments were stressed: in one, patients experienced severe anxiety, irritability, identity disturbances, and were prone to impulsive-compulsive acitivities and poor judgment. Patients in this group would be called Borderline today. In the other category of pathology, patients were dominated by the pursuit of pleasure, had impaired frustration tolerance, and poor self-esteem regulation. Patients in this group would be called Narcissistic today (Socarides, 1978). This way
of thinking about homosexuality influenced the architects of DSM-I in which homosexuality is listed as a Sociopathic Personality Disorder, and DSM-II in which it is listed as a Sexual Deviation, such as sexual sadism or fetishism. Psychodynamically oriented office practitioners were offered no way of conceptualizing homosexuality except in the framework of developmental derailment, character pathology, and sexual pathology. Three major recent intellectual and social-political developments have influenced clinical psychoanalysis, however, and these influences are continuing to exert powerful effects on the way the field as a whole conceptualizes homosexuality. The three developments to which I refer are the Gay Activist Movement, the movement in psychiatry away from a Freudian psychodynamic frame of reference toward a
Downloaded by: Universite Laval. Copyrighted material.
As I mentioned, psychoanalysis itself tended away from research, and this had consequences for psychoanalytic models of homosexuality. Hooker's study, for
R. C. FRIEDMAN, Psychoanalysis and Homosexuality
157
descriptive, empirical one, and the growth and evolution of sexual differentiation theory. The Gay Activist Movement included a Gay Activist psychiatric component. I feel that this influenced psychiatric thinking in a progressive manner. Although the decision by the American Psychiatric Association to drop homosexuality as a diagnostic category from the DSM occurred in a context in which Gay Activism made its influence felt, this decision was not made in response to political pressure,
numerous scientific issues concerning sexual orientation. Meanwhile, at the same time as Gay Activism was becoming a substantial political movement, extremely far-reaching changes were occurring throughout American psychiatary. The field as a whole was moving rapidly towards a biodescriptive framework and away from a psychodynamic framework. These changes were reflected in the alteration in the format of the DSM. Emphasis was now placed on establishment of diagnostic categories that were reliable and valid. Psychodynamically oriented diagnosticians were increasingly held accountable for their views according to generally accepted criteria of science. Knowledge explosions in psychopharmacology and the neural sciences occurred coincidentally. Huge areas of diagnosis and treatment of psychopathology were completely reframed. Traditional "psychoanalytic" concepts about affective disorders, anxiety, obsessions and
compulsions, phobias, just to name a few, were supplemented, and sometimes replaced, by powerful new models. Modern clinicians, psychodynamic or otherwise, do not attribute compulsions to harsh toilet training. Nor do they attribute female psychosexual and character disturbances to difficulties, in shifting from psychological investment in the clitoris to investment in the vagina. The scientific scrutiny by psychiatry concerning the data base for psychoanalytic judgments about sexual orientation, then, was part of a larger process reflecting the importance of empiricism in clinical disciplines. The third influence on recent psychoanalytic discussions of sexual orientation was sexual differentiation theory. I will limit my observations about this to the following:
1 .Constitutional predisposition was an area that Freud stressed throughout his writings. The psychoanalytic literature had moved away from constitutional predisposition for many years. Sexual differentiation theory is influencing the field to redirect its attention to this area. 2. Sexual differentiation theory has also challenged Freud's model of childhood development. The basic principles of gender identity differentiation, for example, are fundamentally different from anything suggested by Freud. It must be noted that, at least in the United States, the full significance of gender psychology and psychoneuroendocrinology has yet to be felt at the level of psychoanalytic education centers. Indeed, most older psychoanalytic faculty is probably not well informed about these areas. Nonetheless, twenty years ago the same could be said of psychopharmacology. This is no longer true today. I am hopeful that since sexual behavior was at the core of psychoanalytic theory at its outset, the discoveries pertaining to sexual
Downloaded by: Universite Laval. Copyrighted material.
but for scientific reasons. Gay Activists and others directed attention to areas underattended to previously. The reasons for the previous lack of attention were socio-political, as well as the reasons for subsequent focusing of attention on the
158
Exp. Clin. Endocrino!. 98 (1991) 2
differentiation will soon become part of Psychoanalytic Institute curricula - generally.
Be that as it may, the 1980's gave witnessed major changes in the way American psychoanalysis conceptualizes sexual orientation. In 1983, for example, the American Psychoanalytic Association sponsored a panel on homosexuality that was radically different from any that had preceded it. This panel, consisting of Robert Stoller, Stanly Leavey, Richard Isay, and myself, viewed homosexuality as non-pathological, and, in addition, directed attention at sexual differentiation theory, and at limitations of previous psychoanalytic models (Panel,
Subsequently, Richard Isay has written extensively about his experience as an analyst of gay men. Many of Isay's perspectives about homosexuality are similar to those previously put forth by Havelock Ellis. Isay's data base consists of 40 adult gay male patients, well-integrated, and accepting of their sexual orientation. From this sample, he created a "framework for the normal development of gay men". Like Ellis, Isay concluded, "the expression of their sexuality is both normal and growth-enhancing for gay men"; and that homosexuality, like heterosexuality, is constitutional in origin. Attempts to alter sexual orientation are ill-advised. Isay related early developmental differences between homosexual and heterosexual
men to primary erotic attraction towards the father in homosexuals, and toward the mother in heterosexuals. Gross gender behavior disturbances during childhood of prehomosexual boys was seen as reactive to primary erotic attraction toward the father. (Isay, 1989, p. 19): "On the basis of my clinical work, I have come to believe that at ages 3, 4, 5, 6 some homosexual children assume opposite gender characteristics in order to attract and sustain the attention of the father...These are usually such attributes as gentleness, sensitivity, and a lack of interest in aggressive sports. Some homosexual children may also seem noticeably feminine in dress and behavior. I believe that they develop these characteristics for the same reason that heterosexual
boys develop certain of their father's attributes - in order to attract first the mother's interest and then someone like the mother. These identifications in homosexual children appear to follow the manifestation of the sexual orientation and the erotic attachment to the father and not to precede them". He attributed retrospective distortion influenced by anxiety about sexual attraction to the father as the cause of the common clinically expressed poor quality early father-son relationships of gay men. Where do Isay's ideas fit into the clinical and nonclinical literature on homosexuality?
The area he discussed is limited to that of the reasonably healthy homosexual person. Certainly, some of his observations about this specific group are compatible, not only with those of Havelock Ellis, but of other analysts, including myself. Specifically, these observations pertain to the issue of change of sexual orientation, and to the capacities for love, work, and play of men in this group. Isay's developmental theories, however, are based entirely on clinical work with adults. I will return to his gender theories shortly.
Downloaded by: Universite Laval. Copyrighted material.
1983).
159
Subsequently, Isay has emerged as a moral leader in the field. He has attempted to get the American Psychoanalytic Association to adopt a statement condemning discrimination against homosexuals as the APA had adopted in 1973, and to go on record condemning exclusion of homosexual individuals as candidates for psychoanalytic training. Isay linked the reluctance of the American Psychoanalytic to do this (i.e. and to refer the issue to its member local institutes) to a widespread lingering belief by many American analysts that homosexuality is psychopathology. Sadly, this is probably true, but much less so than used to be the case. The American Academy of Psychoanalysis, in contrast to the American Psychoanalytic Association, did at its last meeting in 1990 adopt a strong resolution condemning discrimination against gay individuals. The present state of American psychoanalysis regarding homosexuality is, then, inconsistent. This should come as no surprise since the field is inconsistent about so many other issues these days. There does seem to be a generation gap, with younger people much more welcoming of new ideas, as is often true in general. I now want to discuss some specific clinical and scientific issues in light of recent developments in psychodynamic thinking beginning with the determinants and consequences of homophobia - homoparanoia. It is being increasingly appreciated that irrationally based negative attitudes towards gay people generally contribute to the psychological difficulties of gay and bisexual patients. These negative attitudes are routinely found among family and peers of patients, but may also occur in health professionals and mental health professionals as well - including psychoanalysts. The origins of homophobia/homoparanoia have tended to be the target of psychological research but not of systematic detailed investigation from within the psychoanalytic community. The Group for the Advancement of Psychiatry, however, is at work on a monograph on homophobia/homoparanoia. The subcommittee responsible for this does have a number of analysts on it, and the psychodynamic determinants of homophobia/homoparanoia are a major interest of this group. We are collecting clinical material as present. The leadership in this venture, however, still comes from psychiatry, not organized psychoanalysis. I would like to return now to the topic of childhood cross-gender behavior in relation to adult homosexuality, in order to comment on Isay's recent speculations about this. The topic itself is a provocative one in light of the erroneous belief common in the general culture that gay men are not masculine. The data base confirming the association between childhood cross-gender interests and activity and adult homosexuality requires no review in this article. It is helpful to keep the distinction between gender non-conformity and gender psychopathology in mind. As I have pointed out elsewhere: "Boys whose behavior is different than that of cultural norms tend to be accepted if they live in a tolerant culture, and rejected and scapegoated if they live in an intolerant culture. In America, cultural and subcultural norms for sex role behavior in boys tend to be rigidly prescribed. Youngsters who deviate from such norms are likely to be abused, particularly by males" (Friedman, 1990).
Downloaded by: Universite Laval. Copyrighted material.
R. C. FRIEDMAN, Psychoanalysis and Homosexuality
This unfortunate social dynamic influences many of these boys to develop symptoms and syndromes of psychopathology. Data emerging from Susan Coates' clinic in New York City has not confirmed Richard Isay's speculations about the mechanisms leading to GID. Rather, Coates has noted that children with this syndrome generally have severe separation anxiety, come from families with serious psychopathology, and have experienced focal traumatic stresses generally prior to age 3 (Coates, in press). That having been said, however, other clinically meaningful issues must be given their due. Most gay men have not had a history in very early childhood of Gender Identiy Disorder (GID) in full forms as described in DSM-III. Most boys with GID do go on to become gay, however (Friedman, 1988). As I noted, however, generalizations about this extreme subgroup of very young children should not be extended to gay adults. Psychoanalytic theories derived entirely from retrospective reconstructions of adult patients must be viewed with extreme caution, whether they are put forth by Richard Isay on the one hand, or Charles Socarides on the other. I would like to conclude by noting that there has been much bitterness towards psychoanalysis in America expressed by many people in the gay community. Psychoanalysis, however, like homosexuality, or heterosexuality, is not a unitary entity. In general, throughout psychoanalysis there is a tendency to move away from Freud's instinct-drive theories and towards models pertaining to the mental representation of self and others. Hopefully, this will be supplemented by recognition of the need to integrate sexual differentiation theory into psychoanalytic theory. This will, in my view, return sexology to its unique place of importance in psychoanalytic theory. References FREUD, S.: Letter to an American Mother (1935). In: Homosexuality and American Psychiatry, R. BAYER, New York: Basic Books 1981, p. 27. FREUD, S.: Circular Letter with OTTO RANK (1921). In: Homosexual Behavior. Ed. J. MARMOR, New York: Basic Books 1980, p. 395. FRIEDMAN, R. C.: Male Homosexuality: A Contemporary Psychoana!ytic Perspective. New
Haven and London: Yale University Press 1988. LEWES, K.: The Psychoana!ytic Theory of Ma!e Homosexua!ïty. New York: SIMON and SCHUSTER 1988.
HOOKER, E.: The adjustment of the ma!e over homosexual. J. Psycho!. 31(1967)18-30. BAYER, R.: see [1]! SOCARIDES, C. W.: Homosexua!ity. New York: JASON ARONSON 1978.
PANEL: Toward a Further Understanding of Homosexual Men. Presented at the Meeting of the American Psychoanalytic Association, New York, 18 December 1983. Summary by R. C. FRIEDMAN in: J. Amer. Psychoanalyt. Ass. 34 (1986) 193-206. ISAY R.: Being Homosexual. New York: Farrar Straus Giroux 1989. FRIEDMAN, R. C.: Book Review of the Psychoanalytic Theory of Male Homosexuality by KENNETH LEWES, Arch. Sex. Behav. 19, no. 3 (1990) p. 293-301. FRIEDMAN, R. C.: Ma!e Homosexua!ity: A Contemporary Psychoanalytic Perspective. 1988. COATES, S.: Boyhood Gender Identity Disorder. J. Amer. Acad. Psychoana!ysis (in Press).
Author's address: Prof. R. C. FRIEDMAN, 225 Central Park West, APT. 103, New York, N. Y. 10024, U.S.A.
Downloaded by: Universite Laval. Copyrighted material.
Exp. Clin. Endocrino!. 98 (1991) 2
160
