HOMOSEXUALITY:  A Special Non-Political Discussion (Homophobia)

Sander J. Breiner, M.D.

[Editor’s Note: What follows has been excerpted from a longer paper that was presented at MSPP’s December 2004 meeting. The full text of the paper can be read at www.mspp.net]

“Truth never dies, but it leads a wretched life.”

The subject of homosexuality has been a significant subject of interest and conflict in most cultures throughout history. In the last few years it has been a subject of conflictual interest in the scientific community; especially those fields involved in psychotherapy and counseling. “Whenever science is attacked on ideological grounds, its integrity and usefulness are threatened. Science has served society well in tackling some of the world’s greatest problems, but only as long as it has evaded capture by narrow-minded interests ” (Leshner,2003).

In the late 1960s the gay community began a more intensive assertive program, which continues into the present. Episodically it had belligerent qualities. One of its most effective maneuvers was to threaten litigation against the American Psychiatric Association for declaring homosexuality a perversion. There was enough controversy in the field of psychology and medicine about that issue that it became possible (according to legal counsel) that in a court of law the American Psychiatric Association would be vulnerable to a significant financial loss. Since there was no evidence that homosexuals could be "cured," the committee that wrote the Diagnostic and Statistical Manual (under the chairmanship of Dr. Spitzer) decided to remove it from the list of perversions. As a result of the efforts of The National Association for Research and Therapy of Homosexuality and the testimony of various therapists who have successfully treated homosexuals (where they began to function as heterosexuals), Dr. Spitzer recently has reversed his position and now says homosexuality is a treatable condition.

However following the capitulation of the American Psychiatric Association (and covering this change with various intellectualizations), some few psychoanalysts of the American Psychoanalytic Association declared themselves to be homosexuals and supported making changes in a similar fashion in the American Psychoanalytic Association…. Due to the external legal aggression by the homosexual community and homosexuals within their organization, the American Psychoanalytic Association began a series of studies and committee explorations of the issue. As a result of extensive writing by various committees and publications by various members and societies within the Association another capitulation to homosexual political and legal aggression occurred. In a similar vein and under similar significant pressure the same thing occurred in the American Psychological Association.

None of these three scientific associations will publicly acknowledge the preceding. This discussion will attempt to clarify the issues. Terminology and definitions, which are intended to elucidate, are often used to obfuscate when there are political or personal (conscious or unconscious) problems. The following material will quote a variety of sources for definitions; so that we will have a relatively firm base upon which to further our discussions. With the security of this firm base it is more reasonable to have a discussion of some of the issues related to homosexuality.

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Currently in the psychoanalytic literature there are extensive discussions regarding the topic of homosexuality.  Particularly there are expressions by some therapists of possible blocking of exploring homosexuality, where homosexuality is seen by some as a reasonable or not pathological human reaction of adults. The not exploring of this issue of the “reasonableness/normality of homosexuality” by the mainline of psychoanalysts has been considered as a conscious and unconscious avoidance. The writers who have been discussing this issue have been calling this “internalized anti-homosexual attitudes” which they have shorthanded to “internalized homophobia”  (Maylon, 1982).

Though it was recognized by one author (Friedman, 2002) as not originating as a psychoanalytic conception; he and others writing positively about the normality of homosexuality have insisted on referring to this phenomenon as “homophobia.” This tendency by any analytical author to take a concept which has one definition and apply it to a related or other concept tends to “muddy the waters,” contribute to confusion, and even obfuscate the issue.  This well may be what is taking place today in the psychoanalytic literature and discussions on the subject of homosexuality and homophobia….

The editor of the book Homophobia:  How We All Pay the Price (1992)  Warren J. Blumenfeld (“writer and gay activist”) has organized its seventeen chapters so that the concepts of homophobia, anti-homosexuality, social and religious prejudice, and treating homosexuality as a complex symptom are all treated as being part of the same expression of irrational anti-homosexuality and homophobia.

He (Blumenfeld) refers to four types of homophobia:

1. Personal homophobia  “a personal belief system (a prejudice) that sexual minorities either deserve to be pitied as unfortunate beings who are powerless to control their desires or should be hated, that they are psychologically disturbed, genetically defective, unfortunate misfits, that their existence contradicts the laws” of nature, that they are spiritually immoral, infected pariahs, disgusting--to put it quite simply, that they are generally inferior to heterosexuals.

2.  Institutional homophobia “refers to the ways in which governments, businesses, and educational, religious, and professional organizations systematically discriminate on the basis of sexual orientation or identity.”

3. Interpersonal homophobia occurs “when a personal bias or prejudice affects relations among individuals, transforming prejudice into its active component—discrimination.”

4. Cultural homophobia occurs when “the social norms or codes of behavior that, although not expressly written into law or policy, nonetheless work within a society to legitimize oppression.”

….There is no personal, internal, institutional, or cultural homophobia.  The terms do not exist in the recognized scientific literature, as described earlier. There is only one homophobia that has been properly defined….

Calling all responses to homosexuality other than it “is a normal sexual variation” homophobic is anti-scientific and decidedly anti-therapeutic. Even in the Textbook of Homosexuality & Mental Health (Cabaj, 1996) published and sponsored by the American Psychiatric Association, the position is taken that homosexuality is a normal variation of human sexuality and not a mental illness

There is no doubt that homophobia exits. There is also no doubt that there are rationalized and irrational anti-homosexual attitudes. However, it would be very valuable for society in general and therapists in particular to have a clear picture of homophobia separated from all the other topics that have been lumped under that rubric.  With this in mind let us examine the topic of homophobia, as would be correctly defined and limited as a true phobic reaction.

Homophobia is a unique form of a phobic reaction. Like any true phobia, when an individual is forced to face the phobic object or situation, panic can occur. This panic reaction will produce a fight or flight response. If the symptom is a milder form of negative response, it is not a phobia. Not liking spiders is not the same as being terrified of them (arachnaphobia). Not liking homosexuality or homosexuals or being uncomfortable with them is not homophobia. Homophobia, like any phobia is a significant symptom. In some instances it can be considered dangerous; such as in the paranoid psychotic. Fortunately, this latter form is not that common.

There are presently numbers of homosexuals who feel that their sexuality is ego-syntonic. For them, treatment for their sexuality is virtually impossible; and some respond to the recommendation that they seek treatment as a grossly insensitive subjection. That they have become some of the most vocal and strident critics of psychoanalysis is largely the result of their changing conception of their sexuality….another aspect of this problem is that psychoanalytic knowledge, like the basic knowledge in other scientific disciplines, does not--and cannot--receive its validation from majority views or opinions. Nor is its knowledge limited (relative) to specific historical or cultural settings. (Levine, 1979).

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When a fellow human being is in distress, it is normal to try and aid them. If it is a medical problem, it is reasonable for a physician to treat such a hurting individual. If it is a psychological problem, a psychotherapist would respond in a similar fashion. If a homosexual male or female is uncomfortable with that position and wishes to seek help, it is incumbent on any therapist to help them deal with their psychological problem. Particularly is this the case if the patient feels their problem is their being homosexual. To respond to their distress as abnormal (homophobic) is anti-analytic, and grossly insensitive to a patient’s problems. In this situation neither the patient nor the therapist can even be remotely considered homophobic. Quite the opposite. Since these patients like themselves but are in conflict and want to help themselves and the therapist is in a positive relationship with the patient, we should even consider these two individuals in the therapeutic relationship to be homophilic. ?

Sander J. Breiner, M.D., F.A.P.A., is an associate professor of psychiatry at Michigan State University and an assistant professor psychiatry at Wayne State University. He practices in Bloomfield Hills.