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Isay (psychiatry, Cornell Medical College) has published or presented most of these papers in this or another form five in Psychoanalytic study of the child. Annotation copyright Book News, Inc. Portland, Or.
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Dr. Richard Isay is a professor of psychiatry at Weill Cornell Medical College and the Payne Whitney Psychiatric Clinic and a faculty member of the Columbia University Center for Psychoanalytic Training and Research. He was instrumental in getting the American Psychoanalytic Association to adopt a non-discrimination policy for the training of candidates.Excerpt. © Reprinted by permission. All rights reserved.:
1 - What Is Homosexuality?Those who are halves of a male whole pursue males, and being slices, so to speak, of the male, love men throughout their boyhood, and take pleasure in physical contact with men. Such boys and lads are the best of their generation, because they are the most manly.—PLATO, The SymposiumHomosexual men have a predominant erotic attraction to others of the same sex. Their sexual fantasies are either entirely or almost entirely directed toward other men, and have been so since childhood. Because sexual behavior may be inhibited by societal pressure or by internal conflict, a man need not engage in sexual activity to be homosexual. Those who have homo- sexual contacts but, because of censorious social pressures, intrapsychic conflict, or both, are unable to accept that they are gay are also homosexual. There are others who may not even have conscious access to their homoerotic fantasies because they repress, suppress, or deny them. Their fantasies become more available to them during a properly conducted analysis or therapy, and I also consider them to be homosexual.The seven-point scale (0–6) of Alfred Kinsey and his associates emphasizes the behavior and conscious sexual interest of their respondents.2 Fives and sixes on Kinsey’s scale indicate those with exclusive or nearly exclusive homoerotic behavior. I have found sexual fantasy to be a more clinically useful way of defining homosexuality than behavior. Just as a man would be considered heterosexual even if he was constrained from expressing or elected not to express his sexuality for reasons of age, circumstance, or vocation, I am taking into account that some gay men may not express their homoerotic impulses because of internal conflict, social bias, or personal choice.Systematic investigations by psychologists over the years suggest that there is no greater psychopathology in gay men than in heterosexuals. The best known of these are Evelyn Hooker’s studies, designed to determine the usefulness of projective psychological tests in diagnosing overt homosexual behavior and to assess whether there are distinctive personality characteristics in exclusively homosexual men.3 No distinguishing psychopathology or greater degree of social or psychological maladjustment was found in homosexual men. A number of other investigators, using both projective tests to elicit unconscious conflict and objective psychological tests to draw out more conscious, recognized difficulties, have been unable to find greater pathology among homosexuals than among heterosexuals.The distinguished studies by Kinsey and associates that verified a high incidence of homosexual behavior would tend to support the perspective that homosexuality is a nonpathological variant of human sexuality. They surveyed approximately five thousand white American males and found that 4 percent of the adult white male population are exclusively homosexual throughout their lives after adolescence, and that about 10 percent of the total male population are exclusively homosexual for at least three years sometime between the ages of sixteen and sixty-five. A number of European surveys report a com- parably high incidence of homosexuality and homosexual experiences.Clellan Ford and Frank Beach in their cross-cultural investigations and studies of subhuman primates support the obser- vation that regarding homosexuality as pathological is an expression of cultural bias. In the majority of the seventy-six societies they studied, homosexual activities were considered either socially acceptable or normal:Some homosexual behavior occurs in a great many human societies. It tends to be more common in adolescence than in adulthood and appears to be practiced more frequently by men than women. This is also true of the other animal species . . . and particularly so in the infrahuman primates. Even in societies which severely restrict homosexual tendencies, however, some individuals do exhibit homosexual behavior. . . . Within the societies which, unlike our own, provide socially acceptable homosexual roles, a number of individuals, predominantly men, choose to exhibit some measure of homosexual behavior.Of course, in Western societies influenced by the Judeo-Christian view of sexuality and morality, homosexuality has been barely tolerated, and in many countries it has been outlawed. Until the late fifties, Great Britain had imposed severe legal penalties against homosexuals. The Wolfenden Committee was appointed by the House of Lords in 1954 to study these laws. Their report supported the decriminalization in England of homosexual acts between consenting adults in private and was strongly critical of the belief that homosexuality is a disease. The committee pointed out that when there are no symptoms associated with a behavior that may be compatible with “full mental health,” then that behavior cannot be regarded as a disease.In careful consideration of such studies, and because of the recommendations of prominent psychiatrists such as Judd Marmor, who was also an analyst, along with the effective testimony of gays on the social stigmatization of labeling homosexuality a disease, the American Psychiatric Association in 1973 decided to remove homosexuality from its official Diagnostic and Statistic Manual of Mental Disorders.8 Psychoanalysis, in contrast to and in spite of such evidence, remained committed to the conviction that homosexuality was always pathological. Homosexuality was seen ipso facto as a perverse and deviant form of sexuality because gay men do not reach the theoretical normal developmental end point of resolving the Oedipal conflict by desiring someone like their mothers through an identification with their fathers.Psychoanalysts have looked at the early-childhood histories of gay men they have seen as patients, and isolated what appear to be environmental determinants of their desire for other men rather than for women as lovers. Some have said that predilection for a same-sex love object is caused by a close-binding, hostile mother who undermines her son’s masculinity by blocking the development of independence, interfering with the father-son relationship, and inducing a fear of women.9 Others emphasize the role of an absent, weak, detached, or hostile father who makes it impossible for the child to separate from his dominating mother.These psychodynamic conceptions can be traced to Freud, who at one time or other implicated a number of environmental factors in the origin of homosexuality. His major interest, however, was in developing the clinical technique of psycho- analysis. He felt an obligation to stress those environmental factors which psychoanalysts could investigate, rather than emphasize the role of those constitutional factors that he always believed to be of major importance in the formation of a homosexual orientation.After Freud’s death, psychoanalysts became intent upon removing the ambiguity in his ideas about the nature and origin of homosexuality, and decisively settled on a pathological model. The first to criticize Freud’s theory was Sandor Rado, who considered the idea of genetically predisposed bisexuality to be biologically unsound, of no clinical value, and of little use in guiding future research. He believed that Freud’s concept of an inborn potential for homosexuality led analysts to lower unnecessarily their therapeutic expectations when it came to treating homosexual patients and that homosexuality was the phobic response of a man who is so incapacitated by anxiety evoked by his mother, and subsequently by fears of all women, that he applies “aberrant forms of stimulation to his standard genital equipment.”12 Other psychoanalysts such as Irving Bieber, Lionel Ovesey, and Charles Socarides were influenced by Rado and elaborated on this theory of anxiety caused by an intense attachment to the mother. They considered homosexuality to be profoundly pathological, and all homosexuals to be seriously disturbed.My clinical work with gay men for more than thirty years has brought me to the conviction that homosexuality is a nonpathological variant of human sexuality. Unlike most other psychoanalysts, I have found no greater psychopathology in my gay patients than in my heterosexual patients. But also, unlike most psychoanalysts, I work with gay men who generally accept their sexuality. The early aberrant relations with mothers described by many analysts appear to be more characteristic of men who have difficulty sustaining intimate relationships with other men than of gay men in general.Two men discussed later in this book, Benjamin and Carl, had severe character disturbances of a narcissistic and masochistic nature. Of all my patients, they had the most difficulty accepting themselves as gay men. They also had more difficulty than others with intimacy, and both had a need for frequent random sexual encounters, which is not characteristic of all gay men. They were men whose mothers seemed to bind their sons to them because of their own needs and could not permit adequate separation and self-differentiation to occur. If these men had been heterosexual, they would have had similarly poor self-images, identity diffusion, masochistic, self-punitive tendencies, and difficulties with intimate relationships due to early injury to their self-esteem.Some who have studied homosexuality emphasize the importance of personal choice in its development. For example, there are women who, out of feminist conviction, sexually bonded with other women for purposes of power in our male-dominated society but later became disenchanted with the women’s movement, and chose to leave their partners to seek more traditional lives and roles. Political and social motives for determining the sexual object are significantly less frequent in the sexual bonding of gay men, in part, perhaps, because the price paid in social discrimination is probably higher for gay men living together than it is for gay women. More important, there is no evidence to suggest that gay men can revert to heterosexual behavior without great difficulty and without becoming anxious or depressed. Therefore, if choice plays a role in influencing the sexuality of some women, it may be because anatomical differences make it easier for women to perform with either sex, more women are bisexual, or forms of intimacy that are not sexual may be more important for women than for men. I have never encountered in my practice a gay man who chooses to be homosexual, but it is also true that most gay men I know prefer their sexuality to heterosexuality, since what is experienced as normal and natural is usually preferred, even if such behavior is socially disadvantageous.Although homosexuality in men is more appropriately labeled an orientation than a choice or a preference, many homosexual men do prefer the lives they lead to the more conventional lives of most heterosexuals. While some may mourn the fact that they do not have children or the comfort and security offered by a traditional family, there are also many gay men who, like some single heterosexuals, do not want a traditional family structure and enjoy the economic benefits and relative independence of not having a family.Some sociobiologists have proposed that homosexuality may have an evolutionary basis. Proceeding from the idea that traits survive that are adaptive, they suggest that the personal and economic advantages that accrue to the relatives of gay men may contribute to fostering the survival of genes for homosexuality. These benefits could offset any genetic disadvantage that occurs because fewer homosexuals than hetero- sexuals have children. E. O. Wilson has suggested that homosexuality may be a normal trait “that evolved as an important element of early human social organization. Homosexuals may be the genetic carriers of some of mankind’s rare altruistic impulses.” At present there is no empirical support for the idea of kin selection as a way of passing on a gene for homosexuality. It is questionable as well whether homosexuals have any privileged status in our society, and, if some do, to what extent the benefits of such privilege are shared by their relatives.All psychoanalytic theories of homosexuality suggest that homosexual men suffer from a deficiency in their masculinity. Either a distant father fails to help his son separate from his mother, or the mother pathologically binds the boy to her, sometimes because of her own ungratified needs to be mothered. She attempts to get what she lacks by giving, but does so with enormous rage that is emotionally draining to her and wounding to the child. In both scenarios, gay men are believed to have either a conscious or an unconscious feeling of femininity. To put it simply, traditional analysts believe a man cannot be homosexual without also being and/or feeling feminine. Extensive identification with the mother may occur during the first two or three years in the development of any child whose mother fails to let him separate from her because of her neurotic needs or where a father is unable or unwilling to assist the child in disidentifying during this stage of union and merger with the mother. This early identification may sometimes result in profound disturbance in a sense of one’s masculinity. However, mothers or fathers who inhibit the development of their sons in this way are by no means restricted to gay men only; I do not believe that such early difficulties in separation occur significantly more often in gay men than in heterosexuals. None of my patients had any confusion or concern about the sex to which he belonged.Richard Green studied forty-four boys who were feminine and found that two-thirds became homosexual or bisexual adults. His findings confirmed earlier studies that indicated the prevalence of homosexuality in adults who as children had displayed effeminate behavior, avoided rough-and-tumble aggressive play, and were generally unassertive. One should not conclude from these studies, however, that most adult gay men are feminine. We can conclude that most homosexual boys are not typical boys and that they do have some traits usually associated with girls.Some investigators have stressed the importance of neuroendocrine factors in the development of homosexuality. One has hypothesized, on the basis of his studies, that a relative deficit prenatally of the male hormone, androgen, leads to homosexuality by causing a “predominantly female differentiated brain.” The evidence regarding the importance of prenatal endocrine influence on the development of a homosexual object choice is contradictory, and the methodological errors in some of the research has cast doubt on its reliability.22 Richard Friedman has suggested that one may see the childhood aversion to aggressive play as evidence of the prenatal endocrine influence on sexual orientation.On the basis of my clinical work, I have come to believe that although most of their gender atypical behavior is inborn, some homosexual children may emphasize their opposite gender characteristics in order to attract and sustain the attention of the father (see Chapter 3). These are usually such attributes as sensitivity, gentleness, manner of dress, and behavior. I believe that they accentuate these characteristics for the same reason that heterosexual boys may adopt certain of their fathers’ attributes, in order to attract the mother’s interest and attention. These identifications of homosexual boys with their mother is a manifestation of their close bond to her.Some homosexual boys have difficulty experiencing themselves as masculine because they have same-sex fantasies and attractions. In our society, where there is such a rigid delineation of what is masculine and what is feminine, they can see themselves only as the other, as feminine. Because, in our society, there is a need to have gender behavior conform to an...
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