Homosexuality and Psychoanalysis

Respond Clinical Open evening 25 September 1997

Homosexuality possesses an ability to provoke a kind of anxious curiosity. In the first place, exclusive homosexuality occupies an anomalous place in "Nature", denying as it does procreation, the end for which sexuality seems directed.

In addition, the social arrangement of most societies with which we are adequately familiar, as well as traditional moral structures, all support the notion of homosexuality as a deviation, a turning away from natural ends. In short, and quite literally, a perversion.

But, eliciting a strange anxiety in those who are not themselves homosexual, it simultaneously inspires the fascination and repulsion that Freud himself noticed and tried to account for.

Any discussion of homosexuality seems to elicit the same set of questions: Is homosexuality an "unnatural" condition? Why do some people become homosexual? Are they born that way or have they been made so by some psychic injury and stunting? Does the fact of choosing sexual partners of the same sex imply limitations of other kinds, especially in the capacity to form deep, complex, lasting and satisfying relations with other people? Can homosexuality be cured? Should it be? What relation does homosexuality have to such aspects of heterosexual experience as friendship, co-operation, admiration and loyalty?

Is there something special and privileged about the homosexual condition, either in its very experience or its relation to creative achievement? Does heterosexuality represent a corresponding limitation in possibility, so that becoming exclusively heterosexual involves the relinquishment of important potentials. What finally is that urge to unite sexually with someone whose body is like one's own and not complementary to it? And what is that dread that accompanies the very idea of homosexuality for most people?

For psychoanalytic theory, the motivating force behind human behaviour and the shaper of experience and personality is sexuality. Psychoanalysis can relate conscious experience and behaviour, which may or may not appear to be sexual in nature, to an unconscious sexual drive. Or it can relate present experience and behaviour to an earlier, more primitive and infantile sexuality. But in both cases, a basic sexual drive is transformed into recognisable experience and behaviour.

What is especially relevant for our purposes here is that many of the psychoanalytic rules of transformation specify the preservation of the original object of that drive. More precisely, although the infant's first sexual object is the mother, that attachment is neither heterosexual nor homosexual, but unfocused, uncoordinated and all-inclusive. In Freud's phase, it is "polymorphously perverse."

Freud's most famous statement on the subject is the note he wrote to an American mother of a homosexual, which was published in 1951, sixteen years after it was written. The mother's letter seems not to have been preserved, but, judging from Freud's reply, she had apparently asked whether psychoanalysis could change her son's sexual orientation. Significantly, she could not bring herself to mention his condition by name, and it is with this fact that Freud began his reply. He answered in English: I gather from your letter that your son is a homosexual.

I am most impressed by the fact that you do not mention this term yourself in your information about him. May I question why you avoid it? Homosexuality is assuredly no advantage but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development.

Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest men among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime and cruelty too. Even with this clear statement ambiguities remain. Freud's thinking of the legal and moral issues is clear, but his thinking of the specific issues of the pathological nature of homosexuality is not. A document uncovered in 1977 casts important light on this question. In 1921 the British psychoanalyst Ernest Jones had written to Freud informing him that it had been decided to reject the application of an gay man for admission into his psychoanalytic society on the grounds of his acknowledged homosexuality.

Jones went on to bemoan the intractability of the condition in analysis. If the candidate could not be analysed himself and instead persevered in his pathological orientation he could not, Jones decided, be entrusted with the analysis of others. The response Freud made, co-signed by the analyst Otto Rank is surprising: Your query, dear Ernest, concerning prospective membership of homosexuals has been considered by us and we disagree with you. In effect we cannot exclude such persons without other sufficient reasons, as we cannot agree with their legal prosecution. We feel that a decision in such cases should depend upon a thorough examination of the other qualities of the candidate. This is the clearest acknowledgement on Freud's part of the lack of a necessary connection between homosexuality and psychopathological conditions.

At least here, homosexual object choice implied nothing conclusive about other areas of mental functioning or behaviour. Still, there are sufficient ambiguities and hesitations in Freud's work to allow later analysts to draw the opposite inference. In the letter to the American mother, just cited, Freud directly addressed the question of a psychoanalytic cure: By asking me if I can help you, you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. . The answer is. in a general way. We cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible.....What analysis can do for your son runs in a different line.

If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. Freud felt that the failure of psychoanalysis to change people homosexuality had to do with the superficiality of motivation of the part of the patient to be cured: "the homosexual is not able to give up the object of his pleasure, and one cannot convince him that if he changed to the other object he would find again the pleasure that he has renounced." The happily adjusted gay man or lesbian was a figure about whom Freud had no knowledge. As he observed elsewhere, "perverts who can obtain satisfaction rarely have occasion to come in search of analysis." These observations were to play an important part in the history of psychoanalytic ideas about homosexuality and were sometimes seized upon to justify many extreme views. Freud believed in a bisexuality existing in "the innate constitution of every human begin".

This concept was a basic presupposition of psychoanalysis, which he thought it shared with biology. It is unclear if Freud felt that pleasure was to be derived from discharge associated with the reproductive organs, or if he meant more stringently that sexually pleasurable activity should essentially involve the physiological goal of reproduction. The distinction has crucial implications for psychoanalytic attitudes towards homosexuality. For the most part psychoanalytic writers have adopted the second reading and have consequently seen homosexuality as pathological. What was ambiguous in Freud became a doctrine in later psychoanalytic writing; "normal" and "healthy" sexual life required pleasurable genital competence in the service of a reproductive - that is, a heterosexual - aim.

I feel we should remind ourselves that modern sexual activity has little to do with the act of procreation. It is engaged in for its pleasure or its possibility of intimacy, and there is no reason to think that procreative goals are essential or necessary, even unconsciously. The heritage that the early psychoanalytic movement bequeathed to its heirs, for all its powerful and useful insights, and despite an early though short-lived tolerance, was most deficient in failing to provide a theoretically unambiguous account of homosexuality. In addition, ambiguities in the theory were exploited to lend support to certain judgements and suppositions that do not belong in the body of psychoanalysis proper. The attempt to ground the theory of psychoanalysis on hard biological principles had the effect of relegating more nearly humane concerns to a kind of clinical twilight.

The period of the fifties and sixties saw a strengthening of moralistic attitudes towards homosexuality, with an increasing simplification of sophisticated psychoanalytic ideas. Feldman's muddled account of the development of heterosexuality, for example, depended on his notion that "heterosexuality is an anatomically inborn and inevitable fate for both sexes." In treatment, the therapist should labour to convince the homosexual patient that "man is born for woman and woman is born for man." Similarly, Berg began with a plea for sympathy for the plight of the homosexual, proceeded through a popularised version of analytic ideas, and ended with the old, dreary stereotypes: the homosexual is unstable, prone to alcoholism and suicide; homosexuality is close to schizophrenia; homosexual murder is common.

In the same way, Fried promised a new approach to homosexuality, concentrating on the function of the ego and the patient's "interpersonal" relations, but traded in the same silly and ignorant clichés, expressed in a horribly moralistic tone. Analysts of the Karen Horney school offered a long list of traits that characterised all forms of homosexuality: passivity and timidity for men, aggression for women, preoccupation with appearance, sadomasochism, alienation from the self, impaired awareness of emotions, low self esteem and, for men, unconscious effeminacy, and for women, unconscious masculinity. There was a reluctance in this period to acknowledge the importance of constitutional issues and an eagerness to consider environmental factors instead.

This development may be partly a geographical issue, as the centre of psychoanalysis shifted first from Vienna, to London, and then to New York, and the world view of psychoanalysis became more American. The consolidation of social values in the United States after World War Two found its correlative in an emphasis by certain groups within psychoanalysis on such liberal ideals as the progress of civilisation and the amelioration of human ills. Meanwhile, the work of psychoanalysis went on, and most analysts adhered to classic formulations and ideas. Hadden urged group therapy for homosexuality in order to confront patients' rationalisation of their sexual aims and to lead to an anxiety that was therapeutically useful. In addition, such suitably motivated patients could derive additional ego strength from each other. The perennial psychoanalytic interest in the relation between homosexuality and paranoia continued, as well as the relation between homosexuality and addition to alcohol and drugs.

Such work expanded and refined certain theoretical notions about the dynamics of homosexual object choice, but the use of grossly disturbed case material reinforced the informal and unexamined connection between homosexuality and severe emotional disturbance. While certain forms of homosexuality provided an insight into serious emotional disturbance, it was never shown that homosexuality was so grossly disturbed as many writers continued to say it had to be. P Miller proposed three causes for homosexual object choice: a predisposing cause, involving rejection by one or both parents; a precipitating cause, involving homosexual seduction in late childhood; and a perpetuating cause, involving the satisfaction of security needs and an ongoing feminine identification.

His data, however, were derived from the study of fifty prisoners. Glueck used "the homosexual sex offender" as his subject and found that three quarters employed "some type of schizophrenic adaptation," and that they suffered a grave impairment in their superegos and in the capacity for abstract thought and fantasy. He concluded that psychoanalytic treatment was ineffective in such cases, and urges "some of the therapeutic efforts utilising organic therapies, particularly electroshock."

This association of homosexuality with psychosis or serious criminal activity reinforced the old stereotype of the homosexual as a sick or vicious psychic cripple. Here is a small sample of such views: Allen: "the homosexual is ill in much the same way as a dwarf is ill - because he has never developed." Hilton emphasised the intrinsic connection of homosexuality to alcoholism, and claimed that the homosexual is "preponderantly narcissistic, incapable of love and hobbled in his emotional life." Gershman said that homosexuals are "severely alienated people with a core of petrified patterns of living....automaton-like. Zest for living, and the capacity to face the unknown, seem atrophied.

" Fried, a holistic analyst, contributed her own embellishments: "most homosexuals do not feel like adults. Rather they see themselves as children or adolescents; their ego-superego structure is badly damaged" and they have only "a limited capacity for relations with other human beings." In addition, she thought it odd that "homosexual collectives" exist only for "mutual support", while heterosexual groups "are more likely to pursue a goal - to find social entertainment, to accomplish something in the community, to enjoy a sport." Socarides major contribution was the argument that homosexual object choice is the result of pre-oedipal disturbance, specifically at the separation-individuation phase. He later admitted that some homosexuals do not undergo trauma at that stage, but can best be thought of as having been disrupted in their psychosexual development at the oedipal stage.

For him, this condition was not "true" homosexuality. Significantly, he never dealt at length with these oedipal pseudohomosexuals, but referred curtly to the negative Oedipus complex and the fear of the father's power. Thus, his frequent insistence that there are absolutely no homosexuals free of psychopathology, though phrased in an unqualified manner, was somewhat ambiguous. It is not clear if he was characterising all those with a homosexual object choice or only those "true" homosexuals who have never adequately negotiated the separation-individuation phase.

According to Socarides, the failure to pass unscathed through this phase leaves the homosexual fixated on the mother at a stage of undifferentiation of self and object. Hence he maintains a primary identification with the mother and a faulty gender identity. But this identification is highly ambivalent,. As the "demonified mother" is experienced simultaneously as forcing premature separation and a loss of love and as working against complete separation. This leads to an increase in anxiety and frustration, a partial withdrawal of libido from the object and an increase in aggression towards it. In these terms, homosexual acts are unconscious attempts to undo separation by returning to the symbiotic mother-child bond and also to defend against the dear of engulfment and the loss of ego boundaries.

With a dozen works on homosexuality extending over a twenty-five year period, Socarides became the leading expert and spokesman for psychoanalysis, He claimed to have seen 63 homosexual patients in psychoanalytic treatment and have done consultations for 350. Like Bergler, he claimed that the range and validity of his clinical experience permitted him to accept or dismiss evidence that have been systematically obtained., According to him, Kinsey's figure's were exaggerated, while Bieber's one to two per cent prevalence was accurate.

When his etiological theory was challenged by an analyst discussing a patient corresponding to Socaride's schema but who was not homosexual, Socarides rejected the argument, claiming that closer scrutiny would confirm his theory. Similarly, he rejected other contrary psychoanalytic evidence out as hand as "behaviourist", and consequently irrelevant. Bieber and his team claimed that a significantly greater proportion of homosexuals had what he termed "close-binding-intimate mothers," who were seductive to their sons and were also overpowering and inhibiting, and a significantly higher proportion of homosexuals reported detached, hostile or rejecting fathers whom they hated or feared during childhood. Fathers who did not fit this description were sometimes seductive toward their sons, but in all cases "profound interpersonal disturbance" characterised relationships between fathers and sons.

Not one father in 106 cases could be found who was "warmly related" to his son. Third, boys who grew up to be homosexual fit the stereotype of the sissy during latency and adolescence, fearing physical injury and avoiding aggressive activity. From this Bieber drew several large conclusions. A family constellation that included a close-binding-intimate mother and a hostile, detached and rejecting father strongly predisposed a child to later homosexual orientation. Bieber's team rejected Freud's insistence on the centrality of constitutional bisexuality . They denied a homosexual phase in psychosexual development, having found that forty-one percent of the heterosexual controls reported no homosexual "problem" whatsoever.

Bieber went on to state that adult homosexuality as "psychopathologic". Thus, beginning with the assumption that all homosexuals were disturbed and using a pre-selected disturbed sample, he found that indeed, all homosexuals were disturbed. Some studies show that even with gay clients who do not present any particular disturbances in object relations, ego development and so on, we often find a set of difficulties that are not usually present to the same degree in a corresponding group of heterosexual men. Kenneth Lewes, a gay psychoanalyst and writer, points out that such things as cross-sex identifications, patterns of sexual acting out, promiscuity and a particular quality of shame and spite associated with sexual excitement are not, as many analysts have claimed, intrinsic to a homosexual orientation, but to the interpersonal response such an orientation has provoked in childhood.

Gay clients seen by Lewes recalled patterns of guilty excitement and shame attending sexual arousal during latency and adolescence. These may well lead to provocative and spiteful acting out during treatment, as they may also help constitute conscious critical social attitudes and behaviours. In addition, the failure of all but the most enlightened fathers to respond with appropriate support, affection and limit setting to their sons' oedipal sexual excitement would necessarily complicate if not block their sons' identifying with them. Bieber found that not one of his 104 homosexual cases recalled a warm and supportive relation with his father; this early experience may, of course, be understood as helping to determine a homosexual orientation, but it may just as plausibly be thought of as a consequence of his father's anxious and baffled rebuff to his son's importunate sexual strivings.

Things began to change somewhat with the work of Stoller. He argued that homosexuality was not a diagnosis, properly speaking, since it represented only a sexual preference and not a constellation of symptoms, and since different sets of psychodynamics could give rise to that sexual preference. He urged a classification based on personality types, with homosexual and heterosexual varieties, but seemed finally to want to junk the entire classification system. Marmor completed the argument for deletion by denying that all homosexuals were emotionally disturbed, and he rejected Socaride's and Bieber's findings based on a patient sample as essentially meaningless for the current debate. Spitzer, in charge of the revision of the Diagnostic and Statistical Manual, was left to decide whether homosexuality should be included in the manual He decided against inclusion, since mental disorders would be identified by the distress an individual felt or an impairment of functioning.

He ruled that homosexuality would be deleted form the list of mental disorders and that a listing of "ego-dystonic homosexuality" be included. That is, homosexuality that causes distress to the individual. There was no inclusion of ego-dystonic heterosexuality! He stated that the revision in the manual could provide the possibility of finding a homosexual to be free of psychiatric disorder.

Many of the challenges to a rigid psychoanalytic framework have more recently come from the world of feminism. Nancy Chodorow in her book "The Reproduction of Mothering" made a rare attempt to discuss women as well as men. She stated that for girls as much as for boys the primary identification and first love object is the mother. Unlike boys, their gender identity is not weakened by a transfer of identification from mother to father. Instead, she points out, the traditional task of women according to psychoanalytic theory has been to become heterosexual. Women have to transfer their sexual/emotional attachment from mother to father.

But Chodorow states that "a girl never gives up her mother as an internal or external love object, even if she does become heterosexual." That is, even if she does become sexually attracted to men - specifically her father - it is likely that this attraction develops in addition to the primary homosexual attraction rather than as a replacement. Chodorow's conclusion suggests that women are basically bisexual. The most general point to make about the psychoanalytic view of homosexuality is that is was not based as scientific theories supposedly are, on an unbiased inspection and ordering of its data, but on the confluence of that approach with historical accident, unexamined moral and social judgement and the vagaries of the history of psychoanalysis and psychoanalytic discourse at various points in its evolution.

The rigidification of analytic ideas based on limited evidence can be seen more clearly if we consider how the ideal of the bourgeois nuclear family has fared in psychoanalytic discourse. From the beginning, it was seen as the breeding ground of emotional disturbance. But, more significantly, as family therapy began to be established as a discipline, more compelling data were derived indicating its pathological nature.

If analytic judgement of the family as a social institution had been based on clinical experience, we might expect most analyst to have condemned it for its pathogenic workings, since families seen in therapy are necessarily disturbed. Yet this was not the case. Instead we find analysts claimed that the family is still the optimal arrangement. The reason why so many analysts found merit in an institution that was clinically so pathological must lie in a prior allegiance to it and to the larger cultural patterns in which it was embedded. It seemed to be self apparent that the families seen in therapy represented a deviation from the healthy norm. Yet such an allowance has rarely been made for homosexuality. This fairly dispiriting gallop through the history of psychoanalytic views of homosexuality stops short at the point where we now are.

Although I think it is fair to say that the backdrop of psychoanalytic thinking remains entrenched in homophobic attitudes, significant steps have been and are being taken to change this. A growing number of psychoanalytic training bodies are actively working against homophobia and are incorporating in their training space for more modern views of homosexuality to be considered. The work of Kenneth Lewes stands out as a very rich piece of work which demolishes many traditional views of gender and sex. Since the work of Freud and his successors have continued to exercise such a powerful influence upon society, it is small wonder that the more worrying aspects of analytic views of sexuality seem to have permeated many other levels of thinking, including the field of learning disability.

We need to consider to what extent these views are affecting the ways in which our clients are being worked with. There seems to be an ease with which damaging and erroneous labels get applied to our clients. The pathologising of male and female homosexuality is something that may often be witnessed in the referral process of clients to RESPOND, whether it be for psychotherapy or, more particularly, for Risk Assessment. Risk Assessment is a large part of our work, in which clients about whom fears of abusing have been raised work with us for twelve sessions in which we build up as full as possible a picture of their family history, and the real risk of recidivism. It is more often than not the case that in referrals of alleged pedophiles to this assessment service, relationships with same sex peers which turn out to be consensual, are lumped in with paedophile activities.

Analytic pathologising of normal homosexual behaviour often contaminate our views of offenders. In the group I am conducting for men with learning disabilities who sexually offend, a key area has been that of good and bad sex. What is permitted and what is not. I have had to be careful in reminding the men that there may be parts of their sexuality which are not offending parts, which may be healthy. They may want to abuse girls and boys, and feel some clarity around the fact that this is wrong (although their concept of wrong is more likely to be informed by the level of trouble they will get into rather than the damage they will inflict on their victims). There is much more confusion around whether or not they can have sex with other ,men.

Those men in the group who I would describe as being gay struggle terribly with separating their normal, healthy homosexuality from their paedophilia. Which is not surprising, when we consider how bad society is at separating the two. For gay men and lesbians with learning disabilities, it is important that any psychotherapeutic treatment is informed by their presenting needs, but also holds an awareness that there is more likely to be another level of psychic damage in place. Not only may they be experiencing a deeply internalised sense of pain at being born different, at having a disability that renders them in a very different space from most of the rest of the population, but there is also a sense of sexual difference that may be hard to separate from that initial difference.

I would like to end by considering yet another injustice meted out to our clients simply because they have learning disabilities. The blame for this cannot be laid solely at the door of psychoanalysis, since analysis has often merely acted as an extreme barometer of wider societal attitudes. Many residential, day care and other services for people with learning disabilities still appear to be struggling with outdated notions of homosexuality which tend to pathologise rather than to accept. Just as society has acted out an irrational fear of over visibility of homosexuality, it may be true that the our field of work is guilty of such a fear, and a resultant unconscious acting out of denigration.

I'd like to end with the words of Simone de Beauvoir who wrote, "It is in the knowledge of the genuine condition of our lives that we must draw our strength to live and our reasons for acting."