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2009
Growing Up About Gays
Dr. Mark Blechner discusses psychiatry’s progress on sexuality, and challenges ahead
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Health
BY LAWRENCE D. MASS, M.D.
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here are two great, universally recognized demarcators of themodern gay liberation move-ment. The first, of course, is the Stone- wall Rebellion of 1969. The second took place about five years later — the 1973-74 declassification of homosexuality as a mental disorder by the American Psychi-atric Association. The struggle within psychiatry that continued post-declassification was thetouchstone of my own gay activism. Hav-ing experienced striking homophobia while coming out during interviews for a psychiatric residency several yearsafter the declassification — as describedin the first piece I ever wrote for the gay press in Boston’s Gay Community News — I joined forces with gay psychiatrists working for change, editing their news-letter, which carried pieces with titlessuch as “Psychoanalytic Statute Pre- vents Legal Entry of Gay Aliens.” That work and my writing for the gay press were in a watchdog capacity against reactionary forces in psychiatry. In theprocess, I became a chronicler of a criti-cal shift in scientific thinking about sex-uality from, as I liked to put it in thosedays, “the temples of psychiatry to thelaboratories of sex research.” (Much of this early work of mine is published intwo collections — “Dialogues of The Sex-ual Revolution, Volumes 1 and 2,” pub-lished by Haworth/Harrington Park.) The relationship of psychiatry andpsychoanalysis to homosexuality hascome a long way since then. To get a sense of the distance traveled over the last generation, I spoke with Mark Blechner, a highly respected psycho-analyst who, though grabbing less of the spotlight than some others, has been combating homophobia, establish-ing therapeutic outreach to people with AIDS, writing challenging, fascinatingdiscourses on hate, prejudice, and other neglected topics in psychoanalysis, anduncovering important gay history inpsychiatry for much of the intervening years. Blechner’s latest collection, “Sex Changes,” was recently published.
LAWRENCE D. MASS:
Do you think that being a gay psychoanalyst is like being a gay Catholic or gay Republican,in the sense that no matter how hardindividuals like yourself struggle for change, real change in the bigger pic-ture remains at best fragile?
MARK J. BLECHNER:
While we can’t know the future, real changes in the world of psychiatry and psychoanalysishave already happened and are con-tinuing to happen. If you could attend a case conference about a gay man held50 years ago, and then a discussion of the same case today, you would hardly believe they were discussing the sameperson. In the ’50s and ’60s, the per-son’s homosexuality would have beendefined as either the central problem of his life, or at least seen as tied into allthe other problems in his life. Today,especially among younger profession-als, the issue of sexual orientation would almost never be considered as a problem per se. Also, I don’t think any-one today would think to speak of “thehomosexual” as they did half a century ago, just as they spoke about “the Jew”or “the Negro.” Generalization can be a powerful tool of bigotry. Also, it is wrong to presume that because psychoanalysis in 1950s America was so reactionary, that it was always that way. In the early daysof psychoanalysis, at the beginning of the 20th century, psychoanalysts wereamong the most progressive and liberal-minded people in mental health. Morethan 100 years ago, the great Hungarianpsychiatrist Sandor Ferenczi defended a lesbian transvestite against involuntary hospitalization and argued that homo-sexuality was not a disease.In America, the psychoanalyst A. A.Brill, who did the early translations of Freud into English, asserted in 1913,“Homosexuality may occur in persons just as healthy as normal heterosex-ual persons.” This was 44 years beforeEvelyn Hooker published her landmark study, showing that the mental healthof homosexuals was no different thanheterosexuals! Brill also said that, for a homosexual, the experience of hav-ing heterosexual relations was just asmuch a perversion as for a heterosexualto have homosexual relations. And thegreat American psychoanalyst Harry Stack Sullivan developed an all-male ward for gay schizophrenics, in whichmost of the staff was either gay or gay-friendly. That was in Maryland, back inthe 1920s. It was a revolutionary act inpsychiatry, way ahead of the norms insociety, then and even today.Regrettably, psychoanalysts later in the 20th century became a voice for homophobia, but that is changing back again. In my book, I call psychoanalysis“the once and future queer science.” Ithink young psychoanalysts today arenot only more open-minded about sex-ual orientation — many are rethinkingthe whole basis of diagnosing pathology in sexual behavior.It’s interesting that you bring up theCatholic Church. I think that most fun-damentalist religions resist change andare a very regressive force in our society,and they strongly influence medicineand psychiatry. Just consider perver-sion. According to the Oxford EnglishDictionary, the word perversion oncereferred to corruption, distortion, anderror in religious belief. In orthodox reli-gions, there is a right way to behave. If you do things differently, even if it makes you happy and you do not harm any-one, you are still wrong, perverted, andsinful. Many clinicians have bought intosuch a translation from sin to psychopa-thology, even if the connection betweenpathology and sin is not conscious. Thisis true not only in psychiatry, but inmuch of medicine. It may be that Ameri-can medicine’s push for circumcisionderives from Old Testament influences.Most things that have been calledperversions have departed from Old Testament rules, such as the com-mand to “be fruitful and multiply.” EvenFreud defined perversion as any sex act, including fellatio and cunnilingus,that didn’t quickly move to penis-in- vagina intercourse. And masturbation was considered a perversion, too. Most people don’t seem to realize that in the19th century, masturbation, the “sinof Onan” in the Old Testament, wasthought to be a great health problem.Sylvester Graham, for whom Grahamcrackers were named, and John Har- vey Kellogg wrote books with advice onhow to curb masturbation. Few peopletoday realize that their morning CornFlakes were once supposed to keepthem from masturbating. Harry Stack Sullivan stated it bluntly: “Sexual sin isthe mother of psychiatry.”
LDM:
There have been many partici-pants and contributors to modern con-cepts of homosexuality in psychiatry and psychoanalysis over time. And your chapter on Harry Stack Sullivan in “Sex Changes” is rich in conveying some of this older history, much of it previously hidden. How do you see your role in thishistory, as it continues to unfold?
MJB:
A lot of my influence has beenthrough writing, teaching, and lectur-ing. I have wanted to focus not just onhomosexuality, but also on our generalunderstanding of sex, gender, sexualexcitement, and prejudice. I want usnot only to change prejudicial attitudesagainst lesbians and gays, but also tolearn from the mistakes of the past,to improve the treatment by psychia-try and society of all minorities. So, for example, let’s go back to Harry Stack Sullivan’s gay ward for gay schizophren-ics. The patients had an astonishingrecovery rate, approximately 86 per-cent, and this was before anti-psychoticmedication. Sullivan’s ward was a great step in the non-prejudicial treatment of psychotic gay men.But his achievement raises a larger question: Would it help any psychoticpatient who is a victim of prejudice to be put in a therapeutic environment where that prejudice is eliminated? Asfar as I know, that hypothesis has not been tested yet, and almost a century has passed since Sullivan’s work. Weknow that today an African-Americanor Latino is three more likely to be diag-nosed with schizophrenia than a Cau-casian. How much is this difference dueto racial and ethnic prejudice, and how much could we learn from Sullivan’s ward about making treatment moreeffective by limiting prejudice? The way gay people were treated in the’50s through the ’70s by psychiatry wasterrible. But what can we learn from that mistreatment and misunderstanding? Ithink there are lessons for how we now treat other sexual minorities today, suchas heterosexual cross-dressers, voyeurs,and exhibitionists — and transgendered
Dr. Mark Blechner, since the 1970s, has worked on com-bating prejudice and broadening therapeutic approachestoward LGBT people, as well as those living with AIDS.
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