Queer thing about psychoanalysis: instead of answering the question, it explains the query instead. There are not too many contemporary books addressing the sociopolitical, historical and developmental perspectives in the course of gay and lesbian lives. Few issues inspire passionate debate and philosophical disagreement as avowed preference for sexual intimacy with others of one’s gender: initially attributed to presumptive moral failing, homosexuality was soon labeled as a psychological illness. While same-gender sexual orientation may be statistically nonnormative, it is not now considered evidence of deviance, psychopathology, or personal immaturity. In 1973, the membership of the American Psychiatric Association (APA) voted by a significant majority to remove the category of homosexuality from the Diagnostic and Statistical Manual. Part of the Worlds of Desire Chicago Series on Sexuality, Gender and Culture, The Course of Gay and Lesbian Lives; Social and Psychoanalytic Perspectives began as a report commissioned by the executive Council of the APA. Its two main sections deal with the question of origins and the course of psychosocial development, and gender orientation and issues in psychoanalytic intervention. While the former introduces notions of sexual orientation, identity and lifestyle, the latter deals with personal distress and adjustment, psychodynamics, reparative therapy and psychoanalytic intervention.

The most common naïve view when it comes to same-gender sexual desire is that gay men are like women and lesbians are like men. There is absolutely no necessary relationship between masculinity or femininity and sexual orientation; sexual passivity as a concept is distinct from femininity. Being gay (or lesbian) has significance similar to other social attributes, such as political affiliation or ethnicity, but we live in a culture that favors essentialist-biological explanations of wishes, actions and qualities that mould our character and personality. Additionally, the search for biological causes of homosexuality is anchored by moral and legal weight, bearing upon persecution and prosecution: no moral community can punish people for being as biologically destined. There have been numerous, unconvincing studies (the mass not summing to convincing conclusions) attempting to link biological factors using genetic, hormonal and anatomic studies. Same-gender desire is thus assumed to be intrinsic and omnipresent from the time of a presumably different childhood through its first realization in relationships typically beginning in adolescence. In each and every instance, analysands demonstrated defective relationships with their fathers: while this leads to gender nonconformity in childhood, there is no linkage to adult sexual orientation. The book explains well that gender identity be understood as independent of adult sexual orientation.

Along with the feeling of being alone, the reality of difference and alienation even in the biological family of origin constitutes the distinct pain of early gay experience, unparalleled in the family experiences of members of other oppressed groups. In this book, the psychological basis for coming out (the process leading to disclosure to oneself and to others of a homosexual identity) is segmented into sensitization, signification, subculturization, and stabilization. These stage theories are well illustrated in the chapter on realizing homosexual identity: adolescents able to publicly acknowledge their alternative sexual orientation enjoy enhanced self-esteem. It is too facile to subscribe to the notion that homosexual relationships are inherently unstable because they bring together two people with the same gender identity deficit. In the chapter on the adult years, the issues addressed include the controversy over terminology for oneself and one’s partner, the perception that institutions within the gay community are oriented towards the needs of an acceptable singlehood, and the planned transition to a reconstituted, adopted or quasibiological parenthood.

Gay is the wrong term for describing homosexuality, which is hardly carefree and a mere façade for life, not even satisfying at the moment. It is universal that somewhere in a gay man’s development, he will experience rejection, hatred, and even physical abuse for his sexual and affectional expression. The lack of support from family, school, and community, and implicit sense of being ashamed for wishes perceived as being socially unacceptable leads to purported narcissistic psychopathology and disavowed desire among gay men. Much of the dis-ease that gay men suffer from is not intrinsic to their homosexuality but a consequence of the prejudice and discrimination encountered in society. While there has always been an expression of prejudice against those expressing preference for same-gender intimacy, increasing visibility and activism within the gay community has paradoxically enhanced this expression. Men continue to be likely to hold more intense stereotyping and antigay attitudes with regard to gay men than lesbians. Heterosexist attitudes predictably parallel the emergence of HIV: for many, to be gay is to have a fatal disease. Psychological heterosexism may result in difficulties in adult adjustment as poor self-esteem, difficulties in forming continuing intimate relationships, lowered morale, depression and anxiety, increased substance abuse, and even disregard of safer-sex practices. More than half of gay men and women report considering suicide at one time or another, more than ten times the rate of heterosexual men. Gay and straight men not seeking psychiatric intervention cannot be distinguished on the basis of psychological tests. These facts are elaborately documented here.

We are a society obsessed with tracing the causes of same-gender desire but there is little support for assuming any biological basis. The Course makes it abundantly clear that the most distinctive aspect of psychoanalytic intervention among gay men is the enduring sense of shame which so often pervades their sense of self and their relationships with family, friends, and lovers. The cause of same-gender sexual orientation is much less important than understanding the meaning of being homosexual, and helping to rebuild a sense of coherence and personal integrity among a cohort subjected to prejudice from childhood onwards.

The Course was written for therapists, scholars, and advanced students of psychoanalysis. Cohler is a social science professor and Galatzer-Levy is a psychiatry lecturer at the University of Chicago, and both are on the faculty of the Institute for Psychoanalysis in Chicago. The book satisfactorily delves into psychoanalytic opinion and practice regarding homosexuality.

SUGGESTED LITERATURE

· Cohen RA, Schlessinger, LC: Coming Out Straight: Understanding and Healing Homosexuality. Oakhill Press

· Domenici T, Lesser RC, Harris, A: Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. Routledge 1995

· Drescher J: Psychoanalytic Therapy & The Gay Man. Analytic Press 1998

· O’Connor N, Joanna R: Wild Desires and Mistaken Identities (Between Men~Between Women: Lesbian and Gay Studies). Columbia University Press, 1998

· Socarides CW: Homosexuality: A Freedom Too Far: A Psychoanalyst Answers 1000 Questions About Causes & Cures & the Impact of the Gay Rights Movement on American society. Adam Margrave Books 1995

Dr. Nayak is an Assistant Professor of Clinical Radiology in the University of California School of Medicine San Francisco and his interests include mental health, medical ethics, and gender studies. A voracious reader and intrepid epicure, he enjoys his keyboards too much and wonders why most of the pressing questions have no satisfying answers.

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