THERE ARE TWO great, universally recognized demarcators of the modern gay liberation movement. The first, of course, is the Stonewall Rebellion of 1969. The second took place about five years later—the 1973-74 declassification of homosexuality as a mental disorder by the American Psychiatric Association.
The struggle within psychiatry that continued post-declassification was the touchstone of my own gay activism. Having experienced striking homophobia while coming out during interviews for a psychiatric residency several years after the declassification—as described in 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 newsletter, which carried pieces with titles such as “Psychoanalytic Statute Prevents 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 the process, I became a chronicler of a critical shift in scientific thinking about sexuality from, as I liked to put it in those days, “the temples of psychiatry to the laboratories of sex research.”
The relationship of psychiatry and psychoanalysis to homosexuality has come a long way since then. To get a sense of the distance traveled over the last generation, I interviewed Mark J. Blechner, a highly respected psychologist and psychoanalyst who has been combating homophobia, establishing therapeutic outreach to people with AIDS, and writing challenging, fascinating discourses on hate, prejudice, and other neglected topics in psychoanalysis. His latest collection, Sex Changes: Transformations in Society and Psychoanalysis, was recently published by Routledge.
Along with fifty articles and book chapters, Blechner has published two previous books—Hope and Mortality (1997) and The Dream Frontier (2001)—and is the editor-in-chief of the journal Contemporary Psychoanalysis. He is the training and supervising psychoanalyst at the William Alanson White Institute, where, as founder and director of its HIV Clinical Service from 1991 until 2001, he led the first psychoanalytic clinic devoted to working with people with AIDS, their relatives, and caregivers. Blechner has taught at Columbia, Yale, and NYU.
The interview was conducted by e-mail but reflects an ongoing dialogue about psychiatry that Blechner and the interviewer have been carrying on for years.
Lawrence D. Mass: Do you think that being a gay psychologist is like being a gay Catholic or gay Republican, in the sense that no matter how hard individuals like yourself struggle for change, real change in the bigger picture remains at best fragile? Mark J. Blechner: While we can’t know the future, real changes in the world of psychiatry and psychoanalysis have already happened and are continuing to happen. If you could attend a case conference about a gay man held fifty years ago, and then a discussion of the same case today, you would hardly believe they were discussing the same person. In the 50’s and 60’s, the person’s homosexuality would have been defined as the central problem of his life, or at least seen as tied into all the other problems in his life. Today, especially among younger professionals, the issue of sexual orientation would almost never be considered as a problem per se. Also, I don’t think anyone today would think to speak of “the homosexual” 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 1950’s America was so reactionary, that it was always that way. In the early days of psychoanalysis, at the beginning of the 20th century, psychoanalysts were among the most progressive and liberal-minded people in mental health. More than 100 years ago, the great Hungarian psychiatrist Sandor Ferenczi defended a lesbian transvestite against involuntary hospitalization and argued that homosexuality 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 heterosexual persons.” This was 44 years before Evelyn Hooker published her landmark study, showing that the mental health of homosexuals was no different than heterosexuals! Brill also said that, for a homosexual, the experience of having heterosexual relations was just as much a perversion as for a heterosexual to have homosexual relations. And the great American psychoanalyst Harry Stack Sullivan developed an all-male ward for gay schizophrenics, in which most of the staff was either gay or gay-friendly. That was in Maryland, back in the 1920’s. It was a revolutionary act in psychiatry, way ahead of the norms in society, 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.” I think young psychoanalysts today are not only more open-minded about sexual orientation—many are rethinking the whole basis of diagnosing pathology in sexual behavior. It’s interesting that you bring up the Catholic Church. I think most fundamentalist religions resist change and are a very regressive force in our society, and they strongly influence medicine and psychiatry. Just consider perversion. According to the Oxford English Dictionary, the word perversion once referred to corruption, distortion, and error in religious belief. In orthodox religions, there is a right way to behave. If you do things differently, even if it makes you happy and you do not harm anyone, you are still wrong, perverted, and sinful. Many clinicians have bought into such a translation from sin to psychopathology, even if the connection between pathology and sin is not conscious. This is true not only in psychiatry, but in much of medicine. It may be that American medicine’s push for circumcision derives from Old Testament influences. Most things that have been called perversions have departed from Old Testament rules, such as the command to “be fruitful and multiply.” Even Freud 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 the 19th century, masturbation, the “sin of Onan” in the Old Testament, was thought to be a great health problem. Sylvester Graham, for whom Graham crackers were named, and John Harvey Kellogg wrote books with advice on how to curb masturbation. Few people today realize that their morning corn flakes were once supposed to keep them from masturbating. Harry Stack Sullivan stated it bluntly: “Sexual sin is the mother of psychiatry.” LDM: There have been many participants and contributors to modern concepts of homosexuality in psychiatry and psychoanalysis over time. 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 this history, as it continues to unfold? But his achievement raises a larger question: would it help any psychotic patient who is a victim of prejudice to be put in a therapeutic environment where that prejudice is eliminated? As far as I know, that hypothesis has not been tested yet, and almost a century has passed since Sullivan’s work. We know that today an African-American or Latino is three times more likely to be diagnosed with schizophrenia than a Caucasian. How much of this difference is due to racial and ethnic prejudice, and what could we learn from Sullivan’s ward about making treatment more effective by limiting prejudice? The way gay people were treated in the 50’s through the 70’s by psychiatry was terrible. What can we learn from that mistreatment and misunderstanding? I think there are lessons for how we now treat other sexual minorities today, such as heterosexual cross-dressers, voyeurs, and exhibitionists—and transgendered people. A lot of the bad treatment comes from disinformation, wrong facts that get perpetuated. As Charles Rosen said, “The name generally given to widely accepted error is tradition.” For example, many clinicians still think they can get a heterosexual male transvestite to stop cross-dressing, even though there is no good data [to support this]. And most cross-dressers don’t want to change. If they’re in a relationship, they want their wife or girlfriend to accept their cross-dressing and continue to love them. Many of the same issues come up about other sexual minorities. They want help in living an integrated life, not help in becoming something they are not. Psychiatrists had to learn that lesson about gays and lesbians, and now they need to apply those insights to other groups. And we are very prejudiced about cross-dressing: When a woman wears her husband’s shirt to bed, it is considered sexy. When a man wears his wife’s nightgown to bed, it is considered perverted. We know that same prejudice affects gender-atypical children, too. Many more boys who are sissies are brought in for treatment than girls who are tomboys. Two decades ago, when people referred so many people with AIDS to me, I started the HIV Clinical Service at the William Alanson White Psychoanalytic Institute. While its mission wasn’t overtly political, it got many people to rethink their attitudes toward sexual orientation, as well as to illness and mortality. We even discussed the problem of the “heterosexual closet.” John O’Leary, a straight man, was leading an HIV support group, and the group members, all gay, assumed John was gay, too, until he came out as a heterosexual! He had plenty to say about the agony of the closet in a way that straight people could really understand. The HIV Service attracted many younger people, who just didn’t have the prejudicial attitudes of the older analysts. This is an important point; our whole society is becoming less prejudicial. If only people under thirty would vote, we would have national same-sex marriage by now. While political pressure helps, things change just as the older people retire and the younger ones get more influence. LDM: Clearly, there has been a lot of change in psychoanalysis in the current generation, and gay people are now more integrated and stereotypes less frequent. But you’ve touched on conversion therapy, which continues to be a serious problem. Ron Bayer, author of Homosexuality and American Psychiatry, was a little less optimistic than you about the likelihood that the current liberal integration of gay people within psychiatry and the normalization of homosexuality within psychoanalysis and psychiatry would endure the challenges of time. Any further thoughts about such an assessment? When I was made editor of the journal Contemporary Psychoanalysis, nobody even mentioned that I was gay. I think most people thought it was irrelevant to whether I was qualified for the job. And I know of many openly gay psychiatrists who hold prominent positions today in leading teaching hospitals and medical schools. If they are smart and skillful, that’s what matters most. So the trajectory is still moving towards more equality. It’s not all rosy. I wouldn’t discount the horrible fact that gay people are still killed in Iran, Jamaica, and other countries. I wouldn’t discount that in Israel, the Christian, Muslim, and Jewish clergy, who usually can’t agree about anything, cooperated completely in opposing the Gay Pride March in Jerusalem. In general, things are improving, but we certainly must stay vigilant. We ought not forget that Dr. Magnus Hirschfeld, who made enormous strides for gay liberation in Berlin in the 1920’s, had his offices ransacked and his books burned by the Nazis in 1933. Things could get worse, but it is not inevitable. During the Bush years, I was publishing an article in a professional journal, and the editor asked me to change some “dirty” words; he was afraid that the journal might be prosecuted for indecency. That was a frightening experience. But we also must remember that during the Bush years, the Supreme Court in Lawrence v. Texas issued its most important decision ever for gay rights, making sodomy legal in every state. One day, gays and lesbians were criminals. The next day, they were upstanding citizens. It showed the strength of the American form of government that such a decision could come at a time when the federal government was so influenced by religion and was so anti-gay. Lawrence D. Mass, MD, a co-founder of Gay Men’s Health Crisis, is the author of four books on gay culture and history. He lives with his life partner, Arnie Kantrowitiz, in New York City. This article originally appeared in Gay City News, New York (6/26/09).
MJB: A lot of my influence has been through writing, teaching, and lecturing. I have wanted to focus not just on homosexuality, but also on our general understanding of sex, gender, sexual excitement, and prejudice. I want us not only to change prejudicial attitudes against lesbians and gays, but also to learn from the mistakes of the past, to improve the treatment by psychiatry and society of all minorities. So, for example, let’s go back to Harry Stack Sullivan’s gay ward for schizophrenics. The patients had an astonishing recovery rate, approximately 86 percent, and this was before anti-psychotic medication. Sullivan’s ward was a great step in the non-prejudicial treatment of psychotic gay men.
MJB: The Ku Klux Klan still exists today, but I don’t think that diminishes the significance of Obama’s election as the first African-American president. Prejudice doesn’t disappear all at once; prejudice doesn’t disappear completely. But that shouldn’t lead us to despair. NARTH [the National Association for Research and Therapy of Homosexuality]is hardly the dominant voice in American psychiatry and psychoanalysis. Its members are often seen as Neanderthal cranks, spouting old views that are embarrassing. Dr. Charles Socarides continued to discuss the origins of homosexuality in bad parenting right until he died, even when his son Richard served as Bill Clinton’s adviser on gay and lesbian issues.
