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Chapter 5. Psychological health and homosexuality. Is there a role for treatment of homosexual fe

SO YOU SAY YOU’RE STRAIGHT:The one in five hidden homosexual heterosexuals by the late Dr Neil McConaghy book proposal placed here on StraightGuise.com with permission by the author’s daughter, Dr. Finola McConaghy.

Contact Dr. Finola McConaghy at the address and phone below:

 

Dr. Finola McConaghy, Ph.D.
281 Cabbage Tree Rd.
Grose Vale NSW 2753
AUSTRALIA
Phone 0427 427 477

finola.mcconaghy@naturevet.com.au

 

 

All rights reserved.

 

Chapter 5.Psychological health and homosexuality.Is there a role for treatment of homosexual feelings?

Delay coming outpg. 489ASB 2003, 5.

Refs.Suicide and homosexualitypg. 475ASB 2003, 5.

Refs. Re reparative therapypg. 418, ditto.

Impact of homosexual bias on training of clinicians.Pg. 474 ditto.

Email anonymous questionnairesand zoophilia(? Diagnosis as sexual disorder)ASB 2003, December523.

Reducing high risk sexual behaviorpg. 569ASB December 2003.

Reduced sexual desire in lesbians cf heterosexuals R 3285

Depressive symptoms among Hong Kong adolescents: Relation to atypical sexual feelings and behaviors,anon quest – high % don’t knows.TH Lam +,ASB Oct 200433,487+

As discussed subsequently these responses provide a highly valid assessment of men’s heterosexual/homosexual balance of feelings.(Chap 3)

As discussed in more detail in Chapter 8, following various forms of aversive therapy claimed to modify subjects’ sexual orientation, 135 male patients showed no meaningful change in their homosexual/heterosexual ratio of feelings as measured by penile volume plethysmography (McConaghy, 1976). No evidence has been advanced by other workers that any form of treatment has altered subjects’ homosexual/heterosexual ratio of feelings as measured by a valid physiological assessment.

Treatmentsee xxxxbookhomo in articles.? same hhhh in bookhomo disk A1

 

Greenberg:Albertus Magnus, a Dominican scholar, suggested in the thirteenth century, on the basis of Arab sources, that a powder prepared from the fur of a hiena applied to the anus would cure a patient of desire for anal penetration.

Boswell1980-Albertus Magnus in Summa theologiae condemned homosexual acts as the gravest types of sexual sins because they offended “grace, reason, and nature”.Next after these would be those acts that offended “only grace and reason”, e.g. adultery.In other writings he described homosexuality as a contagious disease which passed from one person to another and was especially common among the wealthy.In his treatise onanimals he described a relatively easy cure: the fur from an Arabian animal he called alzabo, burned with pitch and ground to a fine powder, would “cure” a “sodomite” to whose anus it was applied.(Boswell adds Note that this suggests that a sodomite is a homosexual male who engages in anal intercourse).

xxxx

“Lesbian, gay, and bisexual youth are at high risk for mental health problems (number of refs. Cited including self , Ramafedi, Savin-Williams etc)p.277.”High percentage had sought counseling, received mental health services, and made suicidal attempts (D’Augelli, 1996).

Also see Gonsiorek (1995)

“In 1987, the National Institute of Mental Health (NIMH) published the results of a mental health survey of approximately 2000 women who identified themselves as lesbian, perhaps the most extensive survey of its type to date.One of the striking features of the survey is that nearly three-fourths (73%) of the subjects had received some form of counseling or mental health services.Some of the reasons for seeking counseling were as follows (percentages overlap): sadness or depression, 50%; problems with lover, (44%); problems with family, (34%); anxiety or fears,(31%); personal growth, (30%); being gay (21%); alcohol or drug problems, (16%); problems at the job, 11%.”27% had considered suicide and 18% had tried to kill themselves.The suicide risk was highest during adolescence.Many reported discrimination, being verbally attacked, and losing jobs because of their lesbianism.Physical abuse, rape, and childhood molestation, eating disorders and alcoholism same rates as heterosexual women.(National Institute of Mental Health: National Lesbian Health Care Survey (Contract No. 86MO19832201D).Washington, DC, DHHS Publication, 1987).”

Cabaj, R. P. (1996).Substance abuse in gay men, lesbians, and bisexuals. In R. P. Cabaj & T. S. Stein.Textbook of Homosexuality and Mental Health (pp. 783-799).Washington, DC, American Psychiatric Press.Cabaj considered in relation to use of alcohol and other drugs by gay men, lesbians, and bisexuals that most studies and the experience of most clinicians working with these subjects estimate an incidence of substance abuse of all types at approximately 30%, contrasting with an incidence of 10-12% for the general population.Alcohol abuse with the primary focus of most studies.

Hartstein, N. B. Suicide risk in lesbian, gay, and bisexual youth. In R. P. Cabaj & T. S. Stein.Textbook of Homosexuality and Mental Health (pp. 819-837).A task force established by the Secretary of the U.S. Department of Health and Human Services in January 1989, drafted a final report which concluded that studies seemed to confirm a high rate of suicide attempts among lesbians and gay males, particularly during their youth.Uncertainty remained regarding the relationship between attempting suicide and completing suicide.It suggested that gay youth may comprise up to 30% of completed youth suicides annually, an estimate which Hartstein commented has been cited repeatedly although unsupported by research.

Coming out*Lee (1987) concludes successful aging involves being fortunate and/or skillful enough to avoid stresses, including the stress of coming out.

Treatment* and sexual orientation

“Because such struggles with internalized self-hatred are often a normal part of the coming-out process, Brown (1989) and Gonsiorek, (1994) have proposed that the mental health professional who is currently coming out should abstain from working with sexual minority patients until the crisis of self-acceptance has been adequately resolved and that this issue should be addressed in both personal psychotherapy and supervision for the sexual minority health professional.Both Brown and Gonsiorek have suggested a 2-year period for this process.”Brown, L.S. (1996).Ethical concerns with sexual minority patients. In R. P. Cabaj & T. S. Stein.Textbook of Homosexuality and Mental Health (pp. 897-916).Washington, DC, American Psychiatric Press.

 

Problem of counseling adolescents with gender identity concerns.Savin-Williams (1995) accepted that homosexual sex is not the exclusive domain of adolescents who later identify as bisexual, lesbian, or gay, but does not refer to their number.Adds that most youths are loathe to report themselves as being lesbian, bisexual, or gay without indicating this might be appropriate for the majority.“The low (1-3%) percentages reported by surveys are almost certainly not an accurate reflection of the number of youths who are lesbian, bisexual, or gay or who will later define themselves as such”(p. 168) – Ignores Laumann.Should adolescents come out?“Empirical evidence suggests a positive association between coming out to one’s self and feelings of self worth.The psychologically well-adjusted bisexual, lesbian, or gay male individual is out to self and has integrated a sexual identity with her or his overall personal identity (see reviews…” (p. 171).Cites Malyon (1981) for “Disclosing sexual identity to others may be counterproductive to a healthy outcome” and adds “Too often the self-acknowledged lesbian, bisexual, or gay male adolescent does not receive the necessary support to overcome family and peer ridicule, abuse, and alienation”This may result in poor school performance, or dropping out of school.Coming out to their family may result in rejection.Abused youths who run away face a world that is all to ready to exploit them.They are at extreme risk for substance abuse, prostitution, and suicide.Savin-Williams refers to the Harvey Milk School in New York city created by the Hetrick-Martin Institute in response to the harassment received by l,b,and g youth receive in other schools.The most frequently abused are youths wh fail to live up to cultural ideals of sex-appropriate, masculine and feminine behaviors and roles(P. 174,5).Cites a study by Sears (1991: book) that most (? High-school students) passed as heterosexual until graduation.P. 184:maintaining the secrecy of their inner homoerotic life (“passing”) – may be a destructive strategy because it fosters low self-regard, inner turmoil, acting out behavior, and low levels of interpersonal intimacy…The result may be despair, which leads to suicidal feelings or suicide attempts.Healthy personality development requires being “true to yourself.”some youths … are willing to accept the trade-off of social ostracism for feeling authentic to their sexual self…These issues may very well be compounded for the sexual minority adolescent of color who perceives she or he faces a second stigma, her or his race or ethnicity… double stigmatization.

 

Include assessment by penile plethysmography

Psychosurgery etc. Schmidt +ASB, 1981, 301; Sigusch + ASB 1982, 445; Rieber,ASB 1979 523.

Yyyy Lack of information concerning treatment of homosexual partners.

Haldeman, D. C. (1991).Sexual orientation conversion therapy for gay men and lesbians: A scientific examination.In J.C. Gonsiorek & J.D. Weinrich (Eds.), Homosexuality: Research implications for public policy(pp. 149-160).Newbury Park, CA: Sage.

Haldeman, D. C. (1994).The practice and ethics of sexual orientation conversion therapy.J consult clin Psychol62, 221-227.

Pattison, E. & Pattison, M. (1980).“Ex-gays”: religiously mediated change in homosexuals.Am. J. Psychiatry, 137, 1553-1562.30 individuals culled from 300 counseled at EXIT.19 refused follow-up.only 3 of 11 reported no current homosexual desires, fantasies or impulses, and 1 of the 3 was “incidentally homosexual”.Recently founders of Exodus, denounced their own program as ineffective,Michael Busse and Gary Cooper.

 

Stein in his 1996 discussed of possible advantages of adopting a social constructionist as opposed to an essentialist position in the psychotherapy of homosexual men and women.One was that it would diminish concern that all attempts to convert gay men and lesbians to homosexuality invariably reflected a coercive and anti-homosexual approach.He advocated that therapists should not blame individuals for seeking help for those factors that contributed to their sexual development of for their current form of sexuality.They should present an attitude of openness about both future sexual patterns and the extent of choice an individual may have in determining these patterns.(Point out a similar therapeutic attitude would result from the recognition of homosexual heterosexuals).BUT later in same book says “the therapist evaluating a person who is seeking to change his or her sexual orientation is ethically obligated to inform the patient both that homosexuality is not considered officially to be a mental disorder and that there is no valid evidence that change in sexual orientation is possible as a result of psychological intervention.Given these conditions, it is currently ethically indefensible for a therapist to agree to attempt to change the sexual orientation of a patient.”

Failure to recognize most adolescents who are involved in homosexual activity become heterosexualTroiden athink-sexual identity

Aversion treatment Cuba qv

Change of sex orient in mtf tvs.letter criticalASB dec 99581

To strengthen the belief basic to gay liberation that homosexuality is not a disorder, homosexual

activists opposed its being researched on the grounds that such research implied it was a disorder.As a result, though as discussed subsequently, men and women who identify as homosexual compared to those who do not, are more likely to attempt and commit suicide and suffer psychiatric disorders, teaching concerning homosexuality has been markedly reduced in medical education.As it is no longer discussed in textbooks dealing with psychiatric and psychological disorers, to obtain information concerning sexual orientation need to consult sexology textbooks and journals, which are less available to them.Many medical practitioners and psycholoogists therefore have little knowledge concerning homosexuality.? Results in failure to treat men and women’s concerns about their sexual orientation when it would seem appropriate to do so.

It could be argued that it is both “childhoodist” and irrational that the DSM-III-R classifies effeminate behavior in childhood as a gender disorder when its adult expression as homosexuality with its associated variable degree of opposite sex-linked behaviors, is accepted as a normal behavioral variant.However the reactions of peers as well as some older subjects to boys and girls who show marked opposite sex-linked behaviors can cause them marked distress, so that therapy to aid them minimize the behaviors would appear justified.

Bakwin and Bakwin (1953) recommended in the management of effeminate boys that the dominating mother be curbed, the passive father encouraged to be actively involved with the child, and the child encouraged in behavior characteristic of his sex, with clarification of his confusions about sex. Coercion, teasing, and shaming were to be avoided.Green, Newman, and Stoller (1972) using this approach to modify the attitudes of parents, reported reduction of opposite sex-linked behaviors in five effeminate boys.Similar results were obtained without parental involvement by Greenson (1966) who acted as a male role model, teaching an effeminate boy who cross-dressed to swim, and reinforcing his masculine behavior and interest in games they played together.Myrick (1970) reported a marked favorable response of an effeminate boy to treatment by two women teachers advised by the school counselor.The boy was tutored in touch football and was sat next to and therefore involved in many activities with the most popular boy in the class who was also the best athlete.Though prior to treatment the subject played with girls 57% of the time and spent his lunch time with them, he may not have been extremely effeminate, as Myrick commented that effeminate boys can be found in almost every school and could benefit from additional attention by their teachers and counselors.

Rekers and Lovaas (1974) reported a single-subject study of a five year old effeminate boy who in treatment sessions sat at a table on which were boys’ and girls’ toys.His mother was instructed by earphones to reinforce masculine play with smiles and complements and to ignore feminine play by reading a book.During reversal sessions she attended to all his behavior indiscriminately.During baseline assessment prior to treatment his play was almost exclusively feminine.Masculine play increased when it was differentially reinforced and decreased during initial but not later reversal sessions.Subsequently the mother was trained to reward masculine behaviors and ignore feminine behaviors at home.It was reported that two years later the boy looked and acted like any other boy.The authors’ conclusion that there was no doubt the treatment was responsible for the change would appear to be true of the immediate, but possibly not of the long-term change.Bakwin (1960) reported the disappearance without specific treatment of opposite sex preference, cross-dressing and opposite sex-linked behaviors in two years in a boy of five years, and in three years in a girl of 11 years.Bakwin may have recommended to the patents that they reward same sex and discourage opposite sex-linked behaviors.This advice was given by Zuger (1966) to the parents of effeminate boys of whom he commented that with time the telltale symptoms of effeminacy were suppressed as a confirmed orientation toward homosexuality was taking place.Kosky (1987) reported that cross-dressing and other opposite sex-linked behaviors which had been shown for several years by seven boys and a girl disappeared within weeks of their admission to a child psychiatric unit, without attempts being made to encourage same-sex behaviors.Money and Russo (1979) followed-up five effeminate boys into adulthood.They were interviewed annually and on demand, with what was termed a minimal form of treatment in which the interviewer was totally non-judgemental.Opposite sex preference disappeared in all subjects, and cross-dressing in all but one, who cross-dressed for costume parties.Effeminacy was restricted to subtle bodily movements, minimal in four and a little more obvious to an educated observer in the fifth.

 

 

 

Add age of consent

Evidence that the majority of men and women with homosexual feelings are aware of predominant heterosexual feelings and those with homosexual experience have predominant heterosexual experience is also ignored in theories of the development of sexual identity.Failure of men and women with homosexual feelings or behavior to identify as gay has been considered indicative of pathology.Minton and McDonald (1983/1984) in pointing out that many people engage in same-sex acts without necessarily identifying as homosexual considered that rejection of a homosexual identity could be a result of homophobia and the discrepancy experienced as identity confusion.Troiden (1989) likewise pointed out that only a small portion of all people who have homosexual experiences ever adopt lesbian or gay identities and corresponding lifestyles.He also considered that they experienced identity confusion, which they reduced by defining themselves as ambisexual: “I guess I’m attracted to both women and men”.He stated this might or might not reflect their actual sexual interests and considered that adolescent gay males and lesbians who are gender typical, heterosexually active, and homosexually inexperienced were more confused regarding their sexual identities because their characteristics were at variance with prevailing stereotypes.He did not suggest this situation might be best dealt with by attempting to change the stereotypes to acknowledge that the majority of men and women with homosexual feelings or who have carried out homosexual acts are predominantly heterosexual in feelings and will become exclusively heterosexual in behavior.Minton and McDonald (1983/1984) commented that individuals with homosexual preferences usually have only limited opportunities during adolescence to explore and act on their homosexual feelings.They failed to relate this to the evidence that more males, the subjects of most studies of homosexual identity formation, act on their homosexual feelings in adolescence than subsequently.Both these analyses of sexual identity appeared to assume that heterosexuality and homosexuality are categorically opposed, so that the majority of persons with homosexual feelings or behavior who are predominantly heterosexual could be regarded as homophobic or confused homosexuals.

Essentialism:Homosexuality as a psychiatric disorder*

Background reports (Spitzer, RL, Homosexuality decision – a background paper.Psychiatric News, January 16, 1974, pp 11-12:: “clearly homosexuality, per se, does not meet the requirements for a psychiatric disorder since… many homosexual are quite satisfied with their sexual orientation and demonstrate no generalized impairment in social effectiveness or functioning”(a background report submitted to the Board of Trustees in 1973 offered the rationale that – as above);?A proposal about homosexuality and the American Psychiatric Association nomenclature: etc.Am J Psychiat, 130, 1214-1216, 1973Barr, R.…)Led to a compromise between two opposing views with creation of a new diagnostic category, sexual orientation disturbance.In its December 1973 meeting the Board of Trustees approved the removal of homosexuality from the diagnostic nomenclature and its replacement with the diagnosis of sexual orientation disturbance, used in the DSM-II.At the same meeting they approved a position statement deploring all public and private discrimination against homosexuality in such areas as employment, housing, public accommodation.In the 1980 publication of the DSM-III, the category of sexual orientation disturbance was renamed ego dystonic homosexuality, which also proved controversial.The DSM-III-R retained a diagnosis of “persistent and marked distress about one’s sexual orientation”, a sexual disorder not otherwise specified.

 

Homophobia*, biphobia and sissyphobia

Treatment* and sexual orientation

Homosexuality as a psychiatric disorder:Mental health*

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