Sunday, August 9, 2009

The Mental Health Professions and Homosexuality

While in Canberra, bought The Mental Health Professions and Homosexuality: International Perspectives, a surprisingly readable survey of attitudes within psychotherapy to homosexuals and homosexuality.

There is a certain inherent perverse selection that the Introduction alludes in that countries where the issue is most acute are precisely the places one was least likely to get contributions from. Still, studies of the UK, Germany, Switzerland, Norway, Finland, Italy, China and India provide a useful set of comparison examples. The latter two studies also have a wealth of useful historical information. There is also a piece on the emergence of an international gay, lesbian, bisexual psychiatric movement, one on the International Psychoanalytical Association and homosexuality and an interview with a friend and colleague of an early de-pathologiser of homosexuality within pyschoanalysis.

While there are local nuances, there is a clear general pattern. A pathologising of homosexuality and thus homosexuals, implicit or explicit exclusion of homosexuals from admission to training centres as students (as "sufferers" of said pathology) and a more recent easing. That mental health has been regularly equated with "what is felt to be socially comfortable" is quite clear. But as I am vastly unimpressed with the alleged empirical basis of psychoanalysis in particular (and much psychotherapy in general), this is hardly surprising.

It also meant that those motivated by monotheist religious perspectives could and did hold considerable sway. (Since monotheism naturally conceives sexuality in fraught and portentous terms, consideration of sexual activity, desire and orientation becomes charged with great negative tension, which spills over into personal behaviour, social attitudes and public theories.)
The pathologising of homosexuality and homosexuals, and their consequent exclusion from being psychotherapists, is a nice example of the dynamics of exclusion. Such exclusion not only means such perspectives are either not heard or are pre-emptively de-legitimised, it also provides a prop for self-satisfaction among the excluders. Failure to conform to the authoritative framing is taken to be the fault of the people who fail to conform, not a flaw in the framing itself. Which is then protected precisely by such exclusion.

Homosexuality has been associated with whatever is "bad" in the relevant framing. In Leninist states, homosexuality was a manifestation of capitalist or fascist corruption; in India, the corruptions of colonialism; in monotheism, sinful perversion of inherently fraught sexuality; in psychotherapy, a pathological failure to achieve normal development. Given same-sex oriented people are relatively small minority who grow up in other-sex oriented families and social milieus, they are very vulnerable group and easy to anathematise.

Which raises the question of how homosexuality was depathologised (to the extent it has been: for example, leftwing psychotherapist Oliver James still treats homosexuality as (in effect) a pathological failure of parenting). The answer seems to be an interaction between empirical studies – studies that used genuinely independent measures of psychological health regularly found large numbers of psychologically healthy homosexuals – and reduced vulnerability due to increased activism and visibility. A process this book is a useful contribution to.

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