Wednesday, May 2, 2012

Gay Liberation and Psychiatric Arrogance

Last month at the Lyric Stage in Boston I saw The Temperamentals, a docudrama about the founding of the Mattachine Society, the first sustained LGBT advocacy organization in the US. The program pointed me to a biography of Harry Hay (1912 - 2002), founder of the Society.

I was especially interested in Harry Hay's single encounter with psychiatry. Harry had been sexually (very) active since his teen years. He experienced no doubt about his sexual identity and wasn't conflicted about it, despite strong social stigma at the time. After his lone experience of heterosexual intercourse he blurted out - "I certainly hope I never go through that again!"

Harry was a passionate, romantic soul, given to infatuation and heartbreak. He was also a devoted member of the Communist Party. In his mid 20s he told his doctor about a recent breakup. The doctor referred him to a therapist. Harry told the therapist about his despair "in not being able to find a flower-faced boy who was a Marxist like me, and who would stand with me in the class struggle against oppression." The therapist suggested that Harry think about women: "Maybe instead of a girlish boy, you're looking for a boyish girl. Do you know one?" Harry did - Anita Platky, also a member of the Party.

But Harry worried as to whether he could sustain a physical relationship with a woman. The therapist assured him that he could. Harry reported to his biographer - "He told me that all I needed to do to change my orientation was to deliberately close one book and open another."

The official line of the Communist Party was that homosexuals (the word "gay" wasn't in use then) were excluded. It's unclear how much this policy represented homophobia and how much it reflected fear that gays and lesbians were vulnerable to blackmail at the time. (Most likely it was a combination.) Harry's devotion to the Party made heterosexual marriage desirable to him. He couldn't be an activist and leader in the Party if he remained unmarried.

Harry and Anita stayed married for 13 years, but Harry increasingly returned to covert gay relationships and finally to the founding of the Mattachine Society. When he ultimately left the marriage in 1951, Anita felt deeply betrayed.

The therapist's recommendation to Harry in 1938 was consistent with what I was taught as a psychiatry resident in the mid 1960s - that gay orientation was a "symptom" or a "disorder" that could be changed by therapy or willpower. There was no evidence for this view - it was purely ideological. It was an especially implausible recommendation to have made to Harry, given his unambiguous gay orientation. In retrospect, the mental health professions and the therapist Harry saw just one time were arrogant in regarding ideology as truth.

Harry's experience of marriage to a woman he cared about as a friend but couldn't embrace as a sexual partner convinced him that the LGBT community had to organize and advocate for human rights. It's an irony of history that the arrogance of his one-session therapist contributed to the gay liberation movement in a way that couldn't be appreciated at the time!


Mark said...

Thanks, this was a great column.
Mark Moran

Jim Sabin said...

Hi Mark -

It's always good to hear from you. I'm glad you liked the column. You know about the history of the American Psychiatric Association and LGBT issues from writing for Psychiatric News. It was less than 25 years after the founding of the Mattachine Society that the APA stopped classifying homosexuality as a "disorder." Larry Hartman, a good friend from medical school and residency, had a lot to do with that change.



Anonymous said...

A complox and challenging issue.

In the interest of balance, I would urge the psychiatric profession to avoid the opposite extreme of discouraging gays that are dissatisfied with their situation and want to change their orientation--not because they are being bullied into it, but because that's honestly what they desire.

Jim Sabin said...

Dear Anonymous -

Your point is well taken. The key requirements would be: (1) as you said, it must be clear that the potential patient's wish is not the product of bullying or a reaction to stigma; (2) the clinician must be candid about the lack of evidence for effectiveness of therapy for changing sexual orientation; and (3) must discuss the risk of creating or increasing internalized homophobia by treating homosexual desire/orientation as something to be eradicated. And, in addition, it seems to me that a therapist undertaking the effort to work with a patient to change homosexual orientation ought to be prepared to work with a patient who wanted to change heterosexual orientation. Otherwise the clinician would be betraying an attitude of stigma.

Thank you for raising this important and fascinating issue.