September 21, 2015
As I discussed in a previous post, the mental health establishment classified homosexuality as an illness until 1973. That year, the American Psychiatric Association removed it from their Diagnostic and Statistical Manual of Mental Disorders (DSM). The American Psychological Association soon followed suit.
The classification had always reflected value judgments and assumptions about homosexuality. There never was an empirical basis for it.
Another important event roughly coincided with the DSM change. In 1972, against the backdrop of a growing national gay rights movement, a new book was published, Society and the Healthy Homosexual. Its author, psychologist George Weinberg, began his first chapter with a provocative statement:
“I would never consider a patient healthy unless he had overcome his prejudice against homosexuality …. Even if he is heterosexual, his repugnance at homosexuality is certain to be harmful to him.”
A few pages later, Weinberg introduced a term he had coined during the late 1960s: homophobia, which he defined as heterosexuals’ “dread of being in close quarters with homosexuals” and homosexuals’ “self-loathing.”
Homophobia was a radical concept. It redirected society’s focus from what was then widely regarded as the “problem of homosexuality” to the problem of heterosexuals’ prejudice and hostility toward people who were gay. It communicated the idea that something was wrong with heterosexual people who dislike homosexuals.
To be sure, the legitimacy of anti-homosexual hostility had already been questioned by homophile activists after World War II in the United States and decades earlier in Europe. Those critiques, however, didn’t achieve widespread currency. With this new term, Weinberg gave the hostility a name and helped popularize the notion that it was a social problem that merited analysis and intervention.
The term homophobia soon became an important tool for lesbian and gay activists, advocates, and allies. Today, more than 40 years later, it’s more popular than ever.
And, in a 180-degree turn from the DSM’s classification of homosexuality, some people now argue that homophobia should be viewed as a form of mental illness.
It’s a proposal that follows logically from labeling sexual prejudice a phobia, which certainly invites people to think of it as a sickness. And it appeals to some (perhaps many) people.
But is it a good idea, one that could prove useful in eliminating prejudice against sexual minorities? Is homophobia, in fact, a form of psychopathology?
Are Homophobes Mentally Ill?
Labels and terminology can shape how we think about a phenomenon. For several reasons, I believe that embracing homophobia as a diagnostic label has negative effects on our ability to think clearly about sexual prejudice.
To begin, consider what constitutes a mental disorder. In 2001, the 4th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) provided this definition (I’ve emphasized some key phrases):
“a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.“
Many – probably most – heterosexuals who harbor prejudice against sexual minorities don’t experience distress or obvious impairment from it. Nor does it put them at greater risk of death or other negative consequences.
And labeling homophobia “clinically significant” can blind us to the important fact that, in a society that still stigmatizes homosexuality, prejudice against sexual minorities isn’t a maladaptive pathology restricted to a small portion of the population. Rather, it’s part of the routine socialization that — at least until fairly recently — nearly everyone has undergone in the course of growing up.
Ironically, labeling homophobia a mental disorder has something in common with the erroneous classification of homosexuality as a sickness prior to 1973. In both cases, a diagnostic label is used to stigmatize a disliked pattern of thought and behavior. Using the label misrepresents what really is a subjective value judgment as a scientific, empirically grounded conclusion.
Moreover, by equating psychopathology with evil, it also reinforces the stigma that historically has been attached to mental illness.
Yet another problem with labeling homophobia a clinical disorder is that doing so frames heterosexuals’ hostility toward homosexuality as a purely individual phenomenon. This limits our ability to understand the social processes through which sexual prejudice develops and is reinforced. It encourages us to focus on the prejudiced individual while ignoring the larger culture that stigmatizes homosexuality.
This is not to deny that sexual prejudice (like other form of prejudice) is observed in some people with severe psychological problems. But that doesn’t mean homophobia is itself a pathology.
But What About the Newest Scientific Data?
Web and media coverage of a recently published research study by Dr. Giacomo Ciocca and his colleagues from several Italian universities could lead you to believe that we now have evidence that homophobia is linked to mental illness.
So could the study’s title, “Psychoticism, Immature Defense Mechanisms and a Fearful Attachment Style are Associated with a Higher Homophobic Attitude.”
And so could remarks by the study’s senior author, Dr. Emmanuele Jannini, who was quoted as saying “The study is opening a new research avenue, where the real disease to study is homophobia” and “we have the final proof that [homophobia] for sure is” a disease.
Published in the Journal of Sexual Medicine, the study involved administering a measure called the Homophobia Scale (HS) and several other questionnaires to a sample of Italian college students, and then assessing whether and how the scores were intercorrelated.
In brief, the researchers found that HS scores were significantly associated with scores on two checklists of psychological symptoms — “psychoticism” and “depression.” Overall, students with higher HS scores (more prejudice) tended to score higher on a Psychoticism scale, whereas students with lower HS scores (less prejudice) tended to score higher on a Depression scale.
Students with higher HS scores also tended to respond differently from low HS scorers on a questionnaire designed to reveal the types of psychological defense mechanisms a person is likely to use when experiencing anxiety. The high HS scorers tended toward a cluster of defenses that are often labeled “immature,” while the low HS students tended toward “neurotic” defenses.
Finally, when responses to another questionnaire were used to categorize students according to their attachment style — a general psychological pattern that characterizes an individual’s close relationships with others — the students classified as having a “fearful” attachment style had higher HS scores, on average, than those whose attachment style was categorized as “secure.”
A Closer Look
Many Web and media reports accepted the study’s findings at face-value. Here’s a sampling of headlines:
Examining the study’s methodology, however, makes clear that it doesn’t provide support for thinking about prejudice against lesbian, gay, and bisexual people as a disease.
Let’s begin with the sample.
The study participants were 551 psychology students, mostly female (about 71%) and Catholic (74%). The sample wasn’t representative of a larger population so there’s no way of knowing whether the findings can be generalized to anyone else.
Perhaps more importantly, none of the students could be considered mentally ill. Prior to the study, a team of clinical psychologists screened potential participants for severe psychological problems, a procedure that led to the exclusion of nine students who had been diagnosed and treated for a psychiatric disorder.
Consequently, although the students’ scores on the various psychological measures differed (as is routinely the case), the variation presumably was, as psychologists often phrase it, within normal limits.
And the sample may have included few students, if any, who would be considered “homophobic.”
Homophobia was measured using a questionnaire called the Homophobia Scale (HS), which asks respondents how much they agree or disagree with each of 25 statements such as “Gay people make me nervous” and “Homosexuality is immoral” and “Homosexual behavior should not be against the law.”
Here again, there was normal variation among the students in HS scores. But overall, the sample was very low in sexual prejudice. HS scores can range from zero to 100, with higher scores indicating less prejudice. The average score in this study was about 26. Given that the scale consists of 25 items, a substantial portion of participants must have given a “low-prejudice” response (i.e., a 1 or 2 on a 5-point scale) to all 25 items.
So the participants weren’t mentally ill and few, if any, could be labeled homophobic.
Now let’s consider each of the study’s main findings.
Psychoticism and Depression. In addition to the HS scale, the students also completed the Symptom Check List (SCL-90), a widely used questionnaire on which respondents use a 5-point scale (ranging from Not at all to Extremely) to report how much they’ve been bothered or distressed during the previous week by each of 90 problems and complaints, e.g., “Heart pounding or racing,” “Feeling that most people cannot be trusted.”
The SCL-90 can be scored to indicate the extent to which a respondent reports symptoms and feelings that are commonly associated with various psychological problems. Here again, scores vary. Two people with different scores can both be within the “normal” range, i.e., not reporting symptoms to a degree that would warrant a clinical diagnosis.
Using a statistical procedure called multiple regression analysis, the researchers found that scores on the SCL-90 Psychoticism and Depression scales were significantly associated with Homophobia Scale scores, as noted above. This doesn’t mean that students with high HS scores were psychotic or that those with low HS scores were clinically depressed. It simply means that responses to the SCL-90 varied in a way that corresponded to variations in HS scores.
To make sense of this pattern, it’s instructive to examine the symptoms included in the SCL-90. For example, the Psychoticism scale includes “The idea that you should be punished for your sins” and “Having thoughts about sex that bother you a lot.”
It’s easy to imagine the most religious college students in this predominantly Catholic sample being more bothered than their peers by thoughts about sex and believing that they (and all people) should be punished for their sins.
Highly religious students are also more likely than others to score high on the HS scale. Many empirical studies (including my own) have shown that conservative religious beliefs are strongly associated with higher levels of sexual prejudice.
Thus, there’s ample reason — having nothing to do with psychoticism — to expect that students with higher HS scores would also report more distress from thoughts about sex and sin. Responses to these two SCL-90 items alone may well account for the correlation observed between HS and Psychoticism scores. Unfortunately, the researchers’ statistical analysis didn’t take differences in religious belief into account.
Defense Mechanisms. The concept of defense mechanisms derives mainly from psychoanalytic theory, which posits that they are unconscious strategies for avoiding anxiety. Psychoanalysts have developed a long list of them which includes, for example, projection and reaction formation.
In the extreme, they can be associated with psychopathology. Most of them, however, are also used by psychologically healthy people, at least occasionally.
Students in the Ciocca et al. study completed the Defense Style Questionnaire (DSQ), which consists of 40 statements, each of which is intended to indicate a tendency to use one of 20 different defenses. For example, agreeing that “People tend to mistreat me” is supposed to indicate a tendency to use projection. Agreeing that “If someone mugged me and stole my money, I’d rather he be helped than punished” is supposed to be consistent with using reaction formation.
Of course, there are many reasons — having nothing to do with defense — why a person might agree with one or more of these statements.
DSQ scores for individual defenses can be combined into larger categories. Using one of the most common categorization systems, the researchers found that students with higher HS scores tended to score somewhat higher on “immature” defenses (a group that includes projection), while low HS scorers tended to score higher on “neurotic” defenses (which includes reaction formation). In this system, using neurotic defenses to excess is considered less pathological than using immature defenses.
As noted above, however, most of the defenses are used by mentally healthy people (like the students in this sample). Minor variations within a healthy group don’t indicate pathology.
Attachment. Finally, the researchers categorized students according to their predominant attachment style, as assessed by the Relationships Questionnaire (RQ). Respondents to the RQ rate the extent to which their own patterns of relating to others correspond to each of four descriptions.
In the Ciocca et al. study, students in one attachment category (“Fearful”) scored significantly higher on the Homophobia Scale than students in another category (“Secure”). HS scores for students in the other two attachment categories (“Preoccupied” and “Dismissing”) didn’t differ significantly from each other or from the Fearful or Secure groups.
For at least three reasons, no conclusions about homophobia and mental illness can be drawn from this finding.
First, the Relationships Questionnaire isn’t a measure of psychopathology. Mentally healthy people can (and do) occupy any of the four categories.
Second, some research has suggested that high levels of attachment anxiety may be linked to derogation of all outgroups. So the findings of Ciocci et al. may reflect this more general tendency.
Third, results from other published studies that have looked for links between attachment style and homophobia have been inconsistent and contradictory. Like Ciocca et al., none of these studies used a representative sample. The safest conclusion to draw about homophobia and attachment style is that the jury is still out.
In summary, the Ciocca et al., study doesn’t provide evidence that would justify categorizing homophobia as a mental illness. Nor does any other empirical research.
Labeling homophobia a form of psychopathology may score rhetorical points but is inaccurate. And doing so distracts us from achieving a better understanding of the phenomena encompassed by the term homophobia.
As readers of my empirical and theoretical papers know, I’ve been arguing for much of my professional career that scientific research must move beyond homophobia in order to yield insights about cultural stigma and individual prejudice based on sexual orientation.
To facilitate that shift, I’ve developed a conceptual framework for thinking about and studying these phenomena.
I’ll discuss that framework and relevant empirical research in future posts.
June 17, 2015
Supreme Court Justice Ruth Bader Ginsberg has been quoted as saying the Court’s 1973 Roe v. Wade decision went “too far, too fast.”
Her comment has sometimes been cited in speculation that the Court won’t rule that people have a constitutional right to marry a same-sex partner because the Justices are reluctant to get too far ahead of public opinion.
However, public opinion may be well ahead of the Court in this arena. As we await a ruling in the Orbergefell marriage equality cases, it’s a good time to reflect on current public sentiment about marriage rights for same-sex couples, and how and why it has shifted over the last two decades.
Public Opinion Today
Last week, the Pew Research Center reported that 57% of the respondents in their latest national survey (most of whom presumably were heterosexual) said they support “allowing gays and lesbians to marry legally.” Only 39% were opposed.
Compare this to a 2001 Pew poll in which the numbers were reversed: 57% opposed marriage equality and only 35% supported it.
A recent Gallup poll showed the same remarkable turnaround: 60% of their respondents now endorse the statement that “marriages between same-sex couples should be recognized by the law as valid, with the same rights as traditional marriage.”
As with the Pew data, earlier Gallup surveys revealed a quite different pattern. In 2005, 59% opposed marriage equality and only 37% supported it. Still earlier, in 1996, marriage rights for same-sex couples were opposed by more than two thirds (68%) of Gallup respondents, with only 27% in support.
Polling data on marriage equality have been somewhat confusing because different surveys have yielded different numbers. As early as 2010, a few already showed a majority of Americans favoring marriage equality. And even today some still show less than half of the public supporting marriage equality.
This variability is largely explained by methodological differences among the polling organizations, according to a meta-analysis by UCLA political scientist Andrew Flores that was recently published in Public Opinion Quarterly.
When Dr. Flores combined the data from more than 130 different polls, controlling statistically for variations in question wording and “house effects” (i.e., differences among polling organizations in how they collect and analyze their data), he found a clear trend: Support for marriage equality has increased fairly steadily since 1996, with a majority of the public endorsing it by 2014.
The trend of shifting attitudes isn’t limited to marriage equality. We see it as well in public opinion about adoption rights, the ability of same-sex couples to be good parents, protection from employment discrimination, and other issues relevant to law and policy. And it is also evidenced by a steady increase in favorable attitudes toward lesbian and gay people in recent years. (Attitudes toward bisexual women and men have probably changed as well, but few polls have included questions designed to specifically tap those attitudes.)
Change has occurred in nearly every demographic group, although it’s more evident in some groups than in others. For example, marriage equality support has increased more among Democrats and Independents than Republicans. But Republicans’ support has nevertheless been increasing as well.
Is the Shift Generational or Individual?
How can we explain these seismic shifts over a relatively brief time span?
They’re often attributed to ongoing population turnover. According to this explanation, individuals aren’t changing their opinions. Rather, change results from older generations dying out and younger ones taking their place. On average, older people are less likely than their younger counterparts to support marriage equality or express favorable attitudes toward sexual minorities. As time passes and younger generations come of age, their attitudes become more dominant in society as a whole.
This pattern of generational replacement is evident when polling data are broken down by age groups. As shown in the Pew data, for example, support for marriage equality is lowest among adults born during the Depression Era but increases steadily in each successive generation. Baby Boomers are more supportive than their elders, GenXers are more supportive than Boomers, and Milliennials show the strongest support of any age group.
But generational replacement is only part of the story. The Pew graph shows that opinions have also been shifting within each age group. In other words, attitude change isn’t happening only in the population as a whole; heterosexual individuals have been changing their minds about sexual minorities, and at a rapid pace.
In fact, individual change is the primary force behind the big shifts in public opinion. When researchers Gregory Lewis and Lanae Hatalsky combined data from more than 128,000 respondents in nearly 100 national surveys conducted between 2004 and 2011, they found that only 25% of the shift in overall support for marriage equality during those 8 years could be attributed to generational replacement. Most of the change – 75% of it – resulted from individuals who once opposed or were undecided about marriage equality coming to support it.
Why Are People Changing Their Minds?
Why have so many individual Americans changed their minds? There’s no single answer to this question; people have different reasons. But we can see a common thread running through those reasons if we assume that people generally adopt attitudes and opinions to meet their important psychological needs and to feel good about themselves. When any particular attitude stops serving these purposes, it’s susceptible to change.
For example, heterosexual people whose sense of self is grounded mainly in their personal value system – whether deriving from religion, politics, ethics, or other sources – are likely to express attitudes that serve to affirm those values. Whether they support or oppose marriage equality, their attitude functions to solidify their sense of personal identity and increase their feelings of self-worth. If they come to see their stance on marriage equality as inconsistent with key aspects of their value system, however, they may be open to change.
A 2013 Pew survey, for example, found that 28% of those who endorsed marriage equality said they hadn’t always held that view. When asked what made them change their minds, roughly one third cited values — e.g., their own moral and religious beliefs or their support for equality. For them, being true to those values came to mean expressing support for marriage equality.
Other heterosexual people have especially strong needs for social acceptance and affiliation. The main motivation underlying their marriage equality opinions is their desire to secure approval and support from friends, family, and other important groups. If group norms change, however, clinging to the old attitude may block them from meeting those affiliation needs. As support for marriage equality increasingly becomes the norm throughout much of the United States, people seeking their group’s approval are more and more likely to get it by changing their attitudes to conform with the trend.
About one sixth of respondents in the 2013 Pew survey attributed their new-found endorsement of marriage equality to their perception that social acceptance of it is inevitable. For at least some of them, changing their attitudes may have allowed them to continue to enjoy group acceptance in a changing world.
Attitudes can also function to help people make sense of their own past experiences, including their interactions with people from groups other than their own. Having an unpleasant encounter with a lesbian, gay, or bisexual person may lead heterosexuals to hold negative feelings toward all sexual minorities. Conversely, good experiences can generalize to a positive attitude toward the entire group and issues that affect it.
Interestingly, it turns out that heterosexuals’ personal contact with lesbian, gay, or bisexual people usually results in more positive attitudes, not only toward the specific person involved, but also toward sexual minorities as a group. Having a friend or relative who is gay, lesbian, or bisexual can be a potent motivator for heterosexuals to change their opinions.
We see evidence of this pattern in the 2013 Pew poll. About one third of the participants who had come to support marriage equality cited their personal experiences with gay or lesbian friends, family members, or acquaintances as the reason why.
As I’ve discussed in previous blog posts, personal contact appears to be especially influential when it includes open discussion of what it’s like to be lesbian, gay, or bisexual. Such discussions can lead heterosexuals to think about sexual minorities in a new way and to rethink the connections between their personal values and their attitudes toward sexual minorities. And when heterosexuals see that their own family or friendship circle includes sexual minorities, the desire to maintain their social ties can motivate them to rethink their attitudes.
The functional approach I’ve used to organize this discussion focuses on individual psychology. But shifts in public opinion about marriage equality aren’t simply a matter of what goes on inside people’s heads. The larger culture’s beliefs and norms make possible the relationship between particular attitudes and specific psychological needs. As cultural institutions have changed in recent years, so have the ways in which heterosexuals’ attitudes toward marriage equality and sexual minorities are linked to their values, worldview, group memberships, and personal relationships. (For a more sociological perspective on attitude change, see this post from The Conversation.com.)
Back to Justice Ginsburg
Perhaps another quotation from Justice Ginsburg is more fitting to the current moment than her “too far, too fast” comment.
Earlier this week, she displayed a clear understanding of how and why public attitudes toward lesbian, gay, and bisexual people have changed when she cited the power of personal contact and coming out in advancing sexual minority rights:
“People looked around … and it was my next-door neighbor, of whom I was very fond, my child’s best friend, even my child…. They are people we know and we love and we respect, and they are part of us…. Discrimination began to break down very rapidly once they no longer hid in a corner or in a closet.”
If, as many observers expect, she and a majority of her colleagues on the Court affirm same-sex couples’ right to marry, they won’t be getting ahead of public opinion. Rather, they’ll be following the lead of the American people.
February 3, 2015
Not so long ago, homosexuality was triply stigmatized.
Throughout much of the 20th century, in addition to being condemned as a sin and prosecuted as a crime, it was assumed by the mental health professions to be an illness.
Although that assumption was never based on valid scientific research, the stigma attached to homosexuality impelled untold numbers of lesbian, gay, and bisexual people to seek a cure for their condition. Others were coerced into treatment after being arrested or hospitalized.
Psychologists and psychiatrists used a variety of techniques on them, ranging from talk therapy to electroshock, aversive conditioning, lobotomies, hormone injections, hysterectomies, and castrations.
None were effective.
Meanwhile, new research was challenging orthodox beliefs about homosexuality and prompting some mental health professionals and researchers to question the validity of the sickness model.
Alfred Kinsey’s studies revealed that same-sex attraction and behavior were much more common than had been widely believed. Clellan Ford and Frank Beach showed that homosexual behavior was common across human societies and in other species.
And Evelyn Hooker documented the existence of well-adjusted gay men. She also demonstrated that experts in the “diagnosis” of homosexuality could not distinguish between the Rorschach protocols of well-functioning gay and heterosexual men at a level better than chance.
The larger society was also changing. By the 1960s, gay and lesbian activists were challenging the notion that they were mentally ill.
Psychiatric and psychological orthodoxy proved unable to withstand the critical scrutiny that these developments brought. On December 15, 1973, millions of people suddenly found themselves free of mental illness when the American Psychiatric Association’s Board of Directors voted to remove homosexuality as a diagnosis from its Diagnostic and Statistical Manual of Mental Disorders (DSM).
It was arguably the biggest mass cure in the modern history of mental health.
Then, meeting in late January of 1975 – almost exactly 40 years ago – the American Psychological Association (APA) Council of Representatives voted to support the psychiatrists’ action, affirming that:
“Homosexuality per se implies no impairment in judgment, stability, reliability, or general social and vocational capabilities.”
This complete reversal in the status accorded to homosexuality by the mental health profession’s two largest and most influential organizations was to have a huge impact.
Gay, lesbian, and bisexual people would no longer have to grow up assuming they are sick. Reputable psychologists and psychiatrists would no longer tell them they can and should become heterosexual. Because a characteristic that isn’t an illness doesn’t need treatment, the raison d’etre for attempting to cure homosexuality vanished.
Nearly all therapists eventually abandoned their efforts to make gay people straight. New therapeutic approaches were developed that affirm the value of gay, lesbian, and bisexual identities and same-sex relationships while assisting sexual minorities in coping with the challenges created by societal stigma. These approaches are now integral to the education, training, and practice of psychologists and other mental health professionals.
* * * * *
But the significance of this year’s 40th anniversary extends further. The APA’s 1975 resolution also urged mental health professionals
“to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientations.”
Thus, the Association committed itself to advocacy, lobbying, and educational efforts on behalf of sexual minorities. It has since followed through by promoting research and communicating scientific and clinical knowledge about sexual orientation to the courts, elected officials, policy makers, educators, and the general public.
Notably, these efforts have included filing amicus briefs in more than 40 major federal and state court cases involving the rights of sexual minorities. Roughly half of those cases involved legal recognition of same-sex couples. Others addressed state sodomy laws, discrimination, restrictions on military service, parenting rights, and related issues.
Drawing from empirical research, the APA briefs have explained important facts about sexual orientation:
* * * * *
In April, when the U.S. Supreme Court hears oral arguments for four marriage equality cases, the APA will file another amicus brief summarizing current scientific knowledge and professional opinion about sexual orientation, committed intimate relationships, parenting, and related topics.
In doing so, the Association will continue to honor its pledge to take the lead in “removing the stigma.”
* * * * *
A version of this post also appears on the APA’s blog, Psychology Benefits Society.
The APA amicus briefs are available at: http://www.apa.org/about/offices/ogc/amicus/index-issues.aspx
September 16, 2014
Last week, the 7th Circuit Court of Appeals upheld lower court rulings striking down anti-marriage laws in Indiana and Wisconsin. Even those of us who aren’t legal scholars can find good reading in Judge Richard Posner’s written opinion, which skewered the states’ arguments against marriage equality.
As a social scientist, I was pleased that his legal analysis was informed by data from social and behavioral research. And I was gratified that he referenced some of my own work.
Early in his 40-page decision, Judge Posner wrote,
“We begin our detailed analysis of whether prohibiting same-sex marriage denies equal protection of the laws by noting that Indiana and Wisconsin … are discriminating against homosexuals by denying them a right that these states grant to heterosexuals, namely the right to marry an unmarried adult of their choice. And there is little doubt that sexual orientation, the ground of the discrimination, is an immutable (and probably an innate, in the sense of in-born) characteristic rather than a choice. Wisely, neither Indiana nor Wisconsin argues otherwise.” (p. 9, my emphasis)
The evidence he cited in support of this assertion included materials from the American Psychological Association and a paper on which I was the lead author, describing findings from a survey I conducted with a nationally representative sample of lesbian, gay, and bisexual adults.
This blog post is about the research and the context in which I conducted it.
* * * * *
Early research on sexual minority subcultures in the United States tended to focus on gay men. And the researchers often reported that most gay men felt they hadn’t chosen their sexual orientation. For example, in his 1951 book, The Homosexual in America: A Subjective Approach, sociologist Edward Sagarin (writing under the pseudonym Donald Webster Cory) wrote:
“This does not mean that sexual inversion [homosexuality] is voluntary, and that one need only exercise good judgment and will-power in order to overcome it or to choose some other pathway. Not at all. It is entirely involuntary and beyond control, because one did not choose to want to be homosexual.” (p. 183)
And psychologist Evelyn Hooker, in her 1965 paper, Male Homosexuals and Their “Worlds” (in Judd Marmor’s edited book, Sexual Inversion: The Multiple Roots of Homosexuality), reported from her ethnographic observations of gay male communities:
“One of the important features of homosexual subcultures is the pattern of beliefs or the justification system. Central to it is the explanation of why they are homosexuals, involving the question of choice. The majority believe either that they were born as homosexuals or that familial factors operating very early in their lives determined the outcome. In any case, homosexuality is believed to be a fate over which they have no control and in which they have no choice.” (p. 102)
In recent years, religious conservatives have strongly disputed this view, and the argument that homosexuality is a sinful choice has achieved considerable prominence in their public rhetoric. In the 1990s, they mounted media campaigns promoting the notion that people can and should stop being gay. The director of one of these ex-gay campaigns told the New York Times that its goal was to strike at the assumption that homosexuality was immutable and that gay people therefore need protection under anti-discrimination laws.
Not surprisingly, public opinion reflects this dimension of the culture wars. Heterosexuals’ attitudes toward lesbians and gay men are reliably correlated with their beliefs about choice. Antigay heterosexuals are likely to assert that homosexuality is a choice, whereas unprejudiced heterosexuals are likely to believe that sexual orientation is inborn or otherwise not chosen. (As discussed below, the question of whether heterosexuals choose their orientation is rarely asked.)
* * * * *
In the 1990s, I was surprised to discover that, despite all the debate and heated rhetoric, relatively little empirical research had directly examined how people perceive their own sexual orientation.
Indirect evidence for a lack of choice was available. For example, most participants in the Kinsey studies of the 1940s and 1950s reported they had experienced sexual attraction only to one sex (men or women) throughout their entire lives; but the Kinsey team did not ask directly about perceptions of choice.
Illuminating research was conducted by sociologist Vera Whisman, who set out to study lesbians and gay men who said they had chosen their sexual orientation. However, as she reported in her book, Queer By Choice, most of her sample did not experience their patterns of sexual attractions as a choice. Those who were “queer by choice” were typically referring to choosing their sexual behaviors and the labels and identities they adopted for themselves.
Otherwise, anecdotal and autobiographical accounts were available and a few studies reported relevant questionnaire data from small samples. But as best I could tell, no large-scale studies had asked people whether they perceived their own sexual orientation (whether hetero-, homo-, or bisexual) as a choice.
* * * * *
This lack of data prompted me to begin asking about choice in my own research.
Based on the available evidence, I expected to find that many – probably most – gay men didn’t perceive their sexual orientation to be a choice.
For women, however, I thought the pattern might be different. Many feminists argued that lesbianism is a choice women can (and should) make for themselves. And in some early studies, gay men tended to report having been aware of their homosexuality at an earlier age than lesbians, which might be evidence of a gender difference in the experience of choice.
These and other patterns led me to tentatively hypothesize that lesbians would be more likely than gay men to report they experienced some degree of choice about their sexual orientation.
In an exploratory study during the 1990s with a relatively small community sample that included 125 gay and lesbian adults, these hypotheses were supported. My colleagues and I found that most of the gay men (80%) said they had no choice at all about their sexual orientation. The proportion of lesbians who said they had no choice was smaller, but still a majority (62%).
While these findings were interesting, the sample was small. I subsequently decided to ask a similar question in two survey studies with larger and more representative samples that also included enough bisexual women and men to permit meaningful analyses of their responses.
In the first of those surveys, we collected questionnaire data from 2,259 gay, lesbian, and bisexual adults in the greater Sacramento area. One questionnaire item was, “How much choice do you feel that you had about being lesbian/bisexual?” [for men the wording was "gay]/bisexual”]. The 5 response options were “no choice at all,” “very little choice,” “some choice,” “a fair amount of choice,” and “a great deal of choice.”
The results weren’t dramatically different from those we obtained in the pilot study: 87% of the gay men reported they experienced “no choice at all” or “very little choice” about their sexual orientation. Once again, women perceived having more choice than men. Even so, most lesbians (nearly 70%) reported having little or no choice.
It is perhaps not surprising that bisexuals reported feeling they had more choice about their sexual orientation. Nevertheless, nearly 59% of bisexual men and 45% of bisexual women said they experienced little or no choice. Another 15% and 20%, respectively, said they had only “some choice.”
This study’s sample was large but it wasn’t a probability sample, i.e., one that is representative of the population at large. We had recruited the participants mainly through Northern California lesbian, gay, and bisexual community organizations and at community events, most of them in the Sacramento area. People who weren’t active in the community or weren’t open about their sexual orientation were probably underrepresented.
I subsequently had the opportunity to assess how well these findings fit the population as a whole when I surveyed a nationally representative sample of self-identified lesbian, gay, and bisexual adults. We asked them “How much choice do you feel you had about being lesbian?” [Or gay or queer or bisexual or homosexual, depending on the term they had previously said they preferred for describing themselves.] Four response options were available: “no choice at all,” “a small amount of choice,” “a fair amount of choice,” and “a great deal of choice.”
The responses of gay men and lesbians were strikingly similar to those we obtained from the Sacramento-area community sample: 88% of the gay men reported “no choice at all” about being gay, with another 6.9% saying they experienced “a small amount of choice.” Only 5% reported they experienced “a fair amount” or “a great deal” of choice. Among lesbians, 68.4% reported no choice, and another 15.2% reported experiencing a small amount of choice; only 16% experienced a fair amount or a great deal of choice.
Thus, 95% of gay men and 84% of lesbians reported experiencing little or no choice about their sexual orientation. This is the finding Judge Posner cited last week in his opinion.
In contrast to the community study, a majority of bisexuals in the national sample reported having little or no choice about their sexual orientation, although they were less likely than gay men and lesbians to say they experienced no choice at all. Among bisexual men, 38.3% said they experienced no choice, and another 22.4% experienced a small amount of choice, a total of 60.7%. Among bisexual women, the numbers were 40.6% and 15.2%, respectively, a total of 55.8%.
None of these surveys explicitly defined the term choice, so we don’t know whether respondents interpreted it as referring to their pattern of attractions, their sexual behaviors, their identity, or some other facet of sexual orientation. Based on Vera Whisman’s research, cited above, it seems likely that most were referring to the amount of choice they experience in their sexual attractions and desires.
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What about heterosexuals? Do they perceive their sexual orientation as a choice?
To the best of my knowledge, no published research based on a probability sample of heterosexual adults reports data that directly answer this question. I intended to ask it in a national survey I conducted in the 1990s, but was dissuaded from doing so by other members of my research team. They convinced me the question would create problems during data collection because most heterosexuals simply wouldn’t know how to answer it.
This asymmetry in who can answer the choice question can be understood as a reflection of sexual stigma. One manifestation of stigma is the widespread assumption that heterosexuality is normal and unproblematic. Few heterosexuals are ever asked what made them straight, and most have probably never thought about the origin of their own attractions to the other sex.
Homosexuality, by contrast, is viewed as problematic. Nonheterosexuals are routinely asked what made them “that way” and, in the course of coming out, they often ask themselves this question. Even when a scientific study evenhandedly examines the origins of all sexual orientations, its subject matter is typically characterized as what causes people to be gay or bisexual.
In this context of stigma, it is perhaps not surprising that I encountered some raised eyebrows when I initially shared my findings about perceptions of choice with other researchers – not so much because of the numbers, but simply because I had asked the question.
Some assumed that documenting how people perceive their sexual orientation would be the basis for arguing that gay, lesbian, and bisexual people shouldn’t be persecuted because “it’s not their fault” – they never chose to be “that way.” This argument is perceived (often correctly) as implicitly suggesting that (a) being lesbian, gay, or bisexual is a defect, and (b) if people did choose to be anything other than heterosexual, they would deserve to be discriminated against.
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But although Judge Posner’s opinion takes up the question of choice – as did Judge Vaughn Walker, who cited the same research in his decision overturning California’s Proposition 8 – he doesn’t treat homosexuality as a defect. Nor does he suggest that gay, lesbian, and bisexual people would deserve to be persecuted if they freely chose their sexual orientation.
However, Judge Posner recognizes that lesbian, gay, and bisexual people constitute an identifiable minority group defined by an immutable characteristic that is irrelevant to a person’s ability to contribute to society. Consequently, any attempt by the state to discriminate against them must serve some important government objective.
And, as he concluded, the rationale offered by Wisconsin and Indiana for their laws denying marriage rights to same-sex couples, “is so full of holes that it cannot be taken seriously…. The discrimination against same-sex couples is irrational, and therefore unconstitutional…” (pp. 7-8).
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Here are the bibliographic sources for my studies, described above.
Herek, G. M., Cogan, J. C., Gillis, J. R., & Glunt, E. K. (1998). Correlates of internalized homophobia in a community sample of lesbians and gay men. Journal of the Gay and Lesbian Medical Association, 2(1), 17-25.
Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32-43.
Herek, G. M., Norton, A. T., Allen, T. J., & Sims, C. L. (2010). Demographic, psychological, and social characteristics of self-identified lesbian, gay, and bisexual adults in a U.S. probability sample. Sexuality Research and Social Policy, 7, 176-200.
A brief introduction to sampling terminology and methods is available on my website.
September 2, 2014
Today is the 107th anniversary of the birth of Dr. Evelyn Hooker, the psychologist who is widely credited with helping to establish that homosexuality is not inherently linked to mental illness.
In the course of her remarkable life, Dr. Hooker surmounted many of the barriers faced by women who sought an academic career in the 20th century.
She was born Evelyn Gentry on September 2, 1907, to a poor farm family in North Platte, Nebraska. The sixth of nine children, she received her early education in one-room schoolhouses on the Nebraska prairie, followed by high school in Sterling, Colorado. She subsequently earned baccalaureate and master’s degrees at the University of Colorado.
She wanted to apply to the doctoral psychology program at Yale but her University of Colorado department chairman (himself a Yale graduate) refused to recommend a woman. Instead, she entered the graduate program at Johns Hopkins University, receiving her Ph.D. in 1932.
She taught at the Maryland College for Women and then at Whittier College. While at Whittier, she received a fellowship to study psychotherapy for a year in Germany. As Hitler was ascending to power, she resided with a Jewish family in Berlin. While in Europe, she also visited Russia shortly after Stalin’s purge of 1938. Those experiences in totalitarian states further deepened her interest in working for social justice and human rights.
Whittier fired Dr. Hooker and several of her colleagues for their liberal political beliefs. She was subsequently hired by UCLA as an adjunct faculty member. According to the department chairman, she was relegated to that status because the Psychology Department faculty (all but three of whom were men) were unwilling to appoint another woman to a tenure-track position.
In 1951, she married Edward Niles Hooker, a distinguished UCLA professor of English and the man she called her “true love.” He died suddenly in 1957, a loss that deeply pained her.
Dr. Hooker is best known for her psychological research in the 1950s and 1960s with gay men.
Her studies were innovative in several important respects. Rather than simply accepting the conventional wisdom that homosexuality is a pathology, she used the scientific method to test this assumption. And rather than studying homosexual psychiatric patients, she recruited a sample of gay men who were functioning normally in society.
For her best known study, published in 1957 in The Journal of Projective Techniques, she recruited 30 homosexual males and 30 heterosexual males through community organizations in the Los Angeles area. The two groups were matched for age, IQ, and education. None of the men were in therapy at the time of the study.
She administered three projective tests to the men — the Rorschach inkblot test, the Thematic Apperception Test (TAT), and the Make-A-Picture-Story (MAPS) Test). Then she asked outside experts to use the test data to rate each man’s mental health. Although today it seems like an obvious safeguard against bias, Dr. Hooker’s was the first published study to utilize raters who did not know the sexual orientation of the study participants.
Using the Rorschach data, two of the independent experts evaluated the men’s overall adjustment using a 5-point scale. They classified two-thirds of the heterosexuals and two-thirds of the homosexuals in the three highest categories of adjustment.
Hooker presented the judges with the 60 Rorschach protocols in random order and asked them to identify each man’s sexual orientation. Only six of the homosexual men and six of the heterosexual men were correctly identified by both judges. She later gave the judges another opportunity, this time presenting them with matched pairs of protocols, one from a homosexual man and one from a heterosexual. Only 12 of the 30 pairs elicited correct responses from both judges.
A third expert used the TAT and MAPS protocols to evaluate the men’s psychological adjustment. As with the Rorschach responses, the adjustment ratings of the homosexuals and heterosexuals did not differ significantly.
Dr. Hooker concluded from her data that homosexuality is not a clinical entity and that homosexuality is not inherently associated with psychopathology. Her findings have since been replicated by other investigators using a variety of research methods.
In retrospect, we can see that Dr. Hooker’s main hypothesis — that no group differences in psychological distress should exist between heterosexual and homosexual samples — actually applied too strict a test. We know today that some members of stigmatized groups manifest elevated rates of psychological distress — for example, because of the stress imposed on them by social ostracism, harassment, discrimination, and violence. Such correlations don’t mean that group membership is itself a pathology.
By documenting that well-adjusted homosexuals not only existed but in fact were numerous, Dr. Hooker’s research demonstrated that the illness model had no scientific basis. She helped to lay the foundation for the American Psychiatric Association’s 1973 decision to remove homosexuality from its Diagnostic & Statistical Manual of Mental Disorders, and for the American Psychological Association’s subsequent commitment to removing the stigma that has historically been attached to homosexuality.
Dr. Hooker died at her Santa Monica home on November 18, 1996. Her pioneering research and remarkable life were honored with awards from numerous professional organizations, including the American Psychological Association, and many advocacy and community groups.
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For more information, see the 1992 Oscar-nominated documentary, Changing Our Minds The Story of Dr. Evelyn Hooker.
A biographical sketch and a selected bibliography of Dr. Hooker’s publications can be found on my website.
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Postscript. Although homosexuality has not been classified as a mental disorder in the United States for decades, the International Classification of Diseases (ICD) still lists several diagnoses related to homosexuality (although not homosexuality itself) as pathological. For example, “ego-dystonic” sexual orientation, which was removed from the DSM in the 1980s, remains in the ICD.
In preparation for the upcoming 11th edition of the ICD, the World Health Organization created a Working Group on the Classification of Sexual Disorders and Sexual Health to review these diagnoses. In a report released this summer, the Working Group, headed by Prof. Susan Cochran of UCLA, recommended that all of them be eliminated.
The Working Group’s recommendations will be reviewed by the ministers of health from more than 170 WHO countries, including Russia, Uganda, Nigeria, and other nations where sexual stigma is enshrined in law.
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This entry is an expanded and updated version of a 2008 Beyond Homophobia post.
August 25, 2014
In 1957, Dr. Evelyn Hooker’s groundbreaking study documented that, despite the conventional psychiatric wisdom of the day, gay men were not inherently maladjusted. More studies followed that similarly failed to find differences in psychological functioning between heterosexuals and nonheterosexuals.
Eventually, this body of research provided the scientific foundation for the American Psychiatric Association’s 1973 decision to remove homosexuality as a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, and the American Psychological Association’s strong endorsement of that declassification.
With the advantage of hindsight, we can see that debates about Dr. Hooker’s work and that of later researchers — and, more broadly, about the status of homosexuality as a pathology — often conflated questions about homosexuality’s classification as a mental illness with questions about the prevalence of psychological disorders in a particular population. It was inappropriately assumed that if lesbian, gay, or bisexual people had higher rates of psychopathology or psychological distress than heterosexuals, homosexuality itself must be an illness.
We now recognize that sexual stigma in its many forms is a significant stressor that can affect an individual’s physical and mental health. Thus, it is not surprising that large-scale studies of the US population have revealed that, while most lesbian, gay, and bisexual people are functioning well, some are not. And, as a 2011 report by the Institute of Medicine documented, a substantial array of health disparities exist between the population at large and sexual and gender minorities.
Against this backdrop, newly released data from Gallup reveal that US adults who identify as lesbian, gay, bisexual, or transgender (LGBT) report lower levels of well-being than their non-LGBT counterparts. Comparing the self-reports of 2,964 LGBT research participants with those of 81,134 other respondents, and controlling statistically for relevant demographic variables, Dr. Gary Gates found that the latter group reported less well-being in all five areas covered by the index.
The disparities were especially pronounced among women respondents. Sexual and gender minority women scored substantially lower than other women on measures of financial, physical, social, and community well-being, as well as a measure of having a sense of purpose in life. Among men, disparities were observed for financial and social well-being.
The initial report, which is available on the Gallup website, doesn’t separate the well-being scores of lesbian/gay, bisexual, and transgender respondents. Comparing these groups will be important insofar as past research has revealed important differences among them. (From the perspective of scientific research, a problem with combining the groups under the “LGBT” initialism is that it tends to obscure these differences.)
While reading the tables in the report it’s also important to keep in mind that, because the sample sizes are so large, relatively small differences between groups (i.e., 1 or 2 percentage points) can be statistically significant without having much practical importance. But the differences highlighted by Dr. Gates are generally larger than this.
As Dr. Gates concluded,
“These disparities associated with sexual orientation and gender identity highlight the ongoing need for the inclusion of sexual orientation and gender identity measures in data collection focused on health and socio-economic outcomes. Availability of better data that identify the LGBT population will help researchers, healthcare policymakers, and healthcare providers craft better strategies to understand and prevent well-being disparities associated with sexual orientation and gender identity.”
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