Clinically Based Thoughts About
The Development Of Homosexuality

Johanna Krout Tabin, Ph.D.

Source: Collected Papers from the NARTH Annual Conference, Saturday, 29 July 1995.

The Political Correctness of an attitude toward homosexuality has become an unfortunate issue even in the professional/scientific community. I agree with colleagues in NARTH that debate arises because of confusion between protecting civil rights of people who practice homosexuality and recognizing the psychodynamic significance of a homosexual resolution to developmental conflicts.

There is a good deal of theory in the literature to try to explain the origins of homosexuality, but none of it offers a coherent explanation for the idea of two parallel but equivalent tracks of personality development. It is understandable, therefore, that those espousing the two-track idea are attaching much hope to the current spate of publicity relating homosexuality to genes. Before taking up what psychological factors there may be, I think it is important that we get out of the way the notion that homosexuality is something already predetermined at birth.

Obviously, if the publicized genetic evidence stands, then homosexuality (unlike every other variant of human sexual behavior) is a given, in the same way as eye color is created purely by genes. If the genetic evidence does not stand, then human sexuality can be recognized as infinitely more complex than that, including the effects a person's own behavior and other experiences may have on the functioning of the very cells of the brain.

I did not automatically approach this question cynically. I happened to hear on the radio a summary of data which made me feel I had better read the original article by Bailey and Pillard (1991) on twins and not just accept the authors' conclusions, as I otherwise would have done. I wish to provide, as a preamble to developmental considerations, the basic details of why genetic explanations so-far offered are contradicted by the actual data. I am mindful that the language of the laboratory is more easily read than listened to, and therefore I shall try to keep to the essentials.

A new genetic study gaining public attention is based on manipulation of the white (w) gene in fruitflies (Zhang and Odenwald, 1995). This is not necessarily a bizarre comparison to human homosexuality, since organizing genes are phylogenetically the same throughout the animal kingdom, starting at least with insects. Supposedly, changing the w gene proved to create homosexual fruitflies. It is true that in this experiment, the male flies with the changed genes tried indiscriminately to mate with other males. It so happens that they also continued to mate with females. The bottle they were in contained some virgin females, which allowed mating. There also were females which were already inseminated, and refused mating exactly as they did with unchanged males. Furthermore, in this situation, the males which did not have a gene change, if they were in a minority, eventually began to mate with males, also. Finally, I must tell you the theory the authors come to in explaining any change in sexual behavior of fruitflies with this gene change. The authors think that serotonin, one of the main chemicals of the brain, may no longer be produced in the usual amount. Diminished serotonin produces male/male mounting or similar behavior in cats, rats and rabbits. Low levels of serotonin in the human, however, is related to varieties of uncontrollable behavior, so such a basis for human homosexuality would mean many other symptoms that those who look for a genetic explanation of homosexuality would not like. In any case, there is no evidence for it (Odenwald, 1995; personal communication).

Byne, a psychiatrist with a doctorate in biology, and Parsons (1993) looked carefully at other biochemical theories and found that the evidence for a causative connection just is not there. They also noted the actual data in the most widely quoted study, Bailey and Pillard's (1991) investigation of homosexuality in twins. In spite of what Bailey and Pillard claimed and the newspapers reported, if this study proves anything, it is that human homosexuality is not genetically predetermined. These are the critical data: Even identical twins (which means those with identical heredity) correlated between themselves only 52 percent for homosexuality--so other factors must affect matters; but even more critically, fraternal twins were concordant for homosexuality twice as often as were non-twin biological brothers (22 percent vs. 9 percent). From the genetic standpoint, those two figures should have been the same, since non-twin related siblings and fraternal twins form one genetic group. In other words, if the data mean anything, then twinship may be a factor, but genes cannot be.

Treatability is another issue that influences some people to believe that exploring the psychological dynamics of homosexuality is taboo. Freud considered that the sexual satisfaction derived from homosexuality precluded sufficient motivation for effective psychoanalysis. Whether or not he was right about this, the requirements of ego-formation set the parameters for sexuality very early in one's life and changing these takes arduous effort. I believe that a 40 percent "cure" rate is still what is most often reported for unspecified patients in all forms of psychotherapy. Notably, the statistics for cure are still less impressive for the relatively deeper disturbances. Nicolosi (1995, in preparation, private communication) reviewed over two hundred published studies of the treatment of male homosexuality. Overall, he found that 30 percent cited "cures," 40 percent "significant improvement," and 30 percent "no change." It intrigues me that somehow the statistics for treatment in regard to homosexuality should be expected to be higher than for any other of the sexual variants that might be part of a patient's life, supporting the Politically Correct position that homosexuality is merely an alternative lifestyle.

It might be worthwhile to remind ourselves about how we evaluate the developmental significance of particular behaviors in any patient, in relation to therapeutic results. There are questions which seem to be answered differently for homosexuality because of a wish this could be done validly. For example, is a sole criterion of presumed meaning to a patient of a certain behavior ever whether or not the patient changes that behavior through analysis? Do we not say, often enough, that a patient left analysis with a particular behavior unchanged, but with a more comfortable attitude toward it?

Should it be a theoretical criterion against treatability whether a patient leaves analysis with certain behaviors intact and yet the person not only feels comfortable about those behaviors but incorporates them into a constructive manner of living? Do we not often say it about a particular patient in relation to various symptoms, yet feel that those symptoms might be further ameliorable in other patients? Or in that patient at a later time?

Why is homosexuality seen by some in a special light? Perhaps the topic produces such intense feelings of righteousness because gender identity and choice of person to love in terms of gender identity are so basic in ego formation.

This topic takes us to the very beginning of personality development.

We are back to gleaning from personality theory sufficient understanding of development to explain the wide range of personal characteristics that may include homosexuality, and also the nearly complete prevalence of heterosexuality. Nicolosi's treatment of men who are homosexual is squarely based on his reading of developmental factors (Nicolosi, 1991, 1993): What unmet needs of a small boy trying to grow up does homosexuality serve for a man?

It is pretty well agreed upon these days that all human infants organize their perceptions of themselves as beings in the world as fast as their increasing neurological maturity enables them. We all know the importance for everybody of whether someone is a boy or a girl. Is that not the very first question people ask when a new child is born?

The human mind requires order and the initial framework for organizing a sense of self is the evident dichotomy between boy and girl. Other dichotomies, such as good/bad or present/gone-forever, also characterize the thinking of the toddler-age child, but gender identification provides a link between a sense of uniqueness through bodily sensations and a psychosocial identity. Who am I in this family? What does it mean to be ME? Classifying oneself as boy or girl is a very early task (Tabin, 1985; Tabin and Tabin, 1988).

Genital sensations, contributing hugely to both this inevitable classification and a sense of personal uniqueness, become a linchpin of the developing personality. Genital sensations unite body ego, self-definition, and one's sense of oneself in a psychosocial world peopled by two obvious kinds of beings. Thus, from very early on, the developmental course is different for boys and girls.

I want to say something about what I see as the ramifications of this fact in the course of ego development. Limited space keeps me to a summary of my views, however, without justifying them here, as I do elsewhere (Tabin, 1985; Tabin and Tabin, 1988; Tabin, 1989). I began to appreciate the importance of developmental differences between toddler boys and girls when I lea.rned from a young adult patient of mine, in a way that we were able to document, that she was dramatically involved with oedipal feelings by the age of two (Tabin, 1985).

I could see that her present eating disorder made sense on the basis of her feeling herself to be her mother's rival--at the same time that she was still close to the symbolic importance for her of food/mother/body as an interconnected force. It struck me that in that case, she was very different from a boy, whose counterpart feelings would not have made him his mother's rival; and in fact, only in a statistically small proportion of cases, usually among the most pathological (Sours, 1974), do boys develop limiting eating disorders.

Understanding the girl's predicament would be a prelude to understanding the development of female homosexuality. However, the literature is mainly concerned with the statistically more numerous incidence of homosexuality among males. In the space available for this discussion, I will concentrate on questions concerning males.

Therefore, what of personality development in a boy? If we recognize that genital sensations on his part contribute not only to his sense of uniqueness but also to his way of orienting himself as a social being, we can see that his perceptions plus his need for meaning intertwine his sexy feelings with closeness to mother. However, rivalrous feelings with father are not so straightforward for a boy at the early stage as they will be when he reaches the classical oedipal phase, by around four years of age. There are two aspects of how the mind works in toddlers that, taken together, complicate the situation for him.

One factor that is crucial is underscored in the work of Piaget (1948). Yet during toddlerhood and definitely during infancy, contiguity is an important basis for identification of objects. Objects that are close together gain a similar identity. We still see this in adults from the intensity of some people's feelings when they are at a large function, that they must be seated near to the head table. The dilemma for the toddler boy is heightened by a second aspect of how a toddler's mind works, the concreteness of his ideas. Thus, when sexy feelings occur with a wish to be as close to Mommy as possible, to him that very act, in his mind making him be like her, would eliminate from him what is different between them, his penis.

If we recognize how these complexities confound and compound the boy's task in settling for himself who he is and what that means, we are not surprised that Herzog (1980) could point to father hunger in a number of eighteen-month-old boy patients. Closeness to father is as reassuring to the toddler boy about his own bodily integrity as closeness to mother is scary because of the fantasy that he might become emasculinized in the process. Herzog's patients were all children of single mothers who kept the boys with them to sleep at night. His sensitive treatment of these boys was successful in helping them to overcome the night terrors which were their presenting symptoms. However, we can speculate on what it might have meant to their future development if such treatment had not occurred.

It is a given how all of the variations of interpersonal experience which come to the child at this stage affect the shaping of a budding personality. However, the mental tools he has for dealing with the vagaries of interpersonal experience in turn determine how his personality takes shape. Signs of an integrated sense of self begin to emerge at about nine months of age, the same time as the brain waves apparently stabilize, infants begin to pull against gravity to an upright position, language begins, and intentional genitality--purposeful touching for special sensations--is observable.

Many clinicians, infant observers and psychoanalytic theorists have published evidence that while toddlers are aware of sexy feelings and find them to be self-defining, a conscious sense of self by that period also requires attention to issues about autonomy and dependence. Forming an integrated ego under the circumstances includes the role of the upsurge of language (with many consequences, particularly the ability to label or not to label that is so important in the pooling of the unconscious), greater independence in the eating process and the maturation of the sphincters in turn affording an increased sense of personal power and organization; the importance of binary classification (foremost, boy/girl; good/bad; omnipresent/annihilated; etc.), and the range of unruly affects that color all responses.

The logic of heterosexuality comes from the fact that there are two sexes, baby-making consists of their interrelationship--based on their fitting together--one is oneself of either the one or the other sex. These facts are fundamental in the early period of dichotomous thought when the child first creates an organized view of self in the world. Relevant data come from Lev-Ran (1974). He studied adult hermaphrodites in Russia who were born before genetic sex-typing was available at birth. The plasticity of choice of partner is beautifully illustrated by the fact that these hermaphrodites, who were raised in accordance with a doctor's assignment of gender, but eventually learned as adults that their genetic makeup was opposite, resisted "converting." They characteristically showed strong egos with firm gender identity and capacity to marry successfully, heterosexually, on the basis of the original sex assignment. Maybe their parents, out of the parents' own need, underscored clarity of gender identity however they could, thus helping the hermaphrodites to establish strong personal identity. In any case, we can speculate that the hermaphrodites assigned for themselves their choices of partners by combining a self-accepted classification of gender with their sexy feelings, in the context of a two-sexed world.

Perhaps it is already evident that I see homosexuality as deriving from one of the possible solutions that a little one might find in creating as secure a sense of self as he can.

Seeing homosexuality in this way makes it logical that many--if not all--men who organize their personal lives as heterosexuals, nonetheless maintain inner balance through ego maneuvers that sometimes include having occasional frank homosexual fantasies or joining fiercely loyal all-male clubs or enjoyment of writhing male bodies in contact sports. These possibilities reconfirm the integrity of the male body, as opposed to the primordial threat in closeness to females.

The applicability of the toddler situation to frank homosexuality becomes clear in the frequent reliance on non-genital eroticism by use of oral and anal apertures, enjoyment of sexual sadomasochism, and the assignment of roles as "inserters" or recipients. The fact that female genitalia are often fearsome to male homosexuals (while these same men often form close emotional and intellectual ties to women) would seem to be an obvious sign that unconscious fantasies are at work, that led early to resolution by a psychological mechanism characteristic of the toddler years, splitting. The mechanism in this instance mentally splits the idea of a woman between a dangerous, sexual person and an asexual, lovable person. This relieves anxieties that otherwise occur in trying to resolve confusion from wishing for closeness with Mother combined with fear that it would mean of loss of identity.

In the first edition of his book, Lewes (1988) defends the idea that homosexuality may not be based on pathological development, but nowhere offers a theory of how that could be, nor goes into the kinds of symptoms that often characterize homosexual patients.. Encouraged by the hope for a specific biological cause, he spells out in his 1995 introduction to the book the sort of behavior that needs explanation in patients, suggesting that we might view "certain kinds of psychopathology as the sequelae of a homosexuality that has previously occurred" (p. xxvii). He refers to Bieber's finding (1962) that remote fathers are characteristic of the family milieu of homosexual patients, not emphasizing the significance of the other finding, seductive mothers. If there were a genetic basis, then the activation of homosexuality upon the sight of father's erect penis would become plausible and a parallel track development derived from it, as Lewes speculates. However, our knowledge of genetics does not support a two track hypothesis, after all.

We are left with the outline of development that clinical experience has brought us to. Appreciating the importance of oedipal feelings from the beginning of ego-formation affords us the further clarity that Lewes still seeks, but not a supposition that adult homosexuality derives from a benign early history.

Jon Meyers has lately concentrated on the subject of treatment, but in 1986 he presented to CAPP (The Chicago Chapter of Div. 39) an overview of development, based on his extensive clinical experience with this behavior. He found that of those who came for treatment, the people who clung to part-object choices (not permitting themselves relationships with full human beings)--looking for penile contact in public places--showed other signs of ego weakness. Bizarre dress and other manifestations of primitive defense mechanisms tended to appear in this group. Those who established transient relationships with other men showed greater ego strength; and, as one might expect, those who formed lasting bonds with another man displayed more ego strength in other ways, too; with bisexuals on the whole demonstrating the least of disturbed behaviors and, as a group, the greatest ego strength of his sample.

For sure, heterosexuality does not by itself guarantee psychological well-being. However, it is rare not to find conflict about homosexual ideation increasingly manifest in progressively deeper states of despair.

The foregoing, like any generalizations about human nature, cannot be interpreted in a hard and fast manner, yet the general shape of a continuum is discernible. One sees the same thing in degrees of manifest ego strength among anorexics, bulimarexics and bulimics (Sours, 1974), as is apparent in work I have done, also (Tabin, 1985, Tabin and Tabin, 1988).

Recently I began to see a boy of thirteen whose parents realized his need for treatment because of his suicidal feelings. His parents found poetry he wrote to another boy, so they knew that he was involved with homosexual feelings, too. I regret to say that in their first effort to get Ricky help, they brought him to a well known local child psychiatrist, who after a single meeting with Ricky, announced to the parents that they must simply accept the boy's sexual orientation.

When they consulted me for another opinion, I told them that I considered homosexuality to be secondary to deeper causes and my efforts with their son would be concentrated on whatever fears and confusions he let me know about. They were already aware of fearful behavior and confusion in his thought pattern, so it made sense to them for Ricky and me to work together.

Ricky appeared at our first meeting with his hair long, but otherwise dressed in the fashion of youngsters today. Later on, reminiscent of a toddler's defining identity by outer appearance, he made me aware that when he was feeling more homosexual, he wore Brooks Brothers type shirts, and at other times, the loose T-shirts that his schoolmates were likely to wear. He wanted me to know, however, that he was determined in his homosexuality.

To my surprise, when I asked Ricky to explain homosexuality to me, it was clear that he was involved with emotional closeness but had no conscious fantasies about penises and bodily openings. I steadfastly refused, sincerely, to tell him that I thought he was or was not going to live out his life as a homosexual. Rather, my thoughts were on what I could know about and help him with, his feelings of confusion and depression. Whatever seemed right for him after his fears were dissipated would be agreeable with me. However, Ricky kept insisting that I was set upon changing him. I finally pointed this out to him. I asked him why he thought it was that he kept putting words in my mouth. He looked thoughtful and recognized that was what he was doing.

At this point he told me he had a dream. There was a dangerous blob that tried to engulf him and turn him into a girl, but Arnold Schwarzenegger saved him. The next scene was in a bathroom. A girl was in the tub and he was aware of being attracted to her. Then he turned to me and said it was immoral, what he was thinking.

Subsequently, he told me repeatedly that if he were to be heterosexual, he would do terrible things, like rape. Another theme was his rivalry with an older brother, remembering particularly the brother's wrestling with him when he was small and how overwhelmed he felt. His first memory of what he labeled as homosexual feelings was of being enthralled by a wrestler on TV when he was eight years old. More recently, he thought that he was like characters in sitcoms who were obviously homosexual, but very much part of the group.

I habitually do not think or talk in the jargon of psychological theory, but spontaneously, Ricky several times told me that fears of incest came up from his unconscious. These thoughts seemed to center on his mother's breasts.

His opening remarks in my office had identified similarities between his mother and me. Statements that implied any feelings of closeness were immediately followed by his desire to be in touch with George, a lad he had a crush on whose having moved away seemed to have precipitated Ricky's crisis. Ricky also said that in George's presence, he felt he could take on the world.

Obviously, Ricky's suicidal feelings upon George's moving away did not stem from any perception of his that society would condemn him for his being homosexual. The suicidal feelings are understandable in terms of the toddler-age conflicts he struggled with: In the emotional mix he dealt with, someone's not being present meant "all gone," annihilated; in this example, what disappeared was Ricky's source of confirmation of his masculinity/personhood. Life did not seem worth living.

This recurrent association--closeness to a woman followed by a need to have George present in order for Ricky to maintain his personhood--is a dramatic replay of what we know to be part of the process of crystallizing a sense of self in the toddler stage. The rape and other violent sexual fantasies dramatize the use of domination to establish self-identity.

Alternatively, he could secure a sense of masculinity--self-preservation--by closeness to a male. For this boy, being homosexual was a way of settling his conflicts over a need for domination that made him not trust himself with his own sexy feelings.

There is one more person I want to tell you about. You may know of him. His name is Edmund White. A Boy's Story is his account of how he became overtly homosexual. The seductive mother and the remote father whom Bieber (1962) identified in his study and whom we often hear about in personal histories of homosexuality, are evident in White's story. However, I do not bring him up to give another case history.

In the July 17, 1995 New Yorker, Edmund White reviews a book about bisexuality. He concludes with this wistful statement, "Following a tendency that Garber correctly criticizes, I denied the authenticity of my earlier heterosexual feelings in the light of my later homosexual identity. After reading Vice Versa, I find myself willing to reinterpret the narrative of my life."

These words are poignant from someone who has spent his entire adult life as a spokesman for the homosexual community. They are a sad commentary on the current Politically Correct notion that homosexuality is something to embrace, something that is immutable.

More understanding about the dynamics of homosexuality might also be useful to those whose conflicts about it drive them to become evangelical against people who practice homosexuality. This is important because, as Lewes (1988) demonstrates, there are unfortunate effects upon homosexual men from experiencing pejorative attitudes toward homosexuality. It is important for another reason, too. Those who are so severely conflicted that they feel they must prove their own heterosexuality by negative displays toward anyone who is homosexual, at the same time suffer inwardly for their lack of faith in themselves.

We mental health specialists can provide leadership in this matter by maintaining the respect for each of a patient's feelings that acquaintance with someone's unconscious can give us. My guess is that we all still have very much to learn about homosexuality. It will serve our patients and our profession best if here as in all other questions about human behavior, we work with an open-minded attitude, seeking true understanding.

References

Bailey, J. & Pillard, R. (1991). A genetic study of male sexual orientation. Archives of General Psychiatry, 48, 1089-1096.

Bieber, I., et al. (1962). Homosexuality: A psychoanalytical study of male homosexuals. New York: Basic Books.

Byne, W. & Parsons, B. (1993). Human sexual orientation: The biological theories reappraised. Archives of General Psychiatry, 50, 228-239.

Fliegel, Z. (1973). Feminine psychosexual development in Freudian theory, a historical reconstruction. Psychoanalytical Quarterly, 42, 385-408.

Herzog, J.M. (1980). Sleep disturbance and father hunger in 18- to 24-month-old boys. In

Solnit, et al. (eds.), Psychoanalytical Study of the Child, 35, 223-230.

Horney, K. (1924). On the genesis of the castration complex in women. International Journal of Psychoanalysis, 5, 50-65.

Jones, E. (1925). The early development of female sexuality. In Papers on Psychoanalysis, 438-451. Boston: Beacon Press, 1961.

Klein, M. (1928). Early stages of the oedipus conflict. International Journal of Psycho-Analysis, 9, 167-180.

Kwawer, J. (1980). Transference and countertransference in homosexuality: Changing psychoanalytic views. American Journal of Psychotherapy, 34, 72-80.

Lev-Ran, A. (1974). Gender role differentiation in hermaphrodites. Archives of Sexual Behavior, 3(5), 391-423.

Lewes, K. (1988). The psychoanalytic theory of male homosexuality. New York: Aronson.

Lewes, K. (1995). Psychoanalysis and male homosexuality. New York: Aronson.

Meyers, J. (1986). Development of homosexuality. Paper delivered for homosexuality symposium, Spring meeting of Chicago association for psychoanalytic psychology.

Nicolosi, J. (1991). Reparative therapy. New York: Aronson.

Nicolosi, J. (1993). Healing homosexuality: Case studies of reparative therapy. New York: Aronson.

Piaget, J. (1948). The child's conception of space. London: Routledge and Kegan Paul, 1956..

Sours, J.A. (1974). The anorexia nervosa syndrome. International Journal of Psychoanalysis, 35(4), 567-576.

Tabin, J. (1985). On the way to self: Ego and early oedipal development. New York: Columbia University Press.

Tabin, J. (1986). Discussant at homosexuality symposium, Spring meeting of Chicago association for psychoanalytic psychology.

Tabin, C.J. & Tabin, J. (1988). Bulimia and anorexia: Understanding their gender specificity and their complex of symptoms. In Bulimia: Psychoanalytic Theory and Treatment. (Harvey Schwartz, ed.). New York: International Universities Press.

White, E. (1995). Gender uncertainties. New Yorker, July 17, pp. 79-80.

Zhang, S-D. & Odenwald, W.F. (1995). Misexpression of the White (w) gene triggers male-male courtship in drosophila. Proceedings of the National Academy of Sciences, USA, 92, (June 6), 5525-5529.

Updated: 8 February 2008

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