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from Medical Issues
Homosexuality and Mental Health Problems
By N.E. Whitehead, Ph.D.
(Author of "My Genes Made Me Do It")
Summary: Recent studies show homosexuals have a substantially
greater risk of suffering from a psychiatric problems than do
heterosexuals. We see higher rates of suicide, depression, bulimia,
antisocial personality disorder, and substance abuse. This
paper highlights some new and significant considerations that
reflect on the question of those mental illnesses and on their possible
sources.
The American Psychiatric Association removed homosexuality
from its diagnostic list of mental disorders in 1973,
despite substantial protest (see Socarides, 1995). The A.P.A.
was strongly motivated by the desire to reduce the effects
of social oppression. However, one effect of the A.P.A.'s
action was to add psychiatric authority to gay activists'
insistence that homosexuals as a group are as healthy as
heterosexuals. This has discouraged publication of
research that suggests there may, in fact, be psychiatric
problems associated with homosexuality.
In a review of the literature, Gonsiorek (1982) argued there
was no data showing mental differences between gays and
straights--or if there was any, it could be attributed to
social stigma. Similarly, Ross (1988) in a cross-cultural
study, found most gays were in the normal psychological
range. However some papers did give hints of psychiatric
differences between homosexuals and heterosexuals. One
study (Riess, 1980) used the MMPI, that venerable and
well-validated psychological scale, and found that homosexuals
showed definite "personal and emotional oversensitivity."
In 1991 the absolute equality of homosexuality and heterosexuality
was strongly defended in a paper called "The
Empirical Basis for the Demise of the Mental Illness Model"
(Gonsiorek, 1991). But not until 1992 was homosexuality
dropped from the psychiatric manual used by other
nations--the International Classification of Diseases (King
and Bartlett, 1999)--so it appears the rest of the world
doubted the APA 1973 decision for nearly two decades.
Is homosexuality as healthy as heterosexuality? To answer
that question, what is needed are representative samples of
homosexual people which study their mental health, unlike
the volunteer samples which have, in the past, selected out
any disturbed or gender-atypical subjects (such as in the
well-known study by Evelyn Hooker). And fortunately,
such representative surveys have lately become available.
New Studies Suggest Higher Level of Pathology
One important and carefully conducted study found suicide
attempts among homosexuals were six times greater than the average
(Remafedi et al. 1998).
Then, more recently, in the
Archives of General Psychiatry--
an established and well-respected
journal--three papers
appeared with extensive
accompanying commentary
(Fergusson et al. 1999, Herrell et
al. 1999, Sandfort et al. 2001,
and e.g. Bailey 1999). J. Michael
Bailey included a commentary on the above research;
Bailey, it should be noted, conducted many of the muchpublicized
"gay twin studies" which were used by gay
advocates as support for the "born that way" theory.
Neil Whitehead, Ph.D.
Bailey said, "These studies contain arguably the best published
data on the association between homosexuality and
psychopathology, and both converge on the same unhappy
conclusion: homosexual people are at substantially higher
risk for some forms of emotional problems, including suicidality,
major depression, and anxiety disorder, conduct
disorder, and nicotine dependence...The strength of the
new studies is their degree of control."
The first study was on male twins who had served in
Vietnam (Herrell et al. 1999). It concluded that on average,
male homosexuals were 5.1 times more likely to exhibit suicide-
related behavior or thoughts than their heterosexual
counterparts. Some of this factor of 5.1 was associated with
depression and substance abuse, which might or might not
be related to the homosexuality. (When these two problems
were factored out, the factor of 5 decreased to 2.5; still
somewhat significant.) The authors believed there was an
independent factor related to suicidality which was probably
closely associated with some features of homosexuality
itself.
The second study (Fergusson et al. 1999) followed a large
New Zealand group from birth to their early twenties. The
"birth cohort" method of subject selection is especially reliable
and free from most of the biases which bedevil surveys.
This study showed a significantly higher occurrence
of depression, anxiety disorder, conduct disorder, substance
abuse and thoughts about suicide, amongst those
who were homosexually active.
The third paper was a Netherlands study (Sandfort et al.
2001) which again showed a higher level of mental-health
problems among homosexuals, but remarkably, subjects
with HIV infection was not any more likely than those
without HIV infection to suffer from mental health problems.
People who are HIV-positive should at least be
expected to be anxious or depressed!
The paper thus concluded that HIV infection is not a cause
of mental health problems--but that stigmatization from society
was likely the cause--even in the Netherlands, where
alternative lifestyles are more widely accepted than in most
other countries. That interpretation of the data is quite
unconvincing.
The commentaries on those studies brought up three interesting
issues.
1. First, there is now clear evidence that mental health
problems are indeed associated with homosexuality. This
supports those who opposed the APA actions in 1973.
However, the present papers do not answer the question; is
homosexuality itself pathological?
2. The papers do show that since only a minority of a nonclinical
sample of homosexuals has any diagnosable mental
problems (at least by present diagnostic criteria), then most
homosexuals are not mentally ill.
In New Zealand, for example, lesbians are about twice as
likely to have sought help for mental problems as heterosexual
women, but only about 35% of them over their lifespan
did so, and never more than 50% (Anon 1995, Saphira
and Glover, 2000, Welch et al. 2000) This corresponds with
similar findings from the U.S.
Relationship Breakups Motivate Most
Suicide Attempts
Next, we ask--do the papers show that it is gay lifestyle
factors, or society's stigmatization, that are the motivators
that lead a person to attempt suicide? Neither conclusion is
inevitable. Still, Saghir and Robins (1978) examined reasons
for suicide attempts among homosexuals and found
that if the reasons for the attempt were connected with
homosexuality, about 2/3 were due to breakups of relationships
--not outside pressures from society.
Similarly, Bell and Weinberg (1981) also found the major
reason for suicide attempts was the breakup of relationships.
In second place, they said, was the inability to
accept oneself. Since homosexuals have greater numbers
of partners and breakups, compared with heterosexuals,
and since longterm gay male relationships are rarely
monagamous, it is hardly surprising if suicide attempts
are proportionally greater. The median number of partners
for homosexuals is four times higher than for heterosexuals
(Whitehead and Whitehead 1999, calculated
from Laumann et al 1994).
A good general rule of thumb is that suicide attempts are
about three times higher for homosexuals. Could there be
a connection between those two percentages?
Another factor in suicide attempts would be the compulsive
or addictive elements in homosexuality (Pincu, 1989 )
which could lead to feelings of depression when the
lifestyle is out of control (Seligman 1975). There are some,
(estimates vary, but perhaps as many as 50% of young men
today), who do not take consistent precautions against HIV
(Valleroy et al., 2001) and who have considerable problems
with sexual addiction and substance abuse addiction, and
this of course would feed into suicide attempts.
The Effect of Social Stigma
Third, does pressure from society lead to mental health
problems? Less, I believe, than one might imagine. The
authors of the study done in The Netherlands were surprised
to find so much mental illness in homosexual people
in a country where tolerance of homosexuality is greater
than in almost all other countries.
Another good comparison country is New Zealand, which
is much more tolerant of homosexuality than is the United
States. Legislation giving the movement special legal rights
is powerful, consistently enforced throughout the country,
and virtually never challenged. Despite this broad
level of social tolerance, suicide attempts were common
in a New Zealand study and occurred at about the same
rate as in the U.S.
In his cross-cultural comparison of mental health in the
Netherlands, Denmark and the U.S., Ross (1988) could find
no significant differences between countries - i.e. the
greater social hostility in the United States did not result in
a higher level of psychiatric problems.
There are three other issues not covered in the Archives journal
articles which are worthy of consideration. The first two
involve DSM category diagnoses.
Promiscuity and Antisocial Personality
The promiscuous person--either heterosexual or homosexual
--may in fact be more likely to be antisocial. It is worth
noting here the comment of Rotello (1997), who is himself
openly gay: "...the outlaw aspect of gay sexual culture, its
transgressiveness, is seen by many men as one of its greatest
attributes."
Ellis et al. (1995) examined patients at an clinic which
focused on genital and urological problems such as STD's;
he found 38% of the homosexual men seeking such services
had antisocial personality disorder, as well as 28% of heterosexual
men. Both levels were enormously higher than
the 2% rate of antisocial personality disorder for the general
population (which in turn, compares to the 50% rate for
prison inmates) (Matthews 1997).
Perhaps the finding of a higher level of conduct disorder in
the New Zealand study foreshadowed this finding of antisocial
personality . Therapists, of course, are not very likely
to see a large number of individuals who are antisocial
because they are probably less likely to seek help.
Secondly, it was previously noted that 43% of a bulimic
sample of men were homosexual or bisexual (Carlat et al.
1997), a rate about 15 times higher than the rate in the population
in general--meaning homosexual men are probably
disproportionately liable to this mental condition. This may
be due to the very strong preoccupation with appearance
and physique frequently found among male homosexuals.
Ideology of Sexual Liberation
A strong case can be made that the male homosexual
lifestyle itself, in its most extreme form, is mentally disturbed.
Remember that Rotello, a gay advocate, notes that
"the outlaw aspect of gay sexual culture, its transgressiveness,
is seen by many men as one of its greatest attributes."
Same-sex eroticism becomes for many, therefore, the central
value of existence, and nothing else--not even life and
health itself--is allowed to interfere with pursuit of this
lifestyle. Homosexual promiscuity fuels the AIDS crisis in
the West, but even that tragedy it is not allowed to interfere
with sexual freedom.
And, according to Rotello, the idea of taking responsibility
to avoid infecting others with the HIV virus is completely
foreign to many groups trying to counter AIDS. The idea of
protecting oneself is promoted, but protecting others is not
mentioned in most official condom promotions (France in
the '80s was an interesting exception). Bluntly, then, core
gay behavior is both potentially fatal to others, and often
suicidal.
Surely it should be considered "mentally disturbed" to risk
losing one's life for sexual liberation. This is surely among
the most extreme risks practiced by any significant fraction
of society. I have not found a higher risk of death accepted
by any similar-sized population.
In conclusion, then, if we ask the question "Is mental illness
inherent in the homosexual condition?" the answer would
have to be "Further research--uncompromised by politics
--should be carried out to honestly evaluate this issue."
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Updated: 3 September 2008
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