Homosexuality and psychology

Psychology was one of the first disciplines to study homosexuality as a discrete phenomenon. In the late 19th and early 20th centuries, pathological models of homosexuality were standard. Psychologists later began responding to the needs of gay, lesbian, and bisexual people including, most visibly, responses to the AIDS pandemic of the 1980s and 1990s.

Major psychological research on homosexuality, which has been carried out predominantly in America, can be divided into five categories:
 * 1) Why some people are gay or lesbian (Which factors determine that people have same-sex desires?)
 * 2) Anti-gay attitudes and behaviors (What are the causes of discriminatory behavior regarding gays and lesbians and how can this be influenced?)
 * 3) Psychological functioning (Does being gay or lesbian affect one's health status, psychological functioning or general well-being?)
 * 4) Coming out as, and being, gay or lesbian (What determines successful adaptation to a rejecting social climate in gays and lesbians?  Why do some gays and lesbians experience homosexuality as central to their identity, while others experience it as peripheral?  Why do some gay men develop more effeminate behavior than others?  Etc.)
 * 5) Sexuality, intimate relationships, and parenting (How do children of lesbian and gay parents develop?  What determines the attitude of gays and lesbians towards other (sexual) minorities?  Etc.)

Psychological research in these areas has been relevant to counteracting prejudicial ("homophobic") attitudes and actions, and to the LGBT rights movement generally.

Freud and his predecessors (1886 - 1939)
The first attempts to classify homosexuality as a disease were made by the fledgling European sexologist movement in the late nineteenth century. In 1886 noted sexologist Richard von Krafft-Ebing listed homosexuality along with 200 other case studies of deviant sexual practices in his definitive work, Psychopathia Sexualis. Krafft-Ebing proposed that homosexuality was caused by either "congenital [during birth] inversion" or an "acquired inversion".

In 1896 Sigmund Freud published his ideas on psychoanalysis. Freud believed that all humans were innately bisexual and that whether a particular person manifests heterosexuality or homosexuality could result from environmental factors interacting with biological sexual drives. Freud expressed serious doubts about the potential for therapeutic conversion. In a famous letter to a mother who had asked Freud to treat her son, he wrote:

"By asking me if I can help [your son], you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted."

In that letter, he also states that "homosexuality is assuredly no advantage but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness....".

Prominent psychoanalyst Dr. Joseph Merlino, Senior Editor of the book Freud at 150: 21st Century Essays on a Man of Genius, stated in an interview:

Freud maintained that bisexuality was a normal part of development. That all of us went through a period of bisexuality and that, in the end, most of us came out heterosexual but that the bisexual phase we traversed remained on some unconscious level, and was dealt with in other ways....He did not consider it something that should be criminalized, or penalized.... Freud felt there were a number of homosexuals he encountered who did not have a variety of complex problems that homosexuality was a part of. He found people who were totally normal in every other regard except in terms of their sexual preference. In fact, he saw many of them as having higher intellects, higher aesthetic sensibilities, higher morals; those kinds of things. He did not see it as something to criminalize or penalize, or to keep from psychoanalytic training. A lot of the psychoanalytic institutes felt if you were homosexual you should not be accepted; that was not Freud's position.

From this period through the middle of the 20th century, medical attempts to "cure" homosexuality have included surgical treatments such as hysterectomy, ovariectomy, clitoridectomy, castration, vasectomy, pudic nerve surgery, and lobotomy. Substance-based treatment attempts have included hormone treatment, pharmacologic shock treatment, and treatment with sexual stimulants and sexual depressants. Other attempts include aversion therapy, the attempted reduction of aversion to heterosexuality, electroshock treatment, group therapy,    hypnosis,  and psychoanalysis.

After Freud, before Stonewall (1939 - 1969)
During the three decades between Freud's death (1939) and the Stonewall riots (1969), conversion therapy enjoyed a "gilded age" of aggressive treatment of homosexuals and approval from the psychiatric establishment. Prominent researchers arguing for therapeutic conversion included Edmund Bergler, Irving Bieber, Albert Ellis, Abram Kardiner, Sandor Rado, and Charles Socarides. Rado rejected Freud's theory of innate bisexuality and argued instead that heterosexuality is nature's default setting and that homosexuality is caused by parental psychopathology. Socarides and Kardiner developed similar theories: Socarides interpreted same-sex desire as an illness arising from a conflict between the id and the ego usually arising from an early age in "a female-dominated environment wherein the father was absent, weak, detached or sadistic".

The conversion therapists also rejected Freud's pessimism about therapy being able to change sexual orientation: Bieber published a 1962 study concluding that "although this change may be more easily accomplished by some than by others, in our judgment a heterosexual shift is a possibility for all homosexuals who are strongly motivated to change." Homosexuality was assumed to be a psychopathology: Ellis found that "fixed homosexuals in our society are almost variably neurotic or psychotic ... therefore, no so-called normal group of homosexuals is to be found anywhere." This view was endorsed by the 1952 first edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which classified homosexuality as a mental disorder.

Evelyn Hooker was a contrary voice when she published her influential 1957 paper "The Adjustment of the Male Overt Homosexual," where she found that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology."

Similarly, the controversial Kinsey Reports by U.S. biologist Alfred Kinsey are also credited for revolutionizing the study of sexuality, and homosexuality in particular. They found that homosexual thoughts and actions were much more widespread than commonly believed.

Post-Stonewall gay rights movement and the APA's declassification (1969 - Present)


In 1969, the Stonewall riots gave birth to the gay rights movement and increased the visibility of LGBT people. In 1973, after intense lobbying by gay and lesbian groups and new scientific information from researchers like Evelyn Hooker and Kinsey, the APA declassified homosexuality as a mental disorder with a vote of 58% of the membership supporting the measure. It was replaced with a diagnosis of egodystonic homosexuality, which was later removed. The current DSM contains a diagnosis of "persistent and marked distress about one’s sexual orientation."

Joseph Merlino, M.D., co-editor of the book American Psychiatry & Homosexuality, and psychiatry adviser to the New York Daily News, said in an interview of the APA's declassification: It was activism. But there was not hard science to say that homosexuality was a disorder or an illness, and that was the reason why activists took aim at psychiatry and psychoanalysis and challenged them to come up with the data to support that position. And they couldn't! The only data they could come up with were psychoanalytic theories that were not data. The data that they called data was presented from small groups of clinical populations of people who are gay who didn't like or didn't want or couldn't accept being gay. That was the population from which this so-called data was extracted. What the gay activists did in the 1970's was pull out the true data, the scientific data that they could find, and presented it to the diagnosis committee of the American Psychiatric Association and persuaded them that the science that did exist was on the side of homosexuality not being a disease or a disorder. That is why the diagnosis committee--the Nomenclature Committee, which is what it was called--suggested to the Board of the American Psychiatric Association that it be removed, and it was.

In 1974 the ABA endorsed the Model Penal Code, including its decriminalization of consensual adult homosexual acts, and in 1992 the WHO removed homosexuality from its list of mental illnesses, replacing it with egodystonic sexual orientation. The UK Government followed suit in 1994, followed by the Ministry of Health in Russian Federation in 1999 and the Chinese Society of Psychiatry in 2001.

A small minority of psychologists dispute the dominant view that homosexuality is not a mental disorder.

Contemporary Medical View
The current medical view of sexual orientation is that in combination with genetic and hormonal influences, it is determined in part by environmental influences, though "the reasons may be different for different people". From their research on 275 men in the Taiwanese military, Shu and Lung concluded that "paternal protection and maternal care were determined to be the main vulnerability factors in the development of homosexual males." Key factors in the development of homosexuals were "paternal attachment, introversion, and neurotic characteristics." Other researchers have also provided evidence that gay men report having had less loving and more rejecting fathers, and closer relationships with their mothers, than non-gay men. Whether this phenomenon is a cause of homosexuality, or whether parents behave this way in response to gender-variant traits in a child, is unclear. However, most people believe nature and nurture both play complex roles in the development of homosexuality.

Current research also suggests that sexual orientation is not necessarily innate and fixed, but instead can develop across a person's lifetime. A report from the Centre for Addiction and Mental Health states: "For some people, sexual orientation is continuous and fixed throughout their lives. For others, sexual orientation may be fluid and change over time." One study has suggested "considerable fluidity in bisexual, unlabeled, and lesbian women's attractions, behaviors, and identities."

However, they do not consider sexual orientation to be "a conscious choice that can be voluntarily changed." American medical organization have further stated therapy cannot change sexual orientation, and have expressed concerns over potential harms. The American Psychological Association has stated "Can Therapy Change Sexual Orientation? No... It does not require treatment and is not changeable." The director of the APA's LGBT Concerns Office explained: "I don't think that anyone disagrees with the idea that people can change because we know that straight people become gays and lesbians.... the issue is whether therapy changes sexual orientation, which is what many of these people claim." The American Psychiatric Association stated in 2018, "[G]iven the documented harm of "reparative" or conversion therapies regarding sexual orientation, it would likely be seen as unethical to research reparative therapy outcomes..." and cites reports that conversion therapy has harmed some individuals   Similarly, United States Surgeon General David Satcher issued a report stating that "there is no valid scientific evidence that sexual orientation can be changed".

Researchers have found childhood gender nonconformity to be the largest predictor of homosexuality in adulthood. Daryl Bem's Exotic Becomes Erotic theory theorizes that some children will prefer activities that are typical of the other sex and that this will make a gender-conforming child feel different from opposite-sex children, while gender-nonconforming children will feel different from children of their own sex, which may evoke physiological arousal when the child is near members of the sex which it considers as being "different", which will later be transformed into sexual arousal. Researchers have suggested that this nonconformity may be a result of genetics, prenatal hormones, personality, parental care or other environmental factors. Peter Bearman showed that males with a female twin are twice as likely to report same-sex attractions. He theorizes that parents of opposite-sex twins are more likely to give them unisex treatment, leading to less masculine influence on the males. Having an older brother decreases the rates of homosexuality among these twins, contradicting other studies on fraternal birth order and sexual orientation. Bearman theorizes that an older brother establishes gendersocializing mechanisms for the younger brother to follow, which allows him to compensate for unisex treatment.

Anti-gay attitudes and behaviors
Anti-gay attitudes and behaviors (sometimes called homophobia or heterosexism) have themselves been the object of psychological research, usually focusing on anti-gay-male, not anti-lesbian, attitudes.


 * Demographics: Anti-gay attitudes more often found in less educated and religious people, in older people more than younger people, in men more than women, and in people living in rural areas more than people living in urban areas.  These attitudes are also more systematically found in people with racist or sexist beliefs, and in people who do not know gay people on a personal basis.

Psychological functioning
Psychological research in this area includes examining mental health issues (including stress, depression, or addictive behavior) faced by gay and lesbian people as a result of the difficulties they experience because of their sexual orientation, physical appearance issues and eating disorders, and gender atypical behavior.


 * Drug and alcohol use: Gay men are not at a higher risk for drug or alcohol abuse than heterosexual men, but lesbian women may be at a higher risk than heterosexual women. This finding is contrary to a common assumption that, because of the issues people face relating to coming out and anti-gay attitudes, drug and alcohol use is higher among LGB people than heterosexuals.  Several clinical reports address methods of treating alcoholism in LGB clients specifically, including fostering greater acceptance of the client's sexual orientation.
 * Suicide: Gay and bisexual male youths are over 13 times more likely to attempt suicide than heterosexual male youths. No such difference was found between lesbian and straight female youths.  Gay and lesbian youth who attempt suicide are disproportionately subject to anti-gay attitudes, and have weaker skills for coping with discrimination, isolation, and loneliness, than those who do not attempt suicide.
 * Psychiatric disorders: In a Dutch study, gay men reported significantly higher mood and anxiety disorders than straight men, and lesbians were significantly more likely to experience depression (but not other mood or anxiety disorders) than straight women. Although this difference is probably caused by the stresses gay and lesbian people face stemming from anti-gay attitudes,
 * Psychical appearance and eating disorders: Gay men tend to be more concerned about their physical appearance than straight men. Lesbian women are at a lower risk for eating disorders than heterosexual women.
 * Gender atypical behavior: Gay men are more likely to display gender atypical behavior than heterosexual men. The difference is less pronounced between lesbians and straight women.

Coming out as, and being, gay or lesbian
Psychological research in this area includes examining the coming out process, special challenges facing lesbian and gay youth, parental attitudes toward their children's sexual orientation, the mental health effects of being openly gay or closeted, workplace issues, discrimination and violence against lesbian and gay people, and aging issues.


 * Coming out: Many gay and lesbian people go through a "coming out" experience at some point in their lives. Psychologists often say this process includes several stages "in which there is an awareness of being different from peers ('sensitization'), and in which people start to question their sexual identity ('identity confusion').  Subsequently, they start to explore practically the option of being gay or lesbian and learn to deal with the stigma ('identity assumption').  In the final stage, they integrate their sexual desires into a position understanding of self ('commitment')."  However, the process is not always linear and it may differ for lesbians and gay men.
 * Different degrees of coming out: One study found that gay men are more likely to be out to friends and siblings than co-workers, parents, and more distant relatives.
 * Effects of coming out on the person's well-being: Various studies have found that being out improves one's well-being, that openly gay people have less anxiety and better self-esteem and social support than closeted people, and that openly gay people are more satisfied in their relationships. This is attributed to the "negative health consequences of psychological inhibition" found in closeted people.
 * Effects of "traditional values" on the coming out process: One study found that "families with a strong emphasis on traditional values - implying the importance of religion, an emphasis on marriage and having children - were less accepting of homosexuality than were low-tradition families."
 * Determinants of parental attitudes toward homosexuality: One study found that parents who respond negatively to their child's sexual orientation tended to have lower self-esteem and negative attitudes toward women, and that "negative feelings about homosexuality in parents decreased the longer they were aware of their child's homosexuality."
 * Violence against LGBT people ("hate crimes"): One study found that nearly half of its sample had been the victim of verbal or physical violence because of their sexual orientation, usually committed by men. Such victimization is related to higher levels of depression, anxiety, anger, and symptoms of post-traumatic stress.

Sexuality, intimate relationships, and parenting
Psychological research in this area includes examining the sexual behavior of gay and lesbian people (both for its own sake and from a public health perspective), the relative contributions of gender and sexual orientation in determining sexuality and sexual attitudes, same-sex relationships, domestic violence within same-sex relationships, relationship satisfaction, and the impact (if any) on children growing up with same-sex parents.


 * Sexuality: Contemporary psychology views gender, not sexual orientation, as the primary determinant of sexuality. Thus, gay male relationships are more frequently "open" than heterosexual relationships because the individuals are men, not because they are gay.  Likewise, lesbian couples have sex less often than heterosexual couples, "although they seem to be more satisfied with their sex lives."
 * Attitudes toward sex: One study found that gay and lesbian people "had a better sexual self-understanding, and showed less guilt regarding masturbation and sexuality in general" than straight people.
 * Non-consensual sex: One study found that among sexually active gay men, over 27% of them had experienced non-consensual sex at least once.

Standard critiques of current research methodology
There are several standard critiques of the much recent research methodology. First, the research samples of gay men are often white, well-educated, upper-middle-class, self-identified gay men, usually drawn from media publications, organizations, and meeting places. Excluding people of color and low-income gay men from the samples may skew the data, and may reinforce existing stereotypes. A barrier to resolving this problem is the increased cost of gathering more representative samples. A second typical critique is that because cultural and historical context significantly influence the expression of homosexuality, gay and lesbian people should not necessarily be studied in unqualified terms: "gay men in the Netherlands [may have less] in common with gay men in the US than with heterosexual men in the Netherlands."

Psychotherapy with LGB clients
Most LGB people who seek psychotherapy do so for the same reasons as heterosexuals (stress, relationship difficulties, difficulty adjusting to social or work situations, etc.); their sexual orientation may be of primary, incidental, or no importance to their issues and treatment. Whatever the issue, there is a high risk for anti-gay bias in psychotherapy with LGB clients.

Resources and external links

 * American Psychological Association
 * Answers to Your Questions About Sexual Orientation and Homosexuality
 * A Selected Bibliography of Lesbian, Gay, and Bisexual Concerns in Psychology
 * Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients
 * Avoiding Heterosexual Bias in Psychological Research
 * Being Gay Is Just as Healthy as Being Straight
 * Resolution on Sexual Orientation and Marriage
 * Resolution on Sexual Orientation, Parents, and Children


 * American Academy of Pediatrics
 * Sexual Orientation and Adolescents


 * National Mental Health Association
 * Factsheet: Bullying and Gay Youth
 * What Does Gay Mean? How to Talk with Kids about Sexual Orientation and Prejudice