Paul E. Lynch, M.D: And now you know what I meant by the fruits of psychoanalysis enlightening us today on the problems of anti-gay bias.
We will have another analyst next, Dr. Ralph Roughton. First I will give you some of his credentials and then I will tell you a little about my experience with Ralph Roughton. Ralph is Clinical Professor of Psychiatry at Emory University, a Training and Supervising Analyst, and Former Director of the Emory University Psychoanalytic Institute. He served as the Chair of the Committee on Issues of Homosexuality of the American Psychoanalytic Association from 1992 until 1998. Ralph was our first chair. He has served as a member of the Board on Professional Standards, the Executive Council, several task forces and committees, and the Editorial Board of the Journal of the American Psychoanalytic Association. He is currently a delegate from the American to the House of Delegates of the International Psychoanalytical Association where he will be introducing on Monday a resolution for a nondiscrimination policy statement on homosexuality in the International. I first got in touch with Ralph Roughton when I was accepted to the Boston Psychoanalytic Institute and I was told that a new committee was forming in the American, the Committee on Issues of Homosexuality. I called Ralph pretty much to complain, because as I understood it, they had this Committee on Issues of Homosexuality and there was not a single openly gay person on the committee. I did not think that was a good idea. They were not sure whether candidates could be on committees and blah, blah, blah…. It was a very short time before they got back to me, and then Susan, Sid and I were appointed to the committee. We have had a wonderful time working with Ralph since then. Ralph saw what fun Susan, Sid and I were having, and within a few years, he decided to join us outside of the closet. I am sure you will appreciate, given the credentials that I have already read, what a personal as well as professional decision this was for Ralph. At the last meeting of the International Psychoanalytical Association in Barcelona, Spain, there was a lot of unsavory talk about homosexuals, nothing like what we are having here today; we were delusional, sick, all the old stuff. You have heard it before. So I want to tell you all how proud I was sitting in the auditorium when in a panel on homosexuality, Ralph Roughton acknowledged in this inhospitable environment that he is an openly gay, Supervising and Training Analyst from the United States. I welcome Ralph Roughton.

Ralph Roughton, M.D.: Perhaps you can imagine what it is like to prepare for this discussion this morning thinking that you are the third speaker and going to be followed by Barney Frank who will be the finisher and then suddenly to find yourself in that role of the finisher. I promise you that I will not try to mimic Barney, but suggest that you watch him on the evening news tonight.
Dr. Chodorow has given us a very clear psychoanalytic understanding of the dynamics of homophobia placed in the context of cultural factors and of gender identity issues. I agree with her. I see homophobia as essentially an attempt to cope with threats to masculinity by splitting and projecting outward onto external objects which are then denigrated and attacked, in short an insistence that "I am not like that." When we speak of internalized homophobia, we refer to the shame, denigration and anger turned inward onto the self of the homosexual individual either as a re-internalization or from the absorption of homophobic attitudes in the environment and then identifying with the hated and feared object. The primary emotion is shame, but a whole gamut of inhibitions, loss of self esteem, depression and self-destructive behavior often follow.
My focus in this presentation moves from the individual internal dynamics to institutionalized homophobia and its effects, specifically the history of anti-homosexual prejudice in the theory, policies and practice of the American Psychoanalytic Association and to a brief description of the remarkable changes in this organization in the 1990’s. Although I will be discussing organized psychoanalysis, I will also be speaking from a more personal perspective, not an easy task in this cavernous room and with this elevated structural separation from you, the audience-- it is a bit intimidating.
Homophobia, both my own internalized homophobia and that of our culture, kept me confused about my own sexuality for much of my life and kept me hiding in the closet for most of my life. It is a mark of the astonishing changes occurring in our culture and within psychoanalysis and concurrently in my own internal resolution of conflicts that last week I voluntarily allowed my coming out story to be told in Erica Goode’s excellent article in the New York Times and today here I stand in the Grand Ballroom of the Waldorf along with Paul because I am a gay psychoanalyst. Some might call this a manic defense or a counter-homophobic maneuver. I think it represents serious progress in the resolution of whatever it was that went on in this organization and in psychoanalysis that made it not only unsafe, but unthinkable, that made the words homosexual psychoanalyst virtually an oxymoron.
Paul Lynch has referred to his experience of becoming a psychoanalyst. Mine was vastly different. When I began psychoanalytic training in 1967, I had already been in analysis for three years. Neither I, nor my analyst, thought to question my stated wish to rid myself of the homosexual part of myself and we were working toward that goal. I was accepted in the institute because the only question asked in my interviews about homosexual feelings was easily answered with the ambiguous "oh, it has come up in my analysis, but does not seem to be a problem." It was not pursued further. That training analysis and the subsequent second analysis each ended with a period of what I think of now as a pseudo-cure measured by behavioral control and sublimation, but no real change in wish or desire that lasted. Nevertheless, I suspect that both analysts, if they had been asked to fill out a survey of successful changes of sexual orientations through treatment would have included me in that group.
In my institute classes, the assumptions that homosexuality was a disorder and could be treated went unquestioned. This was in the 1960’s. I learned to be skeptical about the value of theories in psychoanalysis and have maintained that skepticism ever since. I will not go into my internal conflicts and struggles, but through the years, by keeping quiet about my real self and relying on a public quasi-false self, my psychoanalytic career advanced. I eventually became a training analyst and then director of my Institute for a five-year term and was quite active in the American, including appointment as the first chair of the Committee on Issues of Homosexuality. (And by the way Paul, I did not choose that name either!) I had suggested the idea for such a committee hoping -- and it was borne out -- that they would ask me to chair it. Thus, with this background, it came as a surprise to many, but not all, that when I decided two and one-half years ago that the time had come for me to acknowledge to my colleagues the part of myself that I had kept hidden, the response both in my local institute and in the American has been warm, positive, and deeply gratifying. Would it have been the same ten years ago? I doubt it.
Now to this meeting. I assume that our audience today comes largely from two groups: One group of mostly straight analysts and one group of mostly gay and lesbian mental health professionals. I belong to both groups, as do an increasing number of us, but I make this separation because I want to speak as a psychoanalyst to our gay and lesbian colleagues about where psychoanalysis went wrong on homosexuality and how it is changing. And I want to speak to my straight analytic colleagues about how we analysts misunderstood and -- however well meaning we may have been -- we nevertheless caused harm. My aim is the further resolution of the wide gulf and profound anger that developed between these two groups. Resolution requires acknowledging the past. As Bishop TuTu says of his work on the Truth and Reconciliation Commission in South Africa, healing requires that we admit past wrongs. In the American, we took an important step when Marvin Margolis as President of the American in 1997 acknowledged in a letter to the New York Times that old psychoanalytic assumptions about homosexuality were mistaken and that this had undoubtedly kept many qualified individuals from becoming psychoanalysts themselves. Notice that I am not saying anything specific about homophobia in our organization, not because I do not think it exists. Elisabeth Young-Bruehl, in her book The Anatomy of Prejudices, questions whether understanding of the dynamics of homophobia in the individual can be usefully applied to large organizations. She also says that perhaps in small organizations that are relatively homogenous this can sometimes be done. I decided that, instead of going down that route and getting into an intellectual discussion about group dynamics and trying to understand the effect of homophobia at that level, I would keep this more personal and try to talk about what I think happened and what went wrong, even if we do not understand the full dynamics of group behavior.
I share Elisabeth Young-Bruehl’s skepticism about facile and reductionistic explanations of organizational character. I believe that the anti-homosexual prejudice operating in the American results from a number of sources and that some people might argue that all of these factors that I will be discussing are simply derivatives of the basic dynamic of homophobia that Dr. Chodorow has outlined for us in many individuals. I will not argue that point because I do not really see how we can arrive at an answer in this short time. I would like, however, to list briefly some factors that I think contributed to the problems in this organization.
First, the height of interest in determining the presumed pathological etiology and the therapeutic zeal for treatment of homosexuality occurred in the fifties and sixties when psychoanalysis was in its glory days of expanding to include a wide scope of problems. I wonder to what extent this was spurred by the wish to use this also on homosexuality, i.e., to include yet another "untreatable" condition.
A second factor I believe is our reliance on a development theory, in fact, our wedding to a developmental theory that had no provision in it for an individual to be both homosexual and emotionally mature. A third factor that I consider is the psychoanalytic reliance on the case study method as data for theorizing and the disdain for comparison studies of non-patient populations that almost universally show no greater degree of pathology in homosexuals then in heterosexuals. The result of this was a conflation of the psychopathology observed in some homosexual patients with the sexual orientation itself. More and more we are coming to accept the idea that sexual orientation and mental health should be regarded as independent dimensions of an individual’s life.
A fourth factor is, I think, what was at one time the general conservative position of psychoanalysis and the tendency in this country toward a moralizing tone that many analysts had. A fifth factor is the interest that came from certain individuals who were particularly involved in studying homosexuality and also from the Association’s and the profession’s uncritical acceptance of their reporting of what, from today’s perspective, we would see as seriously flawed methodology and misinterpreted conclusions. So I wonder what effect this kind of reporting of such methodologically flawed studies would have, i.e., what is the effect of homophobia in individuals who do this kind of work and gain a reputation in our organization? A sixth factor is much larger than recognized until recently. Unlike the important initiative from some women analysts in challenging psychoanalytic theories about female development and psychology, there were no openly gay and lesbian analysts who could serve this same function on this issue. A similar point can be made about the social and professional relationships of analysts. In general, analysts in our organization led a rather sheltered existence until recently, and many analysts did not know, or did not know that they knew, any gay or lesbian people as individuals but only knew them as patients.
Now, what happened to begin the process of change? Richard Isay deserves credit for his persistent efforts in the late 1980’s and early 1990’s to get the leaders of the American to address the issue of anti-homosexual bias and specifically the effect of having virtually no gay or lesbian candidates in training or openly gay faculty. Eventually, against the strong opposition from a few members and reluctant action by the leadership, in 1991, a non-discrimination statement on homosexuality was adopted and amended in 1992 to include training and supervising analysts. In 1992, the Committee on Issues of Homosexuality was formed to identify areas of anti-homosexual bias and to work with institutes and the American toward opening up its institutes, changing attitudes, policies and curriculum.
What are the results? Now we know that there are probably at least forty openly gay and lesbian candidates in training in the various institutes around the country, probably about fifteen openly gay or lesbian faculty members and two training analysts. There may be more whom we do not know. Our committee holds workshops, makes consultative visits to institutes and societies and, in May of 1997, the first welcoming reception for gay and lesbian participants in our meetings was held. The Executive Council has funded a study carried out by the Committee on Scientific Activities to survey all of the literature on homosexuality, both psychoanalytic literature and related fields and to evaluate the validity of the various studies. That study just had its final review by the Committee at this meeting and will be published in book form by the University of Chicago Press. Bertram Cohler has done the major work on this project and is the editor of the book.
Then, one year ago, the Executive Committee voted, with only one negative vote and one abstention, to endorse the Marriage Resolution sponsored by the Lambda Legal Defense and Education Fund. The resolution calls on states not to pass laws which prohibit marriage between same gender couples. I am not sure how many of our straight analyst members realize how very, very important that was, not only in support for the gay community, but in beginning to change the very, very negative attitude towards the American and towards psychoanalysis. In summary, I would say to go from a bitter fight over adopting a simple non-discrimination policy statement in 1991 to endorsing this marriage resolution in 1997, is remarkable progress. But I want to say also to our gay and lesbian colleagues that these measures of progress do not adequately portray the depth of changed attitudes and interest and support that is so clearly expressed to me and other gay and lesbian candidates and members by such a large number of our own members.
Now I want to speak to our straight analyst colleagues. In reviewing our history, we might ask how we got off of track. After all, Freud had a very tolerant attitude toward homosexual individuals. When trying to explain same sex object choices in his developmental theory, he was never able to formulate a satisfactory explanation, and many of his statements are quite ambiguous; but he categorically stated, more than once, that homosexual individuals are not sick. Psychoanalysts who followed Freud were so wed to making the ill-fitting theory work that many abandoned psychoanalytic principles of neutrality, shaped their observations selectively to fit the theory, and generalized from a few disturbed patients to attribute generalized pathology to all homosexuals.
My friends, we caused harm. First, we created situations that either denied acceptance for analytic training or intimidated those who might apply, so that generations of gay men and lesbians who might have become analysts in our institutes did not. When I met with a group of gay psychiatrists in the Association of Gay and Lesbian Psychiatrists a few years ago to tell them of the changes that were coming in the American, the pain and anger in that room was palpable. As one middle-aged psychiatrist told me, with barely controlled emotions, "You have to understand people’s lives were affected." Another way that we have caused harm is in the biased theories and clinical writings in our literature. Much of this passes quickly by even our well-intentioned faculty members who are so embued in the heterosexist cultural and unexamined assumptions. But our gay and lesbian candidates are pointing these out to us, and most of the institutes are responding by re-examining their curriculum and using some of these gay and lesbian candidates as advisors or members of the curriculum committee.
There is another way in which much harm has been done which I will only mention, because it is worth a whole panel discussion itself -- that is, treatment approaches that are based on the assumption that homosexuality is a disorder and can and should be treated. If you think for a moment, if you go into treatment and someone says to you that they will help you overcome this thing, but first you must acknowledge that it is really bad and it is a part of you and something to be expunged, I wonder how successful and helpful any such treatment can be.
As Warren Blumenfeld says in his book on homophobia, "We are all born into a great pollution called homophobia which falls on us like acid rain." I like the sentiment that we are all affected by homophobia, but we must also acknowledge that we have had an active part in harming ourselves as an organization by our own anti-homosexual bias and heterosexist assumptions. We have not only deprived those who wanted to become psychoanalysts of that opportunity, but we have deprived our organization and our profession of many bright and talented people. We have also hurt ourselves by creating a public image of psychoanalysts as strongly homophobic.
Two or three years ago when I was in New York, I attended a Broadway play by Larry Kramer in which a passing reference in the dialogue of the play was made to someone going to a psychoanalyst. The audience hooted and jeered at just the mention of a psychoanalyst. Another example to which I think we should pay attention is that in 1993, when the issue of gays in the military was the hot issue in Washington and all of the other mental health professional organizations -- the two APA’s, the Social Worker’s Organization, the Nurse’s Organization and others -- formed a coalition to support the Clinton Administration in its attempt to overturn this policy of the Military, they did not even ask the American Psychoanalytic Association if it would like to join this coalition. They just assumed that we obviously would not.
Professor Gomes has talked about how religion is usually the first source that people use to justify bigotry and oppression. I am afraid that we have to acknowledge that psychoanalysis and some psychoanalytic writings may very well be the second source that people turn to. I think that we can begin to change that now. We still have a small group of members who work vigorously to oppose civil rights initiatives that would protect gays and lesbians, who are also a growing number of our own membership, from the very real discriminations that we potentially face.
In concluding, I want to say to our gay and lesbian colleagues -- and I can speak from my own personal perspective -- that the American, while not yet perfect, is now a welcoming, gay-friendly organization. I want to acknowledge those leaders of this organization who over the past few years have been important supporters and champions of this change: Bernie Pacella, Larry Chalfin, Judy Schachter, Marvin Margolis, Don Rosenblitt, Bob Pyles, and Dick Fox. These are presidents, presidents-elect of the Association and chairs of its Board of Professional Standards. All have been particularly helpful to us. Now to my psychoanalytic colleagues, a personal note: thank you not only for tolerating me, but for warmly accepting me, and not only for accepting me, but for honoring me as you have today. I believe that we are a better organization for opening our doors and, I even dare to say it, for opening our hearts to those that we closed out for too long. Thank you.

Copyright, 1999, The American Psychoanalytic Foundation. All Rights Reserved.
all photographs by Mervin S. Stewart, M.D.