Discussion

The past few years have seen considerable change in our notions about the etiology, nature and treatment of the so-called perversions, particularly homosexuality. Although social attitudes toward homosexuality have unfortunately not changed at the same pace, nevertheless there has been some modification of some of these restrictive and prejudicial attitudes, especially in some of the more enlightened countries of Europe and to a lesser degree in some of our states here. Apropos of the role of such social attitudes, Dr. Gershman refers to his having taken issue with Dr. Marmor at their recent debate.

The latter seemed to have taken the position that homosexuality is an illness only because we consider it so from the biased viewpoint of our Judeo-Christian Western culture, and that it can be separated out from the rest of our personality as a kind of enclave. Dr. Gershman seems to categorically disagree with this, and feels that homosexuality, even though it may occur in an otherwise well-integrated individual, is an illness with a relatively minor degree of disturbance of his personality, and that it is, therefore, an integral part of the total personality. My own viewpoint is more in keeping with Dr. Gershman's, although I would modify some of his ideas on etiology and psychodynamics. In my own experience— which is extremely limited compared with the vast work, both Dr. Gershman and Dr. Bieber have done with homosexuals over many years —but which includes other perversions as well, I have found that where there is such a disturbance of sexual function there are always disturbances in other areas of personality and function, in the patient's relation to himself and to others.

Dr. Gershman has qualified his use of the term by distinguishing between compulsive homosexuality—that is, a more-or-less persistent, preferential erotic attraction for the same sex, motivated by underlying intrapsychic needs or conflicts, including anxiety —and homosexual behavior—that is, cultur