This paper explores the historical pathologisation of homosexuality and its lasting impact on gay men's mental health and identity, including some of the author's experiences via an autoethnographic narrative. Through the lens of minority stress theory, it examines how societal stigma, internalised shame and structural discrimination contribute to psychological distress among gay men and the broader LGBTQ+ community. The paper critiques the historical complicity of psychoanalysis in reinforcing homophobic narratives while acknowledging contemporary efforts to redress these biases. The paper argues for a therapeutic approach that situates individual distress within broader sociopolitical contexts, advocating for a culturally competent, psychosocially informed psychoanalysis that is both explorative and affirmative, attending to distal (external) as well as proximal (internal) stressors. Finally, it highlights the ongoing struggles within the LGBTQ+ community, urging a collective effort to dismantle intra-community divisions and resist external oppression.