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This article discusses the relationship between self-condemnation for being gay and self-condemnation for feeling unmasculine. The type of patients who are described herein are reasonably well-adjusted men, homosexual in erotic fantasy orientation, comfortable with gay identity and social role, and integrated at a neurotic, nonborderline level (Kernberg, 1975). Although they recall having been labeled “fag” or “sissy” as children, the most painful aspects of this experience are now out of conscious awareness. They are usually integrated in the gay subculture and in conventional heterosexual society as well. During analysis, however, as often happens (Isay, 1989), negative feelings about being homosexual appear. Associated with these feelings is intense shame about being unmasculine. As a general rule both the antihomosexual feelings and the shame about feeling unmasculine have been repressed and together constitute part of the patient's symptomatic “core” — the primary reason for suffering and for the therapeutic intervention of psychoanalysis.
Although heterosexual men often experience low masculine self-esteem, gay patients are far more likely to fuse this feeling — or more properly, this complex set of ideas, images, and feelings — with the orientation of their erotic fantasy life. For example, heterosexual patients who feel unmasculine are not likely to attribute the cause of their unmasculinity to heterosexuality per se. However, the gay patients discussed in this article unconsciously view their homosexual orientation as indissolubly intertwined with masculine inadequacy.