The Cleveland Psychoanalytic Society was the first group to host a special program on homosexuality sponsored by the American Psychoanalytic Foundation. During the weekend of November 7–8, 1997, Ralph Roughton of Atlanta and Paul Lynch of Boston came to Cleveland to help us begin a much-needed dialogue within the analytic community (and the community at large) about our individual and institutional perspectives on male and female homosexuality. The Friday scientific meeting was open to the public.
Roughton began his presentation by contrasting “the older (mis)understanding with newer ways of conceptualizing homosexuality.” He said,
We need a new theory of development that can explain the undeniable existence of healthy, mature homosexual men and women. But we cannot wait for that theory to be evolved to acknowledge that we psychoanalysts were wrong and that we harmed people. It is time that we undertake some remedial self-education and self-analysis, and time we recognize that homosexual men and women are capable of intimate and enduring relationships, often do live lives of integrity and moral rigor, can treat the sick and nurture the young — indeed, we are more like you than we are different from you. It is time that we say “No” to those psychoanalysts who continue to proclaim the opposite.
Roughton reminded us that in 1991 the Executive Council of The American adopted, by an overwhelming majority, an explicit policy of nondiscrimination with regard to sexual orientation in selecting candidates and faculty for psychoanalytic institutes. Marvin Margolis, past president of The American, has acknowledged — both in TAP and in a letter to the New York Times — that our past assumptions about a link between psychopathology and homosexuality were wrong.
Roughton decried the writings of analysts who generalized from individuals to all homosexual men. Statements that homosexuals may have the appearance of not being ill at all, except in masquerading their sexual life, and that some of the most disturbed homosexuals have no anxiety, because their constant engagement in same-sex sex relieves anxiety, are likely true for some homosexual men, Roughton pointed out — just as they are true for some heterosexual men. That is, their sexuality may become compulsive and a symptom of other psychological conflicts.
In tracing the history of this polemic, Roughton brought up a lack of clarity about Freud's theoretical position. He pointed out that Freud's attitude was one of interest and compassion. In 1903, Freud clearly stated “homosexual persons are not sick.”
Roughton described two contrasting points of view: 'You can never enjoy a good life; let us help you change“ and ”If you are homosexual, the road to a good life is through self-acceptance and the development of a positive identity as a lesbian or gay man.“
Roughton also discussed some of the assumptions that have limited our thinking about homosexuality:
It is not possible to be both homosexual and emotionally mature.
One can generalize from homosexual patients in treatment to the homosexual population at large.
Any psychopathology found in homosexual persons can be attributed to homosexuality.
Homosexuality is defined by same-sex behavior.
If you analyze the underlying “cause” of homosexuality, you can change the sexual orientation.
Homosexuals are un-analyzable.
After Roughton elaborated on each of these assumptions, he presented two short clinical examples from his own work. The patients were seen 25 and 10 years ago, when his own theoretical perspectives reflected the old and the newer way of thinking about patients with conflicts about homosexuality. Roughton suggested that we reformulate developmental and sexual theories on the basis of observations from our healthier patients and non-patient gay men and women.
Edward Schiff briefly discussed the paper. He reminded the audience that Freud once summarized the aim of psychoanalysis as transforming neurotic misery into the ordinary suffering of everyday life. Freud was a carefully observing clinician whose theories stemmed from what he saw unfold in his consulting room. With further evidence from patients, the theory was always susceptible to change. In Schiff's opinion, the history of psychoanalysis is marked by theoretical assumptions, sometimes treated as facts and defended as the only admissible theory. Often the so-called facts are anchored “in the shifting sands of a favorite theory.” Schiff told about a century of acrimonious debates in the name of Freud, Jung, Rank, Adler, Ferenczi, Klein, and Anna Freud. Today the debate includes self-psychologists, Kohutians, Mahlerians, and Lacanians, some of whom feel their theory embodies the ultimate truth.
Schiff agreed with Roughton that “the various constitutional, developmental, environmental, and social factors which influence object choice are still in need of further clarification, understanding, and much-needed research to lead us to a [broader] understanding, not only of homosexual object choice but [of] heterosexual object choice as well.” He challenged Roughton, however, for saying so little about the etiology of homosexuality and for not elaborating on what can be understood from these new perspectives. He is convinced that by hearing more, we will struggle more with new concepts and deepen our understanding of homosexuality. If our aim as analysts is to change our patients according to our own agendas, including sexual object choice, then we no longer are functioning as psychoanalysts. As analysts we explore unconscious conflicts with our analysands, leaving choices up to them. To do otherwise, said Schiff, is to abandon neutrality.
Discussion from the audience included references to Freud's lifelong emphasis on the universal psychological bisexuality. The potential for hetero- or homosexual object choice, Freud claimed, is a part of everyone's constitution. The expression of homosexuality and heterosexuality is influenced by the child's experience as well as by his individual constitution. Conflicts resulting from bisexuality are prominent and frequent in both men and women.
Other points of discussion:
The internal contradiction in Freud's writings concerning homosexuality.
The importance of developmental theory in guiding prevalent attitudes about sexuality.
The importance of pleasurable andunpleasurable experiences in moving toward or away from hetero- or homosexual object choice.
The predictability of there being many developmental paths and many possibilities of stumbling on the road to either homo- or heterosexuality.
Anna J. Janicki, M. D., is a psychoanalyst and psychiatrist practicing in Cleveland. She is a member of the Cleveland Psychoanalytic Institute and the Cleveland Psychoanalytic Society and is an assistant clinical professor at the Case Western Reserve University School of Medicine.
The importance of keeping in mind Freud's profound insight that maturity includes choice and inevitable renunciation of certain forms of satisfaction for the sake of others.
Cleveland Psychoanalytic Institute candidates later met with Roughton and Paul Lynch, a pioneering gay physician candidate at Boston Psychoanalytic Institute. In the afternoon Cleveland Psychoanalytic Society members and guests informally discussed ways to improve communication and community outreach in Cleveland. In a workshop, our faculty discussed their own theoretical conceptions and biases. An open house was held at the end of the weekend for mental health professionals.