Last year, disputes arose within institutes on the East Coast about the appropriate way to reckon with papers written in past decades that pathologized gay and gender nonconforming patients. These debates revealed more varied and complicated understandings of the LGBTQ+ experience than some may think exist within APsaA.
Many regard APsaA as having a unified and wholly accepting stance toward the LGBTQ+ community, but during my time as chair of our Committee on Gender and Sexuality (COGS), I have seen a range of complex beliefs psychoanalysts seem to have about gay and gender-nonconforming patients and colleagues—some remarkably open-minded and inspiring, and others containing unconscious, degrading biases. Undoubtedly, we all respond to queerness with a complicated mix of internal reactions, many of which we hide. But as we know, it's the internal responses we're not aware of that often cause the most harm. Reactions to transgender people in particular seem driven by unconscious fear and aggression, which are hard to acknowledge and discuss.
The formation of COGS in 1992, then called the Committee on Issues of Homosexuality, was an important first step in giving queer identities a voice within the psychoanalytic community. The Committee's formation was inspired by a policy passed that same year, following the threat of a lawsuit by the late Richard Isay and the ACLU, that banned discrimination in the selection of candidates, faculty members, training analysts, and supervising analysts within APsaA on the basis of sexual orientation. While there were no policies explicitly prohibiting LGBTQ+ analysts before 1991, there were no openly gay psychoanalysts other than Isay in the association, indicating an organization in which insidious social biases marginalized and silenced members of the LGBTQ+ community. Although the American Psychiatric Association (APA) removed Homosexuality from the DSM-II in 1973, psychoanalysts at that time opposed the move and petitioned APA to initiate a referendum vote on the decision. Psychoanalysts were late to the game in reconsidering their beliefs and recognizing homosexuality as a normal expression of sexuality.
Ralph Roughton, COGS's first chair, described the Committee's mission as advancing “changes in attitude and policy through consultation and education” (“Rethinking Homosexuality: What It Teaches Us about Psychoanalysis,” JAPA, 2002). From its inception, COGS has served as a safe harbor for LGBTQ+ analysts within the organization as well as an activist group to combat anti-LGBTQ+ discrimination within our field and promote education and acceptance.
Psychoanalysts were late to the game in reconsidering their beliefs and recognizing homosexuality as a normal expression of sexuality.
In the early years, the Committee's members, some of whom are still active today, endured attacks on their dignity from senior analysts like Charles Socarides, who held discussion groups at APsaA's national conferences until as late as the early 2000s. Those meetings continued to espouse theories that described homosexuality as a disorder that could be treated. COGS members attended these groups and bravely challenged the homophobic assumptions underlying such thinking. For them, these battles were neither abstract nor theoretical—but rather a plea for basic recognition. Susan Vaughan, former chair of COGS, tells the story of an elevator ride she endured, as a candidate after presenting at an APsaA conference, where Socarides and his colleagues intimidated her with “sniggering, sneering devaluation and muttered under-the-breath comments about homosexuals” (private correspondence, 2021). Some original Committee members, like so many other queer people in those years, had been in treatment with analysts who tried to “cure” them—analysts whom they loved and trusted yet who believed these patients were fundamentally “perverts” incapable of mature love. As a gay man just young enough to avoid being a patient in that kind of treatment, I feel a sickening pain at the awareness of what my colleagues endured, coming of age when they did.
But as society has grown more open-minded in the last few decades, so has APsaA. Today, our organization promotes education and forward-thinking scholarship that approach gender and sexuality through a wider, less pathologizing lens. Each national meeting provides attendees with opportunities to consider and reconsider their thinking in these areas. While prejudice toward many members of the queer community, including transgender, gender nonbinary, bisexual, and polyamorous folks is still ubiquitous in society and in our field, gay and lesbian analysts in APsaA now seem to have much the same access to analytic training and leadership positions as their heterosexual peers.
Since COGS's formation, its members, along with other like-minded analysts within APsaA's leadership, have consistently nudged our organization to take stances meant to protect the LGBTQ+ community. In 1997, we helped APsaA become one of the first mainstream mental health organizations to support marriage equality. In 2012, we spearheaded the creation of an APsaA position statement that denounced the harmful practice of “conversion therapy” which, tragically and incredibly, is still practiced throughout the U.S. today.
In June of 2019, in the midst of a national reckoning, APsaA issued a public apology for the ways it contributed to the pathologizing of LGBTQ+ people. In the press statement, then president Lee Jaffe stated, “Regrettably some of that era's understanding of homosexuality and gender identity can be attributed to the American psychoanalytic establishment … it is long past time to recognize and apologize for our role in the discrimination and trauma caused by our profession.” The apology, undeniably meaningful, took many members of COGS, including myself, by surprise. For decades, we have worked to achieve such public recognition and acceptance from APsaA. Yet even as we celebrate this milestone, some of us question whether APsaA's apology was based on the sincere work of an organization grappling with its past.
In 2016, I was asked to present a case during a COGS workshop at the summer APsaA conference in Chicago. As a third-year candidate new to these meetings, I was excited. The room was packed with experienced analysts who offered insightful feedback about my first control case, a gay man.
After the workshop, I rode in a cab to a COGS social event with Diana Moga and Susan McNamara, then co-chairs of the Committee. We talked pop music and New York City nightclubs…not your typical analytic banter! Over dinner, the Committee discussed the events of the meeting and caught up with each other. Don Spivak showed me pictures of his grandchildren and his fantastic garden in Michigan. It felt to me that the people of this Committee, many but not all of whom are LGBTQ+, were more than just colleagues. They were old friends, and I was grateful to be among them.
The APsaA I walked into in 2016 did not seem discriminatory in the least to me. The feedback I received at the Chicago meeting was sensitive and rich; not a single analyst pathologized my patient for being gay or suggested I try to cure him. Psychoanalysis had come a long way. And yet, while I recognize that as a great feat, in my time chairing COGS I've become aware that our progress isn't as absolute as it outwardly appears. APsaA's updated public positions did not change every analyst's beliefs; bias still exists, although now in a more private realm.
Last year, in response to the growing awareness that, decades ago, Vamik Volkan penned what we now see as degrading writings about gay and trans people, a controversy brewed in certain institutes. The conversations that resulted, perhaps holding and enacting something for our entire organization, were characterized by varying degrees of support, denial, aggression, and defensiveness as psychoanalysts debated appropriate ways to reckon today with our collective past in regard to LGBTQ+ people. It felt to me that there was an overriding wish to simply be done with this difficult reckoning, to either cancel or exonerate, and then quickly move on as if this moment of conversation was an aberration rather than a glimpse into a much bigger matter. Various members of our association called upon me to enact some kind of public acceptance of APsaA's apology, in order, it seemed, to erase our painful past instead of trying to understand the cause and reconcile it with our present. We must not be hasty in either resolving or avoiding these difficult conversations, no matter how unpleasant; they reveal uncomfortable differences of opinion among psychoanalysts that have not been aired before. There is organizational value in speaking the unspoken and grappling with our complicated history.
In 2001, Kenneth Lewes, who passed away from Covid in April 2020, presented “Being Gay and Becoming a Psychoanalyst: Across Three Generations” at an APsaA meeting in New Orleans. In this published talk, Lewes noted that while there had been a major reconciliation between psychoanalysis and gay people, “deeper structural and dynamic forces” still exist in the “non-written history,” alive in private opinion and conversation, in supervision and in the consulting room. (It's important to note trans people weren't an explicit part of the conversation at that time.) Lewes wrote:
Insofar as psychoanalysis itself can be considered as having a psychology and a system of strivings, anxieties and defenses, the discourse on homosexuality that developed from the Second World War until the 1980s was a kind of neurotic symptom or, perhaps, a character disorder (Young-Bruehl, 1996). It was maintained with an amount of energy entirely disproportionate to its ostensible importance; it served as a vehicle for the discharge of disowned sexual and especially sadistic impulses; it had important functions in bolstering a somewhat fragile self-esteem and cultural identity; it was maintained doggedly and irrationally in the face of common sense experience and obvious historical fact; it was virtually unanimous and allowed none of the questioning and free play of intellect that are the marks of non-anxious curiosity and investigation. It was, so to speak, quite syntonic with the egos of those who professed psychoanalytic ideals and ethics. Now that it is over, one wonders what it was all about.
If it were dealing with a patient, an organization or an ideology, psychoanalysis would have plenty to say about the nature and dynamics of a system—psychological, structural, or intellectual—that developed and sustained such an aberration for so long and so unquestioningly. Such aberrations, it knows, do not appear out of thin air, but are rooted deeply in the unconscious strivings and anxieties of that system, and unless these dynamics are understood as an internal event, their symptoms will
Page 10reappear. As a discipline, psychoanalysis knows these things very well, yet about its own history it has fallen silent and so far has said little about this prolonged lapse from sanity. This very silence, I think, is the most unnerving aspect of the history I have just traced. If a patient wished to avoid discussing a prolonged disturbed episode, we would all suspect that he was defending against an internal complex that was still alive and toxic. [emphasis added]
Lewes' statement— “unless these dynamics are understood as an internal event, their symptoms will reappear”—continues to serve as a warning for us and a call to rise to the challenge of discussing these dynamics openly and candidly.
Mentalizing transphobic countertransference requires diligence and honesty; it's an often difficult process requiring us to confront how we developed our own gender identity, recognizing both the cisgender and transgender parts within.
In the rushed attempt to renounce our field's dark past, I am concerned we have adopted too quickly an accepting stance, which renders silent the many and varied perspectives our members actually hold in regard to LGBTQ+ people. I don't believe we have put sufficient effort, individually or collectively, into the kind of dialogue and self-reflection that would be needed for us to reconcile with the fact that psychoanalysts traumatized many queer people through bogus theories and harmful, unfounded practices. Analytic theories not only hurt analytic patients, they also had a major impact on social views at large about gender and sexuality, making damning ideas commonplace, such as the erroneous trope that people “become” gay due to faulty parenting. (The ways in which our field damaged many groups is vital to understand and discuss further but beyond the scope of this article.) Without a comprehensive reckoning, can we be aware of the damaging beliefs that remain embedded in our theory and practice today?
Nowhere is psychoanalytic thinking more confused and conflicted, it seems, than in its approach to trans and gender nonconforming people. On the one hand, for the last two decades such analysts as Adrienne Harris, Ken Corbett, Avgi Saketopoulou, Griffin Hansbury, Jack Drescher, Francisco Gonzalez, and others have paved the way for us to think about gender and nonconforming identities in remarkably perceptive and sensitive ways. On the other hand, some analysts still believe that being transgender is only a disorder caused by trauma. Others are preoccupied with seemingly well-meaning anxiety that trans people will change their minds and regret receiving gender-affirmation surgery. Underlying such worry is often the idea that a trans identity is “just a phase.” Recall the frequent refrain from 30 years ago that coming out as gay was likewise “just a phase.” Further, some analysts refuse to use a stated pronoun when it doesn't match a person's natal sex because it's “too confusing,” or “not correct English.” Rather, these may represent defenses against powerful but unanalyzed countertransference reactions—a gender-policing response to confusion and fear about transgressing stereotypical gender roles. As a cisgender person, I understand this confusion and fear—I experience it myself at times—but my hope is that more analysts will recognize and reflect on their internal reactions to gender rather than countertransferentially enacting them.
It's often the case that once we come to truly know someone from an unfamiliar group, we realize how similar we actually are. While I have been out as a gay man for 20 years, it wasn't until I had the privilege of witnessing a patient slowly come to terms with a transgender identity that I understood and empathized with how fraught the process can be, both for the trans person and those around them. During that treatment, I found myself flooded at times with feelings of anxiety, sympathy, fear, and love. Ultimately, I saw how profound it was for my patient to embody his true gender. I also saw the intense anxiety, almost a form of PTSD, he had developed in response to early scolding, regulation, and constant invalidation about his gender. Such reactions to gender, harmful but sadly common, impinge on our ability to find our gendered selves.
In “Unthinkable Anxieties: Reading Transphobic Countertransference in a Century of Psychoanalytic Writing,” Griffin Hansbury uses Winnicott's description of “unthinkable anxieties” to understand the kinds of anxieties that arise in cisgender therapists when sitting with a transgender patient.
The analyst drowning in the confusional whirlpool of transphobic countertransference is unable and/or unwilling to mentalize the patient's psyche and soma … the trans patient cannot find himself in the mind of this analyst, just as he could not find himself in the mind of his care-giver. He searches but finds only more unbearable, unthinkable anxiety and dread. But the analyst who mentalizes the unmentalized can get out of the whirlpool and get on with the healing work.
Mentalizing transphobic countertransference requires diligence and honesty; it's an often difficult process requiring us to confront how we developed our own gender identity, recognizing both the cisgender and transgender parts within. Through this process, we start to free both ourselves and the other from the harsh gender restrictions and prohibitions that we've unknowingly learned and ingrained.
Anton Hart, in his article “Multicultural Competence to Radical Openness: A Psychoanalytic Engagement of Otherness,” wrote:
When it comes to the problem of prejudice, psychoanalysis offers a more profound remedy than trying to teach people not to be prejudiced or to watch what they say. Because psychoanalysis is interested in understanding what would make one person hate another and is inherently interested in creating contained opportunities for dialogue. Psychoanalysis aspires to help people to become more aware of the ways ignorance is self-protective and that prejudice involves using people to manage dreaded internal experience. (TAP, vol. 51 no.1, 2017)
We are all raised to privilege cisgender, straight identities and devalue queer ones. We all contain an array of multi-determined, degrading thoughts toward queerness and queer people. In order to help heal our LGBTQ+ patients from the damaging beliefs they have internalized about who they are, as well as to respect our LGBTQ+ colleagues, family, and friends, we have an obligation to acknowledge those parts of ourselves that diminish queer identities and hold them next to a higher understanding that these beliefs are simply not right. As Hart reminds us, this is just the kind of work we know how to do as analysts: to self-reflect and maintain a stance of openness to the “unfamiliar, even the frightening, in our patients and in ourselves.” How can we, as individuals and as a field, be honest about and contend with our prejudices rather than enact them?
Thirty years after its formation, COGS is still an active, vibrant, and growing committee upholding its founding promise to facilitate “changes in attitude and policy through consultation and education.” In our Committee meetings, senior members who were active in the 1990s sit next to a younger generation of analysts who are passionate about this work. We regularly offer workshops and discussion groups at the national APsaA meetings exploring various facets of the LGBTQ+ experience. Anyone who would like to learn more about queer identities and the many reactions we have toward them are welcome to attend.
Justin Shubert, Psy.D., Ph.D., is a psychoanalyst in Los Angeles. He is a founding member of the Committee on Diversities and Sociocultural Issues at the New Center for Psychoanalysis, and the chair of APsaA's Committee on Gender and Sexuality.