Judd Marmor. Journal of Gay & Lesbian Psychotherapy. Volume 2, Issue 4. 1998.
The question of whether or not the etiology of homosexuality is “really important” needs to be looked at from a number of different perspectives. From a purely scientific perspective, for example, it is neither more nor less important than the etiology of heterosexuality. A scientific approach, in and of itself, is essentially value-free. Science aims to explore and expand our knowledge about every aspect of our universe. The immediate importance of its findings are often indiscernible and their ultimate consequences sometimes unpredictable. Nevertheless, a basic value inherent in the scientific approach is that extending the frontiers of knowledge is a worthwhile objective.
From an ethical perspective, the etiology of homosexuality, ideally speaking, should be of no importance whatever. Whether homosexuality is innate, acquired, consciously chosen, or any combination of these, the highest ethical imperative in a humanistic society mandates that gays and lesbians be treated no differently than any other religious, ethnic, or racial group, or indeed, than heterosexuals in general. The only reasonable ethical consideration should be whether or not the overt behavior of any individual is harmful or destructive to others.
However, from a socio-politico-religious perspective, the question of etiology takes on a more important dimension because prejudice and hostility against homosexuals in our society, like prejudice in other areas, is based on a lack of knowledge about them. To put it colloquially, prejudice is being down on something one is not up on. Societal homophobia has generally been based, and rationalized, on at least four basic assumptions: (1) that it is sinful and/or immoral (an assumption that rests primarily on religious grounds); (2) that it is an “unnatural” form of behavior and, therefore, inherently unhealthy; (a teleological assumption that nature “intended” all species to be exclusively heterosexual); (3) that it is a “chosen” form of behavior, and, therefore, can be “unchosen;” and (4) that it is potentially “contagious” and can be acquired by exposure to it (is., by “role-modeling or seduction”). The latter three assumptions are particularly important because they are used to “rationally” justify discriminatory patterns against homosexuals-in the military, in employment, in housing, and in a wide variety of activities involving contact with children and adolescents.
Before we deal with these assumptions, let us look briefly at the current state of our knowledge concerning the etiology of homosexuality. For most of the twentieth century the most influential theory of its origins was that of Sigmund Freud (1905, 125-243) who asserted that homosexuality is a “fixation” that occurs when certain life experiences arrest the normal process of sexual development. However, research findings over the past twenty-five years have generated serious doubts about the validity of many traditional psychoanalytic formulations that have arisen out of Freud’s theory. One major reservation is based on the fact that these formulations have been based almost entirely on clinical experience with homosexual patients in therapy and thus represent a skewed sampling of the total homosexual population. (This is equivalent to evaluating the mental health of all heterosexuals solely on the basis of those who end up in psychiatrists’ offices!) For example, the most frequently employed explanation for the male homosexual ”fixation” is the presence of “castration anxiety” (Fenichel, 1945) due to incestuous guilt feelings deriving from a seductive mother and a hostile or distant father. Thus, because a11 women are seen as castrated persons, they presumably arouse the castration anxiety of homosexual men and are unconsciously feared and sexually avoided. However, castration anxiety also is used as an explanation for a wide variety of other psychiatric conditions, including most of the neuroses as well as the entire range of paraphilias; and in fact, symbolic castration anxiety is consistently demonstrable in most male psychiatric patients, gay or straight. Moreover, if such fears are responsible for the heterosexual inhibitions of homosexual men, how can the behavior of bisexual men, many of whom find heterosexual intercourse quite pleasurable, be explained?
Other traditional assumptions about homosexual psychodynamics are similarly contradictory. One of these is that homosexuals are deeply narcissistic individuals; but narcissistic personalities exist in wide profusion among heterosexuals also. Another common hypothesis is that male homosexuals hate or fear women because of powerful unconscious negative feelings toward their mother figures. Yet we know that many male homosexuals have a close and affectionate relationship with women. A contrary postulation is that male homosexuals are strongly identified with their mothers, hence their erotic responsiveness toward men. Another hypothesis asserts that obligatory homosexual behavior in men is the outcome of pre-oedipal problems of separation and individuation from the mother (Socarides, 1968); however, pre-oedipal problems of separation and individuation are equally demonstrable in many neurotic heterosexuals. None of these formulations, therefore, can in themselves be sufficient explanations for obligatory male homosexuality. The simple fact is that although one or another of these dynamic patterns can indeed be demonstrated in some homosexuals, they are not present in others, and none of them is pathognomonic.
Probably the most widely held psychoanalytic assumption about the etiology of homosexuality is that it is specifically induced by a parental constellation of a close-binding, seductive mother and a distant, unloving father (Bieher et al., 1962). This family background is considered to be the basis for the castration anxieties, the fear/hate of women, the feminine identifications, etc. seen in homosexual male patients. However, Siegelman (1974) has demonstrated that such a parental constellation can also be found in the backgrounds of a great many heterosexual men in whom they have not led to a homosexual “fixation.” In actuality, moreover, homosexuals, like heterosexuals, have been shown to come from quite varied backgrounds. Over fifty variables in maternal, paternal and sibling family patterns have been found in male homosexuals-loving mothers, hostile mothers; loving fathers, hostile fathers, idealized fathers; sibling rivalries; intact homes; broken homes, absent mothers, absent fathers, etc. (Hatterer, 1970). Similarly, the assertion that a truly loving father absolutely precludes the development of homosexuality in a son (Bieber et al., 1962) is simply not true. I have personally known and treated a number of male homosexuals who had very warm and positive relationships with their fathers, and the comprehensive study of the development of sexual preference by Bell, Weinberg and Hammersmith (1981) revealed that 17% of the male homosexual subjects felt themselves to be their fathers’ favorites!
Additional light on the family background issue has been shed by more sophisticated studies that have compared the backgrounds of non-patient homosexuals with those of non-patient heterosexuals; these studies have shown no consistent relationship between the nature of the family constellation and subsequent sexual orientation (Siegelman, 1974, 1976). Male homosexuals scoring high in neuroticism and high in femininity did show a greater tendency towards the classical pattern of a close-binding mother and a distant and/or hostile father. However, homosexual males who were masculine in behavior, and those who scored low in neuroticism tended to have parental backgrounds which were indistinguishable from those of well-adjusted heterosexual controls. An interesting finding was that the family backgrounds of emotionally disturbed heterosexuals resembled those of neurotic homosexuals more closely than those of healthy homosexuals, suggesting that the family background of the close-binding mother and unloving father is probably one that simply causes psychopathology in males in general whether the male becomes homosexual or heterosexual! (Indeed, the difference in the family constellations in the backgrounds of “masculine” vs. “effeminate” male homosexuals strongly suggests that the frequently observed rejecting father and close binding mother in the latter group, may be a reaction to the inborn difference in the young boy’s gender behavior rather than a cause of it-i.e., a disappointed paternal reaction and a protective maternal one.)
All of the foregoing psychoanalytic hypotheses suffer from the fallacy of psychological reductionism, which assumes that the etiology of most, if not all, functional variations in thought and behavior can be traced to disturbances in psychological or interpersonal relationships. Thus, if there is a disturbed parent-child relationship in the background of someone with “deviant” sexual behavior, it is assumed that the disturbed relationship is the cause of that variant behavior. Such associations not only do not prove any necessary etiological relationship, but they also ignore relevant contributions to the individual’s personality structure from biological and sociological variables.
Recent, carefully controlled studies of monozygotic (MZ) twins and dizygotic (DZ) twins (Bailey, 1991 and Whitam, 1993) have shown more than twice as high a concordance for homosexuality (52% to 22%) among MZ twins as compared to the DZ twins. The Whitam et al. study also included an MZ triplet set, in which all three were concordant for homosexual orientation! Although such findings do not indicate a singular genetic “cause” for homosexuality, they point strongly to the probability of a genetic predisposition to its development.
Several other research studies in recent years also point in the same direction. One of these has been the finding that a large proportion of homosexual men and women exhibit gender-discordant behavior from early childhood on (Bell, Weinberg and Hammersmith, 1981). Psychoanalysts have generally assumed that such gender-discordant behavior is always the consequence of disturbances in the child’s early family relationships. However, the discovery that such behavior can also be found in children from widely disparate family backgrounds, and often where no pathogenic behavior of the parents can be demonstrated, has mandated a new look at this phenomenon. A substantial majority of these “effeminate” little boys ultimately go on to display homosexual behavior (Green, 1989; Zuger, 1984), and their own description of their feelings is that they have felt “different” from others of their gender from their earliest childhood on.
Studies of how male gender identity develops have begun to shed light on the probable meaning of this phenomenon. We now know that in order for differentiation of a male to take place, testosterone must be secreted in adequate amounts at a critical point in the gestation of the embryo. This assumption has received support from a number of experimental studies in lower animals. The classic study in this regard was done by Dorner (1969) who demonstrated that genotypically and phenotypically normal male rats who were castrated on the first day of life, and then treated with replacement androgens after they had reached maturity, developed normal masculine physiques, but nevertheless manifested female sexual behavior. If, however, after such castration they were given a single small injection of testosterone on the third day of life, the same androgen treatment in adulthood resulted in heterosexual behavior. Dorner postulated that an absolute or relative androgen deficiency. similar to that which he had demonstrated in rats, probably occurs in the process of human development at some critical period of differentiation. He suggested that this deficiency probably creates what he called “a neuro-endocrine predisposition for homosexuality in the adult male.” A recent interesting finding by Hamer et al. (1993) that a particular area on the maternal X chromosome frequently appears to be linked to the presence of homosexual orientation in men, suggests that such a genetic predisposition may be transmitted via the mother’s side of the family.
As for hormonal studies in the past ten or fifteen years, a number of findings have raised the question anew of hormonal differences between homosexual and heterosexual males, especially between obligatory homosexuals and obligatory heterosexuals. Dorner et al. (1975) administered injections of estrogens to group 6 homosexuals and found that the plasma luteinizing hormone (LH) in these subjects followed a response pattern that was more characteristic of females than males; that is to say, there was an initial decrease in the LH level followed by a positive rebound above the base line. Heterosexual controls showed a similar initial decrease but no rebound. A similar study was done by Gladue et al. (1984) comparing obligatory male homosexuals with male and female heterosexuals. Gladue and his co-workers found that the response of the LH level to estrogen injections in the homosexuals was intermediate in its pattern between that found for the heterosexual males and females. This, too, would seem to point to the probability that there is a difference in the degree to which the hypothalamic centers of group 6 homosexual males had been androgenized as compared to those of heterosexual males. The recent finding of LeVay (1991) that the third interstitial nucleus of the anterior hypothalamus (INAH-3) was distinctly smaller (less than half the size) in homosexual males as compared to heterosexual males lends strong confirmation to this assumption.
Anthropological data are also suggestively confirmatory. Whitam and Zent (1984) in a comprehensive survey of an extensive body of data and 5 years of personal field work, concluded that homosexuals are present in all societies, and that the percentage of homosexuals tends to be roughly the same in all societies, somewhere between 4% and 5% among males. The widespread existence of homosexual behavior patterns can be surmised also from the institutionalization of cross-gender behavior in so many disparate societies. Apparently in all of these societies a certain number of people are born who show what we now call gender-discordant behavior.
As for zoological studies, there have been a host of studies in the past decade or more which have demonstrated beyond the shadow of a doubt that, as Denniston (1980, 25-40) states, “homosexual activities occur in every type of animal that has been carefully studied.” Although in lower animals such activities seem clearly related to social dominance and subordination, as one moves up the evolutionary ladder it takes on more and more of the erotic elements seen in humans. In primates both autoerotic and homoerotic practices can be observed quite frequently, more so among males, and anal penetration and ejaculation have also been observed (Chevalier-Sokolnikoff, 1974 and Erwin and Maple, 1976). As the eminent zoologist Frank Beach (1948) has observed, “Human sexuality reflects the essential bi-sexual character of our mammalian inheritance. The extreme modifiability of man’s sex life makes possible the conversion of this essential bisexuality into a form of uni-sexuality with the result that a member of the same sex eventually becomes the only acceptable stimulus to arousal.”
In more recent years, scientists in the emergent field of socio-biology, such as Wilson (1975), have addressed the question of why there is such a widespread occurrence of homosexual behavior in all animal species and have advanced the hypothesis that there may in fact be a biologically adaptive aspect to its persistence. Some of the adaptive factors that they suggest are: (1) it limits population growth; (2) it makes it possible for only the most dominant males to breed and reproduce; and (3) at the same time it maintains a good sized population of males for territorial defense and protection of the females and children in the group.
Assumptions of Contemporary Societal Homophobia
Let us now return to the four assumptions on which contemporary societal homophobia rests, consciously or unconsciously, and examine to what degree a greater understanding of the etiology of homosexuality would be relevant in countering them.
Religious condemnation of homosexual behavior rests primarily on JudeoChristian tradition and particularly on a few passages in the Old and New Testaments. Unhappily, it is doubtful whether a better understanding of the etiology of homosexuality would in and of itself have a significant effect on such religious convictions because these convictions rest, not on reason, but on an unshakable faith that the Biblical passages represent the actual word and command of God rather than being reflections of the sexual mores of the ancient Hebrews and the early Christians two thousand or more years ago. We must remember that there are still religious fundamentalists who find it equally hard to abandon the geocentric concept of the universe or the Biblical version of Creation! But just as the weight of scientific research in astronomy, geology and zoology ultimately has rendered such fundamentalist views irrelevant, it is not unreasonable to hope that the wide-spread dissemination of the findings of scientific research into the etiology of homosexuality will ultimately undermine the irrationality of such religiously based homophobia, at least for the large majority of mankind.
As for the second assumption, namely that homosexuality is contrary to the biological norm and, therefore, ”unnatural,” here too we are dealing with beliefs that reflect a lack of knowledge of the findings of contemporary zoological research to which reference has been made above. Moreover, as I have stated elsewhere “the argument that homosexuality is biologically unnatural, becomes even more specious when one considers that all civilized human behavior from the cooking of food to the wearing of clothes is a departure from the strictly “natural.” We do not label vegetarianism or sexual celibacy as automatic evidences of abnormality even though these behavioral patterns do not follow “natural -’ biological expectations. Actually one of the most distinctive characteristics of human beings is their extraordinary capacity to modify and transform their “natural” biological drives into widely diverse patterns of behavior, whether this be in terms of sexuality, eating, devising shelters, worshipping gods or developing the mathematical precision that enables them to land a man on the moon or fire intercontinental missiles with pinpoint accuracy” (Marmor, 1980, 398).
The third and fourth homophobic assumptions to which we have alluded, namely that homosexuality is a “chosen” form of behavior and can therefore be unchosen or that it can be acquired by exposure to it via role-modeling or seduction can be discussed together because both derive from a similar ignorance about the findings of modern research into the etiology of homosexuality. Both rest on the conviction that homosexuality is an environmentally acquired condition, learned or chosen as a result of individual psychopathology or incidental life experiences. Can knowledge of the fact that there is a significant biological predisposition to homosexuality that is acquired prenatally make a difference? Apparently it can. In a study of attitudes toward homosexuals in four different societies, Ernulf et al. found that the individuals in those societies who believed that homosexuals “were born that way” were distinctly less homophobic than those who did not (Ernulf, 1989).
However, for psychotherapists of male homosexuals, the problem has other ramifications. If therapists believe homosexuality is an acquired behavior pattern (even if they consider themselves to be neutral with regard to homosexuality), their conscious or unconscious bias in favor of a heterosexual way of life may lead them to exert a subtle but significant pressure, via their interpretations, toward trying to influence the homosexual patient toward a heterosexuality that does not come naturally to him. In addition, there are still many psychotherapists who continue to view homosexuality as a mental illness and consciously try to “convert” their homosexual patients to heterosexuality, which often leads to unwarranted and sometimes shocking abuse and mistreatment (Duberman, 1992).
In the light of our current knowledge of its etiology, the existence of homosexuality in a patient coming for psychotherapy should be no more important in and of itself than the existence of heterosexuality. Peoples’ sexual orientations are merely one aspect of their diverse life patterns and should not become the dominant basis for “defining” them. The patient should be treated for the problem that brings him or her into therapy whether it be a neurosis, depression, personality disorder or psychosis, and the patient’s sexual preference should be treated and understood as a given. Unhappily, in today’s world many homosexual patients may have problems of self-rejection or inferiority that they attribute to being homosexual, but which in actuality, arise from growing up in a homophobic society. The focus in such cases, no less than similar feelings in religious or ethnic minorities, should not be on their minority status per se but rather on the nature of the prejudice and discrimination to which they are exposed. The task of the psychotherapist should be to help such patients understand the abnormality of such prejudice, respect themselves, and to turn their anger outward to where it belongs.
Thus, in enabling both patient and therapist to accomplish this task, the newer understanding of the etiology of homosexuality does indeed become a matter of importance.