Homosexuality and Mental Health Problems
By N.E. Whitehead, Ph.D.
Summary: Recent studies show homosexuals have a
substantially greater risk of suffering from a
psychiatric problems than do heterosexuals. We see
higher rates of suicide, depression, bulimia,
antisocial personality disorder, and substance abuse.
This paper highlights some new and significant
considerations that reflect on the question of those
mental illnesses and on their possible sources.
The American Psychiatric Association removed
homosexuality from its diagnostic list of mental
disorders in 1973, despite substantial protest (see
Socarides, 1995). The A.P.A. was strongly motivated by
the desire to reduce the effects of social oppression.
However, one effect of the A.P.A.'s action was to add
psychiatric authority to gay activists' insistence
that homosexuals as a group are as healthy as
heterosexuals. This has discouraged publication of
research that suggests there may, in fact, be
psychiatric problems associated with homosexuality.
In a review of the literature, Gonsiorek (1982) argued
there was no data showing mental differences between
gays and straights--or if there was any, it could be
attributed to social stigma. Similarly, Ross (1988) in
a cross-cultural study, found most gays were in the
normal psychological range. However some papers did
give hints of psychiatric differences between
homosexuals and heterosexuals. One study (Riess, 1980)
used the MMPI, that venerable and well-validated
psychological scale, and found that homosexuals showed
definite "personal and emotional oversensitivity."
In 1991 the absolute equality of homosexuality and
heterosexuality was strongly defended in a paper
called "The Empirical Basis for the Demise of the
Mental Illness Model" (Gonsiorek, 1991). But not until
1992 was homosexuality dropped from the psychiatric
manual used by other nations--the International
Classification of Diseases (King and Bartlett,
1999)--so it appears the rest of the world doubted the
APA 1973 decision for nearly two decades.
Is homosexuality as healthy as heterosexuality? To
answer that question, what is needed are
representative samples of homosexual people which
study their mental health, unlike the volunteer
samples which have, in the past, selected out any
disturbed or gender-atypical subjects (such as in the
well-known study by Evelyn Hooker). And fortunately,
such representative surveys have lately become
available.
New Studies Suggest Higher Level of Pathology
One important and carefully conducted study found
suicide attempts among homosexuals were six times
greater than the average (Remafedi et al. 1998).
Then, more recently, in the Archives of General
Psychiatry-- an established and well-respected
journal--three papers appeared with extensive
accompanying commentary (Fergusson et al. 1999,
Herrell et al. 1999, Sandfort et al. 2001, and e.g.
Bailey 1999). J. Michael Bailey included a commentary
on the above research; Bailey, it should be noted,
conducted many of the muchpublicized "gay twin
studies" which were used by gay advocates as support
for the "born that way" theory. Neil Whitehead, Ph.D.
Bailey said, "These studies contain arguably the best
published data on the association between
homosexuality and psychopathology, and both converge
on the same unhappy conclusion: homosexual people are
at substantially higher risk for some forms of
emotional problems, including suicidality, major
depression, and anxiety disorder, conduct disorder,
and nicotine dependence...The strength of the new
studies is their degree of control."
The first study was on male twins who had served in
Vietnam (Herrell et al. 1999). It concluded that on
average, male homosexuals were 5.1 times more likely
to exhibit suicide- related behavior or thoughts than
their heterosexual counterparts. Some of this factor
of 5.1 was associated with depression and substance
abuse, which might or might not be related to the
homosexuality. (When these two problems were factored
out, the factor of 5 decreased to 2.5; still somewhat
significant.) The authors believed there was an
independent factor related to suicidality which was
probably closely associated with some features of
homosexuality itself.
The second study (Fergusson et al. 1999) followed a
large New Zealand group from birth to their early
twenties. The "birth cohort" method of subject
selection is especially reliable and free from most of
the biases which bedevil surveys. This study showed a
significantly higher occurrence of depression, anxiety
disorder, conduct disorder, substance abuse and
thoughts about suicide, amongst those who were
homosexually active.
The third paper was a Netherlands study (Sandfort et
al. 2001) which again showed a higher level of
mental-health problems among homosexuals, but
remarkably, subjects with HIV infection was not any
more likely than those without HIV infection to suffer
from mental health problems. People who are
HIV-positive should at least be expected to be anxious
or depressed!
The paper thus concluded that HIV infection is not a
cause of mental health problems--but that
stigmatization from society was likely the cause--even
in the Netherlands, where alternative lifestyles are
more widely accepted than in most other countries.
That interpretation of the data is quite unconvincing.
The commentaries on those studies brought up three
interesting issues.
1. First, there is now clear evidence that mental
health problems are indeed associated with
homosexuality. This supports those who opposed the APA
actions in 1973. However, the present papers do not
answer the question; is homosexuality itself
pathological?
2. The papers do show that since only a minority of a
nonclinical sample of homosexuals has any diagnosable
mental problems (at least by present diagnostic
criteria), then most homosexuals are not mentally ill.
In New Zealand, for example, lesbians are about twice
as likely to have sought help for mental problems as
heterosexual women, but only about 35% of them over
their lifespan did so, and never more than 50% (Anon
1995, Saphira and Glover, 2000, Welch et al. 2000)
This corresponds with similar findings from the U.S.
Relationship Breakups Motivate Most
Suicide Attempts
Next, we ask--do the papers show that it is gay
lifestyle factors, or society's stigmatization, that
are the motivators that lead a person to attempt
suicide? Neither conclusion is inevitable. Still,
Saghir and Robins (1978) examined reasons for suicide
attempts among homosexuals and found that if the
reasons for the attempt were connected with
homosexuality, about 2/3 were due to breakups of
relationships --not outside pressures from society.
Similarly, Bell and Weinberg (1981) also found the
major reason for suicide attempts was the breakup of
relationships. In second place, they said, was the
inability to accept oneself. Since homosexuals have
greater numbers of partners and breakups, compared
with heterosexuals, and since longterm gay male
relationships are rarely monagamous, it is hardly
surprising if suicide attempts are proportionally
greater. The median number of partners for homosexuals
is four times higher than for heterosexuals (Whitehead
and Whitehead 1999, calculated from Laumann et al
1994).
A good general rule of thumb is that suicide attempts
are about three times higher for homosexuals. Could
there be a connection between those two percentages?
Another factor in suicide attempts would be the
compulsive or addictive elements in homosexuality
(Pincu, 1989 ) which could lead to feelings of
depression when the lifestyle is out of control
(Seligman 1975). There are some, (estimates vary, but
perhaps as many as 50% of young men today), who do not
take consistent precautions against HIV (Valleroy et
al., 2001) and who have considerable problems with
sexual addiction and substance abuse addiction, and
this of course would feed into suicide attempts.
The Effect of Social Stigma
Third, does pressure from society lead to mental
health problems? Less, I believe, than one might
imagine. The authors of the study done in The
Netherlands were surprised to find so much mental
illness in homosexual people in a country where
tolerance of homosexuality is greater than in almost
all other countries.
Another good comparison country is New Zealand, which
is much more tolerant of homosexuality than is the
United States. Legislation giving the movement special
legal rights is powerful, consistently enforced
throughout the country, and virtually never
challenged. Despite this broad level of social
tolerance, suicide attempts were common in a New
Zealand study and occurred at about the same rate as
in the U.S.
In his cross-cultural comparison of mental health in
the Netherlands, Denmark and the U.S., Ross (1988)
could find no significant differences between
countries - i.e. the greater social hostility in the
United States did not result in a higher level of
psychiatric problems.
There are three other issues not covered in the
Archives journal articles which are worthy of
consideration. The first two involve DSM category
diagnoses.
Promiscuity and Antisocial Personality
The promiscuous person--either heterosexual or
homosexual --may in fact be more likely to be
antisocial. It is worth noting here the comment of
Rotello (1997), who is himself openly gay: "...the
outlaw aspect of gay sexual culture, its
transgressiveness, is seen by many men as one of its
greatest attributes."
Ellis et al. (1995) examined patients at an clinic
which focused on genital and urological problems such
as STD's; he found 38% of the homosexual men seeking
such services had antisocial personality disorder, as
well as 28% of heterosexual men. Both levels were
enormously higher than the 2% rate of antisocial
personality disorder for the general population (which
in turn, compares to the 50% rate for prison inmates)
(Matthews 1997).
Perhaps the finding of a higher level of conduct
disorder in the New Zealand study foreshadowed this
finding of antisocial personality . Therapists, of
course, are not very likely to see a large number of
individuals who are antisocial because they are
probably less likely to seek help.
Secondly, it was previously noted that 43% of a
bulimic sample of men were homosexual or bisexual
(Carlat et al. 1997), a rate about 15 times higher
than the rate in the population in general--meaning
homosexual men are probably disproportionately liable
to this mental condition. This may be due to the very
strong preoccupation with appearance and physique
frequently found among male homosexuals.
Ideology of Sexual Liberation
A strong case can be made that the male homosexual
lifestyle itself, in its most extreme form, is
mentally disturbed. Remember that Rotello, a gay
advocate, notes that "the outlaw aspect of gay sexual
culture, its transgressiveness, is seen by many men as
one of its greatest attributes." Same-sex eroticism
becomes for many, therefore, the central value of
existence, and nothing else--not even life and health
itself--is allowed to interfere with pursuit of this
lifestyle. Homosexual promiscuity fuels the AIDS
crisis in the West, but even that tragedy it is not
allowed to interfere with sexual freedom.
And, according to Rotello, the idea of taking
responsibility to avoid infecting others with the HIV
virus is completely foreign to many groups trying to
counter AIDS. The idea of protecting oneself is
promoted, but protecting others is not mentioned in
most official condom promotions (France in the '80s
was an interesting exception). Bluntly, then, core gay
behavior is both potentially fatal to others, and
often suicidal.
Surely it should be considered "mentally disturbed" to
risk losing one's life for sexual liberation. This is
surely among the most extreme risks practiced by any
significant fraction of society. I have not found a
higher risk of death accepted by any similar-sized
population.
In conclusion, then, if we ask the question "Is mental
illness inherent in the homosexual condition?" the
answer would have to be "Further
research--uncompromised by politics --should be
carried out to honestly evaluate this issue."
