Homosexuality and Mental Health Problems

By N.E. Whitehead, Ph.D.
(Author of "My Genes Made Me Do It")
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."

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