[Here is a case that was infuriating initially for the cruel betrayal of an individual patient by the professional community and society at large, and then more cumulatively and retroactively, for the legion of similar betrayals it most assuredly represents.]
New York, 1990
Other people had entered my offices and suggested to me that they were failing in life – at their jobs, at their relationships, at whatever were their expectations for themselves – but their punctuating body language and their general deportment had always reflected varying levels of frustration, anger, despondency, even embarrassment.
Roger Birney, by contrast, seemed so thoroughly ashamed that his demeanor unsettled me. I merely had asked him what I might have asked anyone else on the initial encounter: “What brings you here?” He had bowed his head in response, turning slightly away to his right. He breathed a short, empty sigh. The corners of his mouth seemed to have fallen to match his sunken shoulders. His posture fell beyond sadness or even depression and descended into humiliation and shame.
He began speaking almost inaudibly, pausing uncomfortably between phrases. ”I think the problem… is… that I’m just not any good,” he said, “not for myself, not for anybody else.” He looked up at me. His dark eyes were sad and deep.
Information leaked out slowly, too, but he did begin to tell me about himself: A man incapable of making commitments, he judged; a thirty-eight-year-old man who had spent most of his adult life failing at relationships with women; a man currently involved with a woman from whom he felt increasingly estranged, and who in fact had encouraged him to make the appointment with me.
He had been trained as a paralegal, earned an associate’s degree by painting and wallpapering in the daytime and attending school at night. He had managed to land a decent job in his chosen field, although he said he had ruined that, too, by becoming romantically involved with the seventeen-year-old daughter of one of the law firm’s wealthiest and most respected clients. He was fired for it.
Roger admitted, too, that he had been manifestly unpopular among the clerks and attorneys at a second law firm and that his continuing feeling of unpopularity had led him to quit a third job in the field. Now he was working full-time as a limousine driver. He planted himself one step above a cabbie, he said, and settled.
His relationships with women were no more successful. He had walked away from any number of girlfriends, even, on two occasions, fiancées. His departure from the relationships always was abrupt, struck his prospective partners as an absolute surprise, and made him feel even more ashamed. He had pretty much convinced himself that he was utterly selfish and unworthy, and that his current girlfriend’s estimation of him possibly was just – and probably not severe enough.
I asked him about his parents’ line of work and he said that his father was a sanitation worker, which he quickly reduced linguistically to ”garbageman.” He said his mother had to work part-time cleaning other apartments in order for the family to make ends meet, and that she worked at all was a source of great shame for his father. His father’s siblings had fared much better in life, and the comparison always wore heavily on Roger’s father. Not reminding Roger’s father of his apparent, comparative failures was a theme within the Birney household. His mother’s frequent refrain, he recalled, was: “Let’s not give Daddy any more to feel bad about. He has enough already.”
As the first session concluded, I gently suggested the possibility that his shame reflected a certain loyalty to his father. Perhaps, he unwittingly “failed” at life as a way not to rise above the level of his father’s success, to not bring further comparison to him just as his mother pleaded.
He raised his eyes first, then lowered them, then raised his head. He looked straight at me, inhaled, and sighed. Soon a slight smile of new recognition crossed his face. In retrospect, it was a powerful moment.
He confirmed my suspicions at the beginning of the second session, saying outright that he was quite moved by the idea that what he had thought was selfish behavior might actually be self-denial. He had been thinking about it all week while driving the limo. He couldn’t shake the thought.
“It wouldn’t explain everything,” he said. “Some things… I don’t know. Sometimes people just do things, behave in ways that they probably ought not to behave… and there’s no… well, there must be explanations, aren’t there? You would know about that.”
Roger shuffled his feet and squirmed in his chair.
“I’ve talked to my girlfriend about it, and she said, ‘Yeah, yeah, it makes sense. Even down to denying the pleasure of our relationship, denying sex, and all of that.'”
“Denying sex?” I asked. “In what way?”
“I’m not particularly turned on by her right now. I don’t know why. Maybe I’m denying myself that kind of pleasure for the reasons you suggested.”
“Well, if you’re not turned on by her right now, what does turn you on, if anything?”
Roger’s shuffling and squirming resumed in earnest. For moments he said nothing. Finally he began by telling me that he thought had been denying his heterosexuality, punishing himself somehow by denying his girlfriend’s advances or even his own natural longings. He then revealed that he had been secretly indulging in behavior that he said was “homosexual” by offering oral sex to truck drivers at rest stops along the interstate, or strangers in public men’s rooms, or cruising gay men in back alleys and parks. It only had made him more ashamed of himself, he said.
“Is that just recent, your engaging in that sort of activity?” I asked curious about his interpretation of his homosexual behavior as a form self-punishment.
Answering that question absorbed a great deal of time, but he eventually revealed that homosexual interludes had been an integral part of his life for many years and the primary subject of his past therapy which ended two years before our consultations. I did not respond, but waited through his discomfort again. He repeated that his sexual behavior was the focus of seven years of prior therapy.
“My therapist thought I was afraid of women. Maybe I was just denying myself that pleasure.” He said his therapist further believed that his homosexual activities, his same-sex attractions, were symptomatic of a “deep psychological dysfunction.” He suggested that Roger’s behavior reflected the lack of resolution of the classic oedipal dilemma. His father’s distant and sometimes hostile behavior toward him was a reaction to Roger’s attachment to his mother, which his father envied. In the face of his father’s rejection, said the therapist, Roger rejected his mother, along with his erotic attraction to her. This, of course, was systematically repressed, so that all that remained conscious were his rejection of women and his desire to please men. He had grown into what the therapist diagnosed a heterophobic man.
Nothing that Roger had said about his own life shocked me, but his previous therapist’s diagnosis of Roger’s “heterophobia” astounded me. Already entrenched in a tradition of family shame, his therapist’s definition further enabled it. He explained that Roger could have no control over his “sick” sexual behavior because it was a symptom of a deeper psychological dysfunction.
By the end of this session I was struggling with my own intellectual and emotional reactions to the damage I had seen done to Roger Birney and to many others by psychotherapists’ loyalty to psychiatric diagnosis that had later sunk out of sight. Years ago, the notion of heterophobia was an accepted explanation for homosexuality and thus led the American Psychiatric Association officially to designate homosexuality a mental illness, one which could be cured through proper treatment. Homosexuality thus had a diagnostic label and a category number. In 1973, the association rescinded the designation and accepted instead the possibility that homosexuality was biologically and/or genetically based. Gay men and lesbians were who and what they were, to the credit or blame of no one. But despite the lifting of the official diagnosis, some psychotherapists still held on to the old belief.
At the beginning of our third session, I asked Roger for a detailed accounting of his homosexual desires, fantasies, and experiences from as far back as he could remember. Initially he told me of incidents from his adolescence, masturbation sessions with other boys, some of which involved experimental touching and kissing under the guise of practicing for later encounters with girls. As he thought more about it, however, he remembered more-that from the age of five or six, he had favored the presence of men and was comforted by their proximity. He even recalled being identified by other adults as well as children as having characteristics and preferences more like a girl’s than a boy’s, though in adulthood he had not a trace of effeminacy. He remembered being physically drawn to the sights, sounds, and scents of men. He told me one vignette that had remained one of the fondest of his early childhood memories, wherein his father had taken him to a public pool and into the men’s locker room. As he grew older, he recalled the incident with increasing fondness and eventually with a sense of eroticism. Next, he revealed that his fantasies in early adolescence were about being close to men and that those fantasies become eroticized in later adolescence. He told me that he and a neighborhood boy had indulged in a regular, if exploratory, sexual involvement when they were fourteen or fifteen for which he felt deeply ashamed.
When I asked him about heterosexual fantasies, desires, and experiences, he answered that he always had to force himself to think about women and summon from himself an erotic reaction. He had managed to contain the homosexual activity, had more or less placed it in a little compartment of his life, until finally he went to a therapist and diagnosed as mentally ill for them.
As he talked about his sexual struggle with women, I realized that he had been brightly animated and descriptive, even fervent, when he was talking about his attraction to men. Discussing women, however, he reverted to the humiliated, shamed demeanor that had so moved me when I first saw him. When he spoke about the “straight” life he had been trying so desperately hard to lead, he was humiliated and empty. He fled into his stories about his male-female relationships just as he must have fled into the relationships themselves, making his real sexuality shameful, secret, and isolating.
This was not a man denying his heterosexuality, but a homosexual man with a life-time history of same-sex attraction who had further shamed for them and be coached not to accept himself.
I wanted to deconstruct Roger’s illusion that he was mentally ill.
I said that in listening to his stories, I could state first that his therapist of seven years was a man loyal to his training. “But,” I said, “given both your history and the current convictions regarding homosexuality, you seem to me to fit directly alongside the many men who are biologically or genetically homosexual. There is nothing psychological about your sexuality. It is who you are, no more, or less.”
Fighting my own desire to demonize his therapist I continued. “Your therapist remained loyal to a long-held, carefully thought out theory of homosexuality that has since been discarded as irrelevant and wrongheaded, though some therapists cling to it yet. Traditional social convictions have condemned homosexuality throughout history, and if you think of the psychiatric establishment as among society’s guardians, it makes sense that it would try to establish homosexuality as explicably and demonstrably wrong.”
“Your memories of your physical attraction to men go back to age five, and that’s without trying very hard to remember. There’s nothing psychological about that. How you handle it becomes more psychologically involved, but the fact is just a fact.”
Roger was looking at me intently, bewildered, I think, at least at that moment, by what he took to be the enormity of the idea. For many people the notion of accepting their homosexuality is a colossal relief, because they have struggled with it for so long and read and heard so much about overinvolved mothers, complexes, damaged egos and libidos, and a whole spectrum of attempted explanations for this simple statistical fact.
Roger said he felt very confused. “Everything is upside down,” he said. I told him he probably had a lot to think about and advised him to go home and let these ideas percolate for a while. It still seems extraordinary to me that homosexuality may never once have occurred to him before. Given his look of surprise, his system of denial must have been herculean and his therapist colluded in it.
Roger returned for the fourth session looking profoundly different. He gazed at me directly. For the first time someone had approved of him, and I think he felt somehow connected to me by that approval. His manner was animated again, though shaky, nervous. He even joked about himself, if cruelly. He said that he was surprised by the depth of his reaction. He spoke of how right it was beginning to feel for him, except that he also felt alternating waves of terror.
“On the one hand,” he said, “I’m asking myself if I have led a totally mistaken life; then, if I’ve wasted my life; then, if I’ve even lived at all. And on the other hand, I don’t know how to begin to live this other life. I fluctuate from feeling that this is right and perfect to feeling frightened to death. I mean, down to the details like how am I going to announce this to my girlfriend, let alone everybody else in my life? ‘Hi, Joyce. Listen, the reason I haven’t wanted to have sex with you lately is that you’re a woman, see, and I’m gay. So I don’t think it’s going to work out with us.’ Even if I accept what you say about my homosexuality – and in my heart I think I do, because it makes such perfect sense, I fluctuate there, too, and feel like I must be sick or depraved. I don’t know who the fuck I am anymore. But I know I am terrified.'”
I told him I could appreciate both his terror and his sadness and anger about having spent so much of his life in this acquiescent denial.
I told him he was particularly vulnerable to feeling the shame because on top of all the societal pressure and the prejudice and the condemnation by religious traditions, there is a powerful tradition of shame in his family, one that has little or nothing to do with sexuality but that certainly would respond overwhelmingly to the idea of sexuality as shameful.
“Your acceptance was so complete that it became an illusion. The illusion that you were sick allowed you to remain loyal to all of these people in your life, to all the conventions and traditions they held dear, to the community at large, and even to the medical establishment. Under the illusion, your failures at relationships with women allow you to participate in the symptoms of your so-called ‘sickness,’ really your true self. But because in the illusion you view that behavior as failure, you continue to fail and continue to feel ashamed, and in so doing you continue to honor your father’s perceived failures and shame as well.”
“By embracing the illusion of mental illness, and keeping your shame both secret and shameful, you also continue to honor your mother’s plea not to give your father any more to feel bad about than he already has. You don’t reveal your secret ‘mental illness – your homosexuality’ so he is not hurt by that; and you don’t surpass him in life, so he’s not hurt by that. One final thing.”
“Shame has been the single most important fact in your life. All of your years of self-denial, all your feelings of illegitimacy have been shaped by it. It’s going to be a slow process of unfolding and learning to honor yourself. It will likely be a roller coaster, sometimes torturously confusing, and sometimes so exhilarating you’ll fear you’re going to explode with joy.”
In the following weeks and months, Roger seemed less interested in honoring his sexuality than in exploring it, and I had to caution him to slow down. The idea was not to try to catch up with what he’d missed in life. The idea was not even about sex, I told him, but about loving himself.