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Psychiatric Times
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Homosexual identities can be described as closeted, homosexually self aware, gay/ lesbian and non-gay identified. This classification privileges the role of self-definition. In coming out, gay people integrate, as best as they can, dissociated aspects of the self. As gay people must decide on a daily basis whether to reveal and to whom they will reveal, coming out is a process that never ends.
In the jargon of contemporary homosexual culture, those who hide their sexual identities are referred to as either closeted or said to be in the closet. Revealing one's homosexuality is referred to as coming out. Clinical experience with gay patients reveals hiding and revealing behaviors to be psychologically complex.
Homosexual Identities
In the developmental histories of gay men and women, periods of difficulty in acknowledging their homosexuality, either to themselves or to others, are often reported. Children who grow up to be gay rarely receive family support in dealing with antihomosexual prejudices. On the contrary, beginning in childhood--and distinguishing them from racial and ethnic minorities--gay people are often subjected to the antihomosexual attitudes of their own families and communities (Drescher et al., 2004). Antihomosexual attitudes include homophobia (Weinberg, 1972), heterosexism (Herek, 1984), moral condemnations of homosexuality (Drescher, 1998) and antigay violence (Herek and Berrill, 1992). Hiding activities learned in childhood often persist into young adulthood, middle age and even senescence, leading many gay people to conceal important aspects of themselves.
Closeted individuals frequently cannot acknowledge to themselves, let alone to others, their homoerotic feelings, attractions and fantasies. Their homosexuality is so unacceptable that it must be kept out of conscious awareness and cannot be integrated into their public persona. Consequently, these feelings must be dissociated from the self and hidden from others.
If and when same-sex feelings and attractions can no longer be kept out of consciousness, the individual becomes homosexually self-aware. Individuals to whom this happens can acknowledge some aspect of their homosexuality to themselves. While homosexually self-aware people might consider accepting and integrating these feelings into their public persona, acceptance is not a pre-determined outcome. For example, a religious, homosexually self-aware man may choose a celibate life to avoid what, for him, would be the problematic integration of his religious and sexual identities.
Individuals who are either consciously prepared to act on their homoerotic feelings or to reveal a homosexual identity to others usually define themselves as gay or lesbian. To be gay, in contrast to being homosexually self-aware, is to claim a normative identity. In other words, defining oneself as gay usually requires some measure of self-acceptance. A gay person may choose to come out to family or intimate acquaintances. Others may come out to people they have met in the gay community while keeping their gay identity separate from the rest of their lives.
Another homosexual identity is the non-gay-identified individual. These people have experienced homosexual self-awareness, may have acted on their feelings, and may have even once identified as gay or lesbian. However, such individuals find it difficult, if not impossible, to naturalize their same-sex feelings and attractions. While recognizing their homosexual feelings, these individuals reject the feelings and, despite the low odds of success, may even seek to change their sexual orientation (Shidlo et al., 2001).
The above classification of homosexual identities privileges the role of self-definition. These identities are not mutually exclusive; there is often overlap between and differing motivations within them. They are shaped by individual and cultural factors. Consequently, when individuals become homosexually self-aware, there is a wide range of psychosocially constructed attitudes and responses they may develop toward their own homosexuality. For example, a homosexually self-aware man may initially identify himself as gay but then regret that decision and return to his earlier practices of hiding. Another may choose a non-gay identity, attempt a "sexual conversion" therapy, but then later decide to accept his homosexual feelings and come out.
Dissociation
What psychological mechanisms facilitate separating one's sexual identity from the rest of one's persona? Sullivan's (1956) concept of dissociation may be illuminating, particularly its most common aspect: selective inattention. A ubiquitous, nonpathological process, selective inattention makes life more manageable, like tuning out the background noise on a busy street. However, through dissociation of anxiety-provoking knowledge about the self, a whole double life can be lived and yet, in some ways, not be known. Clinical presentations of closeted gay people may lie somewhere in severity between selective inattention--most commonly seen in the case of homosexually self-aware patients thinking about "the possibility" that they might be gay--to more severe dissociation--in which any hint of same-sex feelings resides totally out of conscious awareness. More severe forms of dissociation are commonly observed in married men who are homosexually self-aware but cannot permit the thought of themselves as gay (Roughton, 2002).
Self-Esteem and the Closet
Some closeted gay people can reflexively speak without revealing the gender of the person being discussed or without providing any gendered details of their personal lives. Sedgwick (1990) called "'Closetedness' ... a performance initiated as such by the speech act of a silence--not a particular silence, but a silence that accrues particularity by fits and starts, in relation to the discourse that surrounds and differentially constitutes it." Toward that end, a gay person might avoid references to gender altogether: "I went out last night with someone I've been dating for the last few weeks. We went to a movie in their neighborhood. We talked about the possibility of going to the beach next weekend." A heterosexual listening to these words might automatically assume a heterosexual relationship was being discussed.
It can be painful to keep significant aspects of the self hidden or to vigilantly separate aspects of the self from each other. Constant hiding creates difficulties in accurately assessing other people's perceptions of oneself, as well as recognizing one's own strengths. Dissociation's impact on self-esteem can also make it difficult to feel one's actual accomplishments as reflections of one's own abilities. Transparency, invisibility, losing one's voice, and being stuck behind walls or other barriers are some of the terms used to describe the subjective experience of dissociative detachment (Drescher, 1998).
The Closet and Gay-Bashing
For some gay men, "Hiding and passing as heterosexual becomes a lifelong moral hatred of the self; a maze of corruptions, petty lies, and half truths that spoil social relations in family and friendship" (Herdt and Boxer, 1993). There are many gay men who, before they came out, were either "gay-baiters" or "gay-bashers" themselves.
Attacking those perceived to be gay serves several functions. One penile plethysmography study indicated that men with strong antihomosexual beliefs actually had significant homosexual arousal patterns (Adams et al., 1996). Strong antihomosexual feelings may represent an effort to control perceptions of a gay-basher's own sexual identity. This might translate as, "If I attack gay people, no one will think I am gay." Psychoanalysts call this defense "identification with the aggressor" (Freud, 1966). It may represent intrapsychic efforts to maintain a psychological distance from one's own homoerotic feelings. In other words, it is an effort to strengthen dissociative tendencies.
Coming Out
Coming out may be the most commonly shared cultural experience that defines the modern gay identity. Historically, the term was an ironic reference to debutantes "coming out into society" (Chauncey, 1994). In contemporary usage, "coming out of the closet" means telling another person that one is gay.
Years spent in the closet can make the prospect of revealing oneself an emotionally charged experience. However, the process is not just about revealing oneself to others--in coming out, gay people integrate, as best they can, dissociated aspects of the self. Herdt and Boxer (1993) classified coming out as a ritual process of passage that requires a gay person to 1) unlearn the principles of natural or essentialist heterosexuality; 2) unlearn the stereotypes of homosexuality; and 3) learn the ways of the lesbian and gay culture they are entering. Finally, as gay people must decide on a daily basis whether to reveal and to whom they will reveal themselves, coming out is a process that never ends.
Coming out to oneself is a subjective experience of inner recognition. It is a moment that is sometimes charged with excitement and at other times with trepidation. It is a realization that previously unacceptable feelings or desires are part of one's self. It is, in part, a verbal process--putting into words previously inarticulated feelings and ideas. It is a recapturing of disavowed experiences.
Coming out to oneself may precede any sexual contact. Sometimes, the moment of coming out to oneself is sexually exciting. Some gay people describe it as a switch being turned on. "Coming home" or "discovering who I really was" are how gay people frequently describe coming out to themselves. In the language of Winnicott (1965), it can be experienced as a moment in which they make contact with their true selves.
Coming out to oneself may be followed by coming out to others. Such revelations are not always greeted with enthusiasm, and fear of rejection often plays a significant role in a gay person's decision about who to tell or whether to come out. For those who cannot come out in their hometown, moving to another city offers opportunities to come out among strangers. It can be exhilarating to come out in new and faraway places where one is not known to either family or friends. After making such a move, gay people may completely (and perhaps dissociatively) sever relationships with their past lives.
The Therapist's Role
A therapist's recognition and respect for individual differences allows multiple possibilities in the coming out process. There is no single way to come out, a fact sometimes overlooked by well-intentioned therapists trying to affirm a patient's homosexuality. Every coming out situation may be associated with anxiety, relief or both.
As previously stated, being gay, in contrast to being homosexually self-aware, is to claim a normative identity. From this perspective, coming out to oneself is integrative and often serves to affirm a patient's sense of worth. It is a prerequisite of this work that therapists be able to accept their patients' homosexuality as a normal variation of human sexuality, and that they value and respect same-sex feelings and behaviors as well (Drescher, 1998).
A therapist fluent in the meanings of coming out can point out both obstacles to and inhibitions of the process. However, patients may hear therapist fluency as tacit encouragement to "hurry up and come out," even rebuking a therapist for perceived efforts to force movement in that direction. Therapists need to be aware they can be heard this way and treat it as grist for the psychotherapeutic mill.
Therapists should recognize gay patients' struggles to define themselves as the important therapeutic focus--and that this is not a typical struggle for those who claim a heterosexual identity. Gay patients face a whole set of decisions unlike anything heterosexuals face. Hiding from oneself depends upon dissociative defenses, while coming out to oneself holds the possibility of psychological integration. An implicit value of psychotherapy is that integration is more psychologically meaningful than dissociation. Consequently, therapists cannot be neutral about coming out to the self.
Coming out to others can be fraught with danger. A need to hide may be based on reasonable concerns, as in the case of gay men and women serving in the military. A therapist would be unwise to advise a patient to come out without knowing the attitudes and opinions of the intended object of the patient's revelation. A therapist cannot fully predict the consequences of such a revelation on the relationship of those two people. Again, coming out to others needs to be addressed in a way that recognizes individual differences.
Internalized, antihomosexual attitudes are often rigid and disdainful of compromise or "relativism." A patient's dogmatic belief system may not recognize the concept of respectful disagreement. Nevertheless, exploration of such internalized, moral absolutes, and the identifications from which they stem, requires therapeutic tact. Some patients may try to resolve inner conflicts about being gay by selectively attending to their antihomosexual identifications. Unable to tolerate conflicting feelings about homosexuality, these patients rather unconvincingly tell themselves, "It is OK to be gay." This approach reverses the feelings and identifications of a closeted identity. In the subjectivity of the latter, heterosexuality is idealized and homosexuality dissociated. After coming out, being gay is idealized, while disapproving feelings are denied. Therapeutic holding entails being able to contain both sides (Winnicott, 1986).
When gay patients understand their own antihomosexual attitudes--and the defenses against them--they have a wider view of themselves. As patients feel more comfortable with themselves, they may begin to feel more comfortable with others. Not only does this encourage self-awareness, increase self-esteem and enhance the quality of relationships, it helps a patient more accurately assess the implications of coming out. If a patient chooses to come out, the decision needs to be carefully explored. Conversely, the same is true if a patient decides not to come out.
Given the social stigma, the severity of antihomosexual attitudes in the culture and the difficulties associated with revealing one's sexual identity, why would a gay person come out at all? "Most frequently coming out involves choices about how to handle moments of ordinary, daily conversation" (Magee and Miller, 1995). Furthermore, coming out offers gay people the possibility of integrating a wider range of previously split-off affects, not just their sexual feelings (Drescher et al., 2003). Greater ease in expressing themselves, both to themselves and to others, can lead to an enormous enrichment of their work and relationships. To many, such activities constitute a reasonable definition of mental health.
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