Ego-syntonic & Ego-dystonic Homosexuality
HOMOSEXUALITY: Up to only a few years ago, the topic of homosexuality was listed in textbooks
as a paraphilia or a "sexual deviation." We now believe that there is
good reason for homosexuality not to be classified as a disorder. Sexual disorders
used to be defined as conditions that grossly impaired affectionate
sexual relations between a man and a woman, and homosexuality qualified as such a disorder. But DSM-III defines sexual disorders as "conditions
which grossly impair affectionate sexual relations between two human beings." Homosexuality, while it may impair such relations between men
and women, does not, of course, impair them between a man and a man, or a woman and a woman.
The underlying justification for excluding homosexuality as a disorder
distinguishes between ego-syntonic and ego-dystonic homosexuality. Egodystonic
homosexuality is defined as a sustained pattern of homosexuality
which is a source of distress and which is accompanied by the desire to acquire
or increase heterosexuality. Ego-syntonic homosexuality, in contrast,
is not a source of distress and is not marked by a desire to change sexual preference.
When we compare ego-dystonic homosexuality to ego-syntonic homosexuality,
we see that the former involves suffering and a desire to
change, while the latter does not. Since these two elements count strongly
toward calling a behavior disordered, we believe that ego-syntonic homosexuality
is legitimately excluded from the catalogue of psychological disorders.
In contrast, we believe that ego-dystonic homosexuality could be
considered a paraphilia, and so treated.
The crux ofthe matter is that a significant proportion of homosexuals are
satisfied with their sexual orientation, do not show signs of psychopathology,
and function quite effectively at love and at work. Ego-dystonic homosexuals,
on the other hand, are dissatisfied and distressed by their sexual
orientation. They are depressed, anxious, ashamed, guilty, and lonely. They
are also manifestly impaired in their capacity to love. On the one hand, they
feel ashamed of their attraction to members of their own sex, but on the
other, they are not sexually aroused by members of the opposite sex.
Because ego-dystonic homosexuality is a new category, not much is
known about its prevalence, its male to female ratio, its predisposing factors,
and its course. Typically, an ego-dystonic homosexual will have attempted
heterosexual relations unsuccessfully. But merely knowing that he was unaroused
by females, or she by males, may have prevented heterosexual attempts
altogether. Because there is a highly supportive homosexual
subculture in many parts of the United States today, some ego-dystonic homosexuals
accept their sexual orientation and give up the yearning to become
heterosexual. Spontaneous occurrences of satisfactory heterosexual
relations in individuals who have been exclusively homosexual are rare.
The Etiology of Ego-Dystonic Homosexuality
There are two different questions about the causes of ego-dystonic homosexuality:
Where does one's dissatisfaction with one's homosexuality come
from and where does one's sexual preference, one's homosexuality, come
from?
Part of the dissatisfaction or dystonicity stems from the desire to have
children and a conventional family life. Another source of dissatisfaction
comes from pressures that our society puts on individuals to conform to its
sexual norms. Even though American attitudes are changing toward homosexuality,
70 percent of Americans still believe that homosexuals are "sexually
abnormal," 50 percent believe they are "perverted," and 40 percent
believe they are "mentally ill" (Weinberg and Williams, 1974). Against this
sort of disapproval, it would be difficult to retain one's equanimity day in and day out.
Also, a major source of the distress felt by ego-dystonic homosexuals
stems from rejection and disapproval by their families, their acquaintances,
their co-workers, and their own images of "normality."
Some writers believe that the suffering that society's oppression inflicts on
homosexuals raises serious ethical questions about whether a therapist
should ever consent to treat homosexuality. When an ego-dystonic homosexual
comes into therapy with a request that the therapist help him to
change his sexual orientation, these writers believe that the therapist should
refuse. They believe that because the self-loathing and the desire to become
heterosexual are products ofthe oppression of homosexuals by society, the
desire of the ego-dystonic homosexual to change his orientation has been
coerced and is not "voluntary," and so should be disregarded (Davison,
1976, 1978). Others disagree. They believe that individual suffering is often
the product of societal disapproval and rejection. Exactly how the suffering
comes about is theoretical and speculative, but what is not speculative is
that another human being comes into the therapist's office and voices a desire
to change. The expressed desire to change is, for some, the bottom line
of therapeutic decision. The therapist is first and foremost an agent of the
patient. When a patient, in obvious distress, asks for help, the patient has
called on the therapist's primary duties. The bottom line of interaction between
patient and therapist, just as between any two human beings, is that
the expression of desires are taken seriously and, if possible, acted upon.
Locating the cause of the distress is a simpler question than discovering
the cause of the homosexuality.
Many of the same considerations that apply
to sexual learning in both normal heterosexuality and in the paraphilias,
also apply to homosexuality. Prepared Pavlovian conditioning, masturbatory
fantasies, nocturnal emission leading to cathexis, all probably playa
role in the acquisition of a homosexual orientation. One recent theory proposes
that the timing of the maturation of sex drive is critical. If most of your
social group are the same sex as you when sex drive matures, you will tend to
become homosexual. If opposite sexed, you will tend toward heterosexuality.
This theory predicts that early maturing males and individuals with
same-sex siblings will have a higher rate of homosexuality, and this may be
so (Storms, 1981). In addition, homosexuality may be partially determined
by hormones, by heredity, or by how a child is treated by his mother and father.
The Treatment of Ego-Dystonic Homosexuality
Since this is a new category, little is known about its treatment. There are
two aspects, either of which might be treated: the ego-dystonicity and or the
homosexuality. The anxiety, depression, guilt, shame, and loneliness that
make up the ego-dystonicity may be amenable to the treatments for anxiety
and depression outlined in the anxiety and depression chapters. Cognitive
therapy, assumption challenging, and progressive relaxation
should each allay the sadness and fears that make up the distress.
Homosexuality itself may be changeable if the individual strongly wants
to change it. Traditional psychotherapy does not seem to hold much promise
for changes of sexual orientation, but behavior therapy may help. In two
controlled studies involving seventy-one male homosexuals, a group of Brit
ish behavior therapists found that sexual orientation could be changed in
nearly 60 percent of the cases by using aversion therapy ofthe sort described
for the paraphilias. They defined "change" as the absence of homosexual behavior,
plus only occasional homosexual fantasy, plus strong heterosexual
fantasy, and some overt heterosexual behavior one year after treatment. Individuals
who had had some heterosexual experience before therapy showed
more change than primary homosexuals who had had no prior pleasurable
heterosexual history (Feldman and MacCulloch, 1971).
NOTE:
For homosexuals or heterosexuals
who were raise in a shame or guilt based family of origin...
I suggest psychotherapy to come to terms with identity and move into acceptance.
as a paraphilia or a "sexual deviation." We now believe that there is
good reason for homosexuality not to be classified as a disorder. Sexual disorders
used to be defined as conditions that grossly impaired affectionate
sexual relations between a man and a woman, and homosexuality qualified as such a disorder. But DSM-III defines sexual disorders as "conditions
which grossly impair affectionate sexual relations between two human beings." Homosexuality, while it may impair such relations between men
and women, does not, of course, impair them between a man and a man, or a woman and a woman.
The underlying justification for excluding homosexuality as a disorder
distinguishes between ego-syntonic and ego-dystonic homosexuality. Egodystonic
homosexuality is defined as a sustained pattern of homosexuality
which is a source of distress and which is accompanied by the desire to acquire
or increase heterosexuality. Ego-syntonic homosexuality, in contrast,
is not a source of distress and is not marked by a desire to change sexual preference.
When we compare ego-dystonic homosexuality to ego-syntonic homosexuality,
we see that the former involves suffering and a desire to
change, while the latter does not. Since these two elements count strongly
toward calling a behavior disordered, we believe that ego-syntonic homosexuality
is legitimately excluded from the catalogue of psychological disorders.
In contrast, we believe that ego-dystonic homosexuality could be
considered a paraphilia, and so treated.
The crux ofthe matter is that a significant proportion of homosexuals are
satisfied with their sexual orientation, do not show signs of psychopathology,
and function quite effectively at love and at work. Ego-dystonic homosexuals,
on the other hand, are dissatisfied and distressed by their sexual
orientation. They are depressed, anxious, ashamed, guilty, and lonely. They
are also manifestly impaired in their capacity to love. On the one hand, they
feel ashamed of their attraction to members of their own sex, but on the
other, they are not sexually aroused by members of the opposite sex.
Because ego-dystonic homosexuality is a new category, not much is
known about its prevalence, its male to female ratio, its predisposing factors,
and its course. Typically, an ego-dystonic homosexual will have attempted
heterosexual relations unsuccessfully. But merely knowing that he was unaroused
by females, or she by males, may have prevented heterosexual attempts
altogether. Because there is a highly supportive homosexual
subculture in many parts of the United States today, some ego-dystonic homosexuals
accept their sexual orientation and give up the yearning to become
heterosexual. Spontaneous occurrences of satisfactory heterosexual
relations in individuals who have been exclusively homosexual are rare.
The Etiology of Ego-Dystonic Homosexuality
There are two different questions about the causes of ego-dystonic homosexuality:
Where does one's dissatisfaction with one's homosexuality come
from and where does one's sexual preference, one's homosexuality, come
from?
Part of the dissatisfaction or dystonicity stems from the desire to have
children and a conventional family life. Another source of dissatisfaction
comes from pressures that our society puts on individuals to conform to its
sexual norms. Even though American attitudes are changing toward homosexuality,
70 percent of Americans still believe that homosexuals are "sexually
abnormal," 50 percent believe they are "perverted," and 40 percent
believe they are "mentally ill" (Weinberg and Williams, 1974). Against this
sort of disapproval, it would be difficult to retain one's equanimity day in and day out.
Also, a major source of the distress felt by ego-dystonic homosexuals
stems from rejection and disapproval by their families, their acquaintances,
their co-workers, and their own images of "normality."
Some writers believe that the suffering that society's oppression inflicts on
homosexuals raises serious ethical questions about whether a therapist
should ever consent to treat homosexuality. When an ego-dystonic homosexual
comes into therapy with a request that the therapist help him to
change his sexual orientation, these writers believe that the therapist should
refuse. They believe that because the self-loathing and the desire to become
heterosexual are products ofthe oppression of homosexuals by society, the
desire of the ego-dystonic homosexual to change his orientation has been
coerced and is not "voluntary," and so should be disregarded (Davison,
1976, 1978). Others disagree. They believe that individual suffering is often
the product of societal disapproval and rejection. Exactly how the suffering
comes about is theoretical and speculative, but what is not speculative is
that another human being comes into the therapist's office and voices a desire
to change. The expressed desire to change is, for some, the bottom line
of therapeutic decision. The therapist is first and foremost an agent of the
patient. When a patient, in obvious distress, asks for help, the patient has
called on the therapist's primary duties. The bottom line of interaction between
patient and therapist, just as between any two human beings, is that
the expression of desires are taken seriously and, if possible, acted upon.
Locating the cause of the distress is a simpler question than discovering
the cause of the homosexuality.
Many of the same considerations that apply
to sexual learning in both normal heterosexuality and in the paraphilias,
also apply to homosexuality. Prepared Pavlovian conditioning, masturbatory
fantasies, nocturnal emission leading to cathexis, all probably playa
role in the acquisition of a homosexual orientation. One recent theory proposes
that the timing of the maturation of sex drive is critical. If most of your
social group are the same sex as you when sex drive matures, you will tend to
become homosexual. If opposite sexed, you will tend toward heterosexuality.
This theory predicts that early maturing males and individuals with
same-sex siblings will have a higher rate of homosexuality, and this may be
so (Storms, 1981). In addition, homosexuality may be partially determined
by hormones, by heredity, or by how a child is treated by his mother and father.
The Treatment of Ego-Dystonic Homosexuality
Since this is a new category, little is known about its treatment. There are
two aspects, either of which might be treated: the ego-dystonicity and or the
homosexuality. The anxiety, depression, guilt, shame, and loneliness that
make up the ego-dystonicity may be amenable to the treatments for anxiety
and depression outlined in the anxiety and depression chapters. Cognitive
therapy, assumption challenging, and progressive relaxation
should each allay the sadness and fears that make up the distress.
Homosexuality itself may be changeable if the individual strongly wants
to change it. Traditional psychotherapy does not seem to hold much promise
for changes of sexual orientation, but behavior therapy may help. In two
controlled studies involving seventy-one male homosexuals, a group of Brit
ish behavior therapists found that sexual orientation could be changed in
nearly 60 percent of the cases by using aversion therapy ofthe sort described
for the paraphilias. They defined "change" as the absence of homosexual behavior,
plus only occasional homosexual fantasy, plus strong heterosexual
fantasy, and some overt heterosexual behavior one year after treatment. Individuals
who had had some heterosexual experience before therapy showed
more change than primary homosexuals who had had no prior pleasurable
heterosexual history (Feldman and MacCulloch, 1971).
NOTE:
For homosexuals or heterosexuals
who were raise in a shame or guilt based family of origin...
I suggest psychotherapy to come to terms with identity and move into acceptance.