Wednesday, April 7, 2010

The Closet: Psychological Issues of Being In and Coming Out - By Jack Drescher, M.D.


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…

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). Read complete paper – by By Jack Drescher, M.D.

Jack Drescher, M.D. Website

Jack Drescher, MD, is a psychiatrist and psychoanalyst in private practice in New York City.



Dr. Drescher is a leader in his profession. He is a Distinguished Fellow of the American Psychiatric Association, and served as a Consultant to APA’s Committee on Public Affairs (2007-2009). He is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders.  He is a past Chair (2000-2006) of APA’s Committee on GLB Issues and a Past President of APA’s New York County Branch. He is currently the Co-Editor of AppleSource, the newsletter of the NYC DB of the APA. He is President-Elect of the Group for Advancement of Psychiatry, and a Past Trustee of both the Accreditation Council for Psychoanalytic Education and the American Academy of Psychoanalysis and Dynamic Psychiatry. He is a member of numerous distinguished psychiatric, medical and scientific organizations, including The American College of Psychiatrists and the New York Academy of Medicine.



Dr. Drescher is a teacher and educator. He is a Training and Supervising Analyst at the William Alanson White Institute in New York, Clinical Associate Professor of Psychiatry & Behavioral Sciences at New York Medical College, and Adjunct Clinical Assistant Professor at New York University's Postdoctoral Program in Psychotherapy and Psychoanalysis. Read more - Jack Drescher, M.D. Website

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