Multiple studies have identified high rates of psychiatric illness, including depression, drug abuse and suicide attempts, among selfprofessed gays and lesbians.1 Some proponents of GLB rights have used these findings to conclude that mental illness is induced by other people’s unwillingness to accept same-sex attraction and behavior as normal. They point to homophobia, effectively defined as any opposition to or critique of gay sex, as the cause for the higher rates of psychiatric illness, especially among gay youth.2 Although homophobia must be considered as a potential cause for the increase in mental health problems, the medical literature suggests other conclusions.
An extensive study in the Netherlands undermines the assumption that homophobia is the cause of increased psychiatric illness among gays and lesbians. The Dutch have been considerably more accepting of same-sex relationships than other Western countries — in fact, same-sex couples now have the legal right to marry in the Netherlands.3 So a high rate of psychiatric disease associated with homosexual behavior in the Netherlands means that the psychiatric disease cannot so easily be attributed to social rejection and homophobia.
The Dutch study, published in the Archives of General Psychiatry, did indeed find a high rate of psychiatric disease associated with same-sex sex.4 Compared to controls who had no homosexual experience in the 12 months prior to the interview, males who had any homosexual contact within that time period were much more likely to experience major depression, bipolar disorder, panic disorder, agoraphobia and obsessive compulsive disorder. Females with any homosexual contact within the previous 12 months were more often diagnosed with major depression, social phobia or alcohol dependence. In fact, those with a history of homosexual contact had higher rates of nearly all psychiatric pathologies measured in the study.5 The researchers found “that homosexuality is not only associated with mental health problems during adolescence and early adulthood, as has been suggested, but also in later life.”6 Researchers actually fear that methodological features of “the study might underestimate the differences between homosexual and heterosexual people.”7
The Dutch researchers concluded, “this study offers evidence that homosexuality is associated with a higher prevalence of psychiatric disorders. The outcomes are in line with findings from earlier studies in which less rigorous designs have been employed.”8 The researchers offered no opinion as to whether homosexual behavior causes psychiatric disorders, or whether it is the result of psychiatric disorders.
Reckless Sexual Behavior
Depression and drug abuse can lead to reckless sexual behavior, even among those who are most likely to understand the deadly risks. In an article that was part of a series on “AIDS at 20,” the New York Times reported the risks that many gay men take. One night when a gay HIV prevention educator named Seth Watkins got depressed, he met an attractive stranger, had anal intercourse without a condom — and became HIV positive. In spite of his job training, the HIV educator nevertheless employed the psychological defense of “denial” in explaining his own sexual behavior:
“[L]ike an increasing number of gay men in San Francisco and elsewhere, Mr. Watkins sometimes still puts himself and possibly other people at risk. ‘I don’t like to think about it because I don’t want to give anyone H.I.V.,’ Mr. Watkins said.”9
Another gay man named Vince, who had never before had anal intercourse without a condom, went to a sex club on the spur of the moment when he got depressed, and had unprotected sex:
“I was definitely in a period of depression . . . . And there was just something about that particular circumstance and that particular person. I don’t know how to describe it. It just appealed to me; it made it seem like it was all right.”10
Some of the men interviewed by the New York Times are deliberately reckless. One fatalistic gay man with HIV makes no apology for putting other men at risk:
“The prospect of going through the rest of your life having to cover yourself up every time you want to get intimate with someone is an awful one. . . . Now I’ve got H.I.V. and I don’t have to worry about getting it,” he said. “There is a part of me that’s relieved. I was tired of always having to be careful, of this constant diligence that has to be paid to intimacy when intimacy should be spontaneous.”11
After admitting to almost never using condoms he adds:
“There is no such thing as safe sex. . . . If people want to use condoms, they can. I didn’t go out and purposely get H.I.V. Accidents happen.”12
Other reports show similar disregard for the safety of self and others. A1998 study in Seattle found that 10 percent of HIV-positive men admitted they engaged in unprotected anal sex, and the percentage doubled in 2000.13 According to a study of men who attend gay “circuit” parties,14 the danger at such events is even greater. Ten percent of the men surveyed expected to become HIV-positive in their lifetime. Researchers discovered that 17 percent of the circuit party attendees surveyed were already HIV positive.15 Two thirds of those attending circuit parties had oral or anal sex, and 28 percent did not use condoms.16
In addition, drug use at circuit parties is ubiquitous. Although only 57 percent admit going to circuit parties to use drugs, 95 percent of the survey participants said they used psychoactive drugs at the most recent event they attended. There was a direct correlation between the number of drugs used during a circuit party weekend and the likelihood of unprotected anal sex.17 The researchers concluded that in view of their findings, “the likelihood of transmission of HIV and other Sexually Transmitted Diseases among party attendees and secondary partners becomes a real public health concern.”18
Good mental health would dictate foregoing circuit parties and other risky sex. But neither education nor adequate access to health care is a deterrent to such reckless behavior. “Research at the University of New South Wales found well-educated professional men in early middle age — those who experienced the AIDS epidemic of the 1980s — are most likely not to use a condom.”19
For example, Judith Bradford, Caitlin Ryan, and Esther D. Rothblum, “National Lesbian Health Care Survey: Implications for Mental Health Care,” Journal of Consulting and Clinical Psychology, 62(2): 228-242 (1994); Richard C. Pillard, “Sexual orientation and mental disorder,” Psychiatric Annals, 18(1): 52-56 (1988); see also Mubarak S. Dahir, “The Gay Community’s New Epidemic,” Daily News (June 5, 2000), www.gaywired.com/story detail.cfm?Section=12&ID=148&ShowDate=1.
Katherine A. O’Hanlan, M.D., et al., “Homophobia As a Health Hazard,” Report of the Gay & Lesbian Medical Association, pp. 3, 5, www.ohanlan.com/phobiahzd.htm; Laura Dean, et al., “Lesbian, Gay, Bisexual, and Transgender Health: Findings & Concerns,” Journal of the Gay & Lesbian Medical Association, 4(3): 102-151, pp. 102, 116 (2000).
“Netherlands Ends Discrimination in Civil Marriage: Gays to Wed,” Lambda Legal Defense and Education Fund Press Release, March 30, 2001, http://lambdalegal.org/cgibin/ pages/documents/record?record=814.
Theo Sandfort, Ron de Graaf, et al., “Same-sex Sexual Behavior and Psychiatric Disorders,” Archives of General Psychiatry, 58(1): 85-91, p. 89 and Table 2 (January 2001).
Ibid., p. 89.
Ibid., p. 90 (emphasis added).
Erica Goode, “With Fears Fading, More Gays Spurn Old Preventive Message,” New York Times, August 19, 2001.
“Officials Voice Alarm Over Halt in AIDS Decline,” New York Times, August 14, 2001.
“A uniform definition of a circuit party does not exist, partly because such parties continue to evolve. However, a circuit party tends to be a multi-event weekend that occurs each year at around the same time and in the same town . . . .” Gordon Mansergh, Grant Colfax, et al., “The Circuit Party Men’s Health Survey: Findings and Implications for Gay and Bisexual Men,” American Journal of Public Health, 91(6): 953-958, p. 953 (June 2001).
Ibid., p. 955.
Ibid., p. 956.
Ibid., pp. 956-957, Tables 2 & 3.
Ibid., p. 957. The authors’ recommendation was more education.
Julie Robotham, “Safe sex by arrangement as gay men reject condoms,” Sydney Morning Herald, June 7, 2001. Data source: 2000 Male Out Survey, National Centre in HIV Social Research, Australia.