Presented by Dr. Sander Breiner at the NARTH Conference, November, 2004
I. A normal state of flux
The adolescent years are usually spoken of as a unit, where there are generalities and even specifics that cover the entire teen time frame. Just as it is obvious in a group two-year-olds are significantly different than one-year-olds; but that 22-year-olds are very similar to 23-year-olds. We can recognize there are significant differences within a two year age range throughout the preteen and teen years. In addition to the variances by age there are significant variances that have a genetic quality, a familial social quality, and the societal social quality. It is important to keep these concepts in mind when looking at the subject in general as well as any specific clinical entity. These words have been said before, but commonly not applied.
II. Organic change
Neuroscientists believe that the developing brain of the adolescent is significantly influenced by external emotional and social factors. Pubertal maturation starts in the brain and continues through adolescence. There are significant changes in the volume and structure of the gray matter of the brain. For example, frontal gray matter reaches maximum volume about 11 years of age in girls and 12 years of age in boys. The dorsal lateral prefrontal cortex which is important in impulse control does not reach final adult dimensions until 25 years of age. It is also true that normal brain maturation along with reorganization of the brain occurs in response (to some degree) due to social experiences. The gray matter of the frontal lobe increases markedly to its maximum in the pubertal time frame. This area of the brain is vital in determining social responses. It is reorganized and slowly decreases somewhat in size during the adolescent time frame. This neural plasticity has extensive synaptic pruning in the prefrontal cortex during adolescence. In addition, the neurotransmitter systems do not become fully mature until adulthood. (Dahl, 2004)
Certain modifying factors such as stress (physical and psychological), nutrition, and exercise (including sports) can have a significant effect on the activity and development of the reproductive axis and on the timing of the pubertal awakening of this axis. The stress referred to can lead to a suppression of reproductive function by increasing the inhibitory drive to gonadotropin hormone neurons. This can lead to less stimulation of ovarian and testicular function. If the stress is chronic there can be complete suppression of this reproductive axis. “Gonadal steroid hormones modulate activity of a number of neurotransmitter systems, which project throughout the brain and play central roles in regulating many higher order brain functions, including cognitive functions and the emotional regulation.” Therefore, chronic stress from the pre-pubertal through the post pubertal can impair the development of both females and males, even delaying the development of the reproductive capacity and development of secondary sexual characteristics. (Dahl, 2004)
The forebrain of the adolescent is uniquely sensitive to environmental stimuli which can affect the functional organization of the various systems in the brain. The preceding statements are the result of extensive neurological and brain imaging studies.
III. Prepubertal Sexuality (Age 10 to 12)
Before physical sexual maturity is attained sexual identity is not fully established; in fact there is a shifting or ambiguous sexual identity (which is within normal social limits as the norm). This is usually more apparent in girls than boys. The normal maturational experiences post-puberty stimulate the integration processes. This momentum in the direction of a given sexual identity can be lost due to the preceding factors. This can lead to identity crisis (with marked anxiety and depression) and/or identity confusion. For example, a boy with this experience at puberty may feel a sense of isolation and narcissistic hurts, which can lead him to the formation of a homosexual orientation by identifying with a male homosexual who functions as male ego-ideal. (Blos, 1979)
In addition to the significant physical growth spurt that has taken place, these youngsters will have increasingly bonded with each other in more advanced group sports. They also are forming strong identification with male models; not only in their families but in the sports and other direct and indirect contacts. The identifications with these models is important for their security, self-esteem and establishing their identity as males.
Girls in this age range are more physiologically, psychologically and neurologically advanced than boys. They tend to have a more secure bonding with each other as well as with female models. Families and societies that have a more positive attitude about females are in a more stable position than their male counterparts. If the families and society tend to denigrate females, they now enter a period of greater stress.
This is the time of life for both males and females where they are entering into the turmoil that is known as a secondary Oedipal time frame. Just as in the primary Oedipal experience, the resolution involves a homosexual identification with a parent (or surrogate) of the same-sex. Identification requires a feeling of love (affection) for that individual.
IV. Puberty (Ages 12 to 14)
This period of time has more inner turmoil than any other period of time between 10 to 20 years of age. The later teens may demonstrate more turmoil and actual friction with society, but the inner turmoil is less. The young male is dealing with the insecurities of sexual awareness, sexual social functioning, increased identification with male models, and giving up unconscious homosexual attachments. Difficulties in this time frame preventing this resolution, can lead to repercussions that may take years to work through.
If we can assume a normal positive response by family and society to women, then these girls will come through this phase of life quite well. They normally will be in an intense positive relationship with their mother (or surrogate); with the safety of hostile expressions in conflict repeatedly expressed that is short-lived (normally lasting only minutes). The open affection between females is considered a positive normal attribute; while in males it is usually considered effeminate, weak and not masculine. Thus it is easier for a pubertal girl to maintain homosexual affectionate feelings and still see herself as becoming a sexually mature heterosexual woman.
V. Adolescence (Ages 14 to 16)
This is practice time. Though insecure in who they are; they normally know what they want to be. Whatever distorts their normal identifications (models), social/psychological perceptions of females, and stability in their family can usually have conflictual effects in their development for the next few years. It is normal to have friction between the teen and the male parent (or surrogate) of short duration. If it isn’t safe to do this at home, the next safest place will be school. If it isn’t safe there, it will be externalized to society. Though homosexual contacts by females in this period are treated as normal, the male may see it in a different light. In addition, if the male becomes frightened of these aggressive/frictional responses they may defensively turn to increased homosexual orientation, as a protective haven.
In exploring any symptoms or behavioral expression is important to take a multifaceted approach. This should include the evaluation of ego functioning, particularly looking at the level of libidinal fixation or regression, as well as a stage of maturation fixation or aggression in general development of the ego. The processes by which this symptom or behavioral expression is developed, is vital to understanding of the issue. Finally, in evaluating the ego structure of an individual we need to know how the ego is functioning in other areas, particularly in its object relations. (Socarides, 1990)
Therefore, the homosexual inclination or behavior can be an expression of Oedipal and or pre-Oedipal material. It can be an unconscious conflict resolution from the earliest aspects of the ego development to a higher-level of ego organization.
The pre-Oedipal dynamics in that form of homosexual conflict resolution tends to move closer to the projective defensive and paranoid expression.
The incomplete resolution of conflicts that is expressed by even the higher levels of ego organized homosexuality can be seen in the marked frequency of instability in the homosexual “marriages.” These commitments usually do not the last more than two years. There are, during the “commitment,” frequent “adulterous” relationships. This clearly indicates how it is almost a certainty that homosexual behavior is an attempt to resolve unconscious conflicts prior to five years of age.
The earlier in ego development where there are fixations due to unresolved conflicts, the closer that individual is to experiences of narcissistic injury. This can be experienced and expressed as narcissistic rage (in gross or more subtle form) to a therapist; or anyone who takes a therapeutic response to homosexuality. It can even take the direction against anyone who responds to homosexuality as a problem and not a normal way of functioning.
It is obvious that the higher the level of ego organization (Oedipal), the better the prognosis in resolution of the underlying conflict. However, like in all therapeutic (analytic) relationships, the motivation of the patient to understand and resolve their internal conflicts is the most important element for a successful outcome. Anything that counters such a motivation is not only counterproductive but actually has a constrictive inhibitory quality. Therefore, it is incumbent on all reasonable people to support those individuals with homosexual symptomatology to work towards a solution of that problem. It is the opposite of helpful to attempt to treat such symptomatology as normal; thereby reducing the individual’s motivation for help.
A difficulty occurs when reasonable people wish to protect homosexuals from legal and illegal abuse gather under the umbrella of various like-minded organizations. What often results is a collection of individuals with more serious ego defects (early/primitive points of fixation, incomplete maturation) under the same umbrella organization. The result can be destructive or at least injurious to society and individuals. It can be a significant contributory factor to the many negative responses to the usual family structure (heterosexual marriage and children). The so-called “freedom of choice” has become an invitation for increased sexual promiscuity, and results in the increase of sexually transmitted disease.
One of the important dynamic constructions is the sadomasochistic conflict. For example, the passive homosexual with masochistic inclinations will give up a power or maturational position for the sake of love; while those with a more sadistic defensive construction may take a more paranoid type of response and give up love for what they feel is power (hostility) Since there is a known connection between homosexuality and paranoia we can see some elements of this in some of the groups hostility to those who see homosexuality as a social/psychological problem. This can be dangerous for society and counterproductive in any scientific group of discourse.
An interesting clinical point is seen in the not surprising finding of the tendency of the distrustful to paranoid individual to experience and express hostility related to those who don’t agree with them, as if they are the victims. We have seen this in the politically active homosexual groups in social, political, and scientific organizations. Not surprisingly, there is even a tendency to express their homosexual position in grandiose terms. This has resulted in the following:
Currently there is a great deal of literature going around to the nation’s schools that has been prepared by homosexual teachers. This material tells children that they have “legitimate sexual alternatives.” This may not create homosexuals; but certainly will contribute to any sense of insecurity and gender role doubts that are normal in children (especially pubertal and early teens). Instead of contributing to their freedom to think and feel and explore their world; it can significantly contribute to their anxiety and confusion. Teenagers commonly experience homosexual feelings and even a homosexual experience. This usually leads to a normal heterosexual development. The preceding literature of “legitimate sexual alternatives” can only add to their doubts, insecurity and depression. It will increase the tendency toward suicide. Please recall the earlier comments about the potential organic brain effects of this type of stress.
Currently the gay/lesbian community is presenting the concept that homosexuality can be a normal and reasonable choice. The material on the subject, with that opinion, is being offered to many school systems in United States. Therefore, many students in high school and college who experience conflict and anxiety about their sexual feelings and activities with the opposite sex may take the less tension-evoking position of seeing themselves as “bisexual .” It is not uncommon during the teenage years for individuals to struggle with their homosexual and heterosexual fantasies (both conscious and unconscious). This may even result in some homosexual activity. This is not unusual in the normal transition from adolescence to the adult world for those teens who are basically heterosexual. However, for those who are like the preceding group with marked sexual tensions, they may move to a “bisexual” defensive position, particularly when it is enhanced by some of the current literature from the gay/lesbian community. For those teenagers who find their homosexual fantasies and feelings ego dystonic, they are more likely to more easily work through this period of tension and discomfort. Support from the gay/lesbian community in accepting their homosexual feelings as ego syntonic will make their transition to full heterosexuality more difficult and tension laden. It may take these individuals years to recognize their fundamental heterosexual position. (Socarides, 1965, 1979) What effect it has on brain development and the sexual/hormonal neuronal axis is likely to be significant.
VII. Diagnosis of Teen Homosexual Problems
1. The total absence of masturbation or late onset of masturbation with no manifest heterosexual interests.
2. Homosexual behavior through adolescence with the absence of any significant anxiety or guilt or obvious conflict, along with perverse fantasies.
3. Lack of true Oedipal relationships in any aspect of the child’s history.
4. Homosexual fantasies with no heterosexual socializing with a quiet interpersonal attitude and absence of the emotional fluctuations and liability typical of this age.
5. Hostility to their own libidinal urges and absence of feelings about sex.
6. Some homosexual contact with the resentment to growing up and a tendency to suppress other instinctual demands.
7. Persistent homosexual contact past early adolescence.
8. Homosexual relationship with an adult.
9. When the adolescent fully states, “I know I’m a homosexual, I just feel it.”
Since the world of the child is its immediate family, that family needs to be taken into serious consideration. A pre-pubertal age to 16-year-old child should be seen differently than a child who is one step away from the more adult world or away from home at college, etc. Therefore, see the patient and the two parents together, then individually. If there are other individuals living in the home it can be very valuable seeing them to get a clearer picture of the family dynamics. From this vantage point a therapeutic program that is fitted to these unique circumstances can be offered.
If the boy is no longer a small child, but is an older teen, then the parents’ major influence and impact on his life is past. Their most important contribution to his life now, and in the future, is in their loving kindness towards him and in his awareness of the parents respect for him. The knowledge that his parents care for each other; and that there is an intact loving family, always there for him, are now their major contributions to his welfare.
At this point in his life parents can’t “want” things for him. He must want things for himself. Parents can’t want him to be a doctor, and be successful in that endeavor, if he wants to be an architect. His parents can’t wish him to be celibate if he wishes to marry. So, they can’t want him to be heterosexual if he wishes to be homosexual. However, if he feels a homosexual orientation, but wishes to be heterosexual then their support coinciding with his wants can often come to a successful conclusion of a heterosexual orientation. But we must keep in mind that his sincere desires for heterosexual orientation must originate within him, and not be based on compliance with parents’ desires.
The most important issue is the affection between parent and child throughout the many years of their relationship. The maintenance of that positive relationship; and the health and welfare of the participants is the most important issue of all.
Despite the term “gay,” depression is a common conscious and unconscious experience of most homosexuals, both male and female. Is the individual’s major concern their depression or their homosexual orientation? If the concern is primarily of their homosexual orientation; and they wish to understand themselves further, and thereby change that orientation, therapy is available to assist them in that pursuit. If their concern is their depression with homosexuality being of less significance for them; then there is psycho-therapy to assist them in that pursuit. Either way, the patient chooses.
Assuming that depression is the primary interest and the patient is able to participate in intensive dynamic psychotherapy (e.g. psychoanalysis); one can expect a favorable outcome. Since hurt self image, injured self-esteem, and blocks of emotional freedom are common conscious and unconscious experiences of the homosexual; we can expect that the successful outcome in the resolution of the depression problem will be a resumption of the normal psychosexual development into heterosexuality, but not necessarily.
Whatever the choice, the patient decides what route they will take, and how far they will travel. Therapy, of what ever kind is the patient’s choice, to meet their needs. The wishes of society, family, therapist, or professional organizations do not enter into the choice. Whatever the condition, it is always the patient’s freedom of choice.
The diagnosis and treatment is never determined by the symptom. Psychologically the diagnosis is a complex understanding of the patient’s psycho dynamics. It involves the patient’s psychological development, their capacity to tolerate psychological stress without significant decompensation, and their motivation to understand themselves and make the appropriate changes. The type of treatment chosen and the extent of that treatment is a decision initiated by the patient with the therapist concurring.
The most significant factor is the patient’s motivation to understand themselves. If the motivation is to feel better; it is understandable, but must come secondary to their desire to understand their problems and resolve them. (Breiner, 2001)
What are the most common probable causes for male or female homosexuality? Since homosexuality is a complex emotional and behavioral response to a variety of internal conflicts, there is no one good answer. However, certain facts emerge.
1. Any psychological illness of mild to serious dimensions can have a homosexual expression; while the same problem in another individual may have no such homosexual expression.
2. Affection and love for a member of the same sex is a normal part of a child’s psychosexual development. It is necessary to identify with and love an adult member of the same sex as one advances in early childhood. Without that normal experience there will be psychological problems for that individual; but not necessarily homosexuality.
3. Since mothers are the most important person in a child’s life prior to three years of age, how she responds to that child and how the other adults in that household respond to the mother (particularly the father) prepares the child for its orientation to itself and future interpersonal relations. One form of a difficulty in this childhood experience is homosexuality as a defense against the anxiety that has been evoked.
4. Between 15 to 20 months of age a little girl conceives of herself as a female. Little boys are less neurologically advanced in the first three years of life, so their identification as a male is from 18 to 24 months. Both require the benign relationship of mother and father to them and to each other. This is the beginning of the significance of father as a loving caretaker for both the little girl and the little boy. This is the basis for early gender role establishment.
5. The time between three to five years of age for both little boys and little girls is the period for learning the basic social interactions with their peers in play activity, as well as their participation with and observation of their parents. Successfully passing through this time of development permits them the final basic establishment of their sexual role of identifying with a parent (or surrogate) of the same sex.
In summary, though any problem can lead to a homosexual expression, the outstanding elements are: hurt self-esteem (damaged self image), incomplete or conflicted gender role development, conflict over identifying with a member of the same sex, and conflict over being needful of a member of the opposite sex.
The type of treatment always depends on the patient’s needs and wishes. It should never be determined by what the therapist, the family, or society wants. Therefore, the most effective therapy is one based on the working relationship between the therapist and the patient (and the patients conscious and unconscious goals) (Nicolosi, 1991). Assuming that the patient is well motivated and capable of participating in the intense and difficult process of dynamic psychotherapy (e.g. psychoanalysis) that procedure can have the most beneficial result. However, whatever type of therapy that the patient chooses, some form of insight oriented and psychologically supportive psychotherapy should be part of it; for without such additional psychotherapy the benefits will be temporary and/or some other form of psychological symptomatology will emerge.
In my experience I have found that dealing with the underlying anxiety and depression has been the most efficient way of dealing with any problem, including homosexuality.
IX. Closing Comments
It is true that genetics do not determine one’s gender orientation. It is also true that you cannot make someone homosexual except on a temporary basis (e.g., prison homosexuality). However, there are certain problems that can occur related to homosexuality in the teenage period that can have significant repercussions.
The brain that is developing (pre-puberty to adulthood), particularly in the area that deals with emotional and sexual development, is affected organically by social and physical stress. Homosexual indoctrination (direct or subtle) coercive or seductive can organically affect brain and sexual physiologic development to a modest or minimal degree. It cannot permanently produce homosexuality. However, it can certainly lead to a variety of difficulties commonly including hurt self-esteem, distortions in living, depression, selection of life goals, and other problems. Though the individual may eventually select a heterosexual life position, the preceding years of difficulties in developing and organizing one’s life are likely to have more permanent deleterious effects. Therefore, any attitude by society and particularly educators that homosexuality is a reasonable or alternative lifestyle can significantly contribute to psychopathology in this vulnerable age.
Blos, Peter, “The Adolescent Passage,” International Universities Press, New York, 1979
Breiner, S. “Questions On Homosexuality,” “Bulletin NARTH,” Vol. 10, No 1, April 2001, pp 10 -11.
Dahl, Ronald, Linda Spear Ed., “Adolescent Brain Development,” Annals of the New York Academy of Sciences, Vol. 1021, 2004
Karasu, T. and C. Socarides, Ed., “On Sexuality: Psychoanalytic Observations,” International Universities Press, New York 1979
Nicolosi, Joseph, Reparative Therapy of Male Homosexuality, Jason Aronson, New Jersey, 1991.
Socarides, Charles, “The Overt Homosexual,” Grune and Stratton, New York, 1968.
Breiner, S. (9 April 2008). Adolescent Homosexuality., from http://www.narth.com/docs/breiner2.html