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Homosexuality and Mental Ilness

Article  in  Archives of General Psychiatry · November 1999

DOI: 10.1001/archpsyc.56.10.883 · Source: PubMed

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 COMMENTARY

Homosexuality and Mental Illness

N
O TOPIC has caused disorder, conduct disorder, and nico- sexual subjects complicates interpre-
the field of psy- tine dependence (odds ratios, 2.8-6.2 tations of the results. For example,
chiatry more con- [compared with the heterosexual sub- perhaps experimentation with ho-
troversy than ho- sample]). mosexuality among heterosexually
mosexuality, and 2 The study by Herrell et al2 used oriented people is associated with im-
articles in this issue of the ARCHIVES a powerful technique: the co-twin pulsivity, and this trait, rather than
are likely to reopen past controver- control method. Specifically, these in- homosexual orientation, is associ-
sies and begin new ones.1,2 These vestigators studied male twins in ated with psychopathology. The de-
studies contain arguably the best which one was homosexual and the cision to label these subjects homo-
published data on the association be- other heterosexual (by the authors’ sexual by the authors was probably
tween homosexuality and psycho- definitions of these respective cat- guided by both constraints on avail-
pathology, and both converge on the egories). It is difficult to imagine how able data (which were not collected
same unhappy conclusion: homo- findings of mental health differ- primarily to study this question) and
sexual people are at a substantially ences between homosexual and het- concerns about statistical power. Re-
higher risk for some forms of emo- erosexual co-twins might be spuri- garding the latter, homosexuality was
tional problems, including suicid- ous. Herrell et al found that gay twins rare even by the lenient behavioral
ality, major depression, and anxi- had higher lifetime rates on 4 mea- definition (2% in the study by Her-
ety disorder. Preliminary results sures of suicidality compared with rell et al2; 3% in the other studies1,3).
from a large, equally well-con- their heterosexual co-twins (odds ra- The low prevalence of homosexual-
ducted Dutch study3 generally cor- tios, 2.4-6.5). (The heterosexual co- ity undoubtedly also was the reason
roborate these findings. twins of homosexual twins scored why Fergusson et al elected to com-
higher on the suicidal indicators com- bine gay men and lesbians into one
METHODOLOGICAL pared with twins from pairs concor- group in their analyses. Most sexual
ADVANCES AND LIMITATIONS dant for heterosexuality, although the orientation researchers believe that
difference was significant for only one the causes of male and female sexual
The strength of the new studies is suicidal symptom.) Results of logis- orientation differ, and if so, the cor-
their degree of control. All too of- tic regression suggested that much, relates may differ as well. Thus, it
ten, prior studies marshaled to ex- but not all, of the increased risk for would be optimal to perform sepa-
amine the mental illness or health suicide among homosexual subjects rate analyses on gay men and lesbi-
of homosexual people used samples was owing to increased depression. ans. For all of these reasons, future
seemingly selected to prove the point Although the new studies rep- studies should be even larger than the
the researchers hoped to make.4 Gay resent notable methodological ad- new ones and should include direct
men undergoing therapy seemed vances compared with most prior measures of sexual orientation.
dysfunctional, while volunteers from research, they also have their limita-
homophile organizations seemed tions. The most important limita- POTENTIAL EXPLANATIONS
well. The current studies are not sus- tion, shared by both studies (as well
ceptible to this criticism. as their Dutch counterpart3), con- Several reactions to the new studies
cerns the definition of homosexual- are predictable. First, some mental
See also pages ity. Both studies included in the defi- health professionals who opposed the
867 and 876 nition of a homosexual person any successful 1973 referendum to re-
subject who had had a same-sex move homosexuality from DSM-III5
The study by Fergusson et al1 fo- sexual experience as an adult. In con- will feel vindicated. Second, some
cused on 1007 children from New trast, homosexual orientation is usu- social conservatives will attribute
Zealand who were observed until the ally assessed by patterns of sexual at- the findings to the inevitable conse-
ageof21years.Thissamplerepresents traction and fantasy. It is conceivable quencesofthechoiceofahomosexual
80% of a birth cohort; hence, results that some of the subjects who had en- lifestyle. Third, and in stark contrast
are exceedingly unlikely to be owing gaged in homosexual behavior were to the other 2 positions, many people
to unrepresentative sampling or dif- not even attracted to people of their will conclude that widespread pre-
ferentialdropout.Subjectswhomthey own sex. For example, 8 of 28 sub- judice against homosexual people
classified as gay, lesbian, or bisexual jects classified as homosexual by Fer- causes them to be unhappy or worse,
were at an increased lifetime risk gusson et al1 labeled themselves het- mentally ill. Commitment to any of
forsuicidalideationandbehavior,ma- erosexual. The problem is that these positions would be premature,
jor depression, generalized anxiety heterogeneity among the homo- however, and should be discouraged.

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©1999 American Medical Association. All rights reserved.
 In fact, a number of potential inter- childhood10 and adulthood.11 The son et al1 and Herrell et al.2 Second,
pretations of the findings need to be most influential etiologic hypoth- it would be a shame—most of all for
considered, and progress toward sci- esis of homosexuality implicates sex- gay men and lesbians whose mental
entific understanding will be achieved atypical levels of prenatal andro- healthisatstake—ifsociopoliticalcon-
only by eliminating competing expla- gens.12,13 Perhaps these influences also cernspreventedresearchersfromcon-
nations. make gay men more susceptible to scientiousconsiderationofanyreason-
Consider first the idea that in- types of psychopathology more com- able hypothesis.
creased depression and suicidality monly found in women and affect les-
among homosexual people are caused bians analogously. This hypothesis is J. Michael Bailey, PhD
by societal oppression. This is an emi- consistent with the association be- Department of Psychology
nently reasonable hypothesis. Surely tween male homosexuality and both Northwestern University
it must be difficult for young people depression and suicidality found by 2029 Sheridan Rd
to come to grips with their homosexu- Herrell et al,2 as well as prior re- Evanston, IL 60208
ality in a world where homosexual ports14 that gay men, like women,
people are often scorned, mocked, score higher on psychological tests of REFERENCES
mourned,andfeared,andthereiscon- neuroticism than heterosexual men.
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related to self-acceptance, or accep- more commonly affects men than 2. Herrell R, Goldberg J, True WR, Ramakrishnan V,
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