Matzkin, William L.

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The Linacre QuarterlyVolume 43 | Number 4 Article 7November 1976HomosexualityWilliam L. MatzkinFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationMatzkin, William L. (1976) "Homosexuality," The Linacre Quarterly: Vol. 43: No. 4, Article 7.Available at: http://epublications.marquette.edu/lnq/vol43/iss4/7Homosexual ity William L. Motzkin, M.D. The relationship of homosexu-ality to sexual deviations such as fetishism, sadomasochism, vo-yeurism, bestiality, and incest can be mentioned only in passing. A closer tie exists between homo-sexuality and pedophilia, trans-vestitism, t ra n ssex u a I is m, paranoid schizophrenia and the less spectacular inability to enter and sustain a loving relationship than with the preceding syn-dromes. These latter syndromes will he mentioned somewhat less briefly. Our discuss ion will center on five related concepts: (1) nor-mal and healthy sexuality; (2) the range of deviancy from the norm; (3) deviant sex behavior associated with disease; (4) the question of deviant sex behavior with psychic health; (5) the cause of these variations; and (6) treatment if any. Karoly Maria Benkert! writing under the name Kertbenny in 1851 coined the term "homo-sexual." "In addition to the nor-mal sexual urge in man and woman, nature, in her sovereign mood, has endowed at birth cer-tain male and female individuals with the homosexual urge, thus placing them in a sexual bondage which renders them physically and psychically incapable-even November, 1976 with the best intention-of nor-mal erection. This urge creates in advance a direct horror of the op-posite sex, and the victim of this passion finds it impossible to sup-press the feeling which individ-uals of his own sex exercise upon him." (Section 143 des Preus-zischen Strafgesetzbuches vom 14. April 1851 und seine Auf-rechterhaltung) Dr. Mat zkin is former Medical Director of the Pastoral Institute of Washington , D.C., now in pri-uate practice in Bethesda, Md. Currently he is a Psychiatric Con-sultant to the D.C. Department of Human Resources, Department of Pupil Personnel, and the Tri-County Maryland Drug Abuse Centers. 259 Karl Heinrich Ulrichs, defend-ing homosexuality in 1864 and 1870, spoke of these instincts as inborn. The medical community accepted that homosexuality was inborn but pathological. Sex itself was dangerous and those with "perverted" sex instincts were sick. Karl Westphal, in 1869, coined the term "contrary sexual feeling" to describe a homosexual transvestite as resulting from hereditary moral insanity. Mor-eau, in 1887, argued for therapy rather than punishment, a matter for physicians not magistra tes. In general non-proc reative sex (Krafft-Ebing) was seen as dis-ease. Not until mid 20th century was contraception seen as non-pathological. Homosexuality Described Kinsey devised a rating scale for homosexuals because in his surveys, he found some persons who were exclusively homosexual, some equally hetero and homo-sexual and some only occasionally homosexuaL Freud had earlier in-troduced the concept of the facul-tative (or situational, as in prison ) homosexual, who becomes exclusively heterosexual on return to normal society and the obli-gatory homosexual who does not enjoy the opposite sex. Alex Com-fort more recently in Joy of Sex speaks favorably of deviations as gounnet sex as long as these are not the exclusive means of obtain-ing sexual gratification. I inter-pret that Kinsey, Freud, and Comfort would consider a person who is repelled by the conven-260 tional sex act and partner as hav-ing a less than optimal adjust-ment. Summarizing and excerpting from Bieher? in the Comprehen-siue Textbook of Psychiatry 1967. Normality and deviance are sta-tistical concepts. Monogamous love relationships in marriage may he statisticalJy deviant in our society yet they are hardly pathological. The cuJtural rela-tivists rt"ason that if social atti-tudes toward homosexuality were as accepting as they are toward heterosexuality, inversion would not he pathologicaL This point of view contrasts sharply ... that health ... must be assessed in relation to optimal individual and group development and continui-ty not on the basis of conformity to a cultural norm. Contemporary analysts con-tend that pre-genital sex, that is oral, anal and purely phallic sex, contain elements of aggression. It is the aggression that they lind inconsistent with love and genital maturity. Bieber believed of healthy sex-uality, that the couple should be capable of a sustained emotional contact, have mutual respect, pride, interests. . respect each other's integrity, individuality-have realistic expectation of each other . . . sexuality should be enthusiastically enjoyed. Both should wish for children and have the psychological ability to im-plement such wishes-that is, if children ensue, they should have the capacity to relate lovingly, Linacre Quarterly understandingly, responsively to the individual differences of each child. There is a Deed for racial continuity in a setting for optimal psychic growth as a part of "Healthy Sexuality."J I see Bie-ber pointing out a useful direction but not an absolutely obtainable goal. The striving is of itself im-portant, though the goal may be illusive. Alex Comfort l and Mary Cal-derone' speak of the three "R's" of sex: Recreation, Relationship and Reproduction. 1 am of the opinion that the reproduction lends a quality and stabili ty to the sexual relationship-a quality not often to be found without it. Perhaps it does not hurt society directly when consenting individ-uals engage in non-reproductive sex, as much as when the non-prepared couples reproduce, but I do think these childless individ-uals are shortchanged in their de-velopment. It may be desirable to separate the three "R's" con-cept ually, but the in tegration of the three I see as more fulfilling. Clinical observation of the fre-quent connection of sexual devia-tion with disease states has rein forced the notion that sexual deviation in itself is pathological. For example, amentia has been associated wi th pedophilia, mania with transvestitism and paranoid schizophrenia with homosexuali-ty. It ought be said that each may not necessa rily be associated with the other. These sexual manifestations are seen independ-ently of the disease state. We November, 1976 must be cautious in associating deviant sex practices with insani-ty. Physicians elicit a history of masturbation with our emotional-ly disturbed patients about as often as we do in the general public. Sexual Deviation in the Presence of Psychic Health Let us consider the question, may sexual deviations occur in the presence of psychic health? Occasional deviations may occur without impairing the normal psyche. If, howevel'. we speak of obligatory behaviol', where the only source of sexual gratification is from the behavioral deviation, it limits one's options. One thing is obvious: the homosexuals will have fewer partners to choose from than the heterosexuals . They seem obliged to move 1.0 the larger city for partners. There are of course lesbian mothers, some living in communes for the sup-port most of us require of our ex-tended families. Raising children, particularly male children, in a homosexual setting presents seri-ous problems and such was my observation of one lesbian com-mune. Child development studies indicate a need for acceptance from both parents. The loving presence of the opposite sex par-ent or parent surrogate is neces-sary in order to achieve a com-fortable sense of sexual iden ti ty. Certain ly. society's reaction to such behavior adds to the distress of the homosexual. Much of the pain, in the sample that we psy-chiatrists see, is intra-psychic~ 261 that is within the individual, not just between individuals or the individual and society. The intra-psychic pain is an inner discon-tent that disrupts the individual's functioning with himself fore-most, and then with others. From here I will pass on to some cur-rent explanations of homosex-uality. Explanations of Homosexuality 1. Deviant but healthy concept -that homosexuality is simply a statistical concept and only con-sidered pathological in specific societies having taboos against it. 2. Homosexualit y is caused by a sexua l curiosity, experimental acts, and seduction . These are not considered likely or sufficient cause. 3. Homosexuality is genetic or chromosomal-this is not well supported but may be a contrib-uting factor . 4. The prenatal influence of stress as cited by Money in the N.I.M.H. article.' This also may be a cont.ributing factor in some cases. 5. Bieber-Experiential Theory where a seductive mother and underactive father give rise to castrat ion anxiety in t he male and homosexual choice. Actually there are several patterns and Bieber seems to describe a limited sample. 6. Freud-dual genetic and psychic-polymorphous perverse theory. Probably the most con-sistent and workable theory. Freud's theories of homosex-uality were further elaborated by 262 Melanie Klein, Sullivan, Horney, Thompson, Rado and others. (Fo r a brief review see Comprehensive Textbook 0/ Psychiatry-Bieber's article and NlMH article.) From this multiplicity of ex-planations which attempt to clari-fy an amazing variety of life styles, it can be assumed that no one concept is likely to be totally adequate. From experience, the most workable theory for the se-lect group of male homosexuals seeking change is the (perhaps simplistic) psycho-analytic con-cept of castration anxiety. For the female, whose life styles are even more varied, the psycho-analytic concept of penis envy seems even more simplistic. With psycho-analysis 75%-66% of the moti-vated male homosexuals fail to achieve a satisfactory heterosex-ual adjustment. I cannot say what percent of these failures are due to the patient not fitting the theory. This would seem an area worthy of research. Treatment Before one can speak of treat-ment, it is necessary to evaluate the patient. J do not think it ethi -cal to search out cases and treat people who are functional and comfortable. Of those who are not Iunctional, the problem must be defined as intra-psychic or inter-psychic. The intra-psychic group responds well to psychotherapy and analysis. The inter-psychic group responds to counseling, role modeling, psychodrama, etc. If the problem is one of sex role con-fusion as in schizophrenic illness, Linacre Quarterly the schizophrenia assumes priori-t y and the treatment is for the schizophrenia. With alleviation of the schizophrenia the homosexual behavior frequently disappears. If the problem is the resul t of situa-tiona l stress, the treatment may range from simple reassurance to long term therapy, depending on the character and strengths of the person involved. Behavior modifi-cation or operan t conditioning may change the behavior without improving the feeling tone around this change. Stated another way, if the role assigned by society is not consistent with the subject's intrinsic life style, it may be an assault to his psyche. An example of this is when people are socially conditioned to have children. A sign ificant number of these hate the role and make poor or indif-ferent parents. Still others are made miserable by not being able to have children after the condi-tioning. The choice of intervention or treatment calls for skillful assess-men t of each case of homosexuali-ty_ It is most im portant that we have the integrity to decide that no treatment may be the best treatment. This decision is most likely to come from those profes-sionals among us who take seri-ously the Hippocratic Oath. REFERENCES I. Bullough. Vern L.. Ph.D .• " Homo-sexuali ty and the Medical Model:' JOllrllal of lIomo.~eX!lafily. vol. 1. ::: 1. (l 974) . 2. Bicber. I rving. M.D., "SexlJ.'l1 De· viation." Comprehensive Tex /book 0/ Psychiatry 1976. PI). 959·977. 3. Bullough. op. {." . 4 . Comfort. A lex. Ph.D .• Th e Joy uf Sex and More Jo,\' (New York: Crown Publi~hers, Inl· .. 1974) . 5. Calde rone. Mary So, M.D .. "Sex-uality and the Practit:e of Medicine," Mur.\'laml Slale Medical JOll rfUll. vol. 23. :::6 (June 1974 ), PI). 35-40. (;. National Instit ute of Mental Health Task Fon.-e on Hom08ellualily 1972 :::( HSM) 72-911t:i. Dr. John R. C.,v;lnaf:: h (2nd from left) was the rC<:'ipicnt of the Thomas Linane Award for authoring the best pa lJer in the Limlere Quarterly du rinf:: 1975 ( Belle Mor;: The R ighi of , III! Pal;ell/ 10 Die wilh Digtlil.\', Aug., 1975) . The award was p rescn tl'(i nt the N FCPG annuul meeting in Oakbrook, II I.. by Dr. John P. Mullooly (fa r right). editor of the Limlere Qua rte rly. Looking on are Dr. Herb Ha iner ( left ), incoming p resident o f the Federat ion, and Dr. Edward Kilroy. the outgoing president. November, 1976 263 Progress in Medical Ethics: How the Physician Can Help Edwin L Lisson, S.J., S.T.D. Father LisBon, of the Texas In.-stitute of Religion, suggests areas where greater cooperation be-tween physicians alld ethicists will result in mutual awareness and understanding. Looking for a good specialist in medical ethics? With the number of medical-moral questions reach-ing the news media and with in-creasing demands from medical students for medical-moral semi-nars and "Ethical Rounds," many institutions are scrambling to come up with an expert in medi· ca l ethics. But who would this rare crea-ture be? If a physician with the personality and impeccable com-petence of Marcus Welby also held a degree in Moral Theology from the Gregorian in Rome or a degree in Christian Ethics from Harvard, perhaps he would fill the bill. Bu t living, and practic-ing, in the real world where the demands of being merely com-petent in either medicine or eth-ics becomes virtually impossible, the quest for one individual equally competent in both fields may have to be abandoned. Pro-fessor K. Danner Clouser accu-rately and realistically describes this necessary compromise in 264 medical ethics when he asks for a constant and focused inter-change which calls for medical people to become fami liar with the basics of ethical theory, just 3S ethicists specializing in mediA cal-moral questions must become fami lial' with some of the facts of medicine. I The Problems The root of t he problem in finding the ideal medical ethicist lies primarily in the expanding scope of the number and com-plexity of the questions involved together with t he depth or knowl-edge and skills required of either a physician or an et.hicist to re-main basically competent, if not up to date. There is no need here to com-ment on the complexities of the physician's problems. However, the physician may not be aware t.hat the problems facing the ethi-cist a re expanding in not just. one but in two dimensions at the same t.ime. On what might be called a horizontal plane. on the level of concrete practical prob-lems, t.he number and complexity of t.he questions confronting the ethicist are becoming virtually overwhelming. At the same time, the et.hicist confronts another Linacre Quarterly 

Homosexuality

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Homosexuality

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