Homophobia: Description, Development, and Dynamic of Gag Bashing.

WHEN THE POT CALLS THE KETTLE BEIGE: AN EXPOSITION OF HOMOPHOBIA FROM A PSYCHOANALYTIC PERSPECTIVE Homophobia: Description, Development, and Dynamic of Gag Bashing. By Martin Kantor. New York: Praeger, 1998, 223 pages. Cloth, $59.95.

Reviewed by B. R. Simon Rosser, Ph.D., M.P.H., L.P., University of Minnesota Medical School, Department of Family Practice and Community Health, Program in Human Sexuality, 1300 South 2nd Street, #180, Minneapolis, MN 55454; e-mail: rosse001@maroon. tc.umn.edu.

An in-depth clinical understanding of the origins, concomitants, and typology of homophobia remains one of the most urgent and challenging issues in modern sexology. Dr. Kantor's latest book is an important and timely attempt to fill a recognized gap.

Written from a strong psychodynamic perspective, the book opens with a description of homophobia and its manifestations as a subtype of sexophobia. The body of the book focuses on defining types of homophobia organized by psychiatric (DSM) syndromes. Paranoid, affective disorder, phobic-avoidant, and obsessive-compulsive homophobia are discussed, together with homophobia attributed to the various personality disorders. The remaining sections briefly examine causes from psychodynamic, biological, and cognitive perspectives, and offer treatment suggestions both for therapists and for gays and lesbians who encounter homophobes in daily life.

The major strength of this book is that it opens up for psychoanalysis a topic neglected for too long. For students of psychiatry, it provides an excellent basis for a discussion of traditional homophobic assumptions and practices within the field. Indeed, Kantor is challenging psychiatry to break new ground, and is holding the field accountable for what many see as blatant prejudice inappropriate to modern medicine.

A second strength of the book is the refreshing lack of assumption that all homophobia originates in latent homosexuality. Although an analytic approach to homophobia might be vulnerable to such a view, Kantor is to be commended for not succumbing to such an easy analysis. Nor does he pretend that analysis holds all the answers.

To support his schema, Kantor draws on two primary sources: case studies from years of psychoanalysis, apparently involving large numbers of homophobic patients and therapists; and secondary accounts of homophobia reported in the popular press. Hence, his methodology is best described as inductive: moving from the individual case to define different homophobic populations. On the one hand, clinical case studies are sorely needed to describe, in-depth, the underlying dynamics fueling psychopathy; on the other hand, it leaves the methods, when conducted in isolation, vulnerable to certain biases. Principal among these is the over-association of pathology in the population under investigation with whatever is under investigation. In Kantor's words, "Many mythmaking homophobic therapists see only pathology in gays and lesbians, because they only come in contact with gays and lesbians with problems" (p. 199). Dr. Kantor will have to answer similar accusations from his critics, for he has repeated the same methodology with homophobes and, hence, left himself vulnerable to the same criticism.

Is homophobia a mental disorder, a correlate of psychopathology, or something else? This critical question is at the heart of both Kantor's analysis and current studies of homophobia. Kantor makes the bold premise that homophobia is an "emotional disorder," although his schema associates it more widely as a correlate of other mental pathologies. This conceptualization has challenging implications. By defining prejudice as pathology, Kantor can recommend that "Gays and lesbians can avoid being intimidated by thinking of serious homophobes as troubled individuals with emotional problems" (p. 198).

Because Kantor so exclusively relies on case study, the question must be asked whether this is a study of mental illness associated with homophobia, or of homophobia in the mentally ill. Kantor presents his study as the former, although his methods necessitate the latter. It is an important distinction. Until Evelyn Hooker's ground-breaking study of healthy homosexual men, these same methods were used to prove homosexual persons were psychopathic. With homophobia so pervasive in our society, its origins, development, and dynamics may differ from those presented by participants undergoing analysis. Hence, Kantor's findings may not generalize beyond the patient population. It will be important to validate Kantor's findings with studies of homophobia in the general, nonclinical population. Some may find themselves a little put off by the unsubstantiated generalizations and unattributed opinions which are used throughout the book. However, inductive studies and collegial confidentiality may necessitate such use.

Clearly, this book should be considered more a clinical study than academic science. Its foundations lie almost exclusively in the work of other analysts. I find this surprising given the significant research on homophobia provided by psychologists, sociologists, and other researchers. All references to key studies of homophobia, such as those by Greg Herek, George Weinberg, or the National Lesbian and Gay Task Force, are strangely absent. The integration of findings from these studies would help integrate Kantor's analysis into the wider field. The book is obviously the culmination of many years of observation and insight. Perhaps this is why Kantor uses terminology that is not current in the field (e.g., sexophobia for erotophobia, self-homophobia for internalized homophobia, onanism for masturbation, hysterical personality disorder for histrionic, and the presentation of some pathologies he terms personality disorders that are not in the DSM-IV).

Homophobia in all its manifestations--from "bad" thoughts and covert hostile glances to murder and blatant violence--is addressed as a single construct. At times, I found this overly simplistic. I would have appreciated discussion on the development and management of the severity of homophobia, and a clear distinction between homophobia and erotophobia, sexism, classism, and other prejudice. The author makes the point that to excuse homophobia in a person because he/she is prejudiced toward everyone is, in fact, denial. However, I disagree with Kantor's attribution of homophobia in several of his cases. I do not believe that everything negative that happens towards gay and lesbian persons has its foundation in homophobia. For example, Kantor sees separatist lesbian bars as exemplifying homophobia by lesbians toward gay men. If this is prejudice at all, and I would argue it is not, it is surely an example of reverse sexism, not homophobia.

Although Kantor uses a psychodynamic approach to etiology and diagnosis, he principally recommends cognitive therapy in the treatment of homophobia. However, theoretically speaking, if Kantor's typology is accurate then homophobia in those with Axis II disorders may be untreatable, while in Axis I disorders different subtypes may require different interventions.

I was pleased to see Kantor include a section on advice to gay and lesbian people on how to handle different types of homophobia. Too often authors ignore the implications of their clinical studies on their patients, and Kantor is to be commended for not doing so. Unfortunately, as Kantor acknowledges, in real life few of us have the opportunity to diagnose and analyze someone who is about to discriminate against us, beat us up, or kill us. However, his advice should help us to avoid easy answers to a complex issue, as Kantor demonstrates so well.

This book appears written primarily for conservative-to-moderate psychodynamically-oriented therapists. Accordingly, Kantor appears to have skillfully presented his arguments in a manner least likely to alienate this audience. While he criticizes aspects of psychoanalysis, he stops short of confronting the whole paradigm and its legacy as inherently homophobic. This approach, and the values underlying it, may appear too conservative for some tastes. For example, he presents multi-partner sex as likely to be symptomatic of pathology. "Threesome arrangements, however much two people agree to have them, and deny that cheating is involved because they do it together, are always homophobic because they always imply a putdown of the steady partner's worth" (p. 54). Monogamous relationships are presented as inherently healthy and what people really want, a view not necessarily shared by many in the lesbian and gay communities. Separatism of lesbians and gay men is seen as bad. Guilt is speculated as functional to prevent sexual excess and overpopulation, and to enhance other nonsexual activity.

Some may question whether Kantor's book is, itself, sexist and homophobic in parts. While analysts may defend Kantor's analysis as classic psychoanalysis, I imagine few lesbian women would buy this analysis: "Histrionic lesbians are neurotically homophobic of gay men because they imagine gay men, as they imagine all men, as having the penis they envy" (p. 61). In a section entitled "Starting Off Life on the Wrong Foot," Kantor writes,

   One psychiatrist I know suggests gays and lesbians should do as well as
   they can professionally early in life, when others can still see them as
   straight but not married yet--that is, before their homosexuality becomes
   obvious. Now when they are discovered, or come out, they will at least be
   far enough along in their careers to keep their homosexuality from
   mattering so much. He adds that gays and lesbians should avoid choosing the
   wrong profession right from the start. They should ask themselves, "Is it
   worth it to pick a field where it is difficult for me to do well?" (p. 205)

No matter how well-intentioned or cautiously attributed to one colleague's opinion, framing professions as "wrong" for gays and lesbians because they may experience homophobia is like advising persons of color not to become doctors because of the racism sometimes found in medicine. If we all followed such advice, social change would not occur. There is also a disturbing, anti-coming-out perception of homosexuality as a liability inherent in these statements that I found homophobic. At another point, Kantor appears to attribute homophobia to "genetically determined attitudes and behavior" (p. 170), a position few except the most conservative are likely to espouse. At a political level, these assumptions will not sit well with therapists from other traditions, or with gay/lesbian analysts from more liberational and radical perspectives.

I found his section on treatment similarly conservative. His advice to gay and lesbian persons for treating homophobia principally promotes accommodation and compromise. Missing from his list of recommendations for lesbian and gay victims of homophobia are such possibilities as protest, radical violent and nonviolent cooperation, zerotolerance stances, suing the homophobe, and legal interventions, including protection orders from homophobes and suing analysts in situations where homophobic attitudes of the analyst cause harm.

After a strong stance against homophobia, case reports of blatant homophobia in psychiatry, and analysis of its negative effects on analysts and patients alike, I was taken by surprise at Kantor's final conclusion: Because of rampant homophobia, gay and lesbian medical students are recommended to avoid psychiatry rather than to transform it.

Despite these short-comings, I found the book insightful and interesting. I recommend it for all psychodynamically-trained analysts as one of very few texts that use psychodynamic constructs to confront this critical issue in psychiatry. While few may agree with all of Dr. Kantor's insights, analysts should benefit from a critical reading of this important work so that, ultimately, the homophobia present in so many of our patients is no longer ignored.

Michael R. Stevenson, Ph.D. Department of Psychological Sciences Ball State University Muncie, IN 47306, USA