Sexual orientation and associated characteristics among North American academic psychiatrists.Over the past several decades, a number of studies have investigated the psychological and sociological characteristics of mental health practitioners (Armor & Klerman, 1968; Bodkin, Klitzman, & Pope, 1995; Monk & Thomas, 1973). These studies have found wide variations among mental health practitioners in attitudes and approaches toward psychiatric psy·chi·at·ric
Of or relating to psychiatry.
psychiatric adjective Pertaining to psychiatry, mental disorders treatment and etiology etiology /eti·ol·o·gy/ (e?te-ol´ah-je)
1. the science dealing with causes of disease.
2. the cause of a disease. . Over time, these findings have documented a shift among professionals from psychological approaches, dominated by Freudian perspectives, to biological approaches and theoretical understandings of disorders. None of these studies, however, have assessed whether differences in sexual orientation sexual orientation
The direction of one's sexual interest toward members of the same, opposite, or both sexes, especially a direction seen to be dictated by physiologic rather than sociologic forces. among mental health professionals are associated with differences in treatment approaches, attitudes, and perspectives, or other professional and personal characteristics.
This issue is of particular interest because research over recent years on the etiology of homosexuality has shifted from psychological to biological explanations and has received much attention in the popular press and elsewhere (Gladue, Green, & Hellman, 1984; Hamer, Hu, Magnuson, Hu, & Pattatucci, 1993; Levay, 1991; Pillard & Bailey, 1995). Controversy on this issue continues among gays and lesbians, with many preferring social constructionist con·struc·tion·ist
A person who construes a legal text or document in a specified way: a strict constructionist. explanations over biological explanations of sexual orientation.
In light of these issues, it is not clear whether gay psychiatrists, given the stigma stigma: see pistil.
mark of Cain
God’s mark on Cain, a sign of his shame for fratricide. [O. T.: Genesis 4:15]
scarlet letter they have faced and their perceptions of not fitting in with "straight" society, view or treat psychiatric illness differently (e.g., more or less biologically) than their colleagues. It is also not clear whether gay psychiatrists are more or less concerned with orthodoxy or·tho·dox·y
n. pl. or·tho·dox·ies
1. The quality or state of being orthodox.
2. Orthodox practice, custom, or belief.
a. , socially desirable behaviors, or humanistic hu·man·ist
1. A believer in the principles of humanism.
2. One who is concerned with the interests and welfare of humans.
a. A classical scholar.
b. A student of the liberal arts. approaches than are their heterosexual colleagues. These considerations are of interest, as gays and lesbians have become more visible as a group among mental-health providers and patients. Clinics specializing in the mental-health needs of the gay and lesbian community have been established in cities across the country. Increasing numbers of mental-health practitioners have also identified themselves as gay and lesbian and have written about their perspectives in the field (Isay, 1989, 1995). Yet, to date there have been no studies comparing gay and lesbian psychiatrists to their straight colleagues in professional or other personal characteristics.
We examined these issues among academic psychiatrists because they are at the forefront of biological and other recent advances in the field. Moreover, academic psychiatrists are an important group, as they very much influence the direction of the field by teaching medical students and residents, conducting research, and editing journals. We chose academic institutions located in different regions and in different types of geographic areas to sample broadly within this population.
We sent a brief, anonymous questionnaire to 972 North American North American
named after North America.
North American blastomycosis
see North American blastomycosis.
North American cattle tick
see boophilusannulatus. academic psychiatrists at five leading academic medical centers in 1990. The survey instrument (see Appendix) contained questions concerning demographic features, various personal and professional attributes, and assessments of biological versus psychological orientation. To minimize response bias, we did not inform respondents of our specific hypotheses. We stipulated in a cover letter that to protect confidentiality and anonymity, we would not conduct any analyses by individual institution.
In the first publication to report findings of this study, we compared attributes of biologically oriented o·ri·ent
1. Orient The countries of Asia, especially of eastern Asia.
a. The luster characteristic of a pearl of high quality.
b. A pearl having exceptional luster.
3. and psychologically oriented psychiatrists (Bodkin et al., 1995). We found that almost two thirds of respondents could be classified as either biological (27%) or psychotherapeutic psy·cho·ther·a·py
n. pl. psy·cho·ther·a·pies
The treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being (37%) in orientation, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the proportion of their caseload case·load
The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.
Noun to which they provided psychotherapy psychotherapy, treatment of mental and emotional disorders using psychological methods. Psychotherapy, thus, does not include physiological interventions, such as drug therapy or electroconvulsive therapy, although it may be used in combination with such methods. ([is less than or equal to] 25% vs. [is greater than] 75%). Compared with biologically oriented respondents, psychotherapeutically oriented respondents more frequently reported personal histories of psychiatric disorders (64% vs. 39%) and greater satisfaction with clinical work (81% vs. 53% reported that they were very satisfied). Biologically oriented respondents were also more likely to be younger. Subsequent comparisons corrected for age found that biologically oriented psychiatrists were more likely to engage in research as a primary or secondary activity, and to have pursued research since completing residency A duration of stay required by state and local laws that entitles a person to the legal protection and benefits provided by applicable statutes.
States have required state residency for a variety of rights, including the right to vote, the right to run for public office, the training. Psychotherapists as a group were more likely to have experimented with marijuana marijuana or marihuana, drug obtained from the flowering tops, stems, and leaves of the hemp plant, Cannabis sativa (see hemp) or C. indica; the latter species can withstand colder climates. , to be women, to be divorced, and to have family histories of psychiatric illness in one or more first-degree relatives.
One of the questions on the survey instrument regarded sexual orientation. The respondent could self-identify as exclusively heterosexual, predominantly heterosexual, bisexual bisexual /bi·sex·u·al/ (-sek´shoo-al)
1. pertaining to or characterized by bisexuality.
2. an individual exhibiting bisexuality.
3. pertaining to or characterized by hermaphroditism.
4. , predominantly homosexual, or exclusively homosexual. For the present report, we compared the exclusively heterosexual group with the pooled remaining groups on all of the other variables assessed in the survey. The significance of the comparisons between the two groups was assessed by Fisher's exact test Fisher's exact test
a statistical test for association in a two-by-two table based on the exact hypergeometric distribution of the frequencies within the table. (two-tailed).
Of the 972 psychiatrists surveyed, 435 completed and returned the questionnaire, and 76 questionnaires were returned as undeliverable un·de·liv·er·a·ble
Difficult or impossible to deliver: undeliverable mail.
un , yielding a response rate of 49%. Of the respondents, seven (1.6%) did not answer the question regarding sexual orientation. Of the remaining 428 respondents, 389 (90.9%) reported being exclusively heterosexual, 15 (3.5%) predominantly heterosexual, 6 (1.4%) bisexual, 7 (1.6%) predominantly homosexual, and 11 (2.6%) exclusively homosexual.
Significant associations between sexual orientation and other survey variables are summarized on Table 1. Exclusively heterosexual psychiatrists were more likely than nonexclusively heterosexual psychiatrists to be Jewish, to have reported more first-degree relatives with a DSM-III-R Axis I Axis I Psychiatry A classification dimension used with DSM-IV, which includes clinical disorders and syndromes and/or other areas of concern. See DSM-IV, Multiaxial system. psychiatric diagnosis (American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. , 1987), to prescribe medications to at least some of their patients, and to have engaged in research after residency. However, exclusively heterosexual psychiatrists were significantly less likely to report personal use of illicit drugs illicit drug Street drug, see there as a whole and hallucinogens in particular. In addition, there were trends for the exclusively heterosexual psychiatrists to have used less marijuana (any marijuana use: 58% of exclusive heterosexuals vs. 74% of others, p = .059) and stimulants Stimulants
A class of drugs, including Ritalin, used to treat people with autism. They may make children calmer and better able to concentrate, but they also may limit growth or have other side effects.
Mentioned in: Autism (any stimulant stimulant, any substance that causes an increase in activity in various parts of the nervous system or directly increases muscle activity. Cerebral, or psychic, stimulants act on the central nervous system and provide a temporary sense of alertness and well-being as use: 18% of exclusive heterosexuals vs. 32% of others, p = .052).
Table 1. Sexual Orientation and Characteristics of North American Academic Psychiatrists
Sexual Orientation Exclusively Not Exclusively Characteristics Heterosexual Heterosexual Marital Status (Single) 5% 49% (18) (19) Non-Jewish 54% 79% (207) (31) Protestant 30% 54% (114) (21) Number of First-Degree Relatives With Psychiatric Diagnosis: 0 64% 72% (248) (28) 1 25% 18% (98) (7) 2 8% 0% (33) (0) 3 2% 10% (6) (4) 4 1% 0% (3) (0) 5 .3% 0% (1) (0) Prescribing No Medications 3% 13% (5) Any Drug Use 58% 77% (224) (30) Any Hallucinogen Use 17% 32% (63) (12) Research Post-Residency 65% 47% (252) (18) Characteristics p value Marital Status (Single) .000 Non-Jewish .002 Protestant .003 Number of First-Degree Relatives .015 With Psychiatric Diagnosis: 0 1 2 3 4 5 Prescribing No Medications .017 Any Drug Use .025 Any Hallucinogen Use .027 Research Post-Residency .034
Note. All comparisons are performed by Fisher's exact test (for 2 x 2 comparisons) or by exact test for 2 x 6 comparisons (for number of first-degree relations with a psychiatric diagnosis).
No trends or statistically significant differences were found between the two groups in age (as measured in years or in ten-year intervals), gender, college major, plans to enter psychiatry when beginning medical school, consideration of other medical specialties Medical Specialties
See also anatomy; disease and illness; drugs; health; remedies; surgery.
the science of the description of glands. — adenographic, adj. , satisfaction with medical school, principal activities in psychiatry, percentage of patients provided formal psychotherapy, political views, satisfaction with clinical practice, or consulting a mental-health professional for a specific diagnosis. Overall orientation (biological vs. psychological), as assessed by several of the questions, was almost identical among exclusively heterosexual and not exclusively heterosexual psychiatrists. A significant difference emerged on only one item for biological orientation: The exclusively heterosexual psychiatrists were less likely to report a clinical practice in which they prescribed medications to none of their patients (see Table 1).
In a further analysis, we found that 90% of the psychiatrists who were not exclusively heterosexual were male, whereas 79% of the exclusively heterosexual psychiatrists were male. Given the preponderance pre·pon·der·ance also pre·pon·der·an·cy
Superiority in weight, force, importance, or influence.
Noun 1. preponderance of males, we duplicated the previous analyses restricted to males, assessing differences between exclusive and non-exclusive heterosexuals, The results of this analysis were almost identical to that of primary analysis, with virtually all the previously significant differences retaining a significance level of p [is less than] .05. The only exception was for any hallucinogen hallucinogen
Substance that produces psychological effects normally associated only with dreams, schizophrenia, or religious visions. It produces changes in perception (ranging from distortions in what is sensed to perceptions of objects where there are none), thought, and use, which lost some statistical power (p = .067 among males only). In addition, one variable became significant: Of the males who were not exclusively heterosexual, 69% had consulted a mental-health professional for a specific diagnosis compared with 50% of the males who were exclusively heterosexual (p = .049).
Among the potential limitations of this study was the response rate of 49%. This rate raises the possibility of selection bias: Gay and bisexual psychiatrists may have been less willing to complete the questionnaire because of fears of stigma from homosexuality. However, the percentage of gay and bisexual respondents in this survey was in the broad range of that reported in the U.S. adult population, roughly midway between the results found by Kinsey, Pomeroy, and Martin (1948) and Laumann, Gagnon, Michael, and Michaels (1994).
There may also have been information bias--namely, that respondents may not have disclosed certain types of sensitive information, either by leaving a question blank, or by answering it inaccurately. Thus, on items such as those regarding homosexuality and substance abuse, the response rates may represent minimum estimates for this population.
Another limitation was that the overall number of gay and bisexual respondents was modest, reflecting the fact that they constitute a relatively small proportion of the overall population. Thus, for adequate statistical power, it was necessary to combine all of the nonexclusively heterosexual subjects into one group for the analyses. Clearly, there may be differences within this group (e.g., differences between exclusively homosexual and bisexual respondents), but these could not be addressed in the present study. Surveys sampling larger numbers of gay and lesbian mental-health professionals can further explore this issue. There is also a risk of Type II errors, that is, we might not find differences when they are present. This risk could be reduced by sampling gay and lesbian psychiatrists through other means, such as through the membership of a gay organization (e.g., the Gay and Lesbian Medical Association
Another potential limitation is the possible effect of multiple comparisons. The significance levels presented are not corrected for the effects of multiple comparisons (approximately 30). Thus, chance associations may have occurred due to the number of comparisons, particularly when we assessed comparisons of marginal statistical significance. However, classical Bonferroni corrections In statistics, the Bonferroni correction states that if an experimenter is testing n independent hypotheses on a set of data, then the statistical significance level that should be used for each hypothesis separately is 1/n often tend to be overly conservative in that they assume that all of the comparisons are independent of one another. Because this was not the case in our analyses, we presented the findings without correction, allowing readers to judge the validity of the findings.
Another potential limitation is the possibility of confounding variables A confounding variable (also confounding factor, lurking variable, a confound, or confounder) is an extraneous variable in a statistical or research model that should have been experimentally controlled, but was not. . For example, exclusively heterosexual psychiatrists were slightly older than psychiatrists in the other groups. Although this difference in age did not reach statistical significance, age or some other confounding variable may have contributed to the differences observed in this investigation. Again, a study using a larger sample size could effectively examine the contribution of such possible confounding variables.
Despite these limitations, this study offers some basis for speculation concerning the relationship between sexual orientation, the decision to become a psychiatrist, and subsequent professional attitudes and practices. Moreover, as a first study of this population, the data point to differences that can be explored in depth in subsequent research.
Until the 1970s, American psychiatry viewed homosexuality as a disorder listed in DSM-II (American Psychiatric Association, 1968), and consequently gay men and lesbians may have avoided entering the profession. This study suggests that gay men and lesbians have entered the field in the last few decades in a proportion consistent with estimates of their representation in the North American adult population. Moreover, psychiatrists who were not exclusively heterosexual did not differ significantly in most of their approaches toward psychiatric disorders and treatments, with the exception of prescribing medication to their patients. There were no differences between the two groups in biological versus psychological views. This finding suggests that nonexclusively heterosexual psychiatrists represent an integral part of the profession as a whole.
Homosexuality has long been stigmatized and thus can lead to added stress for homosexuals. This stress may account for the increased rate of recreational drug use Recreational drug use is the use of psychoactive drugs for recreational purposes rather than for work, medical or spiritual purposes, although the distinction is not always clear. and the increased tendency to consult a mental-health provider with a diagnosis. High rates of substance use among gay men, lesbians, and bisexuals have been reported elsewhere (McKiman & Peterson, 1989; Skinner, 1994), though without regard to occupation. Conversely con·verse 1
intr.v. con·versed, con·vers·ing, con·vers·es
1. To engage in a spoken exchange of thoughts, ideas, or feelings; talk. See Synonyms at speak.
2. , it might be argued that exclusively heterosexual psychiatrists are less likely to use recreational drugs rec·re·a·tion·al drug
A drug used nonmedically for personal enjoyment.
recreational drug Substance abuse Any agent–most have significant psychotropic effects–used without medical indications or because they have an overall tendency to engage in more socially desirable behaviors.
It is of interest that the nonexclusively heterosexual psychiatrists were more likely to report having a clinical practice in which they did not use medications. This finding suggests that nonexclusively heterosexual physicians may be more likely to have cases involving psychotherapy alone. In particular, gay, lesbian, and bisexual psychiatrists may see more patients concerning sexual orientation issues for which psychotherapy alone is indicated. These psychiatrists, given their own personal experiences of difference, may also be more interested in psychotherapy-only cases in general.
Other findings also suggest that the nonexclusively heterosexual psychiatrists are more humanistic: They prefer psychotherapy-only practices, are less likely to conduct research after residency, and are more open to new experiences (e.g., drug and hallucinogen use). Sexual orientation might thus be part of a phenomenon related to a dimension of heterodoxy-orthodoxy. The finding that exclusively heterosexual psychiatrists were more likely to be Jewish also suggests that these straight psychiatrists may represent an older population of traditionally orthodox Freudians (though age alone as measured in years and in ten-year intervals was not found to be significant).
The issue of possible differences in treatment modalities treatment modality Medtalk The method used to treat a Pt for a particular condition is important not only because straight psychiatrists were less likely to engage in psychotherapy only, but also because of concerns in the gay and lesbian community over essentialist versus nonessentialist explanations of sexual orientation. A psychiatrist adopting a nonessentialist (i,e., nonbiological) interpretation of the origins of sexual orientation and partner preference may also adopt nonbiological interpretations of other behaviors, including those deemed problematic. Although no differences were found between exclusively heterosexual psychiatrists and other psychiatrists in their views of the origins of psychiatric problems, that straight psychiatrists were less likely to use psychotherapy alone suggests that, at least in terms of some aspects of treatment, an essentialist approach may be favored by straight psychiatrists. Being gay or lesbian may thus affect how psychiatrists approach their patients' problems, specifically favoring more humanistic or nonessentialist treatments.
A provocative hypothesis suggested by these data is that psychiatrists enter the profession because of a specific aspect of their personal history, such as feeling different or marginalized. For example, being Jewish or gay or having first-degree relatives with mental illness may prompt an individual to choose psychiatry as a profession. This hypothesis might explain, for example, the unexpected significant negative associations between sexual orientation and being Jewish or having psychiatrically ill first-degree relatives. Possessing any one of these three marginalizing personal characteristics may be sufficient to prompt an interest in psychiatry. Thus, a gay individual might be less likely to require either of the other two attributes in order to be attracted to a career in academic psychiatry, hence producing the significant negative associations.
Future studies could compare straight and gay physicians of other specialties as well, which has not yet been done. However, examining psychiatrists is particularly important, given that psychiatry had long considered homosexuality a treatable illness and that the etiology of homosexuality, like psychiatric problems, is viewed from conflicting biological and psychological perspectives. The hypotheses tested here and others suggested by our data deserve testing in the future with larger samples of gay, lesbian, and bisexual mental-health professionals.
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Hamer, D. H., Hu, S., Magnuson, V. L., Hu, N., & Pattatucci, A.M.L. (1993). A linkage between DNA DNA: see nucleic acid.
or deoxyribonucleic acid
One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. markers on the X chromosome X chromosome
One of the two sex chromosomes (the other is Y) that determine a person's gender. Normal males have both an X and a Y chromosome, and normal females have two X chromosomes. and male sexual orientation. Science, 261, 321-327.
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New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Farrar, Straus, Giroux.
Isay, R. (1995). Becoming gay. New York: Pantheon pantheon (păn`thēŏn', –thēən), term applied originally to a temple to all the gods. The
Pantheon at Rome was built by Agrippa in 27 B.C., destroyed, and rebuilt in the 2d cent. by Hadrian. .
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pertaining to the hypothalamus.
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Skinner, W. (1994). The prevalence and demographic predictors of illicit Not permitted or allowed; prohibited; unlawful; as an illicit trade; illicit intercourse.
ILLICIT. What is unlawful what is forbidden by the law. Vide Unlawful.
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Manuscript accepted November 13, 1997
This work was supported in part by grants from The Aaron Diamond Foundation; and the NIMH through Grant P50-MH 43520 to the HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. Center for Clinical and Behavioral Studies, and through Grant K08-MH01420-01.
Direct correspondence to Robert Klitzman, M.D., Department of Psychiatry, Columbia University Columbia University, mainly in New York City; founded 1754 as King's College by grant of King George II; first college in New York City, fifth oldest in the United States; one of the eight Ivy League institutions. , Unit #10, 722 West 168th Street, New York, NY 10032; e-mail: email@example.com