Book Review

Becoming Gay: The journey to self-acceptance

N Engl J Med 1997; 336:74-75January 2, 1997

Article

Becoming Gay: The journey to self-acceptance
By Richard A. Isay. 210 pp. New York, Pantheon, 1996. $23. ISBN: 0-679-42159-9

Richard Isay has made a career of the struggle to make psychoanalysis safe, available, and effective as a treatment for gay men. In his first book on the subject, Being Homosexual: Gay Men and Their Development (New York: Farrar, Straus & Giroux, 1989), he expounded a model for the formation of homosexual identity that remained true to his training in classical psychoanalysis while challenging the view of American psychoanalysis that homosexuality is a sexual perversion. His new work, Becoming Gay: The Journey to Self-Acceptance, brings the argument about whether gay men are mentally healthy or sexually deviant out of the closet.

Isay bravely introduces his book by describing the painful experience of his own analysis. As a gay man, he learned firsthand the damage that psychoanalysis infused with an antihomosexual bias inflicts on a gay man coming to terms with his homosexual identity. He draws on his extensive psychoanalytic work with gay men to refute the lingering belief in the psychoanalytic community that homosexuals, by definition, suffer from mental disorder.

Isay appears unhappy to settle for turning psychoanalytic thought on its head with regard to homosexual development. He also argues clearly and cogently that gay therapists should disclose their homosexuality to their patients. This is revolutionary stuff. Analysts have long held that the anonymity of the therapist was crucial for transference to develop. Isay writes, “The gay analyst or therapist who hides his sexual orientation does further damage to his patient's self-esteem by conveying his own shame, self-depreciation, or fear of disclosure.” Quoting Freud, he notes, “We must not forget that the analytic relationship is based on a love of truth . . . and that it precludes any kind of sham or deceit.”

Becoming Gay is organized into sections on specific populations of patients, with vivid case discussions. Isay is that rare clinician who is willing to reveal himself. He invites the reader to sit with him during the analytic hour and listen as he nurtures those who have been denied love and acceptance by challenging their low self-regard. His belief in his patients' inherent worth is palpable and a powerful curative agent.

Isay's views on the development of gay adolescents are curious. He seems unconcerned that he is willing to stereotype gay men as not female, but also as not fully male.

Many have felt different since childhood, having enjoyed the company of girls more than other boys, being more musical or artistic, more emotionally expressive, and less interested in competitive sports than their peers and male siblings. These perceived distinctions are real; for many homosexual children, they are expressions of their atypical maleness.

Isay subscribes to the belief that sexual orientation is biologically determined, although he leaves it to others (for example, to Simon LeVay in The Sexual Brain [Cambridge, Mass.: MIT Press, 1993]) to present that argument.

This is not a book about why some men become gay. It is about how gay men adapt to that identity in a society still largely hostile. And it is about the earlier role of psychoanalysis in perpetuating that hostility and the question of whether psychoanalysis can become a therapeutic institution for gay men in the future.

Christopher Bellonci, M.D.
Harvard Medical School, Boston, MA 02115