ABSTRACT On May 1, 2004, the Association of Gay and Lesbian Psychiatrists (AGLP), with co-sponsorship from St. Luke's–Roosevelt Medical Center, The Haworth Press, and the William Alanson White Institute, organized an all-day conference in New York City entitled Homosexuality and Psychoanalysis: New Directions. The proceedings of the third panel focused on “Theoretical Perspectives.” The first panelist, Susan C. Vaughan, MD, discusses how her perspective on lesbian development affects her clinical work with patients. Vaughan believes that the most useful framework for understanding the psychological ramifications of being lesbian is a developmental perspective, by which she means what is experiential about development and appreciating cultural factors, as well as what they might mean intrapsychically to patients as they are going through their lives growing up lesbian. Vaughan presents detailed clinical case material to highlight three developmental themes that are common in the lesbian patients that she have treated, experiences in childhood and adolescence that she contends are shared by many people growing up gay. The three developmental themes are: (1) a difference that is secret, bad, and must remain hidden; (2) overstimulation, and attempts to contain excitement, and the shame that overstimulation produces; and (3) struggles over the relationship between gender identity and sexuality as recurrent refrains in the stories of the lesbian patients she treats. Otto F. Kernberg, MD, gives a brief capsule overview of his approach to patients where homosexuality seems to be an issue. He lists a series of possible presentations of individuals entering treatment that relate to their sexual orientation and sexual identity. He affirms the need for technical neutrality, by which he means a lack of bias for or against the patient becoming heterosexual or homosexual, and the need for therapists to be honest about their own attitudes when treating patients who have problems with their sexual identity. If sexual identity is a source of conflict, treatment is warranted. The kind of treatment depends not on the sexual difficulty but on the severity of the character pathology. Kernberg outlines several possible clinical presentations and the suggested treatment for each. Therapists need to tolerate their own bisexuality when treating patients, and that combined with general knowledge about psychopathology and psychotherapeutic psychoanalytic technique is what it takes. Kernberg concludes by noting that much of what he has to say about homosexuality could also be said about heterosexuality, taking away all the complications of social bias and the influence of technical neutrality. David Schwartz, PhD's presentation is an effort to cast doubt on the validity of efforts to conceptualize and understand human homosexuality in a traditional scientific framework. Schwartz notes that all efforts to scientifically explain naturally occurring psychological phenomena are hampered by ethical and technological restrictions on our ability to manipulate independent variables. Moreover, he argues that the scientific search for an etiology or psychobiological mechanism for different patterns of sexual desire is especially blocked from producing anything but equivocal findings. This, he says, is principally due to the political and cultural implications of sexual behavior. These claims are illustrated with some examples from the history of efforts (psychoanalytic and not) to theorize same-sex desire. The author suggests that a more suitable way for psychoanalysts to increase their knowledge of diverse patterns of eroticism would be to emphasize phenomenological analyses and artistic representations. Ronnie C. Lesser, PhD, concludes the panel. In her discussion, she explicates the various manifestations of heterosexual pathology. As heterosexual pathology is so wide-ranging, Dr. Lesser believes that scientific purposes would be better served if we were to stop talking about “the heterosexual,” and use “the heterosexualities” instead. She then focuses her attention on the particular manifestations of interpersonal pathology exhibited in marriage by the heterosexualities, for example, emotional immaturity, narcissism, promiscuity, and high divorce rate. Since these problems have such dire consequences for their offspring, Lesser proposes a radical solution: that heterosexuals be barred from marriage. These themes are then woven in to her discussion of the other presentations on the panel.
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Jan 1, 2012
Alistair D Sweet 
Open Access