Ego-dystonic homosexuality
In the classification of mental and behavioral disorders contained in the 10th formulation of the World Health Organization (WHO) document for the classification of diseases (ICD-10), homosexuality is no longer considered an illness in itself and is recognized the existence of dystonic forms of all sexual orientations. Echo-dystonic homosexuality is a homosexuality recognized by the subject but not accepted. If a homosexual, fully conscious of being homosexual, comes into conflict with his sexual orientation for religious, moral or social reasons and wishes to change sexual orientation, his homosexuality is called ego-dystonic homosexuality. This category is now outdated and ego-dystonic homosexuality is no longer classified as a mental disorder, but as a simple discomfort due to cultural or social reasons.
The ICD-10 was approved by the 43th WHO Assembly in May 1990 and has been in use in the WHO member States since 1994. The release date for ICD-11 is 2018, and any reference to homosexuality, even the ego-dystonic one, is expected to be completely eliminated.
Two points must be underlined:
1) the excess of psychiatrization has arrived to overcome the limits of the ridiculous (and really of the pathological) with the description, in the XIX century, of a presumed disease, the drapetomania, a "disorder of slaves who have the tendency to escape from their owner due to an innate propensity for the desire to travel". Psychiatry, starting from the assumption that slavery was a normal thing, has come to consider pathological the tendency of slaves to flee!
2) maintaining the category of "ego-dystonic homosexuality" has fueled the thriving market of conversion therapies aimed at bringing back homosexuals to heterosexuality, because these aberrant practices were officially considered forms of treatment for a "disease" and therefore were repayable by health insurances or national health services, if any.
Homosexuality had been deleted from the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association (APA)) since 1973, after a very tortuous path in which ideological resistance, political opportunism and economic interests were intertwined in various ways, in a border territory in which science (psychiatry) risked losing even the appearance of objectivity. In this regard, I refer to a fine article by Jack Drescher: Out of DSM: Depathologizing Homosexuality which illustrates the path that led to the de-pathologisation of homosexuality by the APA.
Let's leave aside, with all the reservations of the case, the category of ego-dystonic homosexuality, and let’s come to the specific object of this article, that is the dysfunctional gay sexuality which is something profoundly different.
Gays and dysfunctional sex
The cultural tradition has accustomed us to the association of sex and pleasure, endorsing the identification of sexuality with the gratification that can derive from it, but the experience teaches that in some cases sexuality, far from being associated with pleasure and gratification, becomes an expression and sometimes a non-secondary cause of depressive states that are inconspicuous but subtle and even dangerous.
The association of sexuality and sense of gratification is not a necessary constant but is induced by sexual imprinting and the first approaches to adult sexuality that act in a varied and complex way on the components of the personality in formation and mold it. You can get to experience sexuality as a real obsession, that is, as an invasive and pervasive dependence that deeply affects the whole personality, you can get to experience sexuality as self-punishment, as a self-imposed form of moral degradation or as constantly accompanied by feelings of guilt associated with an unstoppable impulse to repeat. In other words, sexuality can be a dysfunctional response to the discomfort that not only does not relieve it but can weigh it down in a conditioning way.
When there is a spasmodic exercise of sexuality, particularly when sexuality is divorced from the affective component, the legitimate suspicion arises that this is a dysfunctional sexuality.
I give a very simple but very meaningful example: when a guy lives a very active sexuality but accompanied by a sense of satisfaction and gratification, there is no reason to suspect any form of discomfort, if instead the overactive sexuality is accompanied by depressive feelings, a drop in self-esteem or the perception of a sense of dependence, it is legitimate to ask oneself if there is or not a form of unease behind it.
Sexuality as a manifestation and component of discomfort is more easily encountered in homosexuals and in particular in those homosexuals who, for reasons of social conformity or for facts linked to individual history, live in conditions of repression or present forms of sexuality that are not easily accepted, not even in contexts otherwise welcoming, such as intergenerational relationships.
As it’s obvious and as I have been able to find on several occasions that having suffered in childhood or even in early adolescence forms of sexual abuse predisposes to dysfunctional sexuality but does not determine it in a necessary way.
At the base of dysfunctional sexuality we often find the idea of transgression and of involving others in transgressive behaviors, which often means trying to get out of isolation and share an intimate and at the same time anxiogenic aspect of one's personality.
I would like to point out that dysfunctional sexuality often has its roots in areas of individual experience that have nothing to do with sexuality but which have strong effects on self-esteem and are often linked to the context of the family the individual comes from.
The patrimony of sexual intimacy represents one of the most important and at the same time most fragile dimensions of the personality, an invisible but present dimension on which each person measures the social integration at the deepest level. Of course sexual intimacy can be related to many feelings of guilt, linked to the tendency to invade the sexual intimacy of others or to dispel one's own with abnormal or excessive behaviors.
From what I have been able to see the dichotomy between affectivity and sexuality, which many times seems original, is often strongly accentuated by experiences of rejection, that is, stories with an emotional-sexual background begun with enthusiasm and ended by manifest incompatibility.
The repeated experience of affective incompatibility leads to the shift of emotional investment towards non-affective sexuality. The archetypes emerged from sexual imprinting thus become models to be repeated continuously and progressively less gratifying. The idea of transgression begins to weigh more than that of sharing, behaviors become ritual and stereotyped and a sort of script is formed that must be recited more or less identical regardless of the personality of the partner.
This mechanism, which in fact creates an obsessive dependence, is initially experienced as a mere unease but tends gradually to become compulsive. The emotional components are withdrawn from sexuality but don’t disappear at all from the individual horizon, they remain only in a dimension separate from sexuality. Guys who live in conditions of sexual dysfunctionality have a very deep affectivity that can manifest as such in all its potential, which can be enormous, I mean that those guys can live important friendships, can have, on aspects that don’t touch sexuality, a very rigid moral code, but when it comes to sexuality they will end up feeling dominated by the compulsion to repeat the same behaviors and to try to involve others in behaviors that they consider transgressive and in any case to dissociate affectivity and sexuality.
I must observe that many of the behaviors considered by those guys to be transgressive, are in reality quite common variants of sexual behavior that, when they are not accompanied by a sense of dependence and compulsion to repeat or by the tendency to focus only on them, don’t express and don’t create discomfort at all.
I report a significant example: intergenerational relationships created on an emotional basis are not expressions of discomfort but those relationships, lived without affection and almost self-imposed, manifest an unease that can be profound, the same is true for example for anal penetration that has nothing to do with discomfort, when it is experienced as rewarding and spontaneous, but instead is a sign of a discomfort that can be profound when it is experienced as self-imposed by people who in their sexual fantasies have never considered that particular sexual practice. The same could be said for the use of a particularly provocative, vulgar or aggressive language in sexual encounters and so on. It happens in these cases a little what happens in the OCD (obsessive compulsive disorder), a behavior that in itself would not have anything transgressive, if lived in an emotional, playful and otherwise collaborative dimension and without fixed roles, i.e. with criteria of parity and in a light way, is instead considered transgressive and is experienced as compulsive, but the reason is not in the objective transgressive character of that behavior or in its intrinsic compulsiveness but only in the mind of the subject that associates those behaviors with a situation of discomfort.
Some criteria tend to prevent dysfunctional sexuality as far as possible:
1) Absolute respect for the privacy of the child or adolescent in matters related to sexuality
2) To try to prevent sexual abuse of minors, which have a profound effect on adult life
3) To create an environment that tends to promote self-esteem and develop an affective climate, in particular by providing examples of the association between affectivity and sexuality.
Let us now analyze synthetically each of these points.
I understand very well that in the age of the internet, where children and adolescents have easy access to the network and all its contents, parents may be worried about the child's access to pornography, which in some ways is inevitable; it is however opportune that this access takes place at an age in which there is already a substantially adult sexuality (14-15 years), so that models of behavior are not exclusively imitative, because a model of exclusively imitative sexuality is substantially devoid of affectivity.
Parents are often afraid more than of pornography, of special friendships of their children, that instead have the undeniable merit of encouraging the growth of affectivity and the integration of affectivity and sexuality. Parents can and must talk about sexuality with their child but only avoiding calling him directly into question. Attitudes of an inquisitorial type or of real espionage, like looking through the child's private cards or tampering with his computer are perceived as invasive and violent and break the trust relationship between parents and children.
The prevention of child abuse is a very delicate subject because the overwhelming majority of abuses are perpetrated precisely by the persons to whom the child is entrusted or in any case by family members or by those who habitually frequent the child's home. It is obvious that under these conditions the repressive intervention of the penal law risks being completely circumvented. The golden rule to reduce the possibility of abuse is to never "entrust" the child to others and, if necessary, to entrust him to grandparents or to other family members whose behavior can be certain, and never in a systematic way or for long periods.
Creating an environment that tends to promote self-esteem and the development of an affective climate means in practice creating a family life in the full sense of the term, spending a lot of time with children, playing with them from an early age, gratifying them in comparison with adults and showing them concrete examples of affection between adults. There is nothing that can promote self-esteem and the development of the child's affectivity, such as seeing parents experiencing an emotional and collaborative atmosphere among them. I mean that the child's discomfort is very often the expression of a family hardship.
I have often asked myself about what can be done when a form of dysfunctional sexuality has been rooted for years and here I can only expose my thoughts that are far from indicating a concrete way of proceeding. Naturally I didn't ask myself what a psychologist can do, because a psychologist takes on a determined role that has its own rules, but just of what a friend can do. The variables involved are many and it is very difficult to arrive at a synthesis, I will limit myself to explain the most recurring problems. I will indicate with the letter "A" the guy who experiences a condition of sexual dysfunction and with the letter "B" his friend.
A typical situation: A has a fairly frank dialogue with B and slowly gets to talk with B about his sexuality, manifesting also the aspects that he considers transgressive. In this way A intends to evaluate above all the fidelity of B and his reactions. If B will be annoyed by those speeches or if he will go away not to be seen again, A will live the thing as another refusal towards him and this will confirm him in the idea of marginality and social isolation. If B will listen to A’s speeches in a patient way without reactions of amazement and will try to underline that the transgressive aspects are actually minimal, admitted and not granted that they exist, A will go on to a later phase, he will try to involve B beyond the level of dialogue, he will try to provoke him, to convince him to try some sexual contact, even very superficial, even by telephone, but it will be a sexual contact with those characteristics of transgression that B had considered little or no transgressive at all and here B will have the problem of accepting or not to take this step forward, because if B will accept, almost certainly A will try to take another step forward to involve B more and more, but if B refuses, A will take the opportunity to further depress and to further decrease his self-esteem. At the end of this process, which may take months, B will ask himself whether it is appropriate to give in to the insistence of A and here the answer is not at all obvious, B would not however have the prospect of starting a romance with A, since A is interested in B only on a sexual level, while B could prove a deep emotional involvement for A. B, however, is now aware that the relationship with A is played at another level and that, even if A is not involved at an affective level, or better in terms of couple relationships, B's answer can be very important precisely for A's personal balance, or better for his self-esteem and for overcoming depressive attitudes. B, on the other hand, knows very well that yielding to A once means inducing A to repeat that sexual experience an infinite number of times but always without couple affectivity.
Among the one-way answers: always accept the proposals of A, or say no clearly even if in the least aggressive way, there is a third way, that of an agreement limited especially to periods of maximum stress of A. The purpose of B cannot consist in trying to create a relationship with A, but must be identified in allowing A to achieve greater serenity and greater self-esteem and therefore to live, even towards B an emotional dimension "without couple relationship" but anyway strongly stabilizing. As it’s obvious in this path there are many possible variations and decisions don’t belong to B but are taken together by A and B not with agreements made of words but through significant behavior, as it happens in every important interpersonal relationship.
I would like to end my discussion on dysfunctional sexuality with a clarification: dysfunctional sexuality is often found in people in other respects realized despite their low self-esteem and, I would add, in people who are forced to live lives very different from what they wished, even if they have achieved, in these unwished lives, notable social and economic successes.
With these people it is certainly possible to build affective relationships sometimes very important, that their characteristic non-aggressiveness and their tendency to maintain stable relationships, even if not close, make in fact often very pleasant and gratifying.
If there is one thing from which in any case, it is necessary to refrain it is from judging, because this would further decrease self-esteem and lead these people to more clearly depressive states.
Speaking both with people with dysfunctional sexuality and with their friends, I noticed that respect and affection subsist between them. I have also noted that some problematic situations tend to resolve when, on a general and not specifically sexual level, self-esteem rises and with it the substantial level of socialization. The real danger is the state of abandonment in which the individual is absolutely alone with his depression because then the incentives to reevaluate oneself and to understand that one is really important at least for someone are completely lacking.
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