Gay, Lesbian, Bisexual: “Genetic” or “Mental Disorder”?

This question often brings clients to the psychotherapist’s office. Not when you are a member of the majority of the population whose sexual identity (experiencing yourself as either girl or boy from childhood) and sexual orientation (whom you feel sexually attracted to, mainly from puberty onwards) fits comfortably with the ‘norm’ of your family and cultural group…

But when you or a family member does not “fit in” with the mainstream accepted sexual behaviours, it is met with resistance, and usually results in traumatic distress for individuals, families, friendship groups. Even one’s work occupation may be jeopardised by revealing that one is, for instance, homosexual: As late as the 1990s a male colleague was reportedly refused access to a university clinical psychology training program because he was gay. Recently, I’m told, a winner of a country’s pop singer competition found that a prize sponsorship was withdrawn when he revealed he was gay. Judgement is still so severe that the label of homosexuality can be used as a threat, for instance in sexual harassment: Imagine finding out at work that colleagues are wary of you because the boss suggested you might be a lesbian, when you preferred not to sleep with him… (This has happened!)

Until the 1970s there were university psychology departments who “specialised” in “curing” homosexuality through behavioral methods like electric shock treatment: Young men who sought help for the conflict and trauma they were experiencing were, for instance, shown a series of sexually provocative pictures of male and female models, with shocks following the presentation of the male pictures. Around the world the issues around exclusion, for instance in the USA navy program, were widely published and debated in every possible medium.

So many questions are asked: Can this be cured? Should it be “cured”? How can (e.g.) God forgive such a “sin” if I continue to give in to my desires for the “wrong” sex? Did I or my spouse do something “wrong” to “make” our child “choose” to be (e.g.) homosexual? When, and how, do I tell my parents / friends? How can I find a life partner if I do not enjoy the stereotyped social “gay scene”? What happens if we want children? How do I tell my wife and children that I want to have surgery to be a woman from now on? Someone in my rugby/tennis/hockey club saw my partner and I dancing: how do I prevent rumours and ostracization?

Genetic, Choice or Mental Disorder?

Well, it could be all or none of the above! I will try to explain briefly in lay terms, but encourage readers who wish to know more about the interplay of biology and environment, to read Chapter 7 “Genetic and environmental influences on mental development” in The Brain and the Inner World – An introduction to the neuroscience of subjective experience, by Mark Solms and Oliver Turnbull (2002, London & New York: Karnac).

The genetic factor:

When two “half” cells combine to form the first “egg” cell of a foetus, the gender gene from the sperm cell is either X or Y. The female ovum cell is always X. So we are born with either XX or XY chromosomes on one minute part of our genetic string of determinants.

The basic difference in predisposition to develop into either male or female has a “genetic” component of only one part of chromosome 23 (the last of pairs of genetic material coming half from father and half from mother as our “genetic” inheritance), i.e. one forty-sixths of our genetic inheritance predisposes our gender and sexual orientation. (In the 1990s there was excitement about the finding of a “gay gene” but the reliability of this research has been generally questioned.)

The general “default” rule is: all babies will be “female:” unless there is a Y chromosome. When the foetus has a Y chromosome (i.e. XY) “he” will be predisposed to develop into a person with male genitals, if all further necessary steps follow in the mother’s womb. Thereafter, if – and only if – all other parts of the developmental “recipe” occur at the right time and in the right order in the mother’s womb, “he” will develop a brain that is “male” in its structure and functioning.

If any part of the “recipe” is not followed exactly, there are different outcomes to the predisposed development: for instance, we may have a child with male genetalia, but a female brain factor, so that “he” feels “he” is and should be a girl. We could have a child who has XY chromosomes (such as found in testing of athletes) but who is in every respect fully and completely girl/woman.

The same chances of biological differentiation occur with “girl” babies with XX chromosomes.

Please note that the above conclusions are based on thorough and up to date research; the actual cell clusters, brain cell clusters and chemicals involved have been identified (Solms & Turnbull, 2002; Levay, 1994; Rogers, 1999).

Biological factors:

I use this term to refer to what people often incorrectly term “genetic”, i.e., actual physical influences rather than “psychological beliefs” – although, of course the two are inevitably intertwined!

I will use the influence on the XY-predisposed male development as an example; again, the same influences can change the observable outcome of the XX development. (Information is based on current lecture series by Professor Solms. Consult the sources listed for more detailed descriptions.)

Changes that can occur in the womb:

Remember, if specific sequences of development do not follow in the womb, XY babies would be female! As the foetus grows it develops sex cells known as gonads, which from identical early sex organs in XX and XY foetuses. At a specific point in later foetal development, the Y chromosome (when the foetus is XY determined) plays its role: A substance called testes-determining factor is released and changes the genetic make-up of the gonads that would have become ovaries, into gonads that will develop into testes. This is the beginning of the development of the foetus into a male child. But the process can be changed at many later stages!

When the “male” foetus is 4 to 6 months old (second trimester), testicles begin to develop and release the hormone testosterone, which is transported to all cells through the blood and is recognised by testosterone-sensitive sites on several other foetal organs, which change for later “male” development, e.g., male genitals will form, breasts will not develop fully, hair growth will be different, and the voice box muscles will be shorter and thicker, resulting in lower voice, etc.

While I’ve said in summary that testosterone causes the changes, in fact it has to be transformed into dihydrotestosterone (dht) by an enzyme called 5-alpha-reductase. According to Solms & Turnbull, “the female body will only become a male body if enough of this converted testosterone is present in it” (2002, page 226, my italics). So with intrauterine influences, as well as influences from outside (e.g. when a drug, progesten, was given to pregnant women in the 1950s and 1960s to prevent miscarriage, which inhibited the conversion of testosterone), a baby may develop who has testes and XY chromosomes, but have female genitalia and external development.

Still later in the 2nd trimester of the foetal development another critical process is necessary for continued male differentiation. The testosterone now has to be converted (by the enzyme aromatase) into oestrogen (estrogen) which is now responsible for “masculinising” the still-female brain. If this process is allowed to occur, the soon to be “male” brain becomes larger (similar to other male organs compared to female ones). The growth of the neurological material that joins the left and right halves of the brain (corpus callosum) is inhibited so that this communication pathway between the two brain halves is smaller in male brains (which is a factor in generally better specialisation functions, like visuospatial abilities, in the male, and in better linguistic and “multitasking” abilities in females).

Another important difference in male / female brain development is in the third of four specific groups of cells in the hypothalamus (“INAH-3”), which is significantly larger in male than in female brains. This results in different amounts of various hormones being release in the body and brain in various stages of life, in males and females. This also mediates sexual behaviour in “normally developed” males and female to be different, as well as other social behaviours, such as nurturing and socially aware behaviour of females (due to oxytocin) compared to aggressive and active behaviour of males (due to vasopressin).

So, if for instance, aromatase is suppressed or insufficient, we can have a female brain (causing female-typical behaviours) in a male body. Conversely, if the male brain has formed and, for instance, castration later occurs in childhood (e.g. accidentally during surgery or circumcision, or even intentionally, as in previous centuries to keep boys singing voices from deepening), by puberty the child will identify himself as male, with male sexual and general behaviours and urges, even despite early introduction of hormones to “make” him a female child.

Note that stress in the mother affects the types and quantities of hormones released in the foetus, and any of this interaction may interfere with the “recipe” to become a male or female child totally or partially (with brain and genital confusion). This means that a foetus may be more or less aggressive, fearful, “novelty-seeking” (Cummings, 1994), etc. if mother is stressed or not, e.g. by financial circumstances; war; absent, drunk or abusive partner/s; sickly older child / partner / parent / sibling etc.; exams; moving house; changes in work, etc! And such changes in the baby’s personality traits by time of birth may result in different treatment by the parents and others, of what the gender-apparent baby would otherwise have experienced, for instance, a baby overstimulated by panic-driven adrenaline in the mother’s womb, may be irritable and aggressive at birth, and receive reactions that foster male rather than female behaviours later. Which brings us to…

Changes that can occur outside the womb:

I suggested earlier that some forms of homosexuality could be due to “mental disorder” – a nice attention-grabber since it seems to support some popular belief that homosexuality and bisexuality are “dysfunctional”! I do not believe or imply that gender roles and gender identity is sometimes caused by “madness”. I also do not define changes from the norm in any way as “sin” or other form of “aberrant” behaviour.

The fact is that many factors may influence a growing child or even a grown-up adult to behave in ways that may not have been predicted by his/her gender template once out of the womb. Some of the behaviour changes occur very early because of early interactions from adults, until a child may be stereotyped into considering possibilities of behaviour that fall outside the “norm”. If such behaviours result in positive reinforcement (such as receiving positive attention lacking in the relationship with one or more parental figures), someone may choose a lifestyle in accordance with, for instance, being homosexual or bisexual, even if their natural sexual attraction is not towards that gender or the specific individual. This is not a strange phenomenon: it has occurred for many centuries in heterosexual marriages and liaisons, when individuals had no other socially safe options but to “marry” traditionally, and “multiply”! Certainly in many cultures of arranged marriages a spouse may similarly have to live a life of sexual intimacy with someone for whom s/he can feel no attraction, or even revulsion.

While girl and boy infants may elicit different interactions from other people because of their different brain development, in terms of for instance aggressiveness and activity level, the mere fact that they bodily present as male or female causes people to interact differently with them: adults tend to have more language interaction with babies dressed in pink and more physical interaction with babies wearing blue (irrespective of the hidden gender of the baby).

Several of my clients have spent time exploring the effect it had on them as children when, for instance, the father or mother wanted a boy and got a girl baby, or vice versa. Children eager to win approval and acceptance from parents will often behave more like the opposite sex child they believe the parent would have wanted, and thus that type of gender-behaviour could be reinforced till it becomes firmly incorporated into the child’s sense of his/her own identity. Conversely, children may unconsciously rebel against strictly enforced stereotypical gender role expectations from one or both parents, or family groups, by behaving contrarily so consistently that the habit may appear to have become fixed; they can then feel powerless to change what has been their assumed identity for so long, and defend their earlier “choice” through even stronger opposite gender behaviour.

Other common psychoanalytically-identified factors may also be part of the unconscious or even conscious decision to accommodate discomfort of gender-foreign behaviour in order to be psychologically safe, or free, or comforted, or loved (etc.). For instance, if one parent is powerful and abusive, it might not feel safe for the opposite gender child to behave like the gender model: that may be interpreted as accepting a life sentence of suffering; it may seem inevitable that the only way to survive is to “identify with the aggressor”. An absent parent can also have many influences on the acceptance or “choice” of gender identity: if most of the men in a community, for instance, are generally away (at war, or working away in a city, etc.) one of the results may be that women in the community have to fill “male” roles, and model such behaviours to female children who may extend it to sexual identity and choice. This could also happen in an individual family too, and an absence of a male role model may be a factor in homosexual behaviour in male children…

“Mental disorder” can imply that a person has made certain (usually unconscious) choices to behave in ways that could cause significant distress in personal, work, or social life. These “choices” are often defensive structures to prevent perceived threats of annihilation or rejection from being realised. There are too numerous scenaria to cover even in several books. Sometimes homosexual or bisexual behaviour is an unconscious defensive strategy due to postnatal life circumstances; oftentimes it’s a biological necessity, and “authentic” sexual identity. In any case, it’s deserving of the same welcome and respect that inappropriately judgmental critics claim for their own beliefs and lifestyle choices, including their many defensive structures!

Finding acceptance

So what do you do if you think you fall into one of the categories of gender role or gender identity that may cause rejection? Well, if you’re content with the role or identity, then you may just have to find ways of dealing with societal bias, like a genius, or any other category of person that doesn’t always quite “fit in” may have to do!

You may want to consult with counsellors at facilities that specialise in sexual role and identity adaptation, like The Triangle Project. If you wish you may ask a psychotherapist in private practice to accompany you on your journey of self discovery, and to help you find ways of dealing effectively with the reactions of the rest of the world, as well as your own inner conflict (if present). You may read books and articles on the subject or download informed opinions from specialised internet newsgroups with proper moderators capable of screening out unsubstantiated statements.

Our sexual identity and role/s are a part of our potential or actuality as a complete and wonderful human being with many fascinating physical, mental and emotional qualities… Your current discomfort could be the key that facilitates a journey of integration and healing of many aspects of your complex personality, irrespective or inclusive of the “sexual” choices you may make or sustain. Don’t be afraid to ask for help on the way: we all deserve it!

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