H
OMOSEXUALS, OSPlTALlZATlON, by John C.Lawrence
the increasing impact of gay liberation on modern society, male homosexuals and lesbians are becoming less willing to hide their lifestyles and relationships. This is particularly true in urban areas, where the majority of America’s estimated twenty million homosexuals reside, and where organized gay communities exist, providing support and increasingly sophisticated services to gay persons. Recent literature lends strength to the belief that a homosexual lifestyle can be a valid alternative to the heterosexual norm, and not an indication of mental illness. (Stoller, 1973; Tripp, 1975)
W
ITH
N U R S I N G FORUM
305
No valid research provides evidence to support the many stereotypical myths, psychiatric and otherwise, about homosexuals. The American Psychiatric Association gave credence to that belief when it removed the diagnostic category of homosexuality from its nomenclature in December, 1973. The American Psychological Association recently followed suit. Whether or not one “likes” homosexuals, they are entitled to the same high quality nursing care as others. Nurses can expect to see larger numbers of openly homosexual patients in hospitals and in the community, patients who may rightly demand that their relationships be treated with dignity. Nurses can no longer ignore the issue of homosexuality, yet neither their education nor their experience prepares them to deal with it. What are the implications of caring for the homosexual patient?
The Homosexual Lifestyle Homosexuality is not simply a method of having genital sexual relations, but for many it is a way of living and loving. Homosexuals most often live in pairs in the context of a love relationship, or in communal situations. In the latter, several homosexuals may live together for years, often functioning as a family. One important fact distinguishes homosexual from heterosexual relationships : committed homosexual relationships receive no societal affirmation, recognition, or support, though the love and other feelings involved are comparable to those present in heterosexual marriage. Homosexuals are not socialized to share or celebrate their relationships, but rather to take care to hide them. In particular, they are expected to deny themselves open expressions of love, affection, and commitment. This holds true especially in public places, including the hospital.
306
V O L U M E XIV
NO. 3
1975
Care of the Homosexual in the General Hospital Although the nursing techniques used in the care of a homosexual patient with a physical illness will not differ from those prescribed for heterosexual patients, prejudicial attitudes negatively affect the manner in which their care is given. Moreover, the psychological considerations that play such a large part in the care of heterosexual patients may be absent. Nurses’ failure to recognize the depth, variety, and meaning of homosexual lifestyles can be a constant source of distress to homosexual patients. I speak from personal experience and that of colleagues, friends, and clients. We recognize that hospitalization can be an unpleasant, embarrassing, frightening, and even terrifying experience, and agree that all patients are entitled to every available support during this stressful period. Yet the homosexual patient is often denied the strongest support possible - that of his closest loved one. Legally, he cannot list that person as next of kin on hospital admissions records. He and his mate cannot hold hands, express affection, or show too much concern for each other lest they incur the wrath, curiosity, or derision of the floor staff. Because of these limitations on caring, much psychological pain is superimposed on the physical pain. On the other hand, if the patient is open about his lifestyle, or if his homosexuality is discovered or even suspected while he is hospitalized, he can expect to be avoided by those staff members who are unable to deal with their own anxieties about homosexuality. The presence of a homosexual person can be threatening to everyone, including professionals, who would suppress or deny their own homosexual feelings. Most of us have been taught that homosexual feelings, no matter how weak, are undesirable. Whereas the homosexual patient may merely be avoided
NURSING FORUM
307
by hospital staff, the loved one often incurs their outright hostility, for they see him as interfering where he has no business. The loved one finds himself unable to obtain information about the patient or to participate in decisions that relate to his care. At a time when his energy should be channeled into care and concern for someone he loves, it must be expended instead on bureaucratic hassles in dealing with the fact that he is not recognized as having a legitimate role to play in the situation, or on coping with devaluation of the relationship. Whatever energy is left is devoted to hiding his love instead of providing it, to dampening his feelings at a time when they most need to be expressed, and to censuring what he says and does out of fear that it will offend. To endure a hospital stay may be one of the most bitter and unpleasant of any of the oppressive experiences that homosexual persons are subject to daily. Many homosexuals express horror at the thought of having a loved one hospitalized. They fear losing control, and experience a deep sense of anger at being dismissed as a “queer friend.” One lesbian, whose mate was chronically ill with multiple sclerosis, described hospitalization as “a fragile [experience] . . . that can destroy a relationship.” The situation can become intolerable if extended, and hospital visits can become tortuous. One cannot fight an entire hospital staff while indefinitely bottling up feelings of fear, loss, and concern for the loved one. The price is paid in personal consequences : feelings of worthlessness and frustration. It is demoralizing to stand idly by, ignored, as discharge planning gets done with parents or other “blood” relatives. Probably most upsetting for a loved one is to know that in a crisis, information and decisions might be channeled to a third cousin 3,000 miles away before he himself would be con-
308
VOLUME XIV
NO. 3
1975
sulted by physicians or nurses. Any nurse who has worked on a unit that has had homosexuel patients will recognize the atmosphere I describe. Other feelings common to hospitalized homosexuals and their mates are those of helplessness and hopelessness. They feel at the mercy of the hospital and its staff, who don’t seem to care about, understand, or value homosexual relationships. Many hospital personnel believe such relationships to be immoral or abnormal and have no desire to learn more about them. Such closed, judgmental attitudes erect barriers between staff and homosexual patients, and prevent staff from relating to gay people on a human level. Surely this cannot be conducive to healing and health, mental or physical. The experience of a former client provides a clear example of the problems faced by homosexual couples during one partner’s hospitalization. My client’s mate had been admitted to an intensive care unit suffering from an acute myocardial infarction. My client was not permitted to visit his critically ill loved one because he was not considered “family.” After five days of being frustrated in his attempts to visit, he threatened to tear down the ICU if he were not admitted. The staff had him bodily removed by a security guard after telling him that he was crazy. This man came into my office beside himself with worry, and burst into tears. After interminable hassles and some help from our staff psychiatrist, who made a strategic phone call, we finally were able to arrange for him to visit. But what if his loved one had died? Nurses, doctors, and administrators had not only denied the patient major support from the person he had loved and lived with for twenty-three years, but they also created untold pain and suffering for the latter. Certainly not much can be said for the adequate assessment of patient needs by the nursing
N U R S I N G FORUM
309
personnel in this case. Such situations are heartbreaking and not a credit to our system of values. Mental Health Care Similar difficulties arise in mental health agencies. The homosexual patient is not able to choose the physician or nurses who will work with him; they are assigned. Since patients in general are often reluctant to explore the attitudes of health professionals before accepting treatment from them, homosexuals may be faced with helpers who are biased, unaccepting, and lacking in knowledge about the homosexual lifestyle. Only after a very negative experience may the homosexual discover that he will be hard put to be treated for his presenting problem without also being treated for his homosexuality. The patient becomes the victim of uninformed psychiatrists, nurses, and social workers who arbitrarily decide that he is abnormal or maladjusted by virtue of his sexual preference. Still worse, they may interpret interpersonal problems between the homosexual partners as evidence of the pathology of homosexuality. This is as logical as equating divorce with faulty heterosexuality. When one thinks of blaming heterosexual behavior for the problem in interpersonal relationships that are regularly attributed to homosexual behavior, the irrationality of this approach is evident. Many professionals lose sight of the problem at hand while they attempt to “cure” the patient of his homosexuality, and often stunned and fearful patients at least pretend to go along with the professionals’ treatment plans. These may include electroshock therapy, grueling behavioral modification procedures, or costly hours of psychoanalysis that most often do not achieve the “desired” result. Agencies that serve homosexuals often see these patients later. Many feel demoralized
310
VOLUME XIV
NO. 3
1975
and victimized, and often their basic problem remains untreated. We who have worked in alternative clinics for homosexuals have heard reports from clients of mental health professionals deliberately collaborating to destroy homosexual relationships as a desired treatment goal. That can only be described as an unethical disregard for patients’ rights. Indeed, it is one of the major reasons homosexuals have sought alternatives to traditional psychiatric treatment and why the Homophile Community Mental Health Service was founded in Boston as an alternative type of mental health agency for homosexuals. Psychoanalysts are probably the most distinguished source of this type of “destructive” treatment. Two well-known advocates are psychoanalyst authors Edrnund Bergler (Homosexuality: Disease or Way of Life, 1962) and Charles Socarides (Overt Homosexual, 1968, 1974). It was Socarides who, after the APA Board’s decision to remove homosexuality from the diagnostic manual, forced the issue to a general referendum within the association. Bergler’s book is so negative about homosexuals and homosexual relationships as to be absurd. Yet these men are highly respected within psychiatry, and their theories and attitudes have gone a long way in setting the pace and pattern of treatment for homosexuals. In no way could I imagine either psychotherapist lending support to homosexual relationships or involving the mate in treatment. Their stated goal is to help the patient recognize that the relationship is unhealthy and encourage avoidance, while encouraging heterosexual contact. While such an approach may be arguable for the few homosexuals who strongly wish to change, the fact is that most don’t, and it is they who become the victims of this
N U R S I N G FORUM
311
dominant standard of treatment. Homosexuals who seek help for quite different reasons, or for ordinary living problems, find themselves being coerced to change, while often leaving treatment with the same problem for which they came. Such misuse of therapy has enraged homosexuals across the country to the point where they stormed the convention of the American Psychiatric Association several years ago. Should the homosexual frankly state that he cannot accept the arbitrary campaign to “change” him, he may find himself simply written off as unmotivated for treatment. This is unfortunate, for after counselling several hundred homosexual persons during the last four years, I find that they seek help for the same problems generally found in the population at large, including depression, grief reactions, “marital” difficulties, psychosis, or anxiety reactions resulting from the pressures of membership in any stigmatized minority group. They may also experience temporary situational problems with parents, school, or job. Since heterosexuals also experience these afflictions, it is difficult to justify the idea that homosexuality is at the root of all life’s suffering. If that were so, I would expect many more homosexuals to flock to therapy. Instead, they gather in ever increasing numbers behind the banner of gay liberation to reclaim their rights as human beings. Helping Homosexual Patients Exercise Their Rights
The homosexual patient has every right to know if his potential care-givers are willing to accept and respect his lifestyle and relationships as at least potentially healthy alternatives to heterosexuality. He also has the right to expect that his same sex mate or close friends will be regarded as significant others, and that as such, they will be permitted to
312
VOLUME XIV
NO. 3
1975
be involved in his treatment. To help homosexual patients to exercise their rights, health professionals must seek accurate, current, and enlightened information about homosexuality. Nurses too often function under the influence of myths and stereotypes, long perpetuated by psychiatry and only recently dispelled, that make them little more knowledgeable than the person on the street. They need to reassess their basic attitudes and prejudices, first about their own sexuality and relationships, then about the sexuality of others. They should examine how they respond to homosexual persons and their relationships, understanding that such relationships are often threatening and not easily understood by a heterosexually oriented society. As nurses strive to respect and relate honestly to homosexual persons, nurse and patients alike will grow, and better care will be the outcome. The nurse, I believe, will find that those who are different from herself are not necessarily ill or abnormal ; thus, they may not automatically be candidates for a psychiatric consult. Patients, in turn, may discover that they can be considered worthwhile as they are, which is in itself therapeutic, contrasted with their past experiences in a society that often regards them as sub-human. In general, the homosexual person has the same feelings and needs as the non-homosexual; the only difference between the two is that in his intimate relationships, the homosexual~sneeds are fulfilled with someone of the same sex, who is also a person. Role of the Nurse Clinician
I believe that astute nurse clinicians can facilitate quality care for homosexual patients. The nature of their education and experience, one hopes, makes them more sensitive to the social and political issues that may affect patient care. They
NURSING FORUM
313
should be able to identify staff needs for education about homosexuality, and follow up with a training program that will assist staff to work with homosexual patients more comfortably. They should also support staff members who have particular anxieties about caring for “different” patients. As a way to relieve such anxieties, they might plan group meetings for staff members where they can express their feelings, ask questions, and exchange ideas about homosexuality. A member of the gay community could be an important resource at a meeting of this sort. Nurse clinicians should serve as role models in relating comfortably and openly with the gay patient and his significant others. Their attitudes and behavior will establish the dominant pattern for dealing with same sex relationships. Without such positive leadership and guidance, negative attitudes and behavior are certain to be reinforced, Alternatives for Treatment In the past, the response of health professionals and others within traditional treatment facilities has been distinctly negative. As a result, many homosexual persons avoided seeking health care at all, except under the most serious of circumstances. More recently though, as society has focused on homosexuality as a civil rights issue, the homosexual in need of care has had other options. In urban areas separatist clinics, which are specifically designed to serve the gay population and their families, have been established. The first two agencies, the Homophile Community Health Service in Boston and The Gay Counseling Service in Seattle, were both established in 1970, and have since been joined by more than twenty similar agencies across the country. Most began as mental health or counsel-
314
VOLUME X I V
NO. 3
1975
ing agencies founded by homosexual professionals who volunteered their services. Concurrently, these agencies dedeveloped programs to educate other professional groups, when it became clear that the topic of human sexuality was inadequately covered in medical and nursing curriculums. In 1973, the Massachusetts Gay Nurses’ Alliance conducted an informal survey among nursing and medical schools in their state and several surrounding states on how many schools offered courses or even structured seminars on human sexuality. Out of some fifty schools surveyed only three nursing schools - all with B.S. programs - gave a course or seminar on the subject and only three medical schools - Boston University, Harvard, and Tufts. Richard C . Pillard, M.D., associate professor of Psychiatry at Boston University and the medical director of the Boston Homophile Community Health Service initiated the programs in all three medical schools. Over the last two years, many gay agencies have sponsored weekly “gay health nights” to treat medical problems and to provide preventive health services such as physical examinations. Staff members are not always homosexual, but accept and support gay lifestyles. One of the most important reasons for coming to these clinics, according to their clientele, is that mates and loved ones can be involved in care, particularly if hospitalization is necessary. Within these health agencies, homosexuals have found sympathetic advocates to help them cope with the bureaucracy of traditional medical institutions, and to speak for the importance of their relationships. The demand for services proves beyond doubt the need for such facilities. The Homophile Community Health Service in Boston, in slightly more than four years of operation,
N U R S I N G FORUM
315
has provided mental health services to some 4,000 clients. The weekly health night in Boston attracts as many as fifty persons. Well over 50 percent of the clients who have come to the agency with which I was associated stated on interview that they had had a previous negative experience with the traditional health-care system or a health professional. Such evidence speaks clearly to the need to place this issue squarely before the professional nursing community. Thus far, only gay agencies have provided homosexual persons with what they, as consumers, believe to be adequate health care. Homosexual patients are beginning to demand accountability for the actions of nurses. How will nurses respond? The answer must ultimately rest with those responsible for nursing education and with homosexual nurses themselves. Certainly, sexuality courses in nursing schools are to be encouraged. Students also need to be reminded that passing moral judgments is not a nursing function: such judgments can only impede the ability to give quality care. The late Dr. Howard J. Brown, former New York City Health Commissioner, publicly stated that gay patients won’t be safe within the health-care system until gay staff members can be open advocates for them. Homosexual nurses, if they dare be bold and risk alienation and job loss, can be helpful in educating the nurses with whom they work. They can confront the negative attitudes and behaviors that may be evoked by homosexual patients. Most important, they can care for openly gay patients comfortably, without burdening such patients with uptight feelings. The homosexual nurse can serve as a role model of the healthy homosexual, thereby facilitating a flow of educational information based on personal experience. This may sensitize other staff to the needs of homosexual patients, and help them meet those needs
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1975
without prejudice. The Gay Nurses’ Alliance is attempting to deal with the problems that homosexual patients and nurses now face. It seems appropriate that nursing, the profession closest to the patient, should lead the way. The estimated 20 million homosexuals in the United States are all potential patients. They and their loved ones will continue to suffer indignities and degradation, psychologically if not physically, unless all nurses work to minimize homophobia.
REFERENCES Bergler, Edniund, Homosexuality: Disease or Way of Life? (Paperback), New York: Collier-Mcmillan, 1962. Socarides, Charles, Overt Homosexual: Psychoanalytic Study, New York: Grune, 1968. Overt Homosexual (Reprint), J. Aronson, 1974. Stoller, Robert J. et al., “A Symposium - Should Homosexuality be a Diagnosis?’’ American Journal of Psychiatry, Vol. 130, No. 1 1 , November, 1973, pp. 1207-1216. Tripp, C. A., The Homosexual Matrix, New York: McGrawHill Book Co., 1975.
BIBLIOGRAPHY Fisher, Peter, The Gay Mysrique, New York: Stein and Day, 1972. Martin, Del and Phyllis Lyons, Lesbian Woman, San Francisco: Glide Publications, 1972. Megenity, Jean, “A Plea For Sex Education in Nursing Curriculums,’’ American Journal of Nursing, Vol. 75, No. 7, July, 1975, p. 1171. Miller, Merle, O n Being Different, New York: Random House, 1971. Weinberg, Martin S. and Colin J. Williams, Male Homosexuals: Their Problems and Adapationr, New York: Oxford University Press, 1974. Weinberg, George, Society and the Healthy Homosexual, New York: St. Martin’s Press, 1972.
N U R S I N G FORUM
311
OMOSEXUALS, OSPlTALlZATlON, by John C.Lawrence
the increasing impact of gay liberation on modern society, male homosexuals and lesbians are becoming less willing to hide their lifestyles and relationships. This is particularly true in urban areas, where the majority of America’s estimated twenty million homosexuals reside, and where organized gay communities exist, providing support and increasingly sophisticated services to gay persons. Recent literature lends strength to the belief that a homosexual lifestyle can be a valid alternative to the heterosexual norm, and not an indication of mental illness. (Stoller, 1973; Tripp, 1975)
W
ITH
N U R S I N G FORUM
305
No valid research provides evidence to support the many stereotypical myths, psychiatric and otherwise, about homosexuals. The American Psychiatric Association gave credence to that belief when it removed the diagnostic category of homosexuality from its nomenclature in December, 1973. The American Psychological Association recently followed suit. Whether or not one “likes” homosexuals, they are entitled to the same high quality nursing care as others. Nurses can expect to see larger numbers of openly homosexual patients in hospitals and in the community, patients who may rightly demand that their relationships be treated with dignity. Nurses can no longer ignore the issue of homosexuality, yet neither their education nor their experience prepares them to deal with it. What are the implications of caring for the homosexual patient?
The Homosexual Lifestyle Homosexuality is not simply a method of having genital sexual relations, but for many it is a way of living and loving. Homosexuals most often live in pairs in the context of a love relationship, or in communal situations. In the latter, several homosexuals may live together for years, often functioning as a family. One important fact distinguishes homosexual from heterosexual relationships : committed homosexual relationships receive no societal affirmation, recognition, or support, though the love and other feelings involved are comparable to those present in heterosexual marriage. Homosexuals are not socialized to share or celebrate their relationships, but rather to take care to hide them. In particular, they are expected to deny themselves open expressions of love, affection, and commitment. This holds true especially in public places, including the hospital.
306
V O L U M E XIV
NO. 3
1975
Care of the Homosexual in the General Hospital Although the nursing techniques used in the care of a homosexual patient with a physical illness will not differ from those prescribed for heterosexual patients, prejudicial attitudes negatively affect the manner in which their care is given. Moreover, the psychological considerations that play such a large part in the care of heterosexual patients may be absent. Nurses’ failure to recognize the depth, variety, and meaning of homosexual lifestyles can be a constant source of distress to homosexual patients. I speak from personal experience and that of colleagues, friends, and clients. We recognize that hospitalization can be an unpleasant, embarrassing, frightening, and even terrifying experience, and agree that all patients are entitled to every available support during this stressful period. Yet the homosexual patient is often denied the strongest support possible - that of his closest loved one. Legally, he cannot list that person as next of kin on hospital admissions records. He and his mate cannot hold hands, express affection, or show too much concern for each other lest they incur the wrath, curiosity, or derision of the floor staff. Because of these limitations on caring, much psychological pain is superimposed on the physical pain. On the other hand, if the patient is open about his lifestyle, or if his homosexuality is discovered or even suspected while he is hospitalized, he can expect to be avoided by those staff members who are unable to deal with their own anxieties about homosexuality. The presence of a homosexual person can be threatening to everyone, including professionals, who would suppress or deny their own homosexual feelings. Most of us have been taught that homosexual feelings, no matter how weak, are undesirable. Whereas the homosexual patient may merely be avoided
NURSING FORUM
307
by hospital staff, the loved one often incurs their outright hostility, for they see him as interfering where he has no business. The loved one finds himself unable to obtain information about the patient or to participate in decisions that relate to his care. At a time when his energy should be channeled into care and concern for someone he loves, it must be expended instead on bureaucratic hassles in dealing with the fact that he is not recognized as having a legitimate role to play in the situation, or on coping with devaluation of the relationship. Whatever energy is left is devoted to hiding his love instead of providing it, to dampening his feelings at a time when they most need to be expressed, and to censuring what he says and does out of fear that it will offend. To endure a hospital stay may be one of the most bitter and unpleasant of any of the oppressive experiences that homosexual persons are subject to daily. Many homosexuals express horror at the thought of having a loved one hospitalized. They fear losing control, and experience a deep sense of anger at being dismissed as a “queer friend.” One lesbian, whose mate was chronically ill with multiple sclerosis, described hospitalization as “a fragile [experience] . . . that can destroy a relationship.” The situation can become intolerable if extended, and hospital visits can become tortuous. One cannot fight an entire hospital staff while indefinitely bottling up feelings of fear, loss, and concern for the loved one. The price is paid in personal consequences : feelings of worthlessness and frustration. It is demoralizing to stand idly by, ignored, as discharge planning gets done with parents or other “blood” relatives. Probably most upsetting for a loved one is to know that in a crisis, information and decisions might be channeled to a third cousin 3,000 miles away before he himself would be con-
308
VOLUME XIV
NO. 3
1975
sulted by physicians or nurses. Any nurse who has worked on a unit that has had homosexuel patients will recognize the atmosphere I describe. Other feelings common to hospitalized homosexuals and their mates are those of helplessness and hopelessness. They feel at the mercy of the hospital and its staff, who don’t seem to care about, understand, or value homosexual relationships. Many hospital personnel believe such relationships to be immoral or abnormal and have no desire to learn more about them. Such closed, judgmental attitudes erect barriers between staff and homosexual patients, and prevent staff from relating to gay people on a human level. Surely this cannot be conducive to healing and health, mental or physical. The experience of a former client provides a clear example of the problems faced by homosexual couples during one partner’s hospitalization. My client’s mate had been admitted to an intensive care unit suffering from an acute myocardial infarction. My client was not permitted to visit his critically ill loved one because he was not considered “family.” After five days of being frustrated in his attempts to visit, he threatened to tear down the ICU if he were not admitted. The staff had him bodily removed by a security guard after telling him that he was crazy. This man came into my office beside himself with worry, and burst into tears. After interminable hassles and some help from our staff psychiatrist, who made a strategic phone call, we finally were able to arrange for him to visit. But what if his loved one had died? Nurses, doctors, and administrators had not only denied the patient major support from the person he had loved and lived with for twenty-three years, but they also created untold pain and suffering for the latter. Certainly not much can be said for the adequate assessment of patient needs by the nursing
N U R S I N G FORUM
309
personnel in this case. Such situations are heartbreaking and not a credit to our system of values. Mental Health Care Similar difficulties arise in mental health agencies. The homosexual patient is not able to choose the physician or nurses who will work with him; they are assigned. Since patients in general are often reluctant to explore the attitudes of health professionals before accepting treatment from them, homosexuals may be faced with helpers who are biased, unaccepting, and lacking in knowledge about the homosexual lifestyle. Only after a very negative experience may the homosexual discover that he will be hard put to be treated for his presenting problem without also being treated for his homosexuality. The patient becomes the victim of uninformed psychiatrists, nurses, and social workers who arbitrarily decide that he is abnormal or maladjusted by virtue of his sexual preference. Still worse, they may interpret interpersonal problems between the homosexual partners as evidence of the pathology of homosexuality. This is as logical as equating divorce with faulty heterosexuality. When one thinks of blaming heterosexual behavior for the problem in interpersonal relationships that are regularly attributed to homosexual behavior, the irrationality of this approach is evident. Many professionals lose sight of the problem at hand while they attempt to “cure” the patient of his homosexuality, and often stunned and fearful patients at least pretend to go along with the professionals’ treatment plans. These may include electroshock therapy, grueling behavioral modification procedures, or costly hours of psychoanalysis that most often do not achieve the “desired” result. Agencies that serve homosexuals often see these patients later. Many feel demoralized
310
VOLUME XIV
NO. 3
1975
and victimized, and often their basic problem remains untreated. We who have worked in alternative clinics for homosexuals have heard reports from clients of mental health professionals deliberately collaborating to destroy homosexual relationships as a desired treatment goal. That can only be described as an unethical disregard for patients’ rights. Indeed, it is one of the major reasons homosexuals have sought alternatives to traditional psychiatric treatment and why the Homophile Community Mental Health Service was founded in Boston as an alternative type of mental health agency for homosexuals. Psychoanalysts are probably the most distinguished source of this type of “destructive” treatment. Two well-known advocates are psychoanalyst authors Edrnund Bergler (Homosexuality: Disease or Way of Life, 1962) and Charles Socarides (Overt Homosexual, 1968, 1974). It was Socarides who, after the APA Board’s decision to remove homosexuality from the diagnostic manual, forced the issue to a general referendum within the association. Bergler’s book is so negative about homosexuals and homosexual relationships as to be absurd. Yet these men are highly respected within psychiatry, and their theories and attitudes have gone a long way in setting the pace and pattern of treatment for homosexuals. In no way could I imagine either psychotherapist lending support to homosexual relationships or involving the mate in treatment. Their stated goal is to help the patient recognize that the relationship is unhealthy and encourage avoidance, while encouraging heterosexual contact. While such an approach may be arguable for the few homosexuals who strongly wish to change, the fact is that most don’t, and it is they who become the victims of this
N U R S I N G FORUM
311
dominant standard of treatment. Homosexuals who seek help for quite different reasons, or for ordinary living problems, find themselves being coerced to change, while often leaving treatment with the same problem for which they came. Such misuse of therapy has enraged homosexuals across the country to the point where they stormed the convention of the American Psychiatric Association several years ago. Should the homosexual frankly state that he cannot accept the arbitrary campaign to “change” him, he may find himself simply written off as unmotivated for treatment. This is unfortunate, for after counselling several hundred homosexual persons during the last four years, I find that they seek help for the same problems generally found in the population at large, including depression, grief reactions, “marital” difficulties, psychosis, or anxiety reactions resulting from the pressures of membership in any stigmatized minority group. They may also experience temporary situational problems with parents, school, or job. Since heterosexuals also experience these afflictions, it is difficult to justify the idea that homosexuality is at the root of all life’s suffering. If that were so, I would expect many more homosexuals to flock to therapy. Instead, they gather in ever increasing numbers behind the banner of gay liberation to reclaim their rights as human beings. Helping Homosexual Patients Exercise Their Rights
The homosexual patient has every right to know if his potential care-givers are willing to accept and respect his lifestyle and relationships as at least potentially healthy alternatives to heterosexuality. He also has the right to expect that his same sex mate or close friends will be regarded as significant others, and that as such, they will be permitted to
312
VOLUME XIV
NO. 3
1975
be involved in his treatment. To help homosexual patients to exercise their rights, health professionals must seek accurate, current, and enlightened information about homosexuality. Nurses too often function under the influence of myths and stereotypes, long perpetuated by psychiatry and only recently dispelled, that make them little more knowledgeable than the person on the street. They need to reassess their basic attitudes and prejudices, first about their own sexuality and relationships, then about the sexuality of others. They should examine how they respond to homosexual persons and their relationships, understanding that such relationships are often threatening and not easily understood by a heterosexually oriented society. As nurses strive to respect and relate honestly to homosexual persons, nurse and patients alike will grow, and better care will be the outcome. The nurse, I believe, will find that those who are different from herself are not necessarily ill or abnormal ; thus, they may not automatically be candidates for a psychiatric consult. Patients, in turn, may discover that they can be considered worthwhile as they are, which is in itself therapeutic, contrasted with their past experiences in a society that often regards them as sub-human. In general, the homosexual person has the same feelings and needs as the non-homosexual; the only difference between the two is that in his intimate relationships, the homosexual~sneeds are fulfilled with someone of the same sex, who is also a person. Role of the Nurse Clinician
I believe that astute nurse clinicians can facilitate quality care for homosexual patients. The nature of their education and experience, one hopes, makes them more sensitive to the social and political issues that may affect patient care. They
NURSING FORUM
313
should be able to identify staff needs for education about homosexuality, and follow up with a training program that will assist staff to work with homosexual patients more comfortably. They should also support staff members who have particular anxieties about caring for “different” patients. As a way to relieve such anxieties, they might plan group meetings for staff members where they can express their feelings, ask questions, and exchange ideas about homosexuality. A member of the gay community could be an important resource at a meeting of this sort. Nurse clinicians should serve as role models in relating comfortably and openly with the gay patient and his significant others. Their attitudes and behavior will establish the dominant pattern for dealing with same sex relationships. Without such positive leadership and guidance, negative attitudes and behavior are certain to be reinforced, Alternatives for Treatment In the past, the response of health professionals and others within traditional treatment facilities has been distinctly negative. As a result, many homosexual persons avoided seeking health care at all, except under the most serious of circumstances. More recently though, as society has focused on homosexuality as a civil rights issue, the homosexual in need of care has had other options. In urban areas separatist clinics, which are specifically designed to serve the gay population and their families, have been established. The first two agencies, the Homophile Community Health Service in Boston and The Gay Counseling Service in Seattle, were both established in 1970, and have since been joined by more than twenty similar agencies across the country. Most began as mental health or counsel-
314
VOLUME X I V
NO. 3
1975
ing agencies founded by homosexual professionals who volunteered their services. Concurrently, these agencies dedeveloped programs to educate other professional groups, when it became clear that the topic of human sexuality was inadequately covered in medical and nursing curriculums. In 1973, the Massachusetts Gay Nurses’ Alliance conducted an informal survey among nursing and medical schools in their state and several surrounding states on how many schools offered courses or even structured seminars on human sexuality. Out of some fifty schools surveyed only three nursing schools - all with B.S. programs - gave a course or seminar on the subject and only three medical schools - Boston University, Harvard, and Tufts. Richard C . Pillard, M.D., associate professor of Psychiatry at Boston University and the medical director of the Boston Homophile Community Health Service initiated the programs in all three medical schools. Over the last two years, many gay agencies have sponsored weekly “gay health nights” to treat medical problems and to provide preventive health services such as physical examinations. Staff members are not always homosexual, but accept and support gay lifestyles. One of the most important reasons for coming to these clinics, according to their clientele, is that mates and loved ones can be involved in care, particularly if hospitalization is necessary. Within these health agencies, homosexuals have found sympathetic advocates to help them cope with the bureaucracy of traditional medical institutions, and to speak for the importance of their relationships. The demand for services proves beyond doubt the need for such facilities. The Homophile Community Health Service in Boston, in slightly more than four years of operation,
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has provided mental health services to some 4,000 clients. The weekly health night in Boston attracts as many as fifty persons. Well over 50 percent of the clients who have come to the agency with which I was associated stated on interview that they had had a previous negative experience with the traditional health-care system or a health professional. Such evidence speaks clearly to the need to place this issue squarely before the professional nursing community. Thus far, only gay agencies have provided homosexual persons with what they, as consumers, believe to be adequate health care. Homosexual patients are beginning to demand accountability for the actions of nurses. How will nurses respond? The answer must ultimately rest with those responsible for nursing education and with homosexual nurses themselves. Certainly, sexuality courses in nursing schools are to be encouraged. Students also need to be reminded that passing moral judgments is not a nursing function: such judgments can only impede the ability to give quality care. The late Dr. Howard J. Brown, former New York City Health Commissioner, publicly stated that gay patients won’t be safe within the health-care system until gay staff members can be open advocates for them. Homosexual nurses, if they dare be bold and risk alienation and job loss, can be helpful in educating the nurses with whom they work. They can confront the negative attitudes and behaviors that may be evoked by homosexual patients. Most important, they can care for openly gay patients comfortably, without burdening such patients with uptight feelings. The homosexual nurse can serve as a role model of the healthy homosexual, thereby facilitating a flow of educational information based on personal experience. This may sensitize other staff to the needs of homosexual patients, and help them meet those needs
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without prejudice. The Gay Nurses’ Alliance is attempting to deal with the problems that homosexual patients and nurses now face. It seems appropriate that nursing, the profession closest to the patient, should lead the way. The estimated 20 million homosexuals in the United States are all potential patients. They and their loved ones will continue to suffer indignities and degradation, psychologically if not physically, unless all nurses work to minimize homophobia.
REFERENCES Bergler, Edniund, Homosexuality: Disease or Way of Life? (Paperback), New York: Collier-Mcmillan, 1962. Socarides, Charles, Overt Homosexual: Psychoanalytic Study, New York: Grune, 1968. Overt Homosexual (Reprint), J. Aronson, 1974. Stoller, Robert J. et al., “A Symposium - Should Homosexuality be a Diagnosis?’’ American Journal of Psychiatry, Vol. 130, No. 1 1 , November, 1973, pp. 1207-1216. Tripp, C. A., The Homosexual Matrix, New York: McGrawHill Book Co., 1975.
BIBLIOGRAPHY Fisher, Peter, The Gay Mysrique, New York: Stein and Day, 1972. Martin, Del and Phyllis Lyons, Lesbian Woman, San Francisco: Glide Publications, 1972. Megenity, Jean, “A Plea For Sex Education in Nursing Curriculums,’’ American Journal of Nursing, Vol. 75, No. 7, July, 1975, p. 1171. Miller, Merle, O n Being Different, New York: Random House, 1971. Weinberg, Martin S. and Colin J. Williams, Male Homosexuals: Their Problems and Adapationr, New York: Oxford University Press, 1974. Weinberg, George, Society and the Healthy Homosexual, New York: St. Martin’s Press, 1972.
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