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The Hidden Plague

Gay people experience depression in hugely disproportionate numbers, but it was years before Andrew Solomon connected this fact to his own painful experience.

Vincent Van Gogh, Young Man with a Cap, 1888. Source: Wikimedia Commons

Vincent Van Gogh, Young Man with a Cap, 1888.

When I had my first depressive breakdown almost seven years ago, I didn’t connect it in any way to being gay. I connected it to lots of other things — my mother’s assisted suicide (in which I participated) at the end of a terrible battle with cancer; the trauma of moving back to my home city (New York) from the one where I’d lived for the previous five years (London); the high-pitched tension of publishing my first novel and going out on a book tour. I also definitely associated the breakdown with the fact that I’d recently left a long-term relationship and was single, but the fact that I was gay and single didn’t strike me as particularly significant.

When I began to research gay depression for this magazine, what I found filled me with horror and forced me to a new reckoning with myself and with elements of buried self-doubt I’d never recognized or imagine, despite five years of examination and writing about depression for a book, The Noonday Demon, which is in part an account of my own struggle with the illness.

Gay people experience depression in hugely disproportionate numbers. It is our community’s unacknowledged plague, and the only reason I can think of why we don’t hear about it more is that we are ashamed of it. But the empirical research is right out there. In one recent study of a random population sampling of almost 4,000 men between the ages of 17 and 39, 3.4% of heterosexuals had attempted suicide at some point, while almost 20% of those who had same-sex partners had attempted suicide. Another study showed that 7.3% of homosexuals had made four or more suicide attempts, as opposed to 1% of heterosexuals. There are dozens of other studies that reproduce these grave statistics. Lesbians and gay men have more depression, more panic, more substance abuse, more suicidality, and more suicide than their straight counterparts.

Many explanations have been proposed for this, some more plausible than others, but the most obvious is homophobia. Gay people are more likely than the general population to have been rejected by their families. They are more likely to have had social adjustment problems. Because of those problems, they are more likely to have dropped out of school. They have a higher rate of sexually transmitted diseases. They are less likely to be in stable couplings in their adult life. They are less likely to have committed caretakers in late life. They are more likely to be infected with HIV in the first place, and even those who are not, if they become depressed, are more likely to practice unsafe sex and contract the virus, which in turn exacerbates the depression. Most of all, they are more likely to have lived their lives furtively and to have experienced intense isolation in consequence.

Early this year, I traveled to Utrecht, in the Netherlands to meet with Theo Sandfort, who has done pioneering work on gay depression. Unsurprisingly, Sandfort has found that the rate of depression is higher for closeted people than for uncloseted people and is higher for single people than for those in stable long-term relationships. Overall, Sandfort found that the level of difficulty gay people experience in their day-to-day lives is extremely high in many subtle ways that sometimes pass unnoticed even by those they affect. For example, gay people are less likely to share information about their personal lives with others in their workplace even if they are out of the closet with those colleagues. “And this is the Netherlands,” Sandfort said, “where we are more open to gayness than almost anywhere else in the world. There is a lot of acceptance of homosexuality, but the world is still straight, and the strain of being gay in a straight world is substantial.”

Sandfort knows whereof he speaks. He had a very rough time coming out himself, suffering criticism from both parents. When he was 20, he became depressed and debilitated. He spent seven months in a psychiatric hospital, which turned around his parents’ attitudes, led him into a fresh intimacy with them, and initiated a new kind of mental health that he has since enjoyed. Because “I fell apart and put myself back together,” he said, “I know how I am made, and in consequence know a little bit of how other gay men are made, too.”

While researchers such as Sandfort have been conducting large, well-structured studies to compile correlations and numbers, the meaning of these statistics has remained somewhat confused. In two remarkable papers, “Internalized Homophobia and the Negative Therapeutic Reaction” and “Internal Homophobia and Gender-Valued Self-Esteem in the Psychoanalysis of Gay Patients,” Richard C. Friedman and Jennifer Downey write movingly of the origins and mechanisms of internalized homophobia. A recent study of socialization among gay men indicates that children who will be homosexual adults are often brought up in heterosexist and homophobic contexts and by age 6 or 7 begin to internalize the negative view of homosexuality expressed by their peers or parents. “In this situation,” Friedman and Downey write, “the patient’s developmental course was one in which early childhood was filled with self-hate, which was condensed into internalized homophobic narratives constructed during later childhood.” Internalized homophobia often originates with early childhood abuse and neglect. “Before they become sexually active with others,” Friedman and Downey write, “many children who will become gay men are labeled ‘sissy’ or ‘fag.’ They have been teased, threatened with physical violence, ostracized, and even assaulted by other boys.” Indeed, a 1998 study found that a homosexual orientation was statistically connected to having one’s property stolen or deliberately damaged in school. These painful experiences can generate an almost intractable “global and tenacious self-hatred.”

The experience of recognition that I had as I read this material was overwhelming. I suddenly remembered how hard it had been to be gay and suddenly noticed how hard it still was. I was particularly aware of having been unmasculine as a child and of having been tormented because of this. I was clumsy and unathletic; I wore glasses; I was not interested in spectator sports; I had my nose forever in a book; I formed friendships most easily with girls. I had an age-inappropriate fondness for opera. I was fascinated by glamour. I was shunned by many of my schoolmates. When I went to sleep-away camp the summer I was 10, I was teased and tormented and regularly called a faggot — a word that bewildered me, since I had not formulated sexual desires of any kind to myself. I got beaten up there a lot. By the time I was in seventh grade, the problem had become broader. At school, the watchful eye of a liberal faculty offered some protection, and I was just odd and unpopular: too academic, too uncoordinated, too artistic. On the school bus, however, brutality reigned. I can remember sitting rigidly still there, next to a blind girl with whom I’d made friends, while the entire bus chanted abuse at me, stomping their feet to the rhythm of their invective. I was an object not only of derision but also of an intense hatred that confused me as much as it pained me. This horrible period did not last very long; by the time I was in ninth grade it had all abated, and I was not unpopular (at school or, indeed, on the bus) by my senior year. But I had learned too much about abhorrence and too much about fear, and I was never again to be free of them.

Even those gay people who conform to their gender stereotypes and get through childhood relatively unscathed may be in trouble. the most interesting segment of Friedman and Downey’s work looks at patients who seem similar in their “manifest behavior to those who appear to have put the worst consequences of trauma behind them” but who are in fact severely compromised by an enduring self-loathing. Often such people will express strong prejudice toward those whose homosexuality seems to them ostentatious in some way, including, for example, queeny or effeminate men, on whom they place the scorn they feel for their own feelings of unmasculinity. They may believe, consciously or unconsciously, that they are not truly esteemed in areas entirely separate from their erotic lives — in the workplace, for example — because they believe that those who perceive them to be gay believe them to be inferior. “A negative view of the self as inadequately masculine functions asn an organizing unconscious fantasy,” Friedman and Downey write. People afflicted with these attitudes may attribute all the problems of their lives to their sexuality. Such patients come to believe that they hate themselves because they are gay.

When I first understood what homosexuality was, I knew that it would not be well tolerated within my family. In fourth grade I was taken to a psychiatrist, and years later my mother admitted she had wanted to know whether I was gay; he apparently said that I was not. I am sure that the benighted therapist would have received a commission in short order to straighten out the problem of my sexuality had he assessed it more accurately. I never told my family about the taunts at camp or at school; eventually a schoolmate told his mother about what happened on the school bus every day and his mother told my mother, who wanted to know why I hadn’t said anything to her. How could I? As I began to experience piercing sexual desire, I kept it a secret. When an adorably cute guy made a pass at me during a class trip, I thought he was just trying to get a rise out of me and that he would betray my ugly news to the world; to my eternal sadness, I rebuffed his advances. I chose instead to lose my virginity to a stranger whose name I never learned in an unsavory public location. I hated myself then. During the years that followed, I was consumed by my terrible secret, and I bifurcated myself into the helpless person who did revolting things in basement lavatories and the bright student with lots of friends who was having a great time in college.

By the time I got into my first serious relationship, when I was 24, I had incorporated bushels of unhappy experience into my sense of my sexual self. That relationship, which seems in retrospect to have bee not only surprisingly affectionate but also astonishingly straightforward, marked my transition out of an accrued misery, and for the two years that I lived with that boyfriend, I felt that light had come to the dark part of my life.

Later, I believed that my sexuality was somehow implicated in my mother’s suffering during her final illness; she hated what I was so much, and that hatred was a poison in her that seeped into me and corrupted by romantic pleasures. I cannot separate her homophobia from my own, but I know that they have both cost me dearly, even though she was in many ways a wonderful mother whose love was extremely nourishing and precious to me. When I began to feel suicidal during my first serious depression, I deliberately courted HIV, and in retrospect that seems unsurprising; it was just a way to make the internal tragedy of my desires into a physical reality.

But there is hope. “We believe,” Friedman and Downey write, “that many gay men and women truly leave the consequences of their childhood behind them, and integration into the gay subculture is instrumental in facilitating this felicitous pathway.” They write of how a positive social gay context prepares people to experience security, self-esteem, strong identity, and love.

I have always thought that the language of gay pride has dominated the gay establishment because it is in fact the opposite of what a large number of gay people experience. Gay shame is endemic. “Guilt and shame at being gay leads to self-hatred and to self-destructive behavior,” Friedman and Downey write. Many people who are gay entertain, at least for some initial stretch of time, fantasies of conversion. These are made only more difficult by a gay pride movement that finds gay shame shameful. If you are gay and feel bad about it, prideophiles will jeer at you for your embarrassment, homophobes will jeer at you for being gay, and you will be left genuinely bereft, made to feel as bad by gay tormentors as by school-yard bullies. We do indeed internalize our tormentors. Frequently, we repress the memories of how painful external homophobia was for us as we first experienced it. Gay patients will frequently discover after extended therapy profound beliefs such as “My father (or mother) always hated me because I was homosexual.” Sadly, they may be right. A New Yorker study asked a broad range of people, “Which would you prefer for your son or daughter: to be heterosexual, childless, and unmarried or somewhat unhappily married; or to be homosexual, involved in a stable, happy relationship, and have children?” More than a third of respondents chose “heterosexual, childless, and either unmarried or somewhat unhappily unmarried.” Indeed, many parents view homosexuality as a punishment visited on them for their own transgressions: It is not about the identity of their children but about their own identity.

I tend toward a gay humility that is less brassy than rainbow flag-style gay pride but that is free of the negative attributes of gay shame. I know that there are many things about my life that are, at least in part, overcompensation for lingering homophobic feelings of unmasculinity. I go skydiving, own a gun and belong to a pistol range, do Outward Bound in the summer — all to make up for the time I spend on what I still perceive to be unmasculine interests in clothes, the pursuit of art, and the erotic and emotional embrace of men. I have often described myself as bisexual and have been in three long-term relationships with women, which have occasioned great emotional and physical delight, but I think it is likely that I entered into sexual relationships with women in good part so that I might further prove my masculinity — and this has been an effort of sometimes devastating proportions. Even with men, I have sometimes tried to act out a dominance I didn’t necessarily feel, attempting to redeem my masculinity even in the gay context. I wasted a lot of time this way.

I can now recognize the elements of internalized homophobia, and I believe that I am now largely free of the burden of sadness that came to me with my sexual preferences. I have used medications and extensive therapy to treat my depression; the fact that there is a social origin for my problem does not mean I have to wait for a social solution to it. Gay depression, like all depression, responds favorably to medical, psychological, and social intervention, and those who suffer from it should seek out help as quickly and efficiently as possible. Building a better life cannot really begin until you free yourself from the most abject symptoms.

I have now been in a series of meaningful long-term relationships with men, and in my life with my last boyfriend was incredibly happy during the several years we lived together — happier than I ever hoped it would be. I think battling to see my own phobias and demons clearly has helped me to love more deeply and to value love more entirely; it has given me a self-knowledge and a capacity for intimacy I might otherwise have lacked; it has built character and has led me finally to real contentment and even great joy. In the end, I have no real complaints, but I hope that for the next ones to come this way, the passage will be a little easier.