In the few years since the original publication of Finally Out: Letting Go of Living Straight, a Psychiatrist’s Own Story, the world for gay men and women has changed more than in the sixty-seven years of my life before I wrote it, and the rate of change seems to be accelerating. When I first learned that Massachusetts on May 17, 2004, became the first US state and the sixth jurisdiction in the world to legalize same-sex marriage, I was not only surprised—I was skeptical. How can two men or two women get married; marriage is one man and one woman, isn’t it? My mind was not quite ready to grasp the concept. When I originally wrote this book, Iowa, where Doug and I live, was but one of a very few states that had legalized same-sex marriage.
Few could imagine back then that on June 26, 2015, the United States Supreme Court would hand down its landmark ruling in the case of Obergefell v. Hodges declaring that same-sex couples could legally be married in all fifty states. In a 5–4 decision the US Supreme Court ruled that states cannot prevent same-sex couples from marrying and must recognize their unions wherever their marriages take place. Justice Kennedy wrote, “They ask for equal dignity in the eyes of the law. The Constitution grants them that right.”1
These developments come with increasing acceptance of LGBTQ people in American society. The Pew Research Center reported that as of June 8, 2015, just two weeks before the US Supreme Court announced its decision to legalize same-sex marriage, support for same-sex marriage had reached a record high. In polling done by Pew research, in 2001 Americans opposed same-sex marriage by a margin of 57 percent to 35 percent; in 2016 those percentages were reversed with 55 percent supporting same sex marriage and only 37 percent opposing it.2
Support has increased among nearly all segments of the public, although some groups remain broadly opposed; while support has increased among both Republicans and Democrats, the differences between the two political parties are as wide as they were a decade ago. Greater opposition also comes from older people, people of color, religious conservatives, geographic region, and people who have limited contact with those in the LGBTQ community. The South is the only region where same-sex marriage support falls below 50 percent.3
When the Iowa Supreme Court ruled in Varnum v. Brien (2009) to allow same-sex marriage in Iowa, I often heard from friends in other parts of the country, “Iowa? Of all places.”4 Because the decision surprised so many people, Iowa played a key role in making marriage equality a national conversation. Support for same-sex marriage was no longer seen only as a liberal issue supported primarily on the coasts of the United States but an issue for all LGBTQ people, even in the heart of America.
In December 2010, the US House and Senate passed a bill repealing Don’t Ask, Don’t Tell that ended the restriction of gay, lesbian, and bisexual personnel from serving in the US military. On June 30, 2016, the military lifted its ban on transgender men and women as well.
One other important change in this book from its previous edition relates to the use of the word homosexual, which many in the LGBTQ community now find pejorative. Not only was it used historically in a clinical sense, implying pathology, but it has also been used aggressively by antigay extremists to suggest that gay people are psychologically and spiritually damaged. This word remains in this book many times, but I have tried to use it only when it has historical or clinical significance or in the context of discussions involving religious conservatives where homosexuality is used to denigrate gay men and women. I have tried to avoid its use where gay or same-sex is preferred.
Nothing that I’ve ever written has provoked as much controversy as an essay published on the Psychology Today website on July 5, 2015, called “The Messy Realities of Bisexuality.” My point in writing it was primarily to suggest that bisexuality lacks clarity in definition between attraction, behavior, and identity, but apparently not everyone shares my lack of clarity. According to GLAAD in its report In Focus: Reporting on the Bisexual Community, the definition of bisexuality is “A person who has the capacity to form enduring physical, Romantic, and/or emotional attractions to those of the same gender and to those of another gender.”5
In Focus goes on to say that people may experience bisexuality in differing ways across their life span. While I accept the legitimacy of the definition and I recognize that the B in LGBTQ is often overlooked, bisexuality is a very huge umbrella. It appears from that definition that I would be included since I have had enduring physical, Romantic, and emotional attractions to both genders, but I am far more comfortable defining myself as gay. As one of my interviewees said, “I see a woman and nothing happens, but when I see a man, something happens.” But I also understand that many others are far more comfortable defining themselves as bisexual or something else. Possibly my comfort with the label gay comes from my current life circumstances, and I can accept that under different circumstances that might change. In my small sample nearly 28 percent of the respondents to my survey, all men having sex with men, preferred some label other than gay.
Biphobia is defined as a fear of bisexuals and is often based on stereotypes including inaccurate associations with infidelity, promiscuity, and sexually transmitted diseases. I was roundly criticized in the essay for being biphobic. While I have no fear of bisexuals, I understand why some made that interpretation from what I wrote. While I don’t argue that bisexuality does not exist, I continue to believe that this label is so broadly applied—and probably misapplied—that it lacks consistency. I have tried in this edition of my book to be more sensitive to the issues facing bisexuals, and I hope that nothing in this book suggests that I am being dismissive of bisexuals.
Those 30 percent or so of Americans who resist acceptance of gay people have accelerated their pushback against the advances in LGBTQ freedoms under the rubric of religious freedom. This has generated a raft of proposed laws related to bathrooms for transgender men and women with spurious charges that the use of bathrooms according to gender identity rather than birth gender will increase sexual assaults on women and children. Although acceptance has increased, those who resist acceptance in some cases are violently intolerant. Hate and terror joined forces and collided with a culture of increasing violence on June 12, 2016, in Orlando, Florida, with the largest mass shooting and the deadliest attack on a gay target in United States history.
In a post about GLAAD’s Accelerating Acceptance report, Matt Goodman wrote that over 50 percent of non-LGBTQ Americans now believe that gay people have all the same rights as everyone else, a false and potentially dangerous impression that with marriage equality the law of the land, all the work for LGBTQ equality is now done.6 While the majority of non-LGBTQ Americans are increasingly comfortable with gay people, at the state and federal level, gay people are still discriminated against in employment, housing, and public accommodation, and these problems are compounded for aging LGBTQ. They face many consequences because of continuing negative social attitudes, including homelessness, mental illness, and violence.
Many challenges lie ahead. More than two hundred pieces of anti-LGBTQ legislation have been introduced on the state level. Many states are using the religious freedom argument to support denying services to LGBTQ people. In many places, you can marry your same-sex partner on the weekend and be fired the next week for being openly gay. Twenty-eight states lack antidiscrimination laws that include sexual orientation or gender identity, and no federal law protects access to employment, housing, and public accommodations like hotels or restaurants.
Violence continues to be a big problem in our community. In some places people believe that committing acts of violence against LGBTQ is okay, and the number of bias-motivated killings rose by 20 percent from 2014 to 2015.7 All LGBTQ people know that their safety is not guaranteed. As visibility of transgenders has increased, so has the violence directed at them, and trans people are more likely than gay men, lesbians, and bisexuals to experience poverty, discrimination, and violence.
In terms of healthcare, LGBTQ people are more likely to be uninsured, but the Affordable Care Act, known as Obamacare, prohibits anti-LGBTQ discrimination. HIV continues to ravage our community, particularly people of color and transgender people. Pre-Exposure Prophylaxis (PrEP) is a promising treatment that produces high levels of immunity in people not yet affected by HIV, but the prohibitive cost of prescriptions limits access to this option. About one-third of the estimated nine hundred thousand LGBTQ immigrants are undocumented, and they have even greater challenges in accessing adequate medical care.8
An estimated one billion people now live in countries where marriage of same-sex couples is legal, but that means that about one in seven LGBTQ people live in countries that don’t allow same-sex marriage and in many cases continue to allow people to be put to death for being gay.9 Even in those countries where there exists an increased acceptance of being gay, many men and women, for a wide variety of reasons, live deeply closeted, often lonely, and sometimes desperate lives.
For this book to remain relevant, I needed to address all of these issues.