Until now, I have not published guest articles nor have I published articles unrelated to massage therapy. However, I recently read a paper on gay men, addiction, and post traumatic stress disorder that presented an idea so important that I strongly felt it should be more widely read. As massage therapists, we encounter clients who may seek massage to relieve anxiety and depression and this information could be directly relevant to us.
The author is my long time friend Jeffrey Schneider, volunteer and outreach coordinator for the San Francisco Zen Center. Jeffrey wrote the paper as part of his training to be a drug and alcohol abuse counselor. The paper puts forth the idea that post traumatic stress disorder, caused by growing up in a world where young gay men live in constant fear, may be an unrecognized factor in drug and alcohol addiction in gay men.
The ideas contained in the paper are important ones to be considered. They are relevant to counselors, psychotherapists, and other professionals who work with gay men who may have problems with addiction. In addition, this information is important for the gay community as a whole. Finally, this is something all of us should be aware of, for we are all touched by these issues in one way or another. Recognition of these potential factors may help lead to more effective treatment for gay men who suffer from addiction and could help in the prevention of substance abuse. And perhaps, as the pain and trauma endured by growing young gay men is more deeply understood, it will help to create a world where all children can live without this kind of fear.
I hope that by publishing this paper the ideas put forth will get the attention and careful consideration that they deserve. Permission is granted by the author and by this website to share this paper freely as long as proper attribution is given to the author, Jeffrey Schneider. I hope this paper, and the ideas it contains, will become widely read in the recovery community, the gay community, and among the population at large.
Jeffrey Schneider can be reached at Jeffrey.firstname.lastname@example.org.
November 3, 2008
PTSD as a Possible Determining Factor in Addiction in Gay Men
The Heart asks Pleasure ---first---
And then---Excuse from Pain---
And then---those little Anodynes
That deaden suffering---
And then---to go to sleep---
And then---if it should be
The will of its Inquisitor
The privilege to die---
As a gay kid growing up in grade school and high school and even in college I always felt like a spy trying to pass behind enemy lines or like I was walking through a mine field. Anyone, any time could call me out. Being a sissy or a faggot, there was no appeal because it was ok to give queers hell the way it wasn’t any longer to give it to black people or other traditional targets. I felt isolated, alone and always afraid.
(Robert S. Personal communication, 2008)
A bunch of football players from my high school beat a gay man to death. They were given probation. The younger brother of one of them was in my class and used to call me ‘faggot.’ I was always afraid and tried as much as possible to be invisible. To a large extent I still do.
(Paul S. Personal communication, 2008.)
The above quotations illustrate the experience of many gay men growing up in a culture which tells them, either directly or through innuendo, humor or subliminal messages that they are sick, immoral, disgusting, sinful or depraved. The lessons are early and constant, usually beginning well before the child has even quite understood how exactly he is different and therefore bad. It is the premise of this paper that such an environment creates not only alienation, but can lead to post-traumatic stress disorder and consequently to substance abuse and dependence as a mode of self-soothing. Much of the literature seems to bear this out: The boundaries of the self are violated by stigma, prejudice, and chemicals. For example, closeted LGBT people are assaulted daily by the casual cruelty of slurs and jokes. In addition, as people are “made deviant” by the culture and as unacceptable and as people’s abuse of chemicals separates them from the “normal” world” the connections with self or other are damaged or ruptured. Ultimately, they may end up feeling they are not worthy of connection. (Finnegan and McNally, 2002)
In researching this paper, however, I was surprised to discover very little dealing directly with this specific topic in the peer-reviewed journals (i.e. with the connection between cultural homophobia-induced PTSD and substance abuse disorders). What I am presenting here is therefore my own efforts to combine information about post traumatic stress disorder with available information about the effects of homophobia (both external and internalized) and of substance abuse.
There are two important considerations in the case of gay men which are useful to note. First, unlike members of other oppressed minorities (ethnic, religious, etc.) who may find succor from a threatening world in the bonds of family or religious community, gay men are often isolated from (and frequently threatened by) those who in other cases might be expected to provide respite from a hostile world. (The homophobia of most religious bodies in this country is a matter of indisputable and public fact.) The pervasive sense of alienation cannot but help have severe emotional consequences well past childhood. The individual is essentially “atomized”--- belonging nowhere, bereft of any socially supportive group.
The second consideration is that transgression from traditional gender roles (especially in childhood) has much more severe consequences for boys than for girls. As an example: I was recently visiting St. Louis. On a walk, I passed a grocery store bearing the name “Tom Boy.” I remembered it being a fairly widespread chain in my childhood, with the logo of a pigtailed, freckle-faced girl. It struck me how impossible it was that a grocery store (or anything else) would have been named “Sissy.” Obviously, since it is better to be a boy than a girl, it is acceptable for a girl to adopt boyish characteristics. It is dire for a boy to be girlish. A feminist critique of this social phenomenon is too obvious to comment on here.
The nature of PTSD in the DSM-IV-TR is described in part as consisting of the following:
. . .the person experienced, witnessed, or was confronted with and event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others. . . [and] the person’s response involved fear, helplessness or horror.
This definition suggests either a catastrophic single or closely spaced multiple events----rape, the near continuous horrors of war or captivity, etc.
However, in her book Trauma and Recovery Judith Herman suggests an expanded understanding of trauma:
In survivors of prolonged, repeated trauma, the symptom picture is often far more complex. Survivors of prolonged abuse develop characteristic personality changes, including deformations of relatedness and identity. Survivors of abuse in childhood develop similar problems with relationships and identity; in addition, they are particularly vulnerable to repeated harm, both self-inflicted and at the hands of other. The current formulation of post-traumatic stress disorder fails to capture either the protean symptomatic manifestations of prolonged, repeated trauma or the profound deformations of personality that occur in captivity. (Herman, 1997)
Trauma and its stress disorder can be the result of not a single overwhelming event, but of an ongoing attack on the basic security of the person. Those who are subjected to long-term harassment, violence (threatened or actual, physical, verbal, spiritual or emotional), or attacks on the basic structure of identity can suffer from PTSD as surely as the victim of rape, abduction or any other single cataclysmic event. It is my contention that many gay men in this country exhibit symptoms of this syndrome, including (most pertinently for this paper) substance abuse and dependence. While there may be some criticism of the idea that people “self-medicate” with drugs and alcohol as analgesics against psychic pain, the anecdotal evidence seems to me convincing.
A recent article would seem to support this:
Men, singles and those aged 30 and younger are more likely than other groups in the general population to use psychoactive substances to cope with psychiatric symptoms a large population-based study . . . suggests. (Worchester, 2008).
Once again, we must put together the puzzle pieces. Gay men, especially under 30, are more likely to be single than not. Considering the enormous social barriers to forming and maintaining stable same-sex unions and that until very recently the main (and in some areas only) place to meet other gay men was bars, it is not surprising that alcohol abuse has been a significant factor in the life of the gay community.
Although I said above that there is relatively little written about the subject as such, I was able to find an article that makes some interesting connections:
Participants [824 lesbian, gay and bisexual individuals] who were classified as having at lest one alcohol or drug use disorder were significantly more likely to have experienced heterosexism and internalized homophobia than those who were not classified as having a substance abuse disorder. (Weber 2008)
Authors of three studies have examined the relationship between internalized homophobia and substance use and abuse (Amadio & Chung 2004; Jaffe, Clance, Nichols & Ernshoff, 2000 Kus, 1988), and most reported that substance use and abuse in the LGBT community can be attributed to the internalization of anti-gay bias, which is “found in every sector in our society: legal, medical, scientific, religious, political, social, educational, and judicial.” (Cabaj, 2000). (Weber, 2008)
Given the nature of a homophobic culture, the inevitable alienation of gay men from that culture (including the ever-present threat---or reality---of various forms of physical or psychic violence), the nature of PTSD, and the observed and documented use of AOD as a method of coping, what is surprising is not the we find self-medicating behavior in gay men, but that we do not find a larger population of barely functional alcoholics and drug addicts. It speaks well to the survival strategies of this population that so many gay men are able to achieve some balance and grace in their lives against such difficult odds. The two men quoted at the beginning of this paper are both in recovery from drug and alcohol abuse. Both still struggle with the profound emotional and cognitive issues brought about by the damaging effects of growing up in homophobic environments.
The conclusion I draw is that while healing is possible, it requires attention not only to the AOD-seeking and abusing behaviors, but also to the personal trauma brought on by early abuse from the dominant culture. Something like a reinvention of the self is demanded, turning from seeing oneself as damaged goods. This can be accomplished with great effort, professional and personal, and ideally within a sustaining community of others who are walking the same path.
American Psychiatric Association (2000). Quick Reference to the Diagnostic Criteria from DSM-IV_TR. Arlington, Virginia
Herman, Judith (1997). Trauma and Recovery. New York, NY. BasicBooks
Finnegan, Dana and McNally, Emily (2000). Counseling Lesbian, Gay, Bisexual and Transgender Substance Abusers: Dual Identities. Birmingham, NY: The Haworth Press, Inc.
Weber, Genevieve N. (2008). “Using to Numb the Pain: Substance Use and Abuse Among Lesbian, Gay and Bisexual Individuals” Journal of Mental Health Counseling, January 2008
Worchster, Sharon (2008) “Three Groups More Likely to Self-medicate” Clinical Psychiatry News, March 2008