Adolescent Homosexuality

Presented by Dr. Sander Breiner

at the NARTH Conference, November, 2004

Adolescent Homosexuality
I. A normal state of flux
The adolescent years are usually spoken of as a unit, where there are
generalities and even specifics that cover the entire teen time frame.
Just as it is obvious in a group two-year-olds are significantly different
than one-year-olds; but that 22-year-olds are very similar to 23-yearolds. We can recognize there are significant differences within a two
year age range throughout the preteen and teen years. In addition to
the variances by age there are significant variances that have a
genetic quality, a familial social quality, and the societal social quality.
It is important to keep these concepts in mind when looking at the
subject in general as well as any specific clinical entity. These words
have been said before, but commonly not applied.
II. Organic change
Neuroscientists believe that the developing brain of the adolescent is
significantly influenced by external emotional and social factors.
Pubertal maturation starts in the brain and continues through
adolescence. There are significant changes in the volume and structure
of the gray matter of the brain. For example, frontal gray matter
reaches maximum volume about 11 years of age in girls and 12 years
of age in boys. The dorsal lateral prefrontal cortex which is important
in impulse control does not reach final adult dimensions until 25 years
of age. It is also true that normal brain maturation along with
reorganization of the brain occurs in response (to some degree) due to
social ex-periences. The gray matter of the frontal lobe increases
markedly to its maximum in the pubertal time frame. This area of the
brain is vital in determining social responses. It is reorganized and
slowly decreases somewhat in size during the adolescent time frame.
This neural plasticity has extensive synaptic pruning in the prefrontal
cortex during adolescence. In addition, the neurotransmitter systems
do not become fully mature until adulthood. (Dahl, 2004) Certain
modifying factors such as stress (physical and psychological),
nutrition, and exercise (including sports) can have a significant effect
on the activity and development of the reproductive axis and on the
timing of the pubertal awakening of this axis.

The stress referred to can lead to a suppression of reproductive

function by increasing the inhibitory drive to gonadotropin hormone
neurons. This can lead to less stimulation of ovarian and testicular
function. If the stress is chronic there can be complete suppression of
this reproductive axis. "Gonadal steroid hormones modulate activity of
a number of neurotransmitter systems, which project throughout the
brain and play central roles in regulating many higher order brain
functions, including cognitive functions and the emotional regulation."
Therefore, chronic stress from the pre-pubertal through the post
pubertal can impair the development of both females and males, even
delaying the development of the reproductive capacity and
development of secondary sexual characteristics. (Dahl, 2004)
The forebrain of the adolescent is uniquely sensitive to environmental
stimuli which can affect the functional organization of the various
systems in the brain. The preceding statements are the result of
extensive neurological and brain imaging studies.
III. Prepubertal Sexuality (Age 10 to 12)
Before physical sexual maturity is attained sexual identity is not fully
established; in fact there is a shifting or ambiguous sexual identity
(which is within normal social limits as the norm). This is usually more
apparent in girls than boys. The normal maturational experiences postpuberty stimulate the integration processes. This momentum in the
direction of a given sexual identity can be lost due to the preceding
factors. This can lead to identity crisis (with marked anxiety and
depression) and/or identity confusion. For example, a boy with this
experience at puberty may feel a sense of isolation and narcissistic
hurts, which can lead him to the formation of a homosexual orientation
by identifying with a male homosexual who functions as male egoideal. (Blos, 1979)
Males
In addition to the significant physical growth spurt that has taken
place, these youngsters will have increasingly bonded with each other
in more advanced group sports. They also are forming strong
identification with male models; not only in their families but in the
sports and other direct and indirect contacts. The identifications with
these models is important for their security, self-esteem and
establishing their identity as males.
Females
Girls in this age range are more physiologically, psychologically and
neurologically advanced than boys.

They tend to have a more secure bonding with each other as well as
with female models. Families and societies that have a more positive
attitude about females are in a more stable position than their male
counterparts. If the families and society tend to denigrate females,
they now enter a period of greater stress.
This is the time of life for both males and females where they are
entering into the turmoil that is known as a secondary Oedipal time
frame. Just as in the primary Oedipal experience, the resolution
involves a homosexual identification with a parent (or surrogate) of the
same-sex. Identification requires a feeling of love (affection) for that
individual.
IV. Puberty (Ages 12 to 14)
Males
This period of time has more inner turmoil than any other period of
time between 10 to 20 years of age. The later teens may demonstrate
more turmoil and actual friction with society, but the inner turmoil is
less. The young male is dealing with the insecurities of sexual
awareness, sexual social functioning, increased identification with male
models, and giving up unconscious homosexual attachments.
Difficulties in this time frame preventing this resolution, can lead to
repercussions that may take years to work through.
Females
If we can assume a normal positive response by family and society to
women, then these girls will come through this phase of life quite well.
They normally will be in an intense positive relationship with their
mother (or surrogate); with the safety of hostile expressions in conflict
repeatedly expressed that is short-lived (normally lasting only
minutes). The open affection between females is considered a positive
normal attribute; while in males it is usually considered effeminate,
weak and not masculine. Thus it is easier for a pubertal girl to
maintain homosexual affectionate feelings and still see herself as
becoming a sexually mature heterosexual woman.
V. Adolescence (Ages 14 to 16)
Males
This is practice time. Though insecure in who they are; they normally
know what they want to be. Whatever distorts their normal
identifications (models), social/psychological perceptions of females,
and stability in their family can usually have conflictual effects in their
development for the next few years.

It is normal to have friction between the teen and the male parent (or
surrogate) of short duration. If it isn't safe to do this at home, the next
safest place will be school. If it isn't safe there, it will be externalized
to society. Though homosexual contacts by females in this period are
treated as normal, the male may see it in a different light. In addition,
if the male becomes frightened of these aggressive/frictional responses
they may defensively turn to increased homosexual orientation, as a
protective haven.
VI. Homosexuality
In exploring any symptoms or behavioral expression is important to
take a multifaceted approach. This should include the evaluation of ego
functioning, particularly looking at the level of libidinal fixation or
regression, as well as a stage of maturation fixation or aggression in
general development of the ego. The processes by which this symptom
or behavioral expression is developed, is vital to understanding of the
issue. Finally, in evaluating the ego structure of an individual we need
to know how the ego is functioning in other areas, particularly in its
object relations. (Socarides, 1990)
Therefore, the homosexual inclination or behavior can be an
expression of Oedipal and or pre-Oedipal material. It can be an
unconscious conflict resolution from the earliest aspects of the ego
development to a higher-level of ego organization.
The pre-Oedipal dynamics in that form of homosexual conflict
resolution tends to move closer to the projective defensive and
paranoid expression.
The incomplete resolution of conflicts that is expressed by even the
higher levels of ego organized homosexuality can be seen in the
marked frequency of instability in the homosexual "marriages." These
commitments usually do not the last more than two years. There are,
during the "commitment," frequent "adulterous" relationships. This
clearly indicates how it is almost a certainty that homosexual behavior
is an attempt to resolve unconscious conflicts prior to five years of
age.
The earlier in ego development where there are fixations due to
unresolved conflicts, the closer that individual is to experiences of
narcissistic injury. This can be experienced and expressed as
narcissistic rage (in gross or more subtle form) to a therapist; or
anyone who takes a therapeutic response to homosexuality.

It can even take the direction against anyone who responds to

homosexuality as a problem and not a normal way of functioning.
It is obvious that the higher the level of ego organization (Oedipal),
the better the prognosis in resolution of the underlying conflict.
However, like in all therapeutic (analytic) relationships, the motivation
of the patient to understand and resolve their internal conflicts is the
most important element for a successful outcome. Anything that
counters such a motivation is not only counterproductive but actually
has a constrictive inhibitory quality. Therefore, it is incumbent on all
reasonable people to support those individuals with homosexual
symptomatology to work towards a solution of that problem. It is the
opposite of helpful to attempt to treat such symptomatology as
normal; thereby reducing the individual's motivation for help.
A difficulty occurs when reasonable people wish to protect
homosexuals from legal and illegal abuse gather under the umbrella of
various like-minded organizations. What often results is a collection of
individuals with more serious ego defects (early/primitive points of
fixation, incomplete maturation) under the same umbrella
organization. The result can be destructive or at least injurious to
society and individuals. It can be a significant contributory factor to
the many negative responses to the usual family structure
(heterosexual marriage and children). The so-called "freedom of
choice" has become an invitation for increased sexual promiscuity, and
results in the increase of sexually transmitted disease.
One of the important dynamic constructions is the sadomasochistic
conflict. For example, the passive homosexual with masochistic
inclinations will give up a power or maturational position for the sake
of love; while those with a more sadistic defensive construction may
take a more paranoid type of response and give up love for what they
feel is power (hostility) Since there is a known connection between
homosexuality and paranoia we can see some elements of this in some
of the groups hostility to those who see homosexuality as a
social/psychological problem. This can be dangerous for society and
counterproductive in any scientific group of discourse.
An interesting clinical point is seen in the not surprising finding of the
tendency of the distrustful to paranoid individual to experience and
express hostility related to those who don't agree with them, as if they
are the victims. We have seen this in the politically active homosexual
groups in social, political, and scientific organizations.

Not surprisingly, there is even a tendency to express their homosexual

position in grandiose terms. This has resulted in the following:
Currently there is a great deal of literature going around to the
nation's schools that has been prepared by homosexual teachers. This
material tells children that they have "legitimate sexual alternatives."
This may not create homosexuals; but certainly will contribute to any
sense of insecurity and gender role doubts that are normal in children
(especially pubertal and early teens). Instead of contributing to their
freedom to think and feel and explore their world; it can significantly
contribute to their anxiety and confusion. Teenagers commonly
experience homosexual feelings and even a homosexual experience.
This usually leads to a normal heterosexual development. The
preceding literature of "legitimate sexual alternatives" can only add to
their doubts, insecurity and depression. It will increase the tendency
toward suicide. Please recall the earlier comments about the potential
organic brain effects of this type of stress.
Currently the gay/lesbian community is presenting the concept that
homosexuality can be a normal and reasonable choice. The material on
the subject, with that opinion, is being offered to many school systems
in United States. Therefore, many students in high school and college
who experience conflict and anxiety about their sexual feelings and
activities with the opposite sex may take the less tension-evoking
position of seeing themselves as "bisexual ." It is not uncommon
during the teenage years for individuals to struggle with their
homosexual and heterosexual fantasies (both conscious and
unconscious). This may even result in some homosexual activity. This
is not unusual in the normal transition from adolescence to the adult
world for those teens who are basically heterosexual. However, for
those who are like the preceding group with marked sexual tensions,
they may move to a "bisexual" defensive position, particularly when it
is enhanced by some of the current literature from the gay/lesbian
community. For those teenagers who find their homosexual fantasies
and feelings ego dystonic, they are more likely to more easily work
through this period of tension and discomfort. Support from the
gay/lesbian community in accepting their homosexual feelings as ego
syntonic will make their transition to full heterosexuality more difficult
and tension laden. It may take these individuals years to recognize
their fundamental heterosexual position. (Socarides, 1965, 1979)
What effect it has on brain development and the sexual/hormonal
neuronal axis is likely to be significant.
VII. Diagnosis of Teen Homosexual Problems

1. The total absence of masturbation or late onset of masturbation

with no manifest heterosexual interests.
2. Homosexual behavior through adolescence with the absence of any
significant anxiety or guilt or obvious conflict, along with perverse
fantasies.
3. Lack of true Oedipal relationships in any aspect of the child's
history.
4. Homosexual fantasies with no heterosexual socializing with a quiet
interpersonal attitude and absence of the emotional fluctuations and
liability typical of this age.
5. Hostility to their own libidinal urges and absence of feelings about
sex.
6. Some homosexual contact with the resentment to growing up and a
tendency to suppress other instinctual demands.
7. Persistent homosexual contact past early adolescence.
8. Homosexual relationship with an adult.
9. When the adolescent fully states, "I know I'm a homosexual, I just
feel it."
VIII. Therapy
Since the world of the child is its immediate family, that family needs
to be taken into serious consideration. A pre-pubertal age to 16-yearold child should be seen differently than a child who is one step away
from the more adult world or away from home at college, etc.
Therefore, see the patient and the two parents together, then
individually. If there are other individuals living in the home it can be
very valuable seeing them to get a clearer picture of the family
dynamics. From this vantage point a therapeutic program that is fitted
to these unique circumstances can be offered. If the boy is no longer a
small child, but is an older teen, then the parents' major influence and
impact on his life is past. Their most important contribution to his life
now, and in the future, is in their loving kindness towards him and in
his awareness of the parents respect for him.

The knowledge that his parents care for each other; and that there is
an intact loving family, always there for him, are now their major
contributions to his welfare.
At this point in his life parents can't "want" things for him. He must
want things for himself. Parents can't want him to be a doctor, and be
successful in that endeavor, if he wants to be an architect. His parents
can't wish him to be celibate if he wishes to marry. So, they can't want
him to be heterosexual if he wishes to be homosexual. However, if he
feels a homosexual orientation, but wishes to be heterosexual then
their support coinciding with his wants can often come to a successful
conclusion of a heterosexual orientation. But we must keep in mind
that his sincere desires for heterosexual orientation must originate
within him, and not be based on compliance with parents' desires.
The most important issue is the affection between parent and child
throughout the many years of their relationship. The maintenance of
that positive relationship; and the health and welfare of the
participants is the most important issue of all.
Despite the term "gay," depression is a common conscious and
unconscious experience of most homosexuals, both male and female.
Is the individual's major concern their depression or their homosexual
orientation? If the concern is primarily of their homosexual orientation;
and they wish to understand themselves further, and thereby change
that orientation, therapy is available to assist them in that pursuit. If
their concern is their depression with homosexuality being of less
significance for them; then there is psycho-therapy to assist them in
that pursuit. Either way, the patient chooses.
Assuming that depression is the primary interest and the patient is
able to participate in intensive dynamic psychotherapy (e.g.
psychoanalysis); one can expect a favorable outcome. Since hurt self
image, injured self-esteem, and blocks of emotional freedom are
common conscious and unconscious experiences of the homosexual;
we can expect that the successful outcome in the resolution of the
depression problem will be a resumption of the normal psychosexual
development into heterosexuality, but not necessarily.
Whatever the choice, the patient decides what route they will take,
and how far they will travel. Therapy, of what ever kind is the patient's
choice, to meet their needs. The wishes of society, family, therapist, or
professional organizations do not enter into the choice. Whatever the
condi-tion, it is always the patient's freedom of choice.

The diagnosis and treatment is never determined by the symptom.

Psychologically the diagnosis is a complex understanding of the
patient's psycho dynamics. It involves the patient's psychological
development, their capacity to tolerate psychological stress without
significant decompensation, and their motivation to understand
themselves and make the appropriate changes. The type of treatment
chosen and the extent of that treatment is a decision initiated by the
patient with the therapist concurring.
The most significant factor is the patient's motivation to understand
themselves. If the motivation is to feel better; it is understandable, but
must come secondary to their desire to understand their problems and
resolve them. (Breiner, 2001)
What are the most common probable causes for male or female
homosexuality? Since homosexuality is a complex emotional and
behavioral response to a variety of internal conflicts, there is no one
good answer. However, certain facts emerge.
1. Any psychological illness of mild to serious dimensions can have a
homosexual expression; while the same problem in another individual
may have no such homosexual expression.
2. Affection and love for a member of the same sex is a normal part of
a child's psychosexual development. It is necessary to identify with
and love an adult member of the same sex as one advances in early
childhood. Without that normal experience there will be psychological
problems for that individual; but not necessarily homosexuality.
3. Since mothers are the most important person in a child's life prior to
three years of age, how she responds to that child and how the other
adults in that household respond to the mother (particularly the
father) prepares the child for its orientation to itself and future
interpersonal relations. One form of a difficulty in this childhood
experience is homosexuality as a defense against the anxiety that has
been evoked.
4. Between 15 to 20 months of age a little girl conceives of herself as a
female. Little boys are less neurologically advanced in the first three
years of life, so their identification as a male is from 18 to 24 months.
Both require the benign relationship of mother and father to them and
to each other. This is the beginning of the significance of father as a
loving caretaker for both the little girl and the little boy. This is the
basis for early gender role establishment.

5. The time between three to five years of age for both little boys and
little girls is the period for learning the basic social interactions with
their peers in play activity, as well as their participation with and
observation of their parents. Successfully passing through this time of
development permits them the final basic establishment of their sexual
role of identifying with a parent (or surrogate) of the same sex.
In summary, though any problem can lead to a homosexual
expression, the outstanding elements are: hurt self-esteem (damaged
self image), incomplete or conflicted gender role development, conflict
over identifying with a member of the same sex, and conflict over
being needful of a member of the opposite sex.
The type of treatment always depends on the patient's needs and
wishes. It should never be determined by what the therapist, the
family, or society wants. Therefore, the most effective therapy is one
based on the working relationship between the therapist and the
patient (and the patients conscious and unconscious goals) (Nicolosi,
1991). Assuming that the patient is well motivated and capable of
participating in the intense and difficult process of dynamic
psychotherapy (e.g. psychoanalysis) that procedure can have the most
beneficial result. However, whatever type of therapy that the patient
chooses, some form of insight oriented and psychologically supportive
psychotherapy should be part of it; for without such additional
psychotherapy the benefits will be temporary and/or some other form
of psychological symptomatology will emerge.
In my experience I have found that dealing with the underlying anxiety
and depression has been the most efficient way of dealing with any
problem, including homosexuality.
IX. Closing Comments
It is true that genetics do not determine one's gender orientation. It is
also true that you cannot make someone homosexual except on a
temporary basis (e.g., prison homosexuality). However, there are
certain problems that can occur related to homosexuality in the
teenage period that can have significant repercussions.
The brain that is developing (pre-puberty to adulthood), particularly in
the area that deals with emotional and sexual development, is affected
organically by social and physical stress. Homosexual indoctrination
(direct or subtle) coercive or seductive can organically affect brain and
sexual physiologic development to a modest or minimal degree.

It cannot permanently produce homosexuality. However, it can

certainly lead to a variety of difficulties commonly including hurt selfesteem, distortions in living, depression, selection of life goals, and
other problems. Though the individual may eventually select a
heterosexual life position, the preceding years of difficulties in
developing and organizing one's life are likely to have more permanent
deleterious effects. Therefore, any attitude by society and particularly
educators that homosexuality is a reasonable or alternative lifestyle
can significantly contribute to psychopathology in this vulnerable age.
References
Blos, Peter, "The Adolescent Passage," International Universities Press,
New York, 1979
Breiner, S. "Questions On Homosexuality," "Bulletin NARTH," Vol. 10,
No 1, April 2001, pp 10 -11.
Dahl, Ronald, Linda Spear Ed., "Adolescent Brain Development,"
Annals of the New York Academy of Sciences, Vol. 1021, 2004
Karasu, T. and C. Socarides, Ed., "On Sexuality: Psychoanalytic
Observations," International Universities Press, New York 1979
Nicolosi, Joseph, Reparative Therapy of Male Homosexuality, Jason
Aronson, New Jersey, 1991.
Socarides, Charles, "The Overt Homosexual," Grune and Stratton, New
York, 1968.

Updated: 24 January 2005