Scientific Study

For most of human history, the origins of homosexuality did not elicit scientific interest. Neither was homosexuality treated as a pathological state. Instead, homosexuality was evaluated in moral and religious terms, and it was often condemned. In nineteenth-century Europe, however, many researchers and physicians began to study homosexuality in a systematic way and treat it as pathological. Describing homosexuality as a disease or disorder laid the foundations for discovering its causes and for developing treatments. For a variety of reasons, these researchers were often more interested in the origins and treatment of male homosexuality than female homosexuality. This emphasis may have resulted from greater social visibility of male homosexuality and a bias toward the selection of male subjects in medicine.

Many studies worked to show that homosexuality represented a kind of degenerate or defective human biology (Kraft-Ebing). Locating the origins of homosexuality in biology did not, however, always impose a pathological interpretation. For example, the German sex researcher Karl Heinrich Ulrichs (1825-1895) argued that homosexual men and women represented a third sex, and he offered an elaborate account of how the biological natures of men and women were blended in this sexual variation (Ulrichs). This view led Ulrichs to argue that homosexual men and women should not be punished by the law or mistreated by medicine for acting according to their biological natures (Hirschfeld).

Biology was only one field of study, of course, and not all theorists held that biology dictated the nature of one's sexual interests. Many psychologists looked to experiences in development for the factors that determined the nature and scope of homosexuality in men and women (Ellis). By contrast, the father of psychoanalysis, Sigmund Freud (1856-1939), drew no sharp distinctions between biology and psychology. He looked rather to an interplay of psychology and biology, believing that some people developed homosexually for psychological reasons, while biology played a more decisive role in the sexual development of others (Freud, 1953). In any case, Freud did not think that homosexuality was inherently pathological, though he did not think it represented full sexual maturity.

In the United States, organized psychiatry in the twentieth century first affirmed, and later repudiated, the view that homosexuality was pathological (Bayer). In 1952 the

American Psychiatric Association (APA) described its categories of disease for the first time, and it labeled homosexuality as a "sociopathic personality disorder" (APA, 1952). A 1968 revision of this classification described homosexuality as a "personality disorder," and in 1973 the APA formally abandoned the view that homosexuality was pathological. Yet another revision, in 1980, led the APA to identify homosexuality as an "ego-dystonic disorder," meaning that it could be treated as a disorder if an individual suffered from it. There is no specific mention of homosexuality in the most recent versions of the APA diagnostic nomenclature, but the APA does recognize "sexual orientation distress," which involves persistent and marked distress about sexual orientation (APA, 1994). However, sexual orientation distress would apply to all unwanted and distressing orientations, not just homosexuality. In 1981 the World Health Organization removed homosexuality from its list of diseases. Despite this sea change in the views of the medical profession generally, some physicians and psychologists still maintain that homosexuality is a serious disorder.

Even after the APA depathologized homosexuality, debates about the relationship of homosexuality to health, disease, and illness continued. Some commentators in bioethics tried to describe health and disease in naturalist, or objective, terms that transcended cultural and social variation. These commentators described disease in terms of impediments to the central species functions of survival and reproduction. Heart dysfunction, for example, poses a threat to individual survival no matter the culture in which it occurs. Other commentators were not persuaded that categories of disease and health could be identified apart from moral evaluations about the worth and merit of particular states. For these normativist commentators, human moral evaluations always played a role in determining how a given society defined its states of disease and health (Engelhardt). From either the naturalist or normativist perspectives, it is hard to make the case that homosexuality is necessarily pathological.

Arguing from a naturalist perspective, the philosopher Christopher Boorse has maintained that homosexuality can be treated as a disease because of its interference with reproduction—whatever else it is, homosexuality is sterile (Boorse). In fact, however, homosexuality does not rule out having children, and some cultures manage to accommodate the marriage and parenting of people whose sexuality is primarily homosexual.

It is also doubtful that homosexuality is always a threat to species survival. Sociobiologists have hypothesized that homosexuality might even confer survival advantages to groups, since homosexual men and women may play roles in a society that offset any reduced number of children they might have (Ruse). As to their own survival, homosexual men and women may face individual health risks that others do not, but these risks may be tied to social circumstance rather than to homosexuality itself. For example, even if homosexual men face increased risks of disease and death, those risks are contingent, in the sense that successful treatments and vaccines could significantly dispel the danger.

As for normativist evaluations, it is clear that many men and women embrace their homosexuality without complication, and many cultures have also accommodated those people in one way or another. It is therefore hard to argue that—all other things being equal—homosexuality must lead to disorder and suffering. This is not to deny that some people and some cultures may disapprove of homosexuality, but the variance of response seems to show that it is not homosexuality per se, but how it is valued and treated that sometimes provokes its designation as disease.

For most of human history, medicine did not think of homosexuality in terms of disease. As both naturalist and normativist approaches show, what counts as disease—and what therefore deserves biomedical study and treatment— very much depends on one's theoretical starting points.

More recent commentary has challenged not the roles of health and disease in the study of homosexuality, but the very idea that homosexuality has root causes that science can discover. Indeed, the very fluidity of sexuality—both in individuals and in the sexual roles of various cultures—leads some commentators to maintain that sexual orientations are socially constructed. In this view, there are no homosexuals or heterosexuals in the sense that these are distinct kinds of people (Halperin). It would therefore be a mistake to look for genetic or hormonal causes of sexual orientation, just as it would be a mistake to study the biology of human beings in order to learn why some people are baseball fans and some people are not. Circumstance and society shape baseball fans, not human nature, and some commentators, known as social constructionists, hold the same view of sexual orientation.

In contrast, essentialists argue that human beings have sexual orientations by reason of their given nature, and that sexual orientation is likely rooted in biology. In other words, people are of natural kinds in regard to their sexual nature, and there are homosexuals and heterosexuals in the same way that there are elm trees and maple trees or people with blue eyes and people with brown eyes. From this perspective, sexual orientation amounts to an essential trait, and people express sexuality according to their natural kind (Stein). To essentialists, it is not a mistake to search out the root causes that distinguish people by sexual orientation.

The scientific study of fantasies, desires, and behaviors does not commit social-science researchers to either social constructionism or essentialism. It is possible to study many aspects of sexual psychology and behavior whether sexual orientation is rooted in nature or is simply a reflection of habits and patterns that people acquire in the course of their social development. However, the debate between constructionism and essentialism does have important implications for the causal study of sexual interests. It would be a mistake to look for the root biological causes of sexual interest where they do not exist.There is no well-validated account of how human beings come to have the entrenched sexual interests they have, though it is clear that genetics, anatomy, hormones, and psychological history all play a role. So it is not unscientific to ask why homosexuality comes to the fore in some people, why heterosexuality comes to the fore in others, and why others blend their sexual interests. There may well be genes or neurological features that dispose some people to the sexual interests they have. To be sure, there may be dubious motives behind some researchers' quest to understand the pathways of sexual development, but it is not unscientific to investigate the origins and determinants of sexual orientation.

The origins of sexuality—and homosexuality in particular—have attracted a good deal of scientific interest. Researchers across the life sciences have looked to see whether homosexual men and women have traits in body or mind that others do not have, and to learn whether those traits are causally connected to their sexual interests. Researchers have looked at body shape, the nervous system, hormones, genetics, and so on to discern the influences behind sexual orientation. They have also looked at psychological and behavioral differences, including the ability to whistle, the preference for certain colors, and relationships with family members (LeVay, 1996). There has been no shortage of studies along these lines, and contemporary researchers have continued to add to this domain of research.

In 1991 the neuroanatomist Simon LeVay published a report showing that some brain structures in homosexual men are statistically smaller than the same structures in heterosexual men. But because the size of these structures does not correspond exactly with sexual orientation, this study could not establish any definitive link between neuroanatomy and sexual interests. In 1993 the geneticist Dean Hamer and colleagues published a study showing that homosexual men are more likely than others to have male homosexual relatives, and the pattern of distribution of these male homosexual relatives suggests a genetic inheritance passed through mothers. The study also showed that male homosexual brothers are more likely to share a genetic region in common than nonhomosexual brothers, which also suggests there is a genetic contribution to sexual orientation. Again, however, because this shared genetic region does not correspond exactly with sexual orientation, these patterns do not prove that there is a "gay gene."

Both the LeVay and Hamer studies are preliminary and suggestive, but they are not definitive. Some commentators have nevertheless interpreted these studies as showing that homosexuality is natural, in the sense that there is a describ-able biology behind it (LeVay, 1993). These commentators think scientific study will protect homosexuality from social condemnation by confirming it as part of human biological nature. Others fear that these studies will revive theories that homosexuality is pathological (Bersani).

Where there is scientific uncertainty, there will be speculation and disagreement. For this reason, many analysts turn to ethics rather than science as a guide to the meaning and significance of homosexuality. Ethical analysis of homosexuality has a far longer history than its scientific study, and it will continue to have a role as the findings of science unfold.

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