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Article Excerpt
There is renewed interest in the relationship between homosexual identities and mental health (Cochran, Sullivan, & Mays, 2003; de Graaf, Sandfort & ten Have, 2006; Meyer, 2003; Omoto & Kurtzman, 2006; Sandfort, de Graaf, & Bijl, 2003; Sandfort, de Graaf, Bijl, & Schnabel, 2001) and continuing controversy regarding the use of reparative therapies with lesbian, gay, and bisexual populations (Jenkins & Johnston, 2004; Gonsiorek, 2004; Spitzer, 2003; Zucker, 2003). Heterosexually married men who have sex with men (MMSM) are a key research population in these ongoing debates.
Same-sex sexual behaviors may result from a variety of motivations and may or may not be associated with primary, or exclusive, homosexual interests and behaviors (Dickemann, 1995; Malcolm, 2000). Married men who have sex with men (MMSM) are difficult to study as their same-sex interests and behavior often are clandestine, inhibiting research participation; and, within this population, the often confusing and contradictory relationship between sexual behaviors and identity labels is magnified. While some MMSM conceptualize themselves as gay, others prefer to self-identify as bisexual or heterosexual but their marital status, sexual behaviors, and sexual identity labels may not necessarily be concordant. (Matteson, 1985; Ross, 1983).
There appear to be distinct subpopulations among MMSM (Malcolm, 2000). Some men who have primary same-sex interests and behavior pursue heterosexual marriages due to difficulties in self-acceptance of those same-sex interests but may, nonetheless, engage in homosexual behavior during the marriage. The men may not necessarily self-identify as homosexual while married. Other heterosexually married men have sex with men for a variety of motivations, but their heterosexual interests and behaviors remain primary (Malcolm, 2000; Ross, 1984, 1990). Of critical relevance to the current debates regarding homosexuality, mental health, and the use of reparative therapies is whether the mental health of these men (or some of them) is impaired either by their same-sex sexual behaviours or by their pursuit of homosexual sexual identities.
This article is concerned with the relationship among sexual identity, marital status, and mental health among current and formerly heterosexually married men who have sex with men; and with theoretical and measurement issues that arise in attempting to portray sexual identity development processes in this population.
Homosexual Identity Formation
The formation of lesbian and gay identities has typically been viewed as a staged developmental process (Brady & Busse, 1994; Cass, 1979, 1984, 1990; Coleman, 1982; Meyer & Schwitzer, 1999; Troiden, 1989). Although the various models differ in the number of stages, their defining characteristics, and transitional mechanisms, they all characterize gay and lesbian identity formation as the gradual acceptance of the social and psychological consequences of socially stigmatized erotic desires and the incorporation of those desires into a positive view of the self.
The dominant model, formulated by Cass (1979), has six stages: "identity confusion" (inner turmoil and personal alienation); "identity comparison" (tentative commitment to the homosexual self); "identity tolerance" (increasing commitment to a homosexual identity and seeking contact with like others); "identity acceptance" (a positive view of homosexuality begins to develop); "identity pride" (strong identification as homosexual and anger with broader society); and "identity synthesis" (settling of identity with decrease in both shame and anger). Progress through each of the six stages is associated with increasing levels of intrapersonal and interpersonal congruence in which psychological and social adjustment is associated with higher levels of homosexual identity formation. Cass's model stresses public affirmation as a central component of the process. Other formulations (Brady & Busse, 1994; Troiden, 1989) have indicated that psychological adjustment is more associated with self-acceptance of a gay or lesbian identity, than with public affirmation of that identity.
Brady and Busse (1994) suggest that their data do not support the notion that "there are major psychological gains to 'coming out' to people other than intimate friends and family" (p. 13). Rather, coming out more publicly is associated with other factors that cannot be attributed to the resolution of homosexual identity. These factors may include place of residence, occupation, sex role socialization, or previous trauma experiences related to sexuality. Personality issues and social-cognitive capacities, such as Bieri's (1955) concept of "cognitive complexity," which refers to individuals' capacity to develop and maintain multiple self-constructs, may also play a part in the coming-out process. Brady and Busse found few differences in psychological adjustment among respondents in stages 4, 5, and 6 of Cass's HIF model, but they did find that respondents in these three stages were generally more psychologically adjusted than the sum of men in the earlier stages. Brady and Busse redefine Cass's model into two critical "metastages," with Stage I equivalent to Cass's stages 1, 2, and 3 and Stage II equivalent to stages 4, 5, and 6. They maintain that the "key differences between Stage I and Stage II are whether or not an individual has resolved a coherent self-identity as homosexual and has a sense of where they belong as homosexuals" (1994, p. 13).
This perspective represents a marked difference from Cass's original formulation, where, to reach the final stage of 'identity synthesis' (stage 6), the individual must move through stage 5 (identity pride), in which immersion in homosexual subculture becomes a primary focus. Nevertheless Brady and Busse's perspective is consistent with HIF being an orderly developmental process where there is a staged incremental progression in the degree of self-acceptance and presumably psychological adjustment. The significant difference with Cass's model is whether self-acceptance is dependent upon full...
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