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Homophobia Is Not a Disease, So Let’s Stop Treating It Like One

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A controversial study concluded homophobia might be linked to mental health disorders and should be treated as a disease. But is pathologizing prejudice helpful?

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Photo Illustration by Sarah Rogers/The Daily Beast

Researchers in Italy recently stirred up a minor shitstorm with the release of their study, “Psychoticism, Immature Defense Mechanisms and a Fearful Attachment Style are Associated with a Higher Homophobic Attitude,” published in The Journal of Sexual Medicine.

Many reporters noted the “remarkable” link between homophobic attitudes and psychoticism, a concept not well understood among the general public, but which the authors wrote in their paper is “considered a possible predictor of psychotic states, such as schizophrenia.”

Researchers gave questionnaires to 560 psychology students at the University of Rome; the surveys included Italian versions of the SCL-90-R, the Relationship Questionnaire, and the Homophobia Scale (HS). For the HS portion, participants rated their agreement on a scale of one to five for statements such as “Gay people make me nervous,” and “I enjoy the company of gay people.”

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“After our empirical analysis, we found that psychoticism represents an important risk factor for homophobic attitude,” lead author Emmanuele A. Jannini, M.D., professor of endocrinology and medical sexology at the department of systems medicine at Tor Vergata, University of Rome, and president of the Italian Society of Andrology and Sexual Medicine, told The Daily Beast in an email. “Psychoticism characterizes many aspects of human thought in a dysfunctional way, as a decrease of metacognition and mentalization. The severity of psychoticism is considered a possible predictor for psychiatric disease.”

The researchers also note an association between “immature” defense mechanisms, such as projection and denial, and homophobic attitudes.

The authors write, “To our knowledge, this is the first study assessing both the psychologic and psychopathologic characteristics that could have a predictive in homophobia development. In fact, we found that psychoticism represented an important risk factor for homophobia, demonstrating that pathologic personality traits are involved in homophobic attitudes.”

But some say concluding from this that homophobic attitudes might be a “marker” for future or hidden psychiatric disorders is an overstatement. For a variety of reasons, this was a “modest study with a lot of ambiguities,” says Gregory M. Herek, Ph.D., professor of psychology and an expert in prejudice and sexual orientation at the University of California, Davis.

“There are no empirical data that suggests homophobia is some sort of mental illness, and that includes this study,” Herek says.

The college students studied were between 18 and 30 years old with a mean age of 22. Seventy percent of them were female, which is typical of psych majors, and 408 of the 560 identified as Catholic.

Psychology students are often required—or at least encouraged—to serve as research subjects in studies conducted by their professors, which means drawing conclusions about society at large from them can get a little dicey. That’s particularly true in this case.

Previous research supports the idea that religion, particularly fundamentalism, is one of the biggest factors in prejudice against gays and lesbians. So asking a bunch of young Italian Catholics what they think about things might not necessarily reflect people in general—especially when many of the things they’re asked to consider have religious implications.

“That more students who scored high on the homophobic scale got somewhat higher scores on a checklist that includes things like, ‘Having thoughts about sex bothers you a lot,’ or ‘Feeling that people should be punished for their sins’ isn’t surprising,” Herek says. “It could reflect that this was a heavily Catholic, Italian sampling more than it might be reflective of their risk of developing schizophrenia. A mentally healthy person could be experiencing any of these things, perhaps especially a religious person.”

The SCL-90-R symptom checklist the researchers used to measure psychoticism includes many symptoms that well-adjusted people routinely experience, such as headaches, difficulty sleeping, muscle soreness, and “feeling inferior to others,” Herek says.

The SCL-90-R likely has a normal range and a threshold above which symptoms enter the pathological range, says John Mayer, Ph.D., professor of psychology at the University of New Hampshire in Durham.

“Psychoticism has a provocative meaning,” he says. “But psychoticism has a ‘normal range.’ We all vary along psychoticism, just as we do on extraversion and neuroticism, and there is a band of possible scores that people relatively free of mental disorders might score on.”

“If high homophobia responses did correlate with psychoticism, and psychoticism scores indicate a tendency to suffer from schizophrenic symptoms, then some connection between schizophrenia and homophobic responses might be possible,” Mayer continues. “So I don’t think it’s entirely outlandish. But it’s unclear to me how many of the people in the study who exhibited homophobic responses actually met clinical criteria for psychosis.”

People who suffer from schizophrenia also score high on these tests, Herek says, “but that doesn’t mean that these respondents are necessarily at risk for psychiatric disorders.”

Another finding in this study was a high correlation between low homophobia and depression.

“Subjects using neurotic defenses have a lower level of anxiety and psychological distress and this second type of defenses appears sufficiently to contrast homophobic attitude,” Jannini says.

In the paper, the authors write, “If we suppose that subjects with a high level of psychoticism perceive external reality as a threat and project their anger, for example, against homosexual people, people with depressive traits could direct the anger mainly against themselves.”

Interesting, but no one made a big a deal out of that part of the study.

“‘People unlikely to be homophobic are often depressed’ could have just as easily been the headline for reports on this study,” Herek says. “But that wouldn’t sell as well.”

Some of the study’s limitations aside, the research also raises the question: What is the value of labeling people homophobic?

“I don’t want to denigrate the term, but it can be limiting for researchers who want to study this phenomenon,” Herek says. “It carries a lot of baggage that is unnecessary and misleading. The big problem is the phobia suffix; it conveys an implicit assumption that it’s a clinical entity.”

Mayer agrees: “The disease label is not particularly useful in either case; it’s more productive to talk about attitudes, cultural teachings, and, perhaps, personality traits that incline people to believe and behave one way or another, as opposed to using diagnostic labels.”

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