Psychiatry, social control, and homosexuality : clients' perceptions of therapeutic care in the decades following demedicalization

In 1973, homosexuality was offically demedicalized. However, the effects of this change on the therapeutic relationship between psychiatrists and their gay or lesbian clients has been largely unexplored. Using clients' perspectives obtained through in-depth interviews, this study examines how psychiatric control was perceived to operate in the therapeutic relationship between six gay men and three lesbians and their psychiatrists. Employing Michel Foucault's concept of objectification, the findings of this thesis indicate that, as perceived by the clients, the primary means that psychiatrists used to police them was medicalization. Clients perceived psychiatrists as attempting to impose their definitions of 'normal' sexual behavior through the following strategies of policing: defining homosexuality as a problem, normalization (conversion), denial, avoidance, hostility, lack of support, and sexualization of the homosexual. Although some psychiatrists appear to be becoming more accepting of a homosexual lifestyle, the findings of this study indicate that the clients perceived their psychiatrists as continuing to treat homosexuality as a form of deviance in spite of official demedicalization. This perceived stance is partly attributable to the psychiatrists' apparent lack of knowledge about homosexual-related matters. Nevertheless, the psychiatrists' approach did not foster a therapeutic atmosphere perceived as safe by the clients. Hence, most clients were unable to get their needs as gay men and lesbians met. In response to the perceived homophobic or heterosexist attitudes of their psychiatrists, some clients were silenced. Most of the clients, however, responded with various strategies of resistance, including: formulating their own definitions of their problems, self-educating, withholding relevant personal information, educating psychiatrists about homosexual-related matters, refusing treatment, terminating therapy, and speaking out about negative therapeutic experiences. Overall, clients' resistance operated in a dialectical manner. Clients' acts of resistance emerged out their needs to retain a sense of themselves when confronting psychiatric definitions of homosexuality which they perceived as challenging their very identities as gay men or lesbians. The knowledge gained from their resistances came to inform and ultimately strengthen the clients' sense of themselves