More About the Author
I am a Harvard-trained psychiatrist who has been in full private practice in Boston and New York City, and active in residency training programs at several hospitals, including Massachusetts General and Beth Israel in New York. I have also served as Assistant Clinical Professor of Psychiatry at Mount Sinai Medical School and as Clinical Assistant Professor of Psychiatry at the University of Medicine and Dentistry of New Jersey--New Jersey Medical School. I am the author of some 20 other books, including: Now That You're Out: The Challenges and Joys of Living as a Gay Man (2011), The Essential Guide to Overcoming Avoidant Personality Disorder (2010), Homophobia: State of Sexual bigotry Today; Uncle Sam's Shame, Inside our Broken Veterans Administration (2008), Lifting the Weight: Understanding Depression in Men, Its Causes and Solutions (2007), The Psychopathy of Everyday Life: How Antisocial Personality Disorder Affects All of Us (2006); Together Forever (2005), Understanding Paranoia; A Guide for Professional, Families, and Sufferers (2004); Distancing: Avoidant Personality Disorder, Revised and Expanded (2003), My Guy (2002), Passive-Aggression: A Guide for the Therapist, the Patient, and the Victim (2002), and Treating Emotional Disorder in Gay Men (1999)
In my book on homophobia I advance the thesis that due to the civil rights and gay pride movements, new antidiscrimination laws, and the liberalization of large segments of society, today's homophobia/sexual prejudice differs substantially from the homophobia/sexual prejudice of just 10 years ago.
Today's homophobia is much less openly aggressive than as recently as a decade ago. For in today's social climate, raw aggressive homophobia has generally yielded to subtle passive-aggressive homohatred. Then gays and lesbians were being hunted down and killed; today they are being targeted more as a group than as individuals. Fewer lives are being taken, more are "just" being ruined.
Consistent with the current tendency not to "hate" but to "debate," "hot topics" of homophobia have assumed center stage: gay marriage; gay civil rights; gay adoption; gays and lesbians being accepted into the military, ministry, and Boy Scouts; gays and lesbians having equality of employment in the civilian sector; fears of gay pedophilia (gays as boy scouts, gays and lesbians as teachers), and being gay as an individual choice as distinct from being gay as an inborn biological trait or "defect." All discussions about these issues rest on a single and singular hateful assumption and come to the same conclusion: gays and lesbians, being second-class citizens, and inherently defective, are not to be accorded full equality with straights.
In my book I view and attempt to understand homophobia as a neurotic or psychotic symptom, much like any other phobia, or delusion.
Therefore understanding the development and dynamics of homophobia through and through is the first step in coping with and mastering it.
Methods for identifying, understanding and coping with homophobia are directly applicable to understanding all others forms of bigotry ranging from xenophobia to racism.
The goal of this book is to help gay and lesbian individuals; therapists; educators; and the community to learn to identify and thoroughly understand the new homophobia/sexual prejudice and how to combat it through magic bullet antitheses precisely directed to its specific subtypes.
I believe that the two main writers today on homophobia fail to fully plumb its psychodynamic depths as they generally overlook the relationship between homophobia and familiar emotional disorder, particularly paranoia. Gregory Herek focuses on social causes, and Byrne Fone focuses on historical development. In my opinion, today's homophobia is prevailingly although not exclusively paranoid in substance and passive-aggressive in implementation. I classify the different homophobias according to which mental disorder they most closely parallel. While some homophobia is environmentally determined, serious homophobes show signs of being mentally ill, e.g. they express a personal paranoia passive-aggressively. Also the same cognitive errors that spin off paranoia, or depression, are responsible for creating homohatred.
In focusing away from the superficial view of homophobia as a strictly social/behavioral phenomenon and onto understanding its connection to familiar psychopathology, paranoia in particular, but depression and obsessive-compulsion as well, theses for developing effective antitheses to homohatred can evolve based on time-tested therapeutic methods for dealing with familiar emotional disorder, e.g. methods for handling paranoia.
Different models of homophobia exist. The medical model avers that being gay is the same thing as being sick and the religion model avers that being gay involves being a sinner. Each model relates to the hot topics of today such as gay marriage, gay adoption, and being gay as a choice.
I also discuss self-homophobia, rife in today's gay and lesbian community, and hypersensitivity to homophobia leading to falsely accusing others of being homophobic for personal/emotional reasons or as part of an activism admirable in goal but questionable in method. I caution gays and lesbians not to imagine a homophobia that doesn't exist due to hypersensitivity bordering on paranoia or an activist's need for social struggle.
I discuss the horrific effects of homophobia on gays and lesbians; and how self-homophobia (incorrectly called "introjected homophobia") is as devastating as social homophobia. I also offer homophobes and their victims specific antitheses to cope with and master sexual prejudice.
In summary today's homophobia is more subtle, more passive aggressive than it used to be but it still sends the message that gays and lesbians are second class citizens. Identifying the new homophobia and understanding it through and through is the royal road to coping and achieving full equality through challenge and mastery.
In my book The Essential Guide for Overcoming AvPD, I note that AvPD is an extremely widespread, devastating disorder that generally goes unrecognized or if recognized becomes somewhat distorted by what scientific literature there is on the topic, leaving therapists mystified about how to diagnose and treat it, and patients and other sufferers at a loss as to what is wrong, and how to go about correcting it.
In this book have an extensive section on diagnosis, emphasizing what the DSM-IV and others including myself consider to be the basic criteria for making the diagnosis of AvPD. I then explore development of AvPD and present a holistic view of its causation from the psychoanalytic, cognitive-behavioral, and interpersonal vantage points. I next discuss the various therapies for AvPD, suggesting that they be combined into a specific form of intervention that in its totality I call "avoidance reduction." Finally I present a crossover section written both as a guide for psychotherapists and as a self-help guide for sufferers, concluding with a day by day, one step at a time, month-long guide on how to overcome AvPD.
In my book Uncle Sam's Shame, I note that the VA system of delivering medical care to our emotionally and physically injured veterans is broken, but it can be fixed.
However, if it is to be fixed we need not more lay or professional bureaucratic oversight in the form of committees trying to identify the problems or the press speculating on solutions. We need to enlist in the endeavor the best possible source for true reform: knowledgeable individual clinicians and those clinically oriented who appreciate the workings of the VA from the inside as prior employees and even ex-patients, and who are given the power to make the necessary changes.
I go out on a limb to write a insider's tell-all exposé that identifies the real problems in today's VA and offers practical doable solutions drawn both from my long and extensive clinical experience as a psychiatrist and more specifically from two stints totaling 5 years actually working as a psychiatrist in the system.
My major points are:
Some aspects of VA medicine are characterized by a degree of serious neglect and mismanagement.
Ineffective oversight trickles down from Washington, some untrained and less than fully able nonmedical and medical administrators rule on a regional level, an at times poorly functioning ancillary staff composed of some bored clerks and some diffident secretaries at best add to the laxness and system wide ennui and disinterest, and some poorly trained and diffident doctors hold the vets' lives and wellbeing in hands that do not always have the firmest grasp.
Also involved in the system-wide breakdown are the veterans themselves, some of whom actively participate in the bad medical care that they complain they are receiving, and so need to take the measure of their contribution to the problem and become part of the solution.
Instead of getting to the bottom of what causes the breakdown, too many experts are trying to bring about symptomatic cures, as they pay too much attention to all the ancillary problems with the vets' medical care, such as the lack of availability of records and the crumbling walls, while paying too little heed to the nature and quality of the medical care itself.
Too often committees take on the job of fixing the medical care even though everyone knows that notoriously they set out to make a horse only to instead create a camel. They do have many good suggestions, but these often involve compromises and even those are too rarely actually implementable because they are too broad and too general, e.g. "establish a center of excellence."
Abetting the inadequate approach to reform is a muckraking press speaking in generalities, about only a few of the problems and not necessarily about the most significant ones, e.g. the compromised physical facilities. I focus away from the superficialities and go beyond documenting what is easy to spot and describe (e.g. the paint is peeling, we need more money) to focus on what is not immediately obvious but most notable and central: the compromised medical care itself. I also emphasize the breakdown of care for vets returning from the war in Iraq and Afghanistan though the care is broken for all the vets in the system, in fact for the majority, starting with those who returned from WWII and including the forgotten vets such as those who fought in Grenada and Beirut. Also the press speaks only of problems in treating a few signature illnesses from which vets suffer, particularly Posttraumatic Stress Disorder and traumatic brain injury, though vets have a number of other illnesses, e.g. depression, which are being sorely neglected, misdiagnosed, and improperly treated. Too often the press looks down upon the system from the outside, and untutored medically, and influenced by hidden personal and political agendas, ranging from a too liberal to a too conservative ideology, and possessed of governmental ties that can influence neutrality, gets it wrong.
I focus on the specifics from an insider's point of view as I go into the actual compromised care that the vets are too often receiving and complaining about without much effect.
I conclude by going into the many positive things about the VA, which I note not only because they provide us with a strong basis for reform but because they are also there.
Committees cannot come up with the answers if there are enough of them and they meet often enough. No, committees come up with not with answers but with tepid suggestions based on compromises. The medical care for vets is already tepid and compromised enough. That is why I attempt to bypass the problem of bureaucratic foxes watching equally bureaucratic henhouses by using my experience, knowledge and insight to suggest real remedies likely to improve the climate, efficiency and functionality of this important system of medical care delivery. I have no special interests beyond helping our service men and women attain the maximum emotional and physical health of which they are capable.
More money is not the answer. No, rather the money is there but it has to be disbursed correctly so that most if not all of it goes to improving the disordered medical care--curing that disease not just relieving a few of its symptoms. For fixing the accoutrements of medical care (e.g. computerizing the records) is insufficient. We have to improve what goes actually goes on between doctor and patient. Easier said than done, that is an endpoint and as such requires creative involvement from all the components of the VA from Washington on top down to the clerks and secretaries who also figure prominently in the vets' medical care.
However reluctantly, and though politically incorrect, I do something that few if any other authors have done: place some of the responsibility for the poor medical care vets are receiving on the vets themselves, but only so that I can go on to suggest ways that they can better relate to the system in order to make the system relate better to them.
Vets are not strictly the passive recipients of bad medical care. No, as happens everyplace else in the medical care marketplace, vets tend to be active (if only partially so) participants in the problematic medical treatment that so many of them receive. That is the good news, because it provides us with a ready fix: the vet can help the system do more to help him or her feel better.
In conclusion, the objective of this book is to help Washington, the VA staff, the vets themselves and the general public understand the shortcoming of VA medicine today beyond what they read in the newspapers so that all concerned can chip in to help improve the medical care that all the vets, and not just those returning from Iraq and Afighanistan, are receiving. I reveal exactly how everyone--Washington, veterans, advocacy groups, the various members of the VA staff including the doctors, the nonmedical and medical administration, the clerks and the rest of the ancillary staff, and the vets themselves are all together responsible for the breakdown of the system, for all contribute a share to creating that endpoint: a severe state of havoc with the vets' medical care. I describe some of the signature illness from which vets suffer, and pinpoint exactly how the system specifically manages to mismanage these making already serious medical problems even worse by hitting the sore vet exactly in the spot where it hurts the most. I envision what a more ideal VA of the future might look like, advancing specific doable improvements that will assure that this future actually comes about. I conclude with a description of the more positive aspects of the system, to offer a platform upon which to build meaningful reform.
My insider's exposé of the broken VA system goes from Washington boardroom to local treatment rooms to detail how all concerned, from the VA doctors to the vets themselves, compromise the current VA system of medical care delivery and what needs to be done to make the necessary repairs.