Alan Schwartz

Special Issue on Homelessness and the Transgender Homeless Population

Special Issue on Homelessness and the Transgender Homeless Population Shane S. Spicerabc; Alan Schwartzd; Mary E. Barberef a College of Physicians and Surgeons, Columbia University, New York, New York b The Lesbian, Gay, Bisexual and Transgender Community Center, New York, New York c Private Practice, New York, New York, USA d William Alanson White Psychoanalytic Institute, and Private Practice, New York, New York, USA e Rockland Psychiatric Center, Orangeburg, New York f Columbia College of Physicians and Surgeons, New York, New York, USA

Mental Health Issues in LGBT Seniors

Despite their increasing numbers, older lesbian, gay, bisexual, and transgender (LGBT) adults have mental health needs that remain poorly characterized and treated. This special issue of the Journal of Gay & Lesbian Mental Health, featuring the 2010 Association of Gay and Lesbian Psychiatrists Annual Symposium, aims to address this deficiency by presenting the case of an older gay man with depression and substance use problems, discussing diagnostic, treatment, and management considerations. The case presentation and discussion highlight the need for clinicians to think broadly about the multiple components of mental health in older LGBT adults, with awareness of the historical, developmental, and social contexts that shape their well-being. This discussion also describes the frustrations, quandaries, and opportunities inherent in providing care to an older adult patient with multiple co-morbidities that have become reinforced, in part, by the invisibility and stigma many older LGBT adults experience. The case presentation by Howard Rubin, MD, of an 83-year-old gay man whom he co-treated with David Ortmann, LCSW, followed by a discussion paper by Daniel Hicks, MD, address an understudied topic in LGBT mental health: that of substance abuse in older LGBT persons and, more generally, mental health and well-being in older LGBT persons. Written from a clinical perspective, this section can be read in a multitude of ways: a case history of a patient with depression and co-morbid substance misuse, a candid account of a split treatment with a characterologically challenged patient, a

An Inside Look: Appreciating the Complexity of Gender Identity

The American Psychiatric Association (APA) has been undergoing the process of examining the scientific literature and revising the Diagnostic and Statistical Manual of Mental Disorders (DSM), its official manual of mental disorders, since the late 1990s. This is a monumental project, with a 15-year timeline. One of APA’s stated goals in writing the anticipated DSM-5 is to rigorously examine the recent literature and apply new insights to the revised manual. Reviews of earlier DSM editions resulted in the removal of the diagnoses of homosexuality and later ego-dystonic homosexuality (Drescher & Merlino, 2007). The depathologization of homosexuality has had far-reaching effects, not only on the mental health community or gay and lesbian patients but also on the culture (Bayer, 1981). Asserting that homosexuality was not a mental illness was one important factor in moving the wider culture toward more acceptance of gay and lesbian people. Gender Identity Disorder (GID; APA, 2000) is a diagnosis under review for the DSM-5. In nondiagnostic language, this applies to some people under the wide umbrella of transgender identities. Understandably, the transgender community, as well as many in the lesbian and gay community, are interested to know about the process behind considering whether to continue, modify, or delete the GID diagnosis from the DSM-5. Who is making recommendations and on what basis? Who will make the final decision? Will my/our opinion be heard? In this issue of JGLMH , we have the opportunity to reflect on the complexity of the issues surrounding the future of this diagnosis.

The Growing Regulation of Conversion Therapy

Conversion therapies are any treatments, including individual talk therapy, behavioral (e.g. aversive stimuli), group therapy or milieu (e.g. retreats or inpatient treatments relying on all of the above methods) treatments, which attempt to change an individuals sexual orientation from homosexual to heterosexual. However these practices have been repudiated by major mental health organizations because of increasing evidence that they are ineffective and may cause harm to patients and their families who fail to change. At present, California, New Jersey, Oregon, Illinois, Washington, DC, and the Canadian Province of Ontario have passed legislation banning conversion therapy for minors and an increasing number of US States are considering similar bans. In April 2015, the Obama administration also called for a ban on conversion therapies for minors. The growing trend toward banning conversion therapies creates challenges for licensing boards and ethics committees, most of which are unfamiliar with the issues raised by complaints against conversion therapists. This paper reviews the history of conversion therapy practices as well as clinical, ethical and research issues they raise. With this information, state licensing boards, ethics committees and other regulatory bodies will be better able to adjudicate complaints from members of the public who have been exposed to conversion therapies.

Growing the Research Base

This is an exciting time for lesbian, gay, bisexual, and transgender (LGBT) health and mental health research. The Joint Commission (TJC), the main accreditation body for hospitals, has recognized the need for medical treatment to be culturally competent in order to be accessible and effective (The Joint Commission, 2010). TJC has included sexual and gender minorities among cultural groups that medical professionals need to show competence in treating. In turn, the Institute of Medicine (IOM, 2011) issued a report reviewing the current evidence that LGBT populations carry higher risk of health and mental health problems and called for more and better research on LGBT people. In roughly a generation, the scholarship on LGBT health and mental health has gone from the level of anecdotal clinical reports, to small studies done with convenience samples, to data taken from representative sample surveys and even the U.S. Census. Having the weight of government agencies and regulatory bodies behind this work will certainly continue to push the knowledge base forward. In the service of asking different questions at different levels of detail, we still need clinical data and convenience sample studies. The good thing about all this attention is that with it comes the ability not only to support larger, comprehensive studies but also the willingness of more academic institutions to support smaller and more specific efforts as well. The Journal of Gay & Lesbian Mental Health (JGLMH) has no doubt benefited the growing number of investigators who are able to study LGBT mental health. This issue includes no fewer than four original research

The Full Spectrum

This issue of the Journal of Gay & Lesbian Mental Health marks the beginning of our fourth year as editors. We strive to continue to grow the Journal’s breadth, depth, and quality, seeking to portray the full spectrum of LGBT lives, as well as the full array of mental health issues and services used by LGBT people. In the first Journal issue of 2012, we offer papers on a variety of topics, from educating the public and professionals about LGBT issues, to papers on clinical treatment and clinical research, to the interface of transgender identity and trans people’s portrayal in the media. In the opening paper, “A Critical Review of Assumptions About Gender Variant Children in Psychological Research,” authors Sarah Gray, Alice Carter, and Heidi Levitt write of the need for a sense of context and culture in approaching gender atypical children. Noting that research on gender variant children has typically narrowly focused on whether the children will grow up to be gay or transgender, the authors suggest a different approach might be in order. Such an approach would consider the child in the context of her environment, culture, and relationships and would focus on mental health and adjustment as outcomes rather than solely focusing on gender and sexual identity. The authors review the existing literature through this lens, and we hope their viewpoint will stimulate more dialogue on this important topic. We are pleased to include the proceedings of the 2010 John E. Fryer Award lecture in this issue. Evan Wolfson, founder and director of Freedom to Marry, has turned his riveting 2010 Boston address on winning marriage for gay and lesbian couples into an equally compelling paper. The topic is particularly meaningful given New York’s marriage victory this past summer. Wolfson was given the Fryer Award, which honors an individual who has

Same-Sex Marriage and Mental Health

The collection of papers, “Same-Sex Marriage and Mental Health,” was originally presented as a symposium at the American Psychiatric Association annual meeting in May 2011 in Honolulu, Hawaii. Marriage for gay couples is currently one of the most salient topics in lesbian, gay, bisexual, and transgender (LGBT) activism. The term “same-sex marriage” is not ideal, as it implies that same-sex couples are different or separate from other couples, but it is commonly used phrase. Relationships between marriage and mental health abound. Starting with Jack Drescher’s article “The Removal of Homosexuality from the DSM: Its Impact on Today’s Marriage Equality Debate,” we take a look at the events leading up to the acceptance of homosexuality within the psychiatric field and the impact this has had on our current political environment. Marriage in the United States is, at its heart, two fundamentally different things. It is at once both the state-sanctioned acknowledgment of a couple’s relationship and a gate-keeping mechanism for the provision of social resources such as health care and survivor benefits. Within the same-sex marriage debate, marriage is stressed as a stabilizing force that protects mental health. Robert M. Kertzner’s piece entitled “A Mental Health Research Perspective on Marital Rights and Civil Marriage for Lesbians and Gay Men” reviews studies linking mental health and civil marriage and discusses the important role of research as a tool for advancing public policy. Just as crucial is the work of campaigning for change to existing marriage laws. In her article “Advocating for Marriage and LGBT Mental Health Through Op-Eds,” Mary E. Barber describes the process by which she and others worked to publish

Interview with Lawrence D. Mass, MD

In this interview with physician, activist, and writer Lawrence D. Mass, MD, the story of Dr. Masss development and entry into medicine at a time of cultural revolution unfolds, illustrating how social forces shaped his drive to write and act toward powerful social change. The initial stimulus for this activism was Masss experience with psychiatry during the decade that followed the APA declassification of homosexuality as a mental disorder in 1973–74. The impact of the emergence of AIDS on this process is examined, illustrating Masss key role in discovering, making public and helping those afflicted by AIDS. His exploration of the impact of other forms of discrimination, including anti-Semitism, through his writing is also discussed.

Special Issue In Translation: Clinical Dialogues Spanning the Transgender Spectrum

The mental health profession has a long way to go before it can represent itself as both understanding the complexities of gender identity and providing gender-nonconforming individuals with the best possible care in all realms: from helping individuals who present with an understandable uncertainty and wealth of misinformation about their own doubts about their gender, to helping those who are certain about their own gender incongruity access a panoply of mental health and medical services, to just plain offering competent psychotherapy to gender-nonconforming people which originates from a position of compassion, understanding, and lack of judgment or prejudice and offers clients the same self-scrutinizing, countertransference examining, thoughtful care that we aim to provide all of our clients. One organization, Gay and Lesbian Affirmative Psychotherapy (GLAP) of the Institute for

‘Tis Better to Give Than to Receive: A Patient's Transformational Use of Gifts in an Analytic Therapy

The author discusses William Lubarts paper “Hans and Me: Transformation of Revulsion in the Countertransference within an Analytic Therapy.” In the treatment, Hans gives gifts to the therapist, both material and affective, and the therapists intentional and unintentional responses to these gifts are a critical factor in facilitating their work through impasse in the treatment. After examining the possible meanings and impacts of the various explicit gifts in the treatment, the author considers how, through the process of projective identification, the patient “gives the gift” of his shame to the therapist and how this forces the therapist to attend to it in a manner which helps both the patient and the therapist to grow.