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 THE MODERN CLINICIAN’S
GUIDE TO WORKING WITH
LGBTQ+ CLIENTS

The Modern Clinician’s Guide to Working with LGBTQ+ Clients is a ground-​

breaking resource for therapists working with LGBTQ+ clients whose iden-
tity expressions span all gender-​, sex-​, and relationship-​diverse groups.
Combining the author’s extensive clinical experience with contemporary
evidence-​based research, the chapters of this book explore the origins and
development of sexual minority groups, going beyond lesbian women and gay
men to include transgender and gender nonbinary people, kink and poly-
amory, bisexuality and pansexuality, and those who identify as asexual
or aromantic. The text also offers in-​depth coverage of clinical work with
transgender, gender-​ nonconforming, and nonbinary clients of all ages.
With a wealth of therapeutic strategies and case studies, this resource helps
professionals respond to this ‘Big Tent’ community in an informed and
empathetic way.
Spanning sexuality, gender, relationships, and age groups, The Modern
Clinician’s Guide to Working with LGBTQ+ Clients is an invaluable reference
for psychotherapists in a broad range of clinical settings.

Margaret Nichols, PhD, is a licensed psychologist, AASECT-​certified sex

therapist, and American Board of Sexology diplomate in sex therapy. She
has been a leader in the field of mental health, particularly in New Jersey,
for over 20 years. In addition to founding the Institute for Personal Growth/​
IPG Counseling, Nichols helped create the Women’s Center of Monmouth
County, NJ, one of the first battered women’s shelters in New Jersey, and
founded the Hyacinth Foundation, New Jersey’s primary HIV social service
agency. She is an internationally published author and speaker.
‘Margie Nichols has written the most useful book for clinicians to update their
skills in providing care to sexual and gender diverse individuals, couples and
families. It is extremely timely, well written, practical and useful. This is a must
read for every clinician!’
–​ Eli Coleman, PhD, professor, director and academic
chair of the Sexual Health Program in Human Sexuality,
University of Minnesota Medical School.
‘There are few people in the world as qualified as Margaret Nichols to guide
mental health practitioners in working with sexual issues. No one understands
the intersection of psychotherapy, non-​traditional sexuality, and American cul-
ture better than Margie –​a master in her craft, and a brilliant teacher whose case
descriptions and theory are instantly usable by clinicians of every background.
Read this book –​it will change the way you see your clients, yourself, and the way
you do therapy with everyone.’
–​ Marty Klein, PhD, certified sex therapist, forensic expert,
and author of Sexual Intelligence and His Porn, Her Pain.
‘If you are looking for an understanding of how LGBTQ+ people made their
journey from sinner to sick to affirmation, Dr. Nichols is the most trusted tour
guide. A pioneer way before it was imaginable or even acceptable, Dr. Nichols
creates the safe therapeutic, educational, and political space for queer people
(including kinksters and polyamorists) to take their psychological, relational, and
political seats at the table. Her personal and professional journey contained in
these pages is a tour-​de-​force of courage, persistence, and resistance. Filled with
moving rich case material interwoven with scientific insight, historical events,
and clinical advances, this book is beautifully written and describes how queer
folks overcame societal and medical prejudice to become cultural disruptors and
change agents.
Under Dr. Nichol’s influence in this powerful book, psychology and psycho-
therapy will no longer be viewed as neutral, apolitical endeavors. As Nichols bra-
zenly reveals the political in the “scientific” and “therapeutic,” we are encouraged,
even compelled to ask not what we know about sexualities and gender, but who
gets to shape the discourse. This book is a seminal contribution toward an inclu-
sive and ever-​changing understanding of queer psychologies. It should be read
and studied by clinicians of all personal and theoretical persuasions.’
–​ Suzanne Iasenza, PhD, author of Transforming Sexual
Narratives: A Relational Approach to Sex Therapy.
‘At last, Dr. Margie Nichols, one of our pioneers, has compiled a resource that
is required reading for anyone seeking to work with LGBTQ+ persons, those
involved in kink, polyamory or anyone with an alternative sexual orientation,
gender/​gender identity or relationship/​relating style. The case material along
with thorough reviews of the sociohistorical and scholarly landscape make
this book a standout among its peers. Written with hearts and smarts as well as
humanity and compassion, this volume is destined to become a seminal text.’
–​ Michael C. LaSala, PhD, LCSW, author of Coming Out, Coming Home.
 THE MODERN
CLINICIAN’S GUIDE
TO WORKING WITH
LGBTQ+ CLIENTS
The Inclusive
Psychotherapist

Margaret Nichols
First published 2021
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2021 Taylor & Francis
The right of Margaret Nichols to be identified as author of this work has been
asserted by her in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-​in-​Publication Data
Names: Nichols, Margaret Elizabeth, 1947– author.
Title: The modern clinician’s guide to working with LGBTQ+ clients:
the inclusive psychotherapist / Margaret Nichols.
Description: New York, NY : Routledge, 2021. |
Includes bibliographical references and index. |
Identifiers: LCCN 2020020046 (print) | LCCN 2020020047 (ebook) |
ISBN 9780367077297 (hardback) | ISBN 9780367077303 (paperback) |
ISBN 9780429022395 (ebook)
Subjects: LCSH: Sexual minorities–Psychology. |
Sexual minorities–Mental health. | Sex (Psychology) | Psychotherapy.
Classification: LCC RC451.4.G39 N53 2021 (print) |
LCC RC451.4.G39 (ebook) | DDC 616.890086/6–dc23
LC record available at https://lccn.loc.gov/2020020046
LC ebook record available at https://lccn.loc.gov/2020020047
ISBN: 978-​0-​367-​07729-​7 (hbk)
ISBN: 978-​0-​367-​07730-​3 (pbk)
ISBN: 978-​0-​429-​02239-​5 (ebk)
Typeset in Minion
by Newgen Publishing UK
 CONTENTS

Acknowledgments vii

Introduction: Grad School Didn’t Prepare You for This 1

1 From Bad to Mad to Civil Rights: A History of Deviance

and Acceptance of Same-​Sex Attracted People 11

2 The Roads Converge Again: How the ‘T’ Got Added to

the LGB 25

3 The ‘Big Tent’ and Intersectionality 35

4 Exactly What Are We Studying, Anyway, and What

Does It Mean? 45

5 Who Is Gay? 56

6 The Twentieth-​Century Gay and Lesbian Client 66

7 Today’s Gay or Lesbian Client 77

8 Issues of Gay Men and Boys 91

9 Gay Male Couples 103

10 Counseling Lesbian Women 116

vi Contents

11 Lesbian Couples 129

12 Bi Any Other Name: Science Grapples with

Multiple Gender Attractions 141

13 Clinical Issues of Bisexually Identified Clients 150

14 ‘Aces and Aros’: Asexuals, Aromantics, and Other

Variations on a Theme 159

15 Pansexuals, Mono vs. Multisexuals, and Sexual Fluidity 168

16 From Two Genders to Many 177

17 Working with Adult Transgender Clients 193

18 Working with the Transgender Adolescent 208

19 The Gender-​Expansive Child 223

20 Nonbinary Identities and Gender Fluidity 236

21 BDSM Comes Out of the Shadows 246

22 Working with Kinky Clients 258

23 Introduction to Consensual Nonmonogamy 276

24 Working with Clients Who Are Nonmonogamous:

And Those Who Want to Be 290

Conclusion: The Tangled Path Forward 302

Glossary of Terms 309

Appendix A: Sample Letters for Transgender Clients 317
Appendix B: Clinical Practice Guidelines for Working with People with
Kink Interests 324
Index 327
 ACKNOWLEDGMENTS

F
irst and foremost, I owe a debt of gratitude to the lesbian and gay
activists who, back in the 1970s, got homosexuality removed from the
American Psychiatric Association’s Diagnostic and Statistical Manual,
thereby effecting an overnight ‘cure’ of hundreds of thousands of people.
Without this, I quite literally would not have had my career. I was a graduate
student in psychology at the time; two years later I ‘came out’ in my depart-
ment, something that would not have been possible if being gay was still
considered a mental illness. And I certainly would not have been able to
devote my career to helping queer people had it not been for their efforts.
Second, I am indebted to the brilliant, courageous, and innovative colleagues
in those early days who created the new paradigm that was ‘gay-​affirmative
therapy.’ Prior to 1973, psychotherapy had focused on ‘curing’ homosexu-
ality. Don Clark, Betty Berzon, Vivenne Cass, John Gonsiorek, Eli Coleman,
and many others pioneered concepts like internalized homophobia, stages
of coming out, the need to validate external stigma, and the importance
of dealing with family members and creating ‘chosen families’ and a sup-
portive community. These concepts evolved into the principles of gay/​lesbian
affirmative counseling which in turn are the building blocks of all affirmative
therapies for sex and gender-​diverse people.
Closer to home, I am grateful to the many people over the years who have
encouraged me to write a book –​it took decades, but I finally did it! I owe
the most to the many clients I have worked with from 1976 to the present
who have taught me –​everything. Throughout the years, many colleagues
have educated me, encouraged me, and inspired me. My fellow therapists at
the Institute for Personal Growth have consistently and lovingly created an
environment that encourages out-​of-​the-​box thinking and the development
newgenprepdf

viii Acknowledgments

of cutting-​edge clinical interventions. I am grateful to several IPG and

former IPG colleagues who generously contributed case stories and com-
mentary for this book: Cindy Caneja, L.C.S.W., Sherill Cantrell, L.P.C., James
Fedor, Ph.D., L.C.S.W., Mike Moran, L.C.S.W., Lori Sequeira, L.P.C., and
Kelly Stolberg, L.C.S.W.
The late Dr. Sandra Leiblum trained me in sex therapy and was the first
to push me to write academic articles. My friend and colleague, the late
Michael Shernoff, L.C.S.W., inspired me in ways too numerous to describe.
For many years Michael was a primary connection to other LGBTQ+ health
care providers who were leaders in the field, and he collaborated with me
on numerous training seminars and articles. He is sorely missed for his
friendship as well as his professional acumen.
Special thanks to Dr. Michael LaSala, who offered invaluable advice upon
reading an earlier draft of this manuscript. And this book would have been
much less well written were it not for the editing efforts of Nancy Musgrave,
my life partner. Nancy has been my biggest booster and the strongest encour-
ager of my writing throughout my career. For her support, editing, and much
more, I am eternally grateful.
Finally, my children, Cory, Jesse, Alejandra, and Diana, have always
provided me with the nurturance and love I need to survive. Apologies to
Alejandra and Diana for the many hours during the writing of this book
that I have been effectively absent from their lives. They have been patient
with me beyond belief. My daughter Jesse passed away years before I began
to write this book, but her memory warms me when I am most discouraged
and downhearted.
 INTRODUCTION
Grad School Didn’t
Prepare You for This

A
recent post on one of the therapist listservs I belong to read: ‘ISO
therapist to work with lesbian couple, one partner transitioning, both
partners kinky, wanting to work on adjustment to the transition and
possibly opening up the relationship.’
This is not the gay-​affirmative psychotherapy you may have learned about
in graduate school.
In 2018, Gallup reported that:

•​ 4.5% of Americans self-​identify as gay, lesbian, or bisexual, and 11%

report some same-​sex attractions;
•​ 0.7% are transgender, and 4% identify as nonbinary;
•​ 1% identify as asexual;
•​ One in five Americans have participated in consensually nonmonogamous
relationships, 5% in the last year;
•​ More than half are interested in being dominated sexually, and 36% use
masks, blindfolds, and/​or bondage tools during sex.

In the twenty-​first century, everyone will likely meet, know, or have as a

family member someone with unconventional sex or gender behavior or
identity. And this means every therapist may have clients who diverge from
mainstream expectations of sex or gender.
If you are a therapist, this book will prepare you to work in this new world.
It will help you deal with the broad group of clients who today might be
considered ‘queer’: not just gay and lesbian clients, but transgender, nonbinary,
asexual, bisexual, pansexual, ‘mostly heterosexual,’ kinky, swinging, or poly-
amorous, to name a few. You will understand how the LGBTQ+ community
2 Introduction

has evolved over the last 50 years, why it changed in this particular direction,
and where it’s headed. You will become familiar with concepts like gender and
sexual orientation fluidity and see how many people are sex and/​or gender
diverse without identifying as such. You’ll learn how this big-​tent commu-
nity has influenced the ‘mainstream,’ and what new mainstream trends you
can anticipate.
Most importantly, each minority group will be described and explained
with information about the most common clinical issues you will encounter
and practical therapeutic strategies for helping.

Who I Am
I am a clinical psychologist and certified sex therapist with nearly four decades
of experience working with sex and gender-​diverse clients and training
therapists to work with this population. I am myself queer –​I often introduce
myself as a ‘bisexual lesbian mother who is kinky and nonmonogamous.’ In
1983 I founded a therapy clinic specializing in work with LGBTQ+ clients,
the Institute for Personal Growth (IPG) in New Jersey, and I directed IPG
for 35 years. I now have a small private practice of sex-​and gender-​diverse
clients. More and more, I find myself working with the ‘+’ in ‘LGBTQ+.’ In
the last few months, for example, my clients have included:

• A lesbian couple learning to experiment with BDSM (Bondage and

Discipline, Dominance and Submission, Sadism and Masochism) to
keep the passion alive in their relationship;
• A pansexual nonbinary teen who is struggling to get the adults around
them to use ‘they/​them/​theirs’ pronouns;
• A couple with a 20-​year history in the ‘swingers’ community that is
entering into a polyamorous relationship with another couple;
• A ‘heteroflexible’ millennial man trying to decide whether to tell a pro-
spective girlfriend that he occasionally hooks up with men.

I understand these clients not only because I have lived and worked in the
‘queer’ community for decades –​but also because my personal journey has
included lots of twists and turns off the mainstream road of sex and gender.
By the end of this book, I promise that you will understand these clients
and many more, as well.
I am uniquely qualified to take you on this journey. Besides being a
licensed clinical psychologist, I am a certified sex therapist, and I have spent
my life and career in the LGBTQ+ community. I came out as lesbian in 1975
and in subsequent decades I have acknowledged that I am bisexual, kinky,
and nonmonogamous. I saw my first lesbian client in 1975 while still a psych-
ology intern, and almost immediately realized that I wanted to devote my
 Introduction 3

professional life to helping other ‘queer’ people. In the 1970s it was difficult
to find a therapist who did not consider homosexuality a disease, and so
since that time, as soon as gay men and women in New Jersey discovered
me, my practice never lacked for clients. Eventually, in 1983, I founded the
Institute for Personal Growth, a private practice organization specializing in
therapy for, at first, lesbians and gay men, and, eventually, all others who are
sex and gender diverse. I completed a postdoctoral program in sex therapy
in 1983 as well, and under the guidance of my mentor Dr. Sandra Leiblum
began writing papers on queer sexuality for journals and professional books.
In 1985 I helped start the Hyacinth Foundation, New Jersey’s largest social
service program for people with HIV, and was its first director. Over the years
I’ve trained and supervised hundreds of other mental health professionals in
LGBTQ+ issues around the country and abroad.

Some Themes of this Book

Today’s practitioners are light-​years ahead of where we were in the 1970s
when I did my graduate work. Few still regard homosexuality as a disease,
and most have personal familiarity with gay people. But even as practitioners
have kept pace with the times –​the community has expanded even more
rapidly. As a therapist, you may not need me to tell you about how lesbian
couples are different from other couples (although I will). But you probably
still need help understanding nonbinary people and those in the BDSM com-
munity, not to mention men who identify as ‘mostly straight.’ In this book,
you’ll learn about it all, from the most basic principles of sex-​and gender-​
diverse affirmative care to the complexities of gender-​expansive children and
adolescents.
You will see some common themes in this book. In general, I believe that
to understand the mental health needs of diverse groups you must under-
stand the social and cultural forces impinging upon them, and how these
forces change over time. I hope to show you the narrowness of the lens
through which you were taught to view gender and sexual orientation, and
how much diversity exists in Nature, throughout history, and across cultures.
You will also come to understand how the expansion of the gay commu-
nity over the last half century has reflected changes in the culture at large.
Two major mainstream social changes that are reflected in LGBTQ+ emer-
gence are: the growth of what is often disparagingly called ‘identity politics’;
and the tendency for conditions previously viewed as illnesses to be seen as
identities. Andrew Solomon (2012) noted in his book about children who
differ dramatically from their parents, Far From the Tree, that since the latter
half of the twentieth century, there has been a cultural trend toward viewing
what were once considered ‘disabilities’ or ‘diseases,’ as distinctive identities,
identities that mark membership in a tribe. This has dovetailed with a more
4 Introduction

general trend, described by Francis Fukuyama in Identity: The Demand for

Dignity and the Politics of Resentment (2018). Fukuyama maintains that in
developed countries, concerns about economic survival have been replaced
by concerns about equal treatment and by what he calls ‘thymos,’ the need to
be recognized, seen, and acknowledged as having basic human dignity.
At the same time, the breakdown of institutions like religion have left
many people feeling a need for stronger social affiliations and seeking them
in a variety of different places outside of organized communities of worship.
One way that many people who feel marginalized –​unequal –​form social
connections is to do so based on the aspects of their identities that leave them
feeling socially stigmatized. Some marginalized people share identities with
their parents –​most people of color, for ­example –​and their families and
neighborhoods may provide them with the connection they need.
But some people feel isolated in part because they do NOT ‘fit into’ their
families of origin –​for example, most sex-​and gender-​diverse people. These
people affiliate on the basis of what Solomon calls ‘horizontal identities,’ as
distinct from the ‘vertical identities’ inherited from one’s parents and kin.
Those with similar horizontal identities form communities of support,
and these communities not only support their members but advocate for
social change toward equal rights and recognition. As I will show you, this
perfectly describes LGBTQ+ people, whose subgroups follow a common tra-
jectory over time: first, labeled ‘bad’ or ‘immoral,’ then ‘mad’ or psychiatric-
ally ill, then ‘normal’ but ‘separate,’ and finally, at least in theory, integrated
within the mainstream culture.
As the trajectory of change unfolds, the mental health needs of these
subgroups change. For example, gay-​affirmative therapy first developed after
homosexuality was removed from the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders, in 1973. In the
early stages after this happened, ‘internalized homophobia’ –​inner shame
produced by accepting society’s negative view of gay people –​was the biggest
mental health problem gay people faced. My practice in the 1980s was full
of clients who, first and foremost, needed validation that their sexuality did
not make them evil or sick, and help to understand that it was a bigoted cul-
ture that had inculcated these feelings. Now, unless you practice in deeply
conservative areas, your gay clients probably feel relatively okay about their
orientation, though they may still deal with prejudice from family members,
employers, or the larger community in which they live. Internalized homo-
phobia is not as likely to be their biggest problem. Today, you are more likely
to be working with gay clients whose problems are not much different from
your straight clients, albeit with some twists.
Today, a clinician is much more likely to find internalized self-​hatred in
transgender people, those whose sexual orientation is kinky, or people who
 Introduction 5

practice nonmonogamy, because the culture still holds highly ambivalent

and/​or negative views of these people.

Sex and Gender-​diverse Affirmative Psychotherapy

The example above elucidates one theme that repeats throughout the book: it
is impossible to divorce the mental health issues of LGBTQ+ people from
politics. This is true on a macro level: for example, research indicates that
the mental health of LGBTQ+ people deteriorates after states pass statutes
allowing anti-​gay discrimination (Hatzenbuehler, 2010). And it is true on the
individual level as well. For example, without knowing the shameful history
of how transgender people were harmed by psychiatry, it is hard to under-
stand the mistrust many trans folk still have of the mental health commu-
nity. Knowing that BDSM practitioners are still considered ‘paraphiliacs’ by
psychiatry helps explain that, in treatment, some kinky clients will still refer
to themselves as ‘sick’ and harbor deep shame about their sexuality ‒ and
others are afraid to tell their therapists about their kink.
The relationship between culture and politics and the mental health of
sex and gender-​diverse people informs the practice of what I call sex-​ and
gender-​diverse affirmative psychotherapy, the therapy described in this book.
While specific issues and techniques vary, there are some principles common
to the treatment of all LGBTQ+ people. Here are some of these principles:

1) Sex and gender diversity is normal, not a pathology or illness. Such diver-
sity is found among thousands of animal species, including non-​human
primates, and in all cultures throughout history. The idea that this diver-
sity is ‘abnormal’ derives from the belief that the biological function of
sex is solely procreation, and that forms of sexuality or gender that do
not further the reproductive goal are ‘against Nature.’ But today most
contemporary scientists recognize that sex in the animal world is not
simply about reproduction; in fact, the majority of sex acts in Nature
are non-​procreative. Many biologists believe that sex is more about
connection and affiliation than reproduction. If this is true, the major
argument against considering sex and gender diversity ‘sick’ or ‘patho-
logical’ is demolished.
2) Sex-​/​gender-​diverse people have grown up in a culture that negates
their value, for the most part, often in traumatic ways. This neg-
ation is not simply attitudinal, that is, prejudice or bigotry. It is often
institutionalized: sodomy laws were not ruled unconstitutional by the
Supreme Court until Lawrence v. Texas in 2003; in many states, it is per-
fectly legal to fire or deny housing to anyone from the LGBTQ+ com-
munity; transgender people are not recognized legally in their affirmed
6 Introduction

gender in many states. Part of an affirmative therapist’s role is to val-

idate and empathize with the traumatizing experiences LGBTQ+ people
experience.
3) A primary task of therapy is to affirm and validate the client’s iden-
tity and, when present, to help unearth and resolve socially induced
feelings of worthlessness. Affirmative therapists do not agree to thera-
peutic contracts that include efforts to change the client’s identity or
orientation-​so-​called ‘reparative’ or ‘conversion’ therapy.
4) Sex-​and gender-​diverse people, like everyone else, need to feel they are
living authentically, that is, that their inner experience of themselves is
expressed whenever possible in their interactions with others. This may
involve ‘coming out’ to others, or it may involve finding safe spaces where
they can ‘be themselves.’
5) Therapy often includes advocacy –​for example, the therapist must
be prepared to interact with a school system that is allowing bullying
of LGBTQ+ students; therapists for transgender clients will need to
write letters for medical providers to prescribe hormones or surgical
procedures.
6) Therapy includes knowing and directing clients to community resources.
For many LGBTQ+ clients, a good support group is worth years of
treatment. If you work with this population, you must know what is
available in your area: support groups and supportive organizations,
medical resources, legal help, political groups.
7) While many LGBTQ+ clients come to treatment for the same reasons
as other clients –​depression, anxiety, relationship problems, stress,
parenting issues –​there are some issues more commonly faced by sex-​
and gender-​diverse minorities. For example, at least half of gay male
couples are nonmonogamous and may need help negotiating their open
relationship; many LGBTQ+ clients are estranged from their family of
origin, and the ‘family’ with which they identify is one created from
friends and allies. LGBTQ+ affirmative approaches include a great deal
of specific knowledge –​which you will gain from this book.

Let’s focus for a moment on the first principle: that sex and gender diversity
is normal –​that is, a naturally occurring, non-​pathological phenomenon.
Increasingly, we have scientific data supporting this. A full discussion of
this is beyond the scope of this book, but interested readers are directed,
for example, to Bruce Baghamihl’s book Biological Exuberance (1999) which
enumerates many of the thousands of animal species that regularly exhibit
not only homosexual sexual activity, but unusual non-​procreative sexual
behaviors. Readers can gain insight as well from Joan Roughgarden’s work in
Evolution’s Rainbow (2013) and The Genial Gene (2009), in which she catalogs
the extraordinary range of gender expression in animals and posits the use
 Introduction 7

of sex among animals as a mechanism to promote affiliation and cooper-

ation. Ann Fausto-​Sterling has documented the gender ambiguities inherent
in the human body in her acclaimed book, Sexing the Body (2000). And a
2019 article in the American Psychologist (Hyde et al.) listed evidence from
five sources –​neuroscience, behavioral neuroendocrinology, psychological
findings on similarities between men and women, psychological research on
transgender and nonbinary individuals, and developmental research –​that
contradict the notion of a gender binary. In brief, the more we learn both
about the diverse range of animal behavior and the complexity of gender
determination, the more science supports the non-​pathological viewpoint.
In future chapters of this book, I will discuss some of the cross-​cultural, his-
torical evidence for this point of view in humans.

A Word about Identity: Fingers Pointing at the Moon

According to Francis Fukuyama, the concept of identity is only a few hun-
dred years old (2018).

The foundations of identity were laid with the perception of a disjunction

between one’s inside and one’s outside. Individuals come to believe that
they have a true or authentic identity hiding within themselves that is
somehow at odds with the role they are assigned by their surrounding
society. The modern concept of identity places supreme value on authen-
ticity, on the validation of that inner being that is not being allowed to
express itself.
(p. 25)

So the concept of identity is rooted in internal, lived experience, not

external roles or behaviors. It is important to understand how this impacts
LGBTQ+ identities –​and why it makes research on sex-​and gender-​
diverse minorities difficult. Let us take the example of sexual orientation.
There are, in general, three different measures of sexual orientation used by
scientists: attraction to same-​sex vs. opposite sex people; same vs. opposite
sex sexual behavior; and identity. Most commonly, social science research
uses identity –​a person’s self-​labeling. The problem is, identity is not a ‘stand-​
in’ for the others. Two self-​identified lesbians may share the same identity,
but one may have a long history of bisexual behavior and attractions, and one
may have only experienced same-​sex attractions and relationships.
But we often behave as if identity reflected a real, material ‘thing.’ It is useful
to remember the Buddhist saying about words and spiritual teachings: they
are like fingers pointing at the moon, they are not the moon itself. Sex and
gender variations are real, but the identities people use to describe them are
merely rough analogies. Moreover, these identities vary by time period and
8 Introduction

culture. Indian hijiras, Native American two spirits, and Thai ‘ladyboys’ are
all identities that express gender variance, but the realities they represent,
while similar, are not exactly the same, and efforts to make simple one-​to-​
one comparisons will be inaccurate. And while sex and gender diversity are
universal, because different cultures define the parameters for expression, the
identity labels are different. People must assume the identity that is available
for them within their culture. No one identified as ‘genderqueer’ a hundred
years ago; no one identifies as an ‘Uranian’ –​Karl Ulrichs’ term for a homo-
sexual in the 1800s –​ today.
Moreover, identity is a different level of experience from feelings and behavior.
To the extent that an identity is stigmatized, one can expect fewer people to
choose that identity than are theoretically eligible. For example, surveys of
people’s same-​sex attractions, behavior, and self-​identification always show the
highest number of respondents acknowledge attraction, followed by same-​sex
experience, and finally, the lowest number choose a gay or lesbian identity. In
later chapters I will discuss the process that individuals follow that transforms
feelings into identities. But any culture that stigmatizes variant gender and sexu-
ality incentivizes its members to hide their diversity. Therefore, research that
uses identity labels as measures of variant behavior will underrepresent the
number of people that actually exhibit that behavior or those attractions.

The Rest of This Book

The first section of this book is about the history of the LGBTQ+ community,
and the second is on the science –​what we know, and don’t know ‒ about
what it means to be sex and/​or gender diverse, who fits in these categories,
and the origins of sex and gender variation. You can skip these chapters if
you want and go straight to the clinical stuff. But I recommend that you read
them first, in the order intended. This is because I believe that to understand
how to be a queer-​affirmative therapist, you need to have this background.
Chapters 1, 2, and 3 focus on history, including the history of how sex-​
and gender-​diverse people were viewed by psychiatry. We are taught that
mental health and therapy are apolitical, ‘scientific,’ and free from bias.
Nothing could be further from the truth. Psychiatry has a shameful his-
tory of oppressing women, non-​white people, and sex-​and gender-​diverse
minorities. In the mid-​nineteenth century, slaves who tried to run away were
said to be suffering from ‘drapetomania,’ a disease caused by masters who
were too ‘familiar’ with their slaves and treated them like equals. The cure
was ‘whipping the Devil’ out of them or cutting off both big toes to prevent
running. Women were considered constitutionally prone to ‘hysteria,’ and
thousands of Victorian women were locked in asylums for daring to rebel
against their subordinate, submissive roles. As you will see in the following
 Introduction 9

chapters, during the twentieth century and to an extent today, psychiatry

labeled homosexuals, transgender people, and those with unusual sexual
interests as ‘mad,’ and treatments ranged from institutional confinement to
lobotomies to electric shock. As psychiatrist Thomas Szasz argued decades
ago, the mental health field replaced religion as the enforcer of traditional
social norms, labeling as ‘mad’ those who had previously been considered
‘bad.’ Understanding the history of our field’s maltreatment of sex and gender
minorities helps us comprehend why ‘reparative therapy’ still exists and why
so much of our work today focuses on correcting the damage done by mental
health labeling.
Just as negative biases dominated the mental health field, the scien-
tific study of sex and gender diversity has been warped by prejudice as
well. Chapters 4 and 5 present some of the newer research on animals and
humans that describes and explains in non-​pathologizing ways how diver-
sity operates in the natural world. If you read these chapters, you will forever
more be skeptical of both the pronouncements of evolutionary psychologists
about how homosexuality has no evolutionary value, and of articles about
the ‘gay gene.’
Chapters 6 through 24 will teach you what you need to know as a
mental health practitioner about working with sex-​and gender-​diverse
clients, from gay men and lesbians to those who are polyamorous, kinky,
and/​or asexual. They will prepare you to conduct effective therapy sessions
with anyone who walks into your office with an unconventional identity
or lifestyle. You will learn how to make sex-​and gender-​diverse people
feel safe and comfortable in therapy with you, and you will know about
the most common issues these clients may face. Finally, the last chapter
presents some ideas on where we are going –​will assimilation rule, or
will we travel toward an ever-​increasing proliferation of new identities and
ways of being? Will there be a time when being sex and/​or gender diverse
is not the defining characteristic of one’s sense of self? How will bodies of
the future look if gender-​diverse people continue to push the boundaries
of conventionality? It is my hope that this book will help your clinical
practice today as well as prepare you for the future.
There are some omissions from this book. I have not written about therapy
with intersex people because, frankly, I am inexperienced with this popula-
tion. Moreover, I have omitted some groups that have caught the public’s
eye: I don’t write about ‘furries,’ because it is not a primarily sexual phenom-
enon. I haven’t talked about ‘findoms’ (BDSM play that involves submissives
giving dominants money) because it strikes me as just one of many less
common kinky activities, even if it is currently enjoying 15 minutes of fame.
I’m sure there are other omissions I don’t realize now. They will have to wait
for a future edition of this book.
10 Introduction

The Case Histories and Vignettes

Throughout the book I have illustrated my points using case vignettes
and histories. All of these are composites; that is, they are examples typical
of more than one client, and the ‘clients’ are imaginary people exhibiting the
characteristics and problems of a number of actual people. Thus the identities
are disguised not only by changing details, but by merging details from sev-
eral different clients.

References
Bagemihl, B. (1999). Biological Exuberance: Animal Homosexuality and Natural Diversity.
Macmillan.
Fausto-​Sterling, A. (2000). Sexing the Body: Gender Politics and the Construction of
Sexuality. Basic Books.
Fukuyama, F. (2018). Identity: The Demand for Dignity and the Politics of Resentment.
Farrar, Straus and Giroux.
Hatzenbuehler, M. L. (2010). Social factors as determinants of mental health disparities
in LGB populations: Implications for public policy. Social Issues and Policy Review,
4(1), 31–​62.
Hyde, J. S., Bigler, R. S., Joel, D., Tate, C. C., and van Anders, S. M. (2019). The future
of sex and gender in psychology: Five challenges to the gender binary. American
Psychologist, 74(2), 171.
Roughgarden, J. (2009). The Genial Gene: Deconstructing Darwinian Selfishness.
University of California Press.
Roughgarden, J. (2013). Evolution’s Rainbow: Diversity, Gender, and Sexuality in Nature
and People. University of California Press.
Solomon, A. (2012). Far from the Tree: Parents, Children and the Search forIdentity. Simon
& Schuster.
 1
FROM BAD TO MAD TO
CIVIL RIGHTS
A History of Deviance and Acceptance
of Same-​Sex Attracted People

I
n 2011, biological anthropologists discovered a 5,000-​year-​old skeleton
outside of Prague, a genetic male whose body was arranged in a manner
usually reserved for females. News reports were quick to proclaim this
figure the ‘gay caveman.’ In fact, reporters were conflating sexual orienta-
tion and gender diversity –​we have no way of knowing who this person
was attracted to, only that they were at least somewhat gender variant. As
you will see, this confounding of orientation and gender has been common
throughout history; same-​sex-​oriented people have often been considered to
be ‘gender inverts,’ and often were.
The point, though, is that both sex and gender diversity have been part
of human culture since before recorded history. In later chapters, I’ll be
addressing gender diversity in much more detail; here, I deal primarily
with the history of same-​sex behavior. As Aldrich writes in Gay Life and
Culture: A World History (2006): ‘Since time immemorial and throughout
the world, some men and women have felt a desire for emotional and phys-
ical intimacy with those of the same sex’ (p. 1) Moreover, same-​sex behavior
is common among animals (Baghemihl, 1999), having been observed in at
least 450 different species. And multiple genders and gender changing are
frequently found in Nature as well (Roughgarden, 2013). Those who decry
homosexuality as ‘unnatural’ do not know the facts.
Although same-​sex attractions and behaviors are historically universal,
that does not mean that they appear in the same form as in twenty-​first-​
century Western culture. It may come as a surprise that, in general, ‘sexual
variations in behavior are common across human groups, and a high degree
of tolerance is accorded to same-​gender relationships in the majority of soci-
eties’ (Herdt, 1997, p. 10) –​unlike in modern Western culture. However,
12 From Bad to Mad to Civil Rights

the use of ‘homosexual’ or ‘gay’ as an identity is only about 150 years old.
Herdt notes five forms of same-​gender relations found across cultures and
throughout history. These forms apply primarily to men; in most cultures,
female same-​sex sexuality was usually ignored. In part, the presumed inferior
status of women meant that sex between women wasn’t taken seriously.
The first and arguably the most common of these forms is age-​structured
homosexuality; sex between older males and young men or boys. Greek and
Roman homosexuality was of this type, as is current day homosexual initi-
ation rites among some indigenous tribes of New Guinea. The older male
takes an ‘active,’ or ‘insertor’ role, and the younger male, in the passive, or
receptive role, is considered to be ‘like a woman.’ In many cultures, these
relationships took on a mentor/​mentee quality. In New Guinea, for example,
all young males must participate in sex with older men in order to become
fully masculine adults themselves. A second form of same-​sex sexuality is
gender-​transformed homosexuality, where one person takes on the role of the
‘other’ sex, such as the Native American ‘two spirit’ person, a biological male
who often lives as a woman and assumes a female role. Gender-​transformed
homosexuality can look very much like what we today call being transgender.
Some cultures incorporate same-​sex-​oriented people into niche social roles,
such as the so-​called ‘Sworn Virgins of Albania,’ female-​bodied individ-
uals who live their lives as males in part to satisfy the familial role of sons
in families without male children. Both the second and third forms are in
part socially proscribed roles, not necessarily freely chosen by the same-​sex-​
oriented individual. A fourth form of homosexual relationships appeared in
nineteenth-​century Western Europe –​the person who is identified by others
as a homosexual, as opposed to simply being considered a man engaging
in homosexual behavior. Finally, beginning in the second half of the twen-
tieth century, the form of homosexuality with which we are familiar today
emerged: individuals who consider themselves intrinsically ‘gay’ and for
whom gayness is an important part of their identity, and who seek egalitarian
relationships with same-​sex peers.
It is important to note that the last form of same-​sex relationships,
between equal partners who identify as gay and see their orientation as
baked-​in and lifelong, is one of the least common forms, historically and
culturally. In fact, exclusive homosexuality was rare: to be accurate, most of
the historical/​cross-​cultural forms of same-​sex behavior existed in people –​
men –​who also had heterosexual sex, for example, they had wives and chil-
dren. Technically, what seems most culturally and historically universal is
bisexuality, and later we will see that in the United States today, bisexually
identified people outnumber those who embrace a lesbian or gay male iden-
tity. Even homosexuality as identity is relatively new; throughout most of
human history individuals engaging in same-​sex acts were not considered
different from others except in their behavior: a man was not ‘homosexual,’
 From Bad to Mad to Civil Rights 13

he merely engaged in some sexual acts with other men. It is useful to under-
stand how these two identity-​based types of homosexuality came to be dom-
inant in the West.
Greek and Roman societies accepted homosexual behavior, but exclusive
homosexuality was rare. Males (female same-​sex sexuality was much less
common, or at least less noted) were expected to take wives and produce
children, but this did not preclude them from having male lovers as well.
In both these cultures, the sexual prohibitions that existed had to do with
the position the male assumed in sex: being the receptive, or submissive,
partner was considered unmanly and thus relegated to younger male part-
ners or slaves. The active partner could penetrate males or females without
stigma, and extramarital relations were accepted for men. It was the advent
of Christianity that heralded the beginning of disapproval of homosexual
acts, and this was in line with the general anti-​erotic tone of the Christian
ascetic ethos. Sexual pleasure of any kind was frowned upon. Heterosexual
intercourse among married partners, with the express purpose of procre-
ation, eventually became the only religiously sanctioned sexual behavior. The
anti-​homosexual bias of the Church was perhaps most pronounced during
the Middle Ages and the Inquisition, but it existed after the Enlightenment
as well and, indeed, still exists today. We see this emphasis on procreative
sex, not only in religious beliefs about same-​sex relations, but even in reli-
gious attitudes toward birth control: ‘religious freedom’ was the rationale
used by the Trump administration to roll back Obama-​era rules man-
dating that health insurance include coverage for contraceptive devices. Up
until the mid-​1800s those who committed homosexual acts were considered
depraved and immoral –​‘bad.’ Western European, and later American, laws
complimented religious disapproval with secular punishment.

Science Weighs In
The latter half of the nineteenth century saw the rise of a more medicalized,
‘scientific’ view of sexuality. The earliest known use of the word ‘homosexual’
is in a letter written in 1868 by Karl Maria Kertbeny to Karl Ulrichs, early sex
reformers; both men were active in a movement to oppose Germany’s harsh
anti-​sodomy statutes. Karl Ulrichs argued the ‘scientific’ perspective that
same-​sex yearnings were ‘natural’ for some people. He considered homo-
sexuality a form of gender inversion: he thought ‘Urnings,’ his word for men
who loved men, to be psychological hermaphrodites, with male bodies and
female minds. This conceptualization removed same-​sex attraction from the
realm of ‘sin’ and placed it within ‘Nature.’ Shortly after this, Richard von
Kraft-​Ebbing claimed same-​sex attraction as a medical problem. His book,
Psychopathia Sexualis, published in 1893, attempted to describe and classify
sexual deviancy. Although Kraft-​Ebbing believed that same-​sex attractions
14 From Bad to Mad to Civil Rights

were rooted in biology, unlike Ulrichs he did not consider them ‘natural’ or
‘normal.’ Instead he saw them as medical pathologies to be cured, espousing
therapeutic methods over legal sanctions. While Kraft-​ Ebbing thought
homosexuality to be the result of both genetic and environmental factors,
and others saw it as entirely hereditary, most scientists and doctors of the late
nineteenth century agreed that it was an abnormal perversion. Ulrichs, the
British physician Havelock Ellis, and later the German proponent of homo-
sexual rights, Magnus Hirschfield, were distinctly in the minority in their
belief that homosexuality was a natural, normal biological variation.
Freud is responsible for the twentieth-​century view of homosexuality as
a psychiatric condition representing the failure to develop ‘normal’ hetero-
sexuality. Freud believed that human infants were born bisexual and as a
result of predictable phases of sexual development ‘progressed’ to a hetero-
sexual orientation. Thus homosexuality was an ‘immature’ form of sexu-
ality, an infantile fixation that was the result of a combination of genetic
and environmental factors. Freud’s views were comparatively benign and
accepting, and he was pessimistic about the possibility of cure. Freud’s per-
spective dominated the young field of psychiatry until the 1940s and the
advent of Sandor Rado. Rado was a Hungarian-​born American analyst who
founded the adaptational school of psychoanalysis. Rado rejected Freud’s
views of inborn bisexuality. He conceptualized homosexuality as a phobic
response to the opposite sex, and considered it treatable through analysis.
Rado’s work paved the way for American analysts like Irving Bieber, who
in 1962 published an influential study of 106 homosexual and 100 hetero-
sexual psychoanalytic patients. Bieber’s work was an attempt to explore the
etiology of homosexuality. He presented findings suggesting that the homo-
sexual patients were more likely to have distant or absent fathers and overly
intimate relationships with their mothers. Bieber’s study also concluded
that as a result of psychoanalytic treatment, 27% of the homosexual patients
had ‘converted’ to a heterosexual orientation. Bieber’s study was accepted
as accurate despite a methodology that would today be ridiculed: findings
about the family were based on the therapists’ reports, rather than clients’
or parents’ narratives. But because the study was well regarded, the main-
stream psychiatric view of homosexuality came to be that it was a condition
created by disturbed family dynamics and changeable with dedication, hard
work, and psychotherapy. Bieber, and shortly thereafter Charles Socarides,
another psychiatrist, came to be the leading proponents of the view that
homosexuals needed psychotherapy, not acceptance, and that they could
be ‘converted’ back to heterosexuality. Socarides persisted in that view long
after psychiatry had declared homosexuality to be non-​pathological. In
1992, along with Joseph Nicolosi, Socarides founded NARTH, the National
Association for Research and Therapy of Homosexuality. NARTH has
become associated with religious conservatives, who are often sponsors
 From Bad to Mad to Civil Rights 15

of so-​called ‘reparative therapy,’ attempts to change those with a same-​sex

orientation.
The pathology view of same-​sex attractions prevailed throughout most
of the twentieth century, and when the American Psychiatry Association
issued its first compendium of mental disorders in 1952, the Diagnostic and
Statistical Manual, Mental Disorders (DSM I) included homosexuality as a
‘sociopathic personality disturbance.’ Moreover, the assumption of the path-
ology of homosexuality outlasted the pervasiveness of psychoanalysis. ‘When
the dominance of psychoanalytic theory in American psychiatry began to
wane in the 1960’s, other schools of thought incorporated, without much dif-
ficulty, the view that homosexuality was an abnormality’ (Bayer, 1987, p. 38).
Challenges to this view came first from the scientific community. In 1949
Alfred Kinsey published his research volume on the sexual behavior of the
American male. The public was shocked by his findings, among which was
the revelation that 37% of his white male subjects had experienced at least
one homosexual sexual experience during adulthood. Kinsey believed the
prevalence of homosexual behavior was evidence of its normality. Soon
after, the anthropologists Cleland Ford and Frank Beach published a cross-​
cultural study of 76 cultures (1951). They found that in 49 of these societies,
homosexual behavior was not only accepted but socially sanctioned for
some members. And in the 1950s the psychologist Evelyn Hooker published
research on non-​clinical samples of homosexual men showing that they
exhibited no more psychopathology and/​or functional impairment than
heterosexual controls (1957). Hooker argued that if the only evidence of psy-
chopathology in homosexuals was their behavior and desires, homosexuality
could not be considered a mental disorder. Meanwhile, theoretical challenges
to the psychiatric view came from psychiatrists like Thomas Szasz, who in
The Myth of Mental Illness argued that psychiatry’s treatment of homosexuals
was evidence that the field of psychiatry had taken on social control functions
previously the domain of religion.

Homosexuality is Normalized
These scientific inquiries did little to change mainstream views of homo-
sexuality, however. Until the latter decades of the twentieth century much of
the public saw homosexuals as depraved, psychiatrically ill degenerates who
preyed upon young people. And the mental health community disregarded
non-​psychiatric studies such as the work of Kinsey and Ford and Beach. It
was activism that turned the tide.
The post-​World War II era in the United States saw the emergence of
homosexual political activism in the form of ‘homophile’ groups. The most
important of these was the Mattachine Society for men, founded in 1950,
and the Daughters of Bilitis for women, founded in 1955. It was Mattachine,
16 From Bad to Mad to Civil Rights

for example, that convinced Evelyn Hooker to do her ground-​breaking

research. These groups, however, tended to see psychiatrists as allies rather
than enemies. To understand this, it is important to realize the conditions of
the time and how World War II changed the sensibilities of many same-​sex-​
oriented people. Thousands of gay men and lesbians joined the military after
Pearl Harbor, and the need for recruits meant that few efforts were made
to weed out those with ‘homosexual tendencies.’ For many gay soldiers and
lesbian WAACS (Women’s Auxiliary Army Corps), the military provided
a space to meet and become involved with others like them. Once the war
ended, some of these soldiers were reluctant to give up the sexual/​romantic
freedom that they had found during their enlistment. Many flocked to urban
centers where small ‘gayborhoods’ were forming, and these centers were fer-
tile ground for the development of activist groups.
But American society was not only deeply homophobic, it was severely
punitive toward those gay people whose activities became known. Every state
had sodomy laws; 45 US cities had laws against cross-​dressing. It was illegal
to serve alcohol to a homosexual, illegal for homosexuals to dance together in
public, and perfectly legal to deny someone housing, employment, or social
services because of their homosexuality. Bars where gay people congregated
were regularly raided by the police, with patrons arrested and their names
published in the newspaper. Parents –​and spouses –​could have their chil-
dren or partners committed to psychiatric institutions if they were found to
be gay. I recently watched the movie Before Stonewall, a documentary made
in 1984. The documentarians interviewed many gay men and lesbians born
in the first part of the twentieth century, who lived their adult lives in the
1930s, 1940s, 1950s, and 1960s. It is shocking today to hear their stories: of
lives lived surreptitiously in the shadows for fear of exposure; of families who
nearly universally disowned a gay child; of people committed for extended
periods of time to mental institutions for just the whisper that they might
be gay; of McCarthy-​inspired witch hunts conducted in the military and
government that ousted and disgraced thousands of hard-​working, patri-
otic Americans. I came out in 1975, and that era seems oppressive by today’s
standards, but it was a walk in the park to be gay in the 1970s compared to
what it had been a mere 20 years earlier.
Given the impact of the criminalization of homosexuality, the psychiatric
classification of homosexuality was of relatively minor importance.

When homosexuals did speak out publicly it was to urge the repeal of
criminal sanctions for consensual homosexual activity. Since the threat
of criminal prosecution was the immediate danger, it is not surprising
that homosexuals did not attack the standard psychiatric view of sexual
deviation.
(Bayer, p. 68)
 From Bad to Mad to Civil Rights 17

This was particularly true because the mental health field also urged
decriminalization. Although psychiatrists saw homosexuals as mentally ill,
they also saw mental illness as distinctly different from criminality. The latter
needed to be punished, but the former could be cured, and so psychoanalysts in
particular argued that treatment should replace incarceration. This inclined
gay people toward seeing psychiatrists as allies, but not only because they
favored decriminalization. A considerable number of gay people agreed
with the premise that their homosexuality represented mental illness, and at
the time psychiatry promised a cure. Many early homophile groups wanted
acceptance –​but acceptance for their ‘disability,’ which they considered
inborn and not chosen. In the 1950s, issues of the Mattachine Review, the
official publication of the Mattachine Society, were notable for their articles
debating whether homosexuality was a mental disorder. The concept that
‘gay is good’ did not emerge until after Stonewall.
By the 1960s, the tide was beginning to turn. Frank Kameny, one of the more
prominent pre-​Stonewall activists, was convinced that the ‘mental illness’
designation stigmatized homosexuals and stood in the way of obtaining full
civil rights. In 1965 the Washington, DC chapter of Mattachine, headed by
Kameny, declared that ‘homosexuality is not an illness, disturbance, or other
pathology in any sense but is merely a preference, orientation, or propensity
on a par with, and not different in kind from, heterosexuality’ (Bayer, 1987,
p. 88). The New York chapter of Mattachine soon joined the opposition to the
psychiatric classification.
The year 1969 is generally marked as the beginning of the modern gay
activist movement, with the June 1969 ‘Stonewall Rebellion’ emblematic
of the sea change in the attitudes of gay men and women. Political change
was no longer focused on pleading for the acceptance of gay people as a
disabled minority, but rather on demanding recognition of gay people
as the equals of heterosexuals. By 1970 gay activist leaders were focused upon
the removal of the ‘mental illness’ designation as a goal. Beginning in 1970
gay activists disrupted meetings of the American Psychiatric Association
and related psychotherapy organizations in order to agitate for their pos-
ition. In 1973 the APA removed homosexuality from the Diagnostic and
Statistical Manual, first by vote of the Nomenclature Committee, and then,
in an unprecedented action forced by APA members like Socarides and
Bieber, by a full vote of the membership. The removal was supported by
the membership but not by a large majority: the final vote was 58% in favor
of removal and 37% opposed. The entire process was criticized by many
psychiatrists as motivated by politics and not science. In truth, they were
right: the research findings disseminated in the 1950s by Hooker and others
served as the rationale for the decision, but it was clearly driven by political
considerations, chief among them the desire to end the disruptions of their
own professional meetings.
18 From Bad to Mad to Civil Rights

An interesting side note to this process is something revealed many years

later by psychologist Charles Silverstein, one of the activists involved in
lobbying the APA (2009). In a letter to the Archives of Sexual Behavior, the
preeminent journal in the field of sexology, Silverstein writes of the mindset
that he and other activists had at the time:

I argued that psychiatric diagnosis was the child of morality and that
Judeo-​Christian values controlled psychiatric practice … Besides homo-
sexuality, the DSM also listed sadism, masochism, exhibitionism, voy-
eurism, pedophilia, and fetishes as mental disorders. If there was no
objective, independent evidence that a homosexual orientation is in
itself abnormal, then what justification was there for including any of the
other sexual behaviors in DSM?
(p. 162)

Although neither Silverstein nor his colleagues argued this position to the
APA committee at the time, it was a perspective shared by many sex-​and
gender-​diverse people. As we shall see, in later years, both transgender
activists and activists in the BDSM community used this rationale to argue,
respectively, for the removal of the diagnosis of gender identity disorder and
the removal of all ‘paraphilias’ from the DSM.
The social impact of the de-​classification of homosexuality was enor-
mous. Most historians believe that, without this, the substantial civil rights
gains made by gay and lesbian people since the 1970s would not have been
possible. It served, first, as a successful basis for challenging sodomy laws.
During the 1970s, most states removed their sodomy laws. In 2003, the
Supreme Court ruling in Lawrence v. Texas invalidated the sodomy laws of
the 14 states that still had them on the books. But the effects of the removal
went beyond decriminalization. Psychiatrist Jack Drescher sums up the long-​
term impact of the decision (2015):

The result, in many countries, eventually led, among other things, to

(1) the repeal of sodomy laws that criminalized homosexuality; (2) the
enactment of laws protecting the human rights of lesbian, gay, bisexual
and transgender (LGBT) people in society and the workplace; (3) the
ability of LGBT personnel to serve openly in the military; (4) marriage
equality and civil unions in an ever growing number of countries;
(5) the facilitation of gay parents’ adoption rights; (6) the easing of gay
spouses’ rights of inheritance; and (7) an ever increasing number of
religious denominations that would allow openly gay people to serve
as clergy.
(p. 572)
 From Bad to Mad to Civil Rights 19

The Impact of the De-​pathologization of Homosexuality

Why should therapists care about this history? First, I hope it serves as a
lesson about psychiatric diagnoses, at least regarding sex-​and gender-​diverse
people. I will be referring to this history later in this book when I write about
transgender concerns, and about other sexual variations such as BDSM and
consensual nonmonogamy. Mental health professionals need a healthy dose
of skepticism when evaluating claims that socially nonnormative behaviors
and feelings are evidence of psychiatric illness. Second, knowing this his-
tory informs a generational view of the issues faced by gay people. When
I first saw lesbian women and gay men as a psychology intern in the 1970s,
a few short years after the APA decision, most of them considered them-
selves to be mentally ill and some asked to be cured. During the late 1970s
and throughout the 1980s, many of the clients who came for therapy to the
Institute for Personal Growth had come of age when it was dangerous to
reveal your homosexuality to anyone, including family.

Case Vignette
Lucille, a lesbian woman in her late 40s, was typical of the clients we saw
back then. As a teen in the 1950s, Lucille’s family had found her with another
young girl and surmised her gayness. They promptly had her committed to
a psychiatric institution, where she remained for many months, subjected to
heavy mind-​altering medication and, finally, electro-​shock therapy. Later, in
her 20s, Lucille was stopped by police outside a clandestine gay bar. In those
days, gay bars frequently changed locations and kept their location unpub-
licized because of laws against serving alcohol to homosexuals, and against
same-​sex dancing, and because law enforcement officers frequently were hos-
tile to those suspected of same-​sex desires. The officers who stopped Lucille
searched the bag she was carrying (often called a ‘butch bag’) and discovered
men’s clothing. On the pretense that she was breaking a law forbidding people
to dress in the clothing of the opposite sex, the police threatened to arrest her
but ultimately instead settled for beating her and leaving her injured, lying
in a gutter.
It goes without saying that those experiences left Lucille traumatized and
fearful. She sought out therapy in 1979 because she was aware that her his-
tory had left her unable to sustain a long-​term relationship. At first, treatment
consisted of simply letting Lucille tell her story, repeatedly and in detail, and
validating that her experiences were unjust. She found it difficult to believe that
the profession that had victimized her as a teen could help her now, but on the
other hand she found it affirming that I, a ‘legitimate’ mental health profes-
sional, asserted that her treatment had been cruel, brutal, and unfair. Lucille
20 From Bad to Mad to Civil Rights

also needed to grieve the loss of the family that had rejected her and the wasted
years when she lived alone and afraid, consumed with self-​hatred for her sexual
orientation.

The Development of Affirmative Therapy

Back in the early days of the Institute for Personal Growth, clients like
Lucille were common. The primary issues we handled were severe
trauma, loss and grief, and intense self-​hatred, called ‘internalized homo-
phobia.’ For many clients, simply reframing their problems as an intern-
alization of unjust social stigma was enlightening and the first step to
recovery. Today, most gay people are much less self-​hating, and the inten-
sive work to help uncover the internalization of cultural condemnation
is less necessary.
The concept of ‘internalized homophobia’ was one of many concepts
that were developed by gay and lesbian mental health practitioners post-​
1973. Once homosexuality was removed from the DSM, gay psychiatrists,
psychologists, and social workers began to feel they could safely ‘come out,’
that is, reveal their sexual orientation. Before 1973, being gay could be
grounds for dismissal from a graduate school or training program. John
Fryer, the gay psychiatrist who testified at hearings held in 1972 during
the American Psychiatric Association’s deliberations, appeared wearing a
mask and using the name ‘Dr. Henry Anonymous’ because he could have
lost his license to practice were his true identity known. But after 1973,
gay therapists began to ‘come out’ in large numbers, often eager to change
the field. I myself ‘came out’ professionally in 1975 while still a graduate
student, and like many others, quickly decided to devote my career to the
mental health needs of lesbians and gay men. This meant not only challen-
ging the status quo of my profession –​it meant developing a whole ‘psych-
ology of sexual orientation.’ A field devoted to ‘curing’ homosexuals had
neither theory nor methodology to help gay people who wanted to accept
their gayness and thrive while living a gay life. By the mid-​1970s, some gay
mental health professionals began publishing work that focused on healing
techniques: Don Clark’s Loving Someone Gay (1977) and Betty Berzon’s
Positively Gay (1979) were among the first of these books. By the early 1980s,
this approach –​that of validating a client’s sexual orientation and helping
them overcome the effects of years of social oppression –​had been labeled
‘gay-​affirmative therapy.’ The principles of ‘gay-​affirmative therapy’ have,
over the years, been extended to work with other sex and gender minor-
ities. This book is a product of this movement, 40 years or more of work,
by primarily sex-​and gender-​diverse professionals, to develop therapeutic
approaches for stigmatized LGBTQ+ minorities.
 Another Random Document on
Scribd Without Any Related Topics
främmande, men hemma är det numera en hvardagsgäst. De första
åren, då dess moln ännu voro sällsynta, sökte Lovisa genom smek
och muntra upptåg jaga dem på flykten, och lyckades äfven alltid;
men allting blir enformigt med tiden och unga frun ledsnade
sluteligen.

Under den nu förstförflutna sommaren hade ett utländskt

fruntimmer, — en af de många, som nu af nyfikenhet besöka vårt
fosterland, — hyrt ett ställe i kyrkbyn och bodde der några månader,
under den vackra tiden. Hon var en infödd fransyska, likväl af polskt
ursprung, och gift med en ryss. Förtjust att här på landet finna dem
som talade hennes modersmål, blef hon en daglig gäst i
prostgården, och sällan förgick någon dag utan lustpartier och
nöjen, som landet och den närmaste staden kunde erbjuda.

Med lif och själ upptagen af dessa förströelser, försummade Lovisa

alldeles sin man, och allt djupare fårades hans panna. Dock, i
sällskap och utomhus, var han ännu alltid den underhållande
sällskapsmannen. Lovisa insåg att detta var förställning, likväl borde
icke hon, som så mycket vårdslösat honom, ansett sig vara
försummad af honom, och till och med låtit denna tanke någon gång
iklädas ord.

Han svarade ej, men en blixt framljungade då ur hans mörka

ögon, som skulle bragt hvarje annan mindre lättsinnig qvitum till
besinning.

Lovisa var för mycket fjäsad, för att tro sig vara förbunden att
uppoffra sina nöjen åt en pedantisk och knarrig man, som Walter nu
syntes henne vara. Det sista året hon tillbragt i Åbo, hade lärt henne
att för högt uppskatta den yttre glansen och det chimäriska af
sällskapslifvet. Der hade Walter förekommit henne som ett lysande
fenomen bland de fjärilar, som fladdrade omkring henne. Huru
lycklig trodde hon sig icke bli med en man, som uti kunskaper och
behag vida öfverträffade alla dem, med hvilka hon i hemorten skulle
umgås, och under den korta förlofningstiden syntes ju äfven han
vara lika så intagen som hon af nöjen och förströelser, så snart han
icke var hindrad af några göromål.

Förlofningstiden borde egenteligen vara egnad att förbereda den

tillkommande trefnaden, i det att de förlofvade lärde känna
hvarandras sätt att tänka och uppfatta lifvets ändamål och
ömsesidiga pligter. Få äro likväl de, som göra detta. Hvem ville väl
förbittra den glada och lyckliga fästmötiden med dylika tråkiga
ämnen och reflexiouer? dem hinner man nog med efteråt, om de
nödvändigt höra till saken…

Efter Lovisas tanke skulle smekmånaden vara beständigt, men hon

betänkte icke att verlden och samhället taga mannens verksamhet
och själsförmögenheter i anspråk, och Walter var icke den, som ville
bli obemärkt, snarare sökte han att tränga sig fram.

Uttröttad af trägna studier och litterära arbeten, samt

ansträngningar i och för sitt embete, sökte han förgäfves tröst och
uppmuntran hos den qvinna, som, efter hvad han en gång trodde,
skulle bidraga till ernående af den inre frid han saknade, och försona
honom med den tanken, att han valt en bana, der han, mera än
någon annan, behöfde ett kärleksrikt hjerta att luta sig till, en mild
ledstjerna, som ledsagade den skeppsbrutna till hamnen… ty
skeppsbruten kunde man kalla Walter. Ingen rotfästad vördnad för
ett högre väsende medförde han från fädernehuset, der fadren
endast hade ränkfull vinning till hufvudsyfte, och i hvars sedolära, i
likhet med hans viner, endast färgen och bouqueten utgjorde
dygden: stor sak i grumlet på bottnen, det såg ingen af hans kunder.
Modrens öfvermod och fåfänga skulle enligt deras tanke uppehålla
husets kredit. Ingendera meddelade således gossen och ynglingen
något begrepp om det Högsta, det goda, den Allestädes närvarande,
den de sjelfva, med sitt husliga lif, nästan förnekade. Sådan kom han
hemifrån, sådan inträdde han, välförsedd med mynt, i studentlifvet.
Att han der intog menniskorna genom sitt utseende, sin redan
förvärfvade sällskapston och äfven genom sitt goda hufvud, kanna vi
redan.

Då anlände en resande till Åbo. Denne mans uppträdande i

societén väckte furore. Han var Stockholmare och hade rest
utomlands. Hvad behöfdes väl mera! Att Walter snart blef ett bihang
till denna komet, inser man lätt. Ett sådant fenomen vore ej hälften
så lysande, eller ådroge sig hopens uppmärksamhet, om det ej
förstode att skaffa sig ett släp.

En lika åsigt förenade dem närmare, och snart voro de

insepareble, ty den utländske fashionabla herrn höll till godo med att
dela Walters rum och bord, och slutligen hans börs.

I ersättning derför, frånstal han Walter de fördomar denne ännu

kunde äga, och lärde honom att ej sätta tro till annat än sitt eget
omdöme. Denna lära smickrade Walters redan dessutom stegrade
stolthet. Denna fasta tro på egen ofelbarhet, skulle vara ett surrogat
för andras inbillningar om Gudom, uppenbarelse och hopp om
odödlighet, … ämnen för deras qvicka sarkasmer! Den
vördnadsvärde X., en af universitetets lärare, hade fattat misstankar
till det utländska fenomenets sedo- och troslära, och varnade Walter
för denna farliga man. Detta hade tjenat till intet, om icke denne,
genom utsigten till ett stort arf, återvändt till Sverige.
 Walter hade så gerna gjort honom sällskap dit, men hindrades
genom uteblifna remisser från fadren, som, trött vid sonens
öfverdådiga fordringar, gjorde honom skarpa föreställningar; det var
då Walter gaf honom det redan bekanta svaret. Hans resa måste
således inställas, och den notable herrn lät sedermera aldrig höra af
sig.

Marenius, med hvilken han under de första åren af sin studenttid

varit bekant, återkom nu, efter ett års frånvaro, till akademien, för
att promoveras, vid hvilket tillfälle lagern äfven tillföll Walter.

Den förres redliga och vänfasta karakter ådrog sig den andres
högaktning, i synnerhet som denne, utan att göra anspråk på hedern
af namnet kavaljer, ägde ett bildadt umgängessätt och goda studier.
Samma känsla, som afhåller en svärjare af profession att i den
persons närvaro, som afskyr denna oskickliga vana, framkalla
afgrundens legioner till sitt vittne och biträde vid den lumpnaste sak,
samma känsla afhöll äfven Walter att upptäcka för Marenius sina
tvifvelsmål och fria åsigter om hvad denne ansåg såsom sitt högsta
goda, såsom den sol, som skulle upplysa honom sjelf och belysa den
väg, hvarpå de åt hans ledning anförtrodda medmenniskor skulle
vandra.

Deras formade bekantskap varade endast några månader;

dessutom var denna tid upptagen af trägna studier. Marenius, redan
prestvigd, skyndade att emottaga sin syssla. Det var här de ånyo
träffades.

Walters kärlek till Lotta var enligt hans åsigt endast ett tidsfördrif;
det roade honom att se huru långt kärlek och högmod kunde drifva
en landtflicka. Det var högmodet som hindrade Lotta att falla, och
detta retade honom. Hvem vet huru det gått, om icke Lovisa, som
redan förut gjort ett flygtigt intryck på hans hjerta, kommit emellan,
och omständigheterna förenat sig att göra hennes ägande till hans
enda tanke.

Walter var ingen bof; det gjorde honom ondt om Lotta… hennes
dödssätt grep honom djupt, men han tröstade sig snart med sitt
vanliga sophisteri och med den föresatsen, att väl uppfylla det kall
han åtagit sig.

Det gjorde han äfven till det yttre; men själen och anden felades;
det var det som folket, ehuru obildadt, saknade, och han sjelf ännu
mera. Fåfängt sökte han hvad han engång förlorat…

När han, uttröttad af sina grubblerier, sökte upp Lovisa, var hon
merendels upptagen att inöfva sig i det musikstycket, eller den sång,
som skulle exeqveras i det och det sällskapet; eller räknade hon ut
rutorna i ett symönster; eller också träffade han henne läsande i en
af Walter Scotts romaner, som hon, oaktadt all dess tråkighet,
nödvändigt ville sluta…

Nu kom den af oss i förbigående omnämnda utländska damen att

bo i deras grannskap. Lovisa fann sig utomordentligt smickrad af den
utmärkelse den eleganta frun egnade henne framför alla ortens
fruntimmer. Med en fransyskas liflighet och obetänksamhet
förebrådde hon Lovisa, både på skämt och allvar, att hon med sitt
intagande utseende, sina här ovanliga sällskapstalanger, sin fina
takt, att hon, som just var skapad för den stora verlden, låtit gräfva
ned sig som en liten prestfru här på landet, då hon kunnat briljera i
en helt annan omgifnlng; hennes man var visst utmärkt artig och
underhållande, när han ville, men… detta sades under en skämtande
ton… syntes, efter hennes tanka, mera älska sina dammiga böcker,
än sin unga charmanta fru…
 Lovisa, ehuru förtjust af hennes smickrande omdömen öfver
henne sjelf, ville dock aldrig ge henne rätt, vis à vis Walter. Det stred
för mycket mot hennes egenkärlek, det någon skulle tro, eller ens
förmoda, att hon vore mindre älskad af sin man; men udden af
skämtet sårade likväl, och det var vid denna tidpunkt hon första
gången förebrådde honom sin brist på ömhet och uppmärksamhet.

Nu var det höst; den qvicka fransyskan var bortrest, och hade
efterlemnat en tomhet, desto mera oangenäm for Lovisa, som en
missgynnande väderlek och ett miserabelt vägföre hindrade henne
från att söka förströelser utomhus. Det är nu vi göra anspråk på
läsarens tålamod, vid skildringen af händelsernas gång i vår fordom
så lugna prostgård; det är ju derom man i allmänhet brukar tala och
dömma, ty få äro de, som intränga i själens djupa schackter.

En dag hade Walter icke varit synlig för sin familj, utan begärt
frukosten upp till sitt rum. Då middagsbordet var dukadt, föll det
Lovisa in, för första gången på mycket lång tid, att sjelf gå upp, för
att de sin man komma ned att äta, men dörren var tillreglad
innanföre, hvarföre hon knackade på, och sade att maten var färdig.

Fördjupad i sina tankar och göromål, gaf Walter ej akt på ropen,

utan trodde förmodligen att det var huspigan, och svarade tvärt: —
Jag vill vara ostörd ännu en stund, sedan kommer jag. Den som är
hungrig kan äta, utan att vänta på mig.

Denna i sig sjelf obetydliga och i alla hus vanliga tilldragelse

förtretade Lovisa, som i dag var vid retligt lynne och utan ny lektyr;
den som fanns, var genomläst, och hon, som många andra, läste
icke en och samma bok tvenne gånger. Prostinnan, som hyste
aktning för sin måg, föreställde också Lovisa denna gång hennes
orättvisa, och väntade med maten; efter en half timma kom också
Walter.

Lovisa, ännu mera retad af modrens tilltal, satt på en soffa, med

sin lilla flicka i knät, och låtsade alldeles icke blifva sin man varse.

Fru Bryller underrättade honom då skämtande, huru hans fru velat

göra honom ett besök och huru snöpligt hon blifvit affärdad.

Walter närmade sig då Lovisa, som ännu allt icke såg upp; barnet
sträckte armarna mot fadren, som tog flickan, och kysste henne
hjertligt. Lovisa steg upp, utan att säga något.

— Jag tror du blef ond, Lovisa, sade han allvarsamt, och tillade
sedan, med tonvigt: — Också jag hat göromål, som ej få hindras
eller försummas.

Denna ursäkt, om den var en sådan, var ingalunda lämplig att

återställa hennes humör, likväl svarade hon ingenting, kanske
emedan modren var närvarande.

Prostinnan, som önskade förströ sin måg, berättade alla de

nyheter hon visste. Bland annat, att dragontorpsenkan, Lottas mor,
kommit på förmiddagen, för att afhemta de saker hon qvarlemnat på
vinden. Hon ärnade sedan lefva och dö hos sin bror, som var målare
i Uleåborg, dit hennes gosse äfven skulle komma i lära; han skulle
nu åtfölja modren dit. Orsaken, hvarföre hon kommit i ett sådant
menföre den långa vägen, var, att hon fått fri resa med en slägtinge,
som personligen måste infinna sig vid höstetinget här i socken.

Walter syntes ej fästa mera afseende på denna, än på de andra

nyheterna, men påskyndade måltiden, under klagan på hopade
göromål, och sade sig ännu ha det protokoll oskrifvet, hvilket gällde
de punkter som blifvit beslutna vid sista socknestämman, och som
skulle granskas och undertecknas dagen derpå, efter högmässans
slut. Vanligtvis drack han sitt eftermiddagskaffe der nere, nu begärde
han det upp till sig.

— Han tar lifvet af sig med det fasliga studerandet och

skriblerandet, yttrade svärmodren, sedan han lemnat dem. — Jag
förstår mig visst icke på hvartill det tjenar, ty salig Bryller tog sysslan
helt annorlunda och lättare; när han skrifvit ut sin predikan ur andra
äldre postillor, och studerat in den — som i sednare tider var honom
en lätt sak, ty han kunde dessa böcker nästan utantill — hade han
nog tid öfrig både att äta och sofva. Men, nya tider och nya seder.
Du borde likväl icke vara så tvär emot Walter, såsom du ofta är.

— Så der tar mamma alltid hans parti emot mig, anmärkte Lovisa,
och satte sig vid sitt piano, för att genom musikens trollkraft
bortjaga sin inbillade olycka, utan aning om att den verkliga stod för
dörren.

Sedan fruarna druckit kaffe och huspigan fört upp "Kyrkherrns

stora koppar", sade fru Bryller till sin dotter:

— Hör på, kära Lovisa, folket har ett göromål för sig i
bagarstugan, som fordrar min eftersyn. Jag skall skicka hit din gamla
amma, ge henne kaffe och prata vänligt med gumman en stund, tills
jag kommer tillbakas.

Denna gång behöfdes ej modrens uppmaning till vänlighet.

Oaktadt sin flyktighet och nyckfullhet, hade Lovisa ett lättrördt
hjerta, isynnerhet höll hon af dem hon känt sedan sin barndom. Med
deltagande frågade hon efter gummans omständigheter.
 Hon var, enligt gummans egna ord, undergifven och nöjd med sitt
öde, och tackade Gud och hederliga menniskor, som i en så svår och
pröfvande tid kommit henne till hjelp. Väl hade det nu varit henne
bra påkostande; då hon återkommit hit, der allt påminte henne om
Lotta, men hon visste att ta förnuftet till fånga, och tro, som den
plågade Job, att allt hvad Gud gör, är godt.

— Likväl, fortfor hon efter en paus, — då jag genomsåg de saker

jag hade i kistan deruppe, och såg hennes skrin, och derifrån tog
fram hennes granna märkduk, hälsomsprofver och hennes skrifbok,
då knotade jag åter att min snälla flicka skulle få ett sådant slut —
sådan är menniskan!… Jag tog allt detta ned med mig, för att visa
det för kyrkherdskan.

Icke utan en viss triumferande uppsyn tog hon nu fram dessa

bevis på dottrens skicklighet. Hon hade hört prostinnan klaga, att i
den dyra, förnäma pensionen Lovisa icke fick lära sig sådana nyttiga
arbeten.

Lovisa såg med likgiltighet derpå, men rördes af den tanken, att
den som tillverkat detta, nu hvilade i den kalla jorden.

— Vill inte min lilla goda fru också se hennes skrifbok? frågade
gumman, och framräckte den.

Den innehöll blott några blad, men dessa voro fullskrifna.

Vid bokens öppnande föll något på golfvet; det var ett

sammanviket papper med något inuti.

— Ack se, det der kom jag alls icke ihåg, sade gumman, sedan
hon tagit upp det. — Här är ett par prestkragor, på hvilka den
stackars flickan arbetade innan — olyckan skedde. Aldrig vet jag om
de voro beställda eller ej. Något står der utanpå, men jag kan icke
läsa skrifvit.

— Låt mig få se. De tillhöra Walter. För upp dem sjelf, så får du
dem säkert väl betalta, och Lovisa öppnade sjelf falsdörrn och visade
henne till det rum i öfra våningen, som Walter valt till sitt arbetsrum,
uran att ens tänka på att han önskat vara ostörd, ty ett ögonkast på
de qvarlemnade papperen hade väckt hennes nyfikenhet. Hon
återvände skyndsamt och läste med stigande förvåning följande:

"Hvad den tiden är odrägligt lång. Doktorn säger att jag skall
förströ mig genom arbete och glam med grannflickorna. Arbete har
jag nog, man har in hemtat hit linnesöm åt henne; — hvad gör hon?
Hör på hans kärleksprat. Speglar sig i hans ögon! Akta dig Lovisa!
dessa ögon äro trollspeglar. Jag har skådat i dem och blifvit helt
förvandlad; ha, huru jag nu ser ut, måntro Erik skulle känna igen
mig?! … … …"

"Mor tror jag håller på med mina skriföfningar, eller skrifver de

visor hon hemtade från byn, för att roa mig. Visor och famnsagor
äro icke mera tid för mig. Jag skulle eljest nog ha en underlig saga
att förtälja."

"När de möttes vid vår stugudörr, och jag såg deras blickar, —
hörde af deras ord, att de voro gamla bekanta, redan då for ett
svärd genom min själ!"

"Hvarföre hade han dolt detta för mig? Hvarföre en gång till och
med försäkra mig om motsatsen? — Hvarföre? Jo för att insöfva den
arma landtflickan i den tro, att hon ensamt ägde hans hjerta!"
 "O, huru många lustslott byggde jag icke på hans försäkran, att
han endast vore här en liten tid, för att sedan i en stor stad skaffa
sig en syssla — prest svor han på att han aldrig skulle bli. — Han
ville då ditföra mig som sin brud, men till dess skulle vår kärlek vara
en hemlighet för alla, äfven för min mor, sade han. Att detta icke var
rätt, insåg jag nog; men han hade två goda förespråkare i mitt
hjerta: min kärlek och mitt högmod, — ty högmodig säga de ju alla
att jag är. — Kärleken trodde på hans ord, som om de varit Guds
egen röst, och högmodet sade mig jemt, huru roligt det vore att
öfverraska alla, genom att en dag uppträda såsom hans hustru."

"I den stora staden kunde ingen veta att jag varit den fattiga Lotta
från dragontorpet, ett mellanting — öfversedd af de rika, dömd att
slafva och arbeta för dem, med afund betraktad af fattiga och
okunniga, för det företräde jag egde framför dem, och hvaröfver de
säga mig vara högmodig…"

"Svartsjukans första gnistor föllö i min själ, när jag fann att han,
på hvilken jag trodde mera än mig sjelf, bedragit mig, när han sagt
att han icke kände, icke brydde sig om mamsell Bryller, som
väntades hem. — Detta sade jag honom om natten, när jag band de
kransar, hvarmed han ville fira hennes namnsdag, ty vi voro en stund
allena, medan de andra flickorna gingo för alt plocka mera rosor.
Huru insöfde han mig icke då med sitt söta tal, sina falska ord, han
sade, det han väl ofta sett, äfven dansat med Lovisa, men att hon
varit honom så likgiltig, att han ej engång efterfrågat hennes namn.
Det var således öfverraskning och vanlig höflighet som förefallit mig
så misstänkt. Ack, jag trodde honom åter, och berusade mig med
försoningskyssen! Det var och blir den sista!!"
 "Huru beskrifva den dag som följde på denna natt: en dag full af
bitterhet och qval! Jag såg henne lik en engel insväfva i rummet,
beundrad och hyllad af alla för sin skönhet och granna klädsel. Jag
kastade ovillkorligt en blick i den stora spegeln midt emot
kakelugnen, bredvid hvilken jag stod. Jag såg mig stå der blek och
glömd af alla, i min snäfva urtvättade kattunsklädning — en gåfva af
medlidande! Glömd af alla, ty hans blickar bott på henne … … …"

"Lotta, den arma Lotta, som han så ofta kallat sin söta, fin älskade
flicka, erhöll under den långa, eviga middagsmåltiden ej ett ögonkast
… … …"

"När alla lemnat bordet, gaf han mig en vink, det var för att
bereda henne ett nöje. Förbittrad och nästan utan medvetande som
jag var, måste de andra flickorna hjelpa på mig den hvita klädningen
och kransen, och jag ställde mig att sjunga jemte dem."

"Jag hörde en gång fröken Nora omtala en slags bilder, som kallas
automater, månne jag nu ej liknade en sådan? ty jag rörde mig
endast efter befalning. Jag kände ej hela hans tlllställning, ty jag
trodde att allt bestod i det granna med blommor utfirade tornet och
vår sång, men då flög ett förhänge upp, och en röst — var den från
höjden, eller från djupet? — ropade i mitt inre öra: 'Detta är en bild
af honom! Detta vackra med blomster utfirade yttre hyser ett svart
hjerta, der hennes namn brinner med glödande drag' … … …"

"Alla sade: det är vackert och kanske sade jag det också, ty hon,
Lovisa, som stod nära mig, hviskade till mig: — Vet du Lotta, jag såg
detta redan i går, och då föreföll det mig, som en grafvård. Då for
det som en blixt genom mitt hjerta, och jag önskade att det vore
min graf … … …"
 "För mig voro dagens plågor icke ännu slut: jag måste se deras
förtrolighet i dansen, hans eldiga blickar, hennes triumferande
leende; höra de omkring ståendes anmärkningar om det vackra
paret. Jag utstod icke längre att stå der. Jag smög mig ut på
förstugutrappan och lutade mitt heta hufvud mot en pelare, redan
fuktig af nattkylan; der hörde jag planer uppgöras af högmodet och
egennyttan … … …"

"Huru långe jag låg der, vet jag icke. Jag kom mig åter före, när
en del af gästerna foro bort. När jag åter kom i salen, sade jag åt de
andra flickorna att jag sofvit; man skrattade åt mig. Då kom han och
bjöd mig upp till dans, jag tvekade först, men gick sedan; det var
den sista! Hur olik den vi dansade tillsammans på Barske Gretas
bröllop, johannisqvälln … … …"

"Prostinnans röst bad oss sluta, hon varnade mig för förkylning…
Ha, tänkte jag, det skulle kanske bli min död! Och jag gick, så varm
jag var, ensam hemåt. Det brusade för mina öron, natten var mörk,
och dimma betäckte jorden. Den natten var en bild af mitt inre."

"När jag återkom till mig sjelf, låg jag i min säng. Min mor gret och
sade att man funnit mig på kyrkby ängen, att jag sedan haft feber
och yrat; man hade länge tviflat om mitt lif… Hvarföre fick jag icke
dö?!"

"Hon har varit här, hon, den lyckliga, som han älskar!… men
hvarföre talar hon aldrig om honom! Månne hon anar något, och tror
att hon derigenom skulle såra mig? Ack, så långt tänker icke den
rika; de tro icke att den ringares hjerta äfven kan vara känsligt för
ett ömmare vidrörande … … …"
 "Ännu synes ingen misstänka den rätta orsaken till min sjukdom,
men skall det alltid kunna bli en hemlighet? Nej! — och då ett åtlöje
för… nej, nej, jag måste härifrån!… men hvarthän? … … …"

"Hon lofvade uppfylla min önskan, att få hvila der… Ett

framkastadt ord af min mor upplyfte mig, att detta endast kunde ske
genom — sjelfmord… Sjelfmord!… tanken är ryslig; men han sade
ju, att memmiskorna vore lyckligare om de ej stretade under
fördomar. En annan gång hörde jag honom såga till ryttmästarn: —
Hvarföre skall man icke kunna bortfalla lifvet som en skädning, om
der är oss till besvär. — Ansvaret må således blifva hans … … …"

"Hvad är detta! Bryter han då alla löften, äfven dem han gjort sig
sjelf? Sade han icke så många gånger, att han hvarken ville, skulle
eller borde bli prest. Jag förstod väl icke rätt hvad han menade, men
trodde. Nu äro äfven dessa hans ord — såpbubblor … … …"

"Mor bannade mig i dag; sade att jag var lat. Hädanefter får hon
vara mig förutan… Sedan onda makter strida inom mig, är all trefnad
borta oss emellan; … bandet är slitet mellan mig och verlden, jag
trifs icke här. Walter, Walter! du har sjelf låtit mig tvifla om
återseendet i en annan verld… måtte likväl samvetet en gång straffa
dig i denna!!"

"Hvad tröst, hvad välsignelse skall han, som prest, kunna meddela
andra? — 'Nog kan han tala granna ord', sade Eriks mor, 'men kärna
ha de icke!' Erik! — honom vill jag icke återse… således bort, bort! …
… …"

Med rysning läste Lovisa igenom dessa orediga och svårlästa

anteckningar. Det blir likväl kinkigt nog att troget analysera de
känslor, hvarmed hon slutade dem. Lovisa var icke elak; hur skulle
hon blifvit det? hon, som egde allt och varit älskad och firad af alla,
— och likväl förblef hon, som så ofta varit djupt gripen af blktade
händelser, hon, som gråtit vid den olyckliga utgången af en roman,
eller det tragiska på skådebanan, hon förblef nu nästan kall, och
detta var likväl verklighet. O, huru ofta är icke menniskan sådan!…
Vi ville ej derföre säga att hon var känslolös vid denna oförmodade
utveckling af en händelse, som hon beklagat, men sedan lättsinnigt
glömt. Nu var visst äfven medlidande med Lotta den öfvervägande
känslan, men det fanns äfven andra underordnade, som uppstego
jemte denna. Det var en hemlig glädje att vara befriad från en
medtäflerska, som kunnat bli farlig med tiden. Det var en liten
förtrytsamhet, att den finska soldatdottren sträckt sina tankar så
högt, att hon inbillat sig bli Walters maka.

Hans uppförande bedömde hon långt mildare än det förtjente;

sådana exempel voro väl mera sällsynta på landet, den tiden; men
Lovisa hade varit i staden… Äfven var ju hon sjelf det föremål, som
förmått honom att lemna sina fattade föresatser; egenkärlekens
fernissa betäckte således hans förhållande. Resultatet af hennes
betraktelser var slutligen detta: "visserligen var det ömkligt med
Lotta, men likväl bäst att det gick som det gick." …

— Här sitter du och läser lappri, och bryr dig om ingenting! med
dessa ord inträdde hastigt prostinnan Bryller i rummet, åtföljd af
Lottas mor, som såg helt förskräckt ut. Den förstnämnda skyndade
till ett skåp, lemnade en butelj och en droppflaska åt gumman, bad
henne gå förut, sjelf tog hon en matsked från skänken och skyndade
efter.

— Hvad är på färde, mamma? frågade Lovisa, och stack papperen

skyndsamt mellan noterna på pianot, framför hvilket hon satt.
 — Din man har hastigt blifvit sjuk; tag eau de cologne med dig
och kom med, svarade modren, och skyndade förut med en ättiks-
karafin i handen.

Walter satt bakåt lutad i sin länstol, blek och orörlig, med båda
händerna sammantryckte mot bröstet, likasom felades honom luft.
Framför honom, på skrifbordet, låg det påbegynta protokollet,
nedanför, på golfvet, det papper, hvari det af Lotta förfärdigade
arbetet varit inlagdt; kragorna lågo på hans knä. Det syntes tydligt
att han, i samma ögonblick han öppnat detta papper, överfallits af
någon häftig plåga, som beröfvat honom förmågan att röra sig.

Prostinnan var utom sig, gned hans tinningar och pulsar med
ättika och slagvatten, under det att Lovisa höll eau de cologne under
hans näsa; först hade hon, likväl obemärkt af modren, tillegnat sig
det på golfvet liggande papperet. Hon dömde ganska rätt, att detta
gifvit anledning till katastrofen. Småningom kom Walter sig före.
Oaktadt hans motvilja, förmådde prostinnan honom dock att ta in en
god dosis Hoffmansdroppar; de gjorde snart god verkan, ty djupa
andedrag arbetade sig fram utur det beklämda bröstet.

Emellertid hade Lovisa förstulet öppnat papperet och funnit dessa

ord:

"Håll till godo detta sista arbete af Lotta, och håll edra presterliga
eder bättre, än ni hållit edra andra löften!"

Lovisa hade just smygt papperet på sitt förra ställe, då Walter såg
sig omkring med rediga blickar, tackade både sin fru och svärmor för
deras omsorg, sade att han nu vore bra, och bad dem lemna honom.
Lovisa, som verkeligen älskade sin man, och nu trodde sig hafva
stora skäl att bevisa honom sin ömhet, önskade blifva qvar, emedan
han lätt kunde få ett förnyadt anfall. En tår glänste i hennes öga, vid
denna bön. Walter drog henne sakta till sig, kysste bort tåren, och
sade rörd:

— Icke nu, bästa Lovisa, jag beböfver ensamhet, så snart jag

slutat detta arbete, kommer jag ned till dig. Skulle jag dröja för
länge, tillade han leende, — kan du ju höra efter mig.

Lovisa lemnade honom således allena; men drifven både af ömhet

och nyfikenhet, lyssnade hon ofta vid hans kammardörr. Hon hörde
honom länge gå med starka steg fram och åter, stundom trodde hon
sig höra afbrutna ord, hvilka hon likväl icke kunde fatta, sedan hörde
hon att han satte sig för att skrifva.

Öfvertygad att all fara var förbi, kallade hon till sig Lottas mor, på
sitt eget rum, för att nogare få reda på hvad som passerat deruppe.

Varsamt och tyst hade gumman inträdt i hans rum. Kyrkoherden

hade varit så fördjupad i sitt skrifarbete, art han ej hörde henne
komma. Hon hade länge stått vid dörrn, utan att han såg upp.
Förlägen, och villrådig huru hon skulle göra sig bemärkt af honom,
steg hon ett steg närmare och helsade smått. Nu vände han sig
hastigt om, såg henne, och bleknade som ett lärft, sade hon.
Derefter rodnade han, och frågade med sträng ton hvad hon ville, i
det att han reste sig till hälften i stolen. Rädd att ha väckt hans
missnöje, framräckte hon med darrande hand det lilla pakettet.

Han kastade en hastig blick på stilen, som säkert var honom

bekant från förra tider, och nedsjönk åter i sin stol, likväl egde han
nog sinnesnärvaro att med konstlad likgiltighet öppna papperet och
se på arbetet. Då såg han de oss redan bekanta orden. Säkert
förekommo de honom som ett "mene, mene, tekel upharsin", ty han
föll tillbaka mot stolkarmen, och den förskräckta hustrun skyndade
ned efter hjelp.

För Lovisa, som nyss fått nyckeln till gåtan, stod saken tydlig och
klar. En viss instinkt, som oftast mer än förståndet leder den unga
qvinnan, hindrade henne ifrån att till och med för sin mor blotta
mannens fordna svagheter. Således teg hon och hörde blott på när
modren en stund sednare kom in till henne, sedan hon blifvit allena,
och bråkade sitt hufvud med hundrade gissningar om Walters
hastiga åkomma. Hon stadnade sedan vid den sannolikaste: att han
redan förut illamående, som han likväl dolt af kärlek för dem, och
nerfsvag blefven, af sitt trägna och onödiga hufvudbråk, blifvit
skrämd att finna någon i rummet, som han ej hört komma in.

— Också var det ingalunda någon behaglig surpris, att få der

apropos sä ett pakett från en sjelfmörderska, tillade hon.

Under tiden de voro i Lovisas rum, hade Walter lemnat sitt arbete
och gått ned i salen, men som ingen var der, beslöt han vänta på
Lovisa, och ville under tiden förströ sig genom musik. Fiol spelade
Walter utmärkt väl, men blott mindre stycken på detta instrument,
som han äfven ej vidrört på länge. Han bläddrade derföre genom
noterna, för att finna något bekant stycke, då föllo i hans ögon de
olyckliga papperen som Lovisa der undangömt och qvarlemnat. Utan
att med visshet förmoda att de rörde honom, stoppade han dem
hastigt hos sig, ty han igenkände stilen, och ville undvika all
anledning att tala om Lotta.

Lovisa kom nu in med lilla Valentina; fadren tog barnet på sitt knä
och bad mamma spela något muntrande. Lovisa gladdes åt hans
lugna sinnesstäming. Denna afton förflöt emellan de begge makarna
förtroligare än på länge varit fallet.
 Först om söndagsmorgonen, sedan Lovisa hunnit kläda sig och
kom in i salen, — då Walter redan länge varit uppe, för att, som han
sagt, sluta det i går ofulländade arbetet och se genom uppsatsen till
sin predikan — föll Lottas papper henne i minnet. Hon ville i all
tysthet förstöra dem, men de voro borta.

För att undvika uppseende, ville hon ej fråga någon efter dem,
och osäker om icke Walter tagit dem, var hon en stund orolig, men
lugnade sig snart, och beslöt att icke låtsa om någonting.

På vanlig tid begaf Walter sig till kyrkan. Först inträdde han i
salen, gick till skänken och slog i en sup åt klockaren, som följde
honom, bärande handboken, protokollet jemte andra papper. Sjelf
smakade Walter aldrig bränvin, men han tog sig ett glas madera, ty
luften var töknig och osund.

Till afsked kysste han sin fru och lilla dotter. Prostinnan, som
ärnade sig i kyrkan, klädde sig och var derföre icke närvarande.

Walter reste som vanligt i en ensittsig chäs och körde sjelf;

klockaren satt bakom. Menföret gjorde att det var litet folk i kyrkan;
församlingen utgjordes nästan endast af dem som skulle
underteckna sockenstämmans beslut. Predikan var kort, och ansågs
uppbygglig, som vanligt. Lysningar och publikationer voro förbi, och
gudstjensten slut. Då inbjöd presten sockneledamöterna till
sakristian, för att underteckna documentet, som genast skulle
skickas till vederbörlig ort, och erbjöd sig att genomläsa punkterna.
"Hvartill är det nödigt, vi känna ju dess innehåll och lita på vår värde
kyrkoherde," sade alla och skrefvo under, hvarefter det förseglades.

Prostinnan, jemte sin bror baron väntade att Walter skulle följa
hem med dem. Då kom denne med ovanlig skyndsamhet, det låg till
och med något sjelkaktigt i hela hans väsende, hvilket de efteråt
anmärkte. Han bad dem fara allena, ty han vore kallad på sjukbesök
till en adlig fru, som han namngaf. Detta förundrade både baronen
och hans svärmor, som icke hört det minsta om hennes sjukdom.
Prostinnan bad sin måg köra försigtigt, och de reste hvar sin väg.

Helt ensam tillryggalade Walter den mer än half mils långa vägen
till den omnämnda fruns egendom. Frun, som alldeles icke varit sjuk,
var sedan ett par veckor hemifrån, hos sin gifta dotter i ———.
Walter, som snart syntes ha glömt ändamålet för sitt besök, begärde
af hushållerskan något mat, och sade sig vara mycket hungrig.
Ehuru hon hade hört att han aldrig nyttjade bränvin, satte hon likväl,
efter gammal sed, fram sådant, tillika med smör, bröd och ost, och
skyndade sig sedan i köket, för att anrätta något passande.

Bordet var dukadt, förrätten och soppan införd; hushållsmamseln

bad honom servera sig sjelf efter behag och aflägsnade sig, för att
sjelf grädda några goda pankakor.

När hon bar in dem, stog en stark bränvinsånga emot henne. Hon
kastade en blick på den nyss fyllda flaskan: den var tom. —
Soppskålen deremot full ända till brädden. Det står här aldrig rätt till,
tänkte hon, men sökte att hålla god min, och förde ut skålen med
dess starka innehåll. Under det att hennes gäst grep sig an med
sista rätten, hade hon rådighet nog att skicka ett ridande bud till
prostgården, för att underrätta dem der om detta besynnerliga
uppträde.

Numera rädd att gå in, såg hon försigtigt genom nyckelhålet; han
hade kastat sig på en soffa och insomnat.
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