A Critique of the Writings of Richard Isay

Joseph Berger, M. D.

In this paper, Dr. Berger critiques the published case studies of psychiatrist Richard Isay. Dr. Isay, he claims, treats his sexually confused (and possibly heterosexual) patients from a strong gay- affirmative bias.

It is the third patient, "C", who surely provokes the most profound challenges and questions about Isay's understandings and orientation.

Mr. "C" was a 47-year-old married man, the father of two daughters. He is described as: "a devoted father and husband... he had a wife and children from whom he gained enormous pleasure. He liked the conventionality, the relative lack of stress in his life, and his professional success." He had had some homosexual experience when younger, before an analysis and the subsequent marriage, but no homosexual experience since being married.

Isay admits, "He had no regrets over the change in his sexual behaviour, except that he felt something was missing in his life - he called it a "passion."

His presenting symptoms were "depression, apathy, low self-esteem, lack of sexual interest in his wife."

Isay is quite dogmatic about this patient. In spite of all evidence to the contrary, and in spite of numerous alternative possible explanations, Isay insists - "C was still homosexual."

Many therapists deal with men and women in this age group who have very similar symptoms, who "long for the lost love of [their] youth," who feel "something - that they call as passion - is missing in [their] life."

Countless patients are like that. But most therapists usually explore the many issues that are so frequently present around aging, marital frustrations, work and career issues, deeper feelings of success or failure, and whether a person has been able to reach very private inner goals that may have been unrealistic. Also, teenage daughters not infrequently provoke conflict, especially in middle-aged fathers whose own sexual life is not satisfactory and fulfilling.

It is quite possible that another therapist would have explored some of these ideas with Mr. "C," and possibly have involved his wife in a joint therapy to look at the marriage and the absence of sexual activity.

Because of Isay's bias, Mr. "C" seems to have been left asexual. It is quite possible that with a therapist who was not so committed to a homosexual framework but worked in a more therapeutic manner, that Mr. "C" might have been better able to work through some of the deeper reasons for his depression and apathy, and come to a more fulfilling outcome, including that of a healthy sex life.

Patient "D", a married but separated man in his late thirties, had been depressed and had homosexual experiences when younger, but through an earlier analysis had recovered from depression and met and married a woman. To many therapists, he would seem to have been clearly heterosexual, retreating from comfortable heterosexuality when his sense of self, and pride and enjoyment in his work and activities, were diminished or undermined. The adaptational approach of Ovesey and his colleagues remains very helpful in understanding and treating such patients.

Therapy would therefore be directed toward exploring with such a patient when and how he comes to feel that way, and the effect it has on his sexuality. Possibly, the early origins of why he would search for a man, might emerge. There are a number of psychodynamic possibilities. The well-known ones include a wish for a powerful father to "take over" and help the patient back on to the "right path," and provide the strength, support, reassurance, etc., that the patient seeks. There may be wishes to be loved, admired, and respected by a man in a way that was missing in childhood.

Isay chooses to take a completely opposite approach in interpreting the material. He claims that the patient was always homosexual and remained so, implying that the marriage was a mistake undertaken under "pressure" from a biased analyst. The symptoms that brought the patient to Isay were therefore seen as a consequence of the stress of living such a lie. During therapy with Isay, the patient resumed active homosexual behavior.

Bibliography

Case histories are critiqued from those described in Isay, R.A., "On the Analytic Therapy of Gay Men." In Stein, T.S, and Cohen, C.J., eds., Contemporary Perspectives on Psychotherapy with Lesbians and Gay Men. New York: Plenum 1986.

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