Counsellor
I have worked as a psychologist and counsellor for over 25 years with gay men. I now am a counsellor in Vancouver where I mostly work with gay men. I do a monthly column on gay health in the local gay newspaper - Xtra.
Social anxiety is very common with gay men. Most people who suffer from social anxiety don’t even recognize that they have a problem. According to Wikipedia social anxiety is:
An emotion characterized by a discomfort or a fear when a person is in a social interaction that involves a concern of being judged or evaluated by others. It is typically characterised by an intense fear of what others are thinking about them (specifically fear of embarrassment or humiliation, criticism, or rejection), which results in the individual feeling insecure and not good enough for other people, and/or the assumption that peers will automatically reject them.
Social anxiety begins at a very young age, when boys become aware of being different from other boys. Gay boys will fear of being rejected and become hyper vigilant around others.
The fear of being in social situations results in the person avoiding social situations. Social anxiety is not avoidance of people, it is avoidance of people in social settings. Interestingly, the same person who avoids social situations is still able to run large meetings at work, manage many employees, and teach 30 or 300 persons at a time with little or no anxiety. In all of these situations there is a structure and the role is clear, and maybe even having some authority provides comfort. In social situations the rules and expectations of how one is to behave is vague, the structure is flexible. What a person talks about and how it is said is not spelled out. This is where fear creeps in, that is, the fear of saying or doing the wrong thing, the fear of being judged, of looking foolish etc.
The most common reaction to anxiety in social situations is to withdraw as much as possible. Bathhouses are a good place for guys with social anxiety because there is sex and connections that can happen without the pressures of conversations in a group of people. It is not surprising that bathhouses thrive, because they provide an outlet for guys. Not everyone in a bathhouse has social anxiety but it is a safer place to meet guys and hook-up without the fear of social conversations.
It’s normal for people with social anxiety to gradually reduce their social commitments and spend more time alone or with one or two friends. This alone time often leads to depression. Most people with depression look for treatment when the cause is likely due to loneliness.
To avoid loneliness, it’s typical for gay guys in their mid-30s or 40s will get a dog or a cat. A dog can work well for the guy to get out and walk his dog without too much social interaction. If he is in a social situation or a date he will have the excuse that he has to get back to let his dog out. The dog becomes a good reason to only have short social interactions. But also the relationship with the dog provides some comfort and feeling of being needed and belonging.
There is nothing wrong with a dog replacing socializing in groups. Having a dog works well as a way of coping with the loneliness and isolation. In fact it works so well that many guys do not even try to socialize and live a life of avoiding connecting, and socializing. Not everyone who has a dog (or cat) has social anxiety but it could be something to examine if the pet helps one to avoid or limit the amount of time in social gatherings.
According to WebMD, social anxiety is relatively easy to overcome by counselling:
The counsellor will “guide the person’s thoughts in a more rational direction and help the person stop avoiding situations that once caused anxiety. It teaches people to react differently to the situations that trigger their anxiety symptoms. Therapy may include systematic desensitization or real life exposure to the feared situation. With systematic desensitization, the person imagines the frightening situation and works through his or her fears in a safe and relaxed environment, such as the therapist’s office. Real life exposure gradually exposes the person to the situation but with the support of the therapist”.
People do not talk about social anxiety and therefore goes undiagnosed and untreated. The result is people who are lonely, isolated and depressed without understanding why. Take a moment to look at yourself and how much social fears and anxieties limit the amount of time is spent in social situations.
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While there are many effective methods in reducing the risk of HIV transmission during anal intercourse, some are more popular or more widely used than others. Condoms have been promoted as the most popular option for over 25 years, but condom fatigue has long set in. It’s time for public health to offer a more meaningful dialogue on other alternatives to reduce HIV transmission.
Current research suggests condoms are only up to 76% effective in preventing HIV infections during anal intercourse, whereas, Truvada as PrEP can reduce an individuals risk by over 99%. It’s also incredibly important for HIV negative people to know that having bareback sex with a partner who is undetectable is over 99% effective.
What you need to know about reducing your risk of HIV infection:
Condoms:
Truvada as PrEP:
Undetectable partners:
You can use these three risk reduction methods separately, or combined. For example, you can take Truvada as PrEP and have an undetectable partner. Or use condoms with undetectable partners. Or use Truvada as PrEP along with condoms.
It is also important to be educated on sexually transmitted infections (STIs). You should know how you can reduce your risk and be easily treated for STIs. Getting tested regularly is key for your sexual health. You should always know your HIV and STI status.
Public health has been slow to provide new information for individuals to make smart, educated, and informed decisions. The conversation needs to move to alternative options to reduce the risk of HIV and to make sex fun again. The message of using condoms is engrained, but with the advances of AVR’s, condoms aren’t the only method of risk reduction like they were during the peak of the HIV/AIDS crisis. Besides, it is still possible to become HIV positive even while using only condoms.
Change can be difficult for some, especially when condoms have been the only message hear for decades. The time is now to talk to your doctor and understand that there are new and alternative ways to reduce your risk of HIV, that doesn’t rely on out-dated practices.
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Talking to your child about being gay and coming out is a challenge for every parent. It’s the parent that wants to be respectful and wait for their child to come to them, to talk about their sexuality. The question of a child’s sexuality can be difficult to talk about. Rejection is the biggest fear your kid will have, while the parent will be concerned about respecting their child’s privacy. Parents also worry about mis-interpreting things, getting it wrong, not knowing how to approach the situation, or by offending their child by bringing up the question when in fact their child may not know or have discovered his or her own sexuality.
Children wrestle with their sexual identity. When they figure out for themselves that they are gay it takes a while to become comfortable with the their own awareness. Once they’ve established that comfort of sexual orientation and identity, it then becomes easier to learn more and talk to others about it. It’s important for parents to know that a child is less likely to discuss his or her sexuality if there is any fear of rejection.
Parents need to create a safe and accepting environment. This can happen with gay issues are in the new, on TV, or in a movie. Parents can show acceptance of people who are different and discuss positively how being gay or bisexual is not an issue for the parent with friends, co-workers, or even other family members.
Talking about issues about how gay rights have evolved over the years, including marriage and adoption, are great ways to show acceptance, tolerance and understanding. Avoid using gay jokes and negative humour; gay men remember these jokes and comments for years and recall these negative expressions and concerns about how their parents would respond when they tell them they are gay.
In the book, All Out: A Father and Son Confront the Hard Truths That Made Them Better Men, written by leading Canadian broadcaster and anchor of Good Morning America, Kevin Newman and his son Alex Newman, address the challenges when Alex tells his family he is gay. In the book, Alex tells how he calls the family together to make an announcement. He was so anxious that he could hardly speak and could not tell his family he was gay. After a minute or two of seeing his son struggle to talk with his family, Kevin Newman asked Alex if he is gay. Kevin Newman writes about how difficult it was to ask Alex if he was gay and feeling that if he was wrong he will have damaged his relationship with his son.
This book is very helpful to understand the feelings Alex had, as well as providing insight into how his father experienced his feelings about his son being gay.
If the parent is not accepting of their child then it is important to talk with your about your struggle. Learning more about gay culture is incredibly helpful and talking to other parents who have gay children is often very helpful.
Acceptance of a gay child can be a challenge for some parents. Most parents end up accepting and continuing to love their gay sons. Sometime this can take years. For everyone’s benefit the sooner the parent can find peace with his or her gay child the better everyone will be.
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Denial is refusing to accept reality or fact, acting as if in a painful event, thought, or feeling did not exist.
Gay men are very good at denial. It’s considered to be one of the most primitive defense mechanisms, characteristic of childhood development. It’s used to avoid dealing with painful feelings that people don’t want to admit.
For gay men, denial starts early, often denying that they are gay. It’s a frequent response to initial internal feeling of attraction to other guys. It’s learned at an early age. Gay boys learn to hone denial, turning it into a useful way of dealing with issues and situations they don’t like or want to avoid.
In the work environment, gay men will claim to be bisexual. Yes, they could have sex with women, but these same guys haven’t looked sexually at a women in decades, let alone have sex with them. Not all guys who identify as bisexual are in denial, but some certainly are. Their dishonesty is giving bisexuals a bad rep.
Denial serves to protect the person from facing uncomfortable feelings. This can last either a short time, minutes or hours, or can go on form months, years, or even decades.
It’s a defence mechanism that is used and necessary, but it can easily cripple a person, and hold them back from growth and movement. It can distort reality, making an image that is more acceptable at the expense of truth. Facing the truth is hard. For more people, the path to living a gay life begins with denial of gay feelings.
Denial is not pathological, but gay men often find denial as a go-to method of coping with unwanted information. It’s recognized as part of understanding gay men.
David Marr in A Life: Patrick White described Nobel Prize winner, Patrick White:
“As he grew up he had been faced with the choice of all homosexuals must make between sticking to rules-perhaps for a lifetime-or making sense of life by following the irrational, often painful truths revealed within themselves. Curiosity, scepticism and doubt are second nature to those who choose the second path.”
While a gay man may try to ‘stick to the rules’, or follow the irrational, often painful truths, using denial is a way of avoiding the truth of what may happen if you face the gay feelings head-on.
Men who identify as gay have moved past their denial and see the truth, that they are attracted to men. Guys who want to find trust fulfillment have to go beyond just acceptance.
Acceptance is not the opposite of denial. It is tolerating, admitting, and recognizing. It doesn’t always bring about changes in life, it’s just the next phase of moving towards fulfillment.
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The world is made up of both givers and takers. Givers are people who like to do things for other people and go out of their way to help those in need. Takers, on the other hand, are people who like to have someone to accommodate their desires and give them what they want. Some people only give, some only take, but the majority of people fall somewhere in between these extremes, where it’s comfortable to both give and take.
Most gay men find themselves in the middle of being givers and takers. Knowing if you are more of a giver or a taker is important to helping understand your relationships with others. Givers tend to be more passive, accommodating, and unassertive. Givers like to give to their partner, and feels less comfortable when receiving from others. Even receiving praise is difficult, but giving it comes easily and naturally.
“Givers are people whose primary motivation is to take care of others, to make sure others are well, and to contribute to others and society,” said Emma Seppala in a November 2013 article published in Psychology Today. “In a relationship, these are people who are always thinking about gifts for their partner, who take their partners’ interests into consideration, and who are always thinking ‘What else can I do for you?’ They’re pretty awesome.”
Takers tend to be more assertive, aggressive, and even demanding. They have a sense of entitlement, expect to be pampered, and want all their needs looked after.
“Takers are just that—takers. They usually treat people well only if and when those people can help them reach their goals,” explained Emma Seppala. “They know how to work the crowd and seduce, but under the surface, they are primarily motivated by self-interest. You can recognize a taker by how poorly they treat people they believe are of no use to them. You know you’re in a relationship with a taker when you feel sucked dry for all you have—money, affection, time, etc. Once the taker has everything they want, you may be relegated to the unimportant sphere of their life.”
Givers are often attracted to takers who enjoy having their needs accommodated. In the long run these kind of relationships often fail because the giver wants something in return from his partner. Very often the taker will find another giver, and the giver will find another taker.
It is not uncommon for a guy who is a more extreme giver to become more balanced in his giving. Takers find it harder to change, often finding guys who want to look after their needs. Extreme givers are more likely to go to counselling because their life is not working well for them.
Guys in the middle tend to fall on one side or the other of the giver-taker continuum. These guys have a tendency to be either giver or taker, but in a more balanced approach.
So is there are relationship between giver-taker and top-bottom? You could assume that the giver will be more likely to give his body to be taken, meaning that he is more likely a bottom. The taker would more likely take what he wants from his partner. The giver isn’t always a bottom, but he would tend to be in most cases.
It is important to understand if you are a giver or taker in your friendships and relationships. It could affect your choice of friends or partners and to ensure your emotional needs are being met based on the relationships in your life.
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Heterosexual people’s lives are pretty straight forward. Go to school, get a job, find a girl friend, get married, have kids, retire, and enjoy having grandchildren. It’s been this way for generations. It’s engrained as the ideal North American lifestyle path that every man shall follow for a successful, happy life. At least that’s what we are told and meant to believe. But wait, what if you’re gay? That doesn’t work at all.
Gay men don’t follow the same path at their heterosexual counterparts. Essentially, there is not template for gay men to follow. While you think it might be obviously for a gay man to come out, find a partner, settle down, and live a great life with dual-incomes, it doesn’t exactly work that way.
Some gay men never come out of the closet, fearing retribution or rejection by friends and family. Some guys aren’t interested in finding a life-long partner or want to settle down in a relationship. Other gay men have no interest in investing in real estate or creating an estate to pass on. Without a model to follow (or to rebel against), for gay men, finding their way through life can be incredibly difficult and pose challenges along the way. On the flip side, gay men often have stronger character, are independent thinkers, and are creative problem solvers.
Young gay men often feel alone, scared, and lost because they aren’t able to follow the same path as heterosexual men. They face separate challenges of coming out, dating, bullying, and relationships. Their struggles are tougher. Young gay men who finally figure out they are gay, and accept the heteronormative idea of what a traditional man’s life is like, often has a harder time coping and adapting.
For men who realize they are gay when they are at an older stage of life have completely different challenges to face. A young gay man merrily goes along, creating his own template and expectations of life, throwing away the ideals of a heterosexuals life path into the trash. Whereas men who are further along in life feel confused about how to proceed on who he is, how it will impact his life, and what changes need to be made. Many men at this stage discard their old identify and create a new one. It’s a huge challenge. Going from having a planned out life to creating a new path in an incredible change, and it’s not easy.
Gay men have to find their own way through life, developing valuable skills and taking pride in their accomplishments along the way. But the awareness of this lifelong challenge is daunting. When gay men become aware of their altered path, they often feel alone on their life path and that they want to give up. Suicide, drugs, and alcohol are common coping mechanisms used to overcome the overwhelming feelings of stress and confusion.
The great news is that many gay men do find their way and create their own life path. Their paths are usually much more vibrant and very unique to their own personal needs, compared to their heterosexual counterparts, because their plans take into account the challenges they face along their journey. It may seem scary, but in fact, it’s beautiful and full of wonderful experiences many heterosexual men don’t get to understand.
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There is probably no other topic that has been written about so much over the last few thousand years as love has. Still, songs, TV shows, movies, and books all relate back to love and relationships. Yet love and relationships are still very confusing. What is love anyway?
It’s a difficult and personal question with many different kinds of complex layers. Can you really love chocolate ice cream? Maybe this is not love, but just a way of expressing great enjoyment of the delicious frozen dessert. You may love your family, but likely the feelings are different than loving your boyfriend.
Love and relationships are very confusing. How do you know if you are in a boyfriend or buddy relationship? For some guys, their buddy is their boyfriend. There is a difference in the feelings between two guys who are buddies compared to the relationship between two guys who are in love. Gay guys know that having sex doesn’t mean you’re automatically boyfriends. Buddies can have sex together but still just be buddies, just as equally as two boyfriends could also be buddies. It is important to understand these differences of being buddies and loving boyfriends when it comes to relationships.
Guys who spend years in a loving relationship at some point become best friends. They are no longer boyfriends, but they spend a great deal of time together, talking about very personal issues, sharing intimate thoughts and feelings. But they are just buddies now. Something has changed. It’s not that their caring for each other and how important they are for one another. Heteronormative society does not recognize these types of caring relationships.
What is the difference between buddies and boyfriends? Both buddies and loving boyfriends care about each other, are supportive, and will do almost anything for them. There would be a tremendous loss if the relationship ended, with pain and suffering.
But guys who are in love have something special, that is different from buddies. They give themselves to their boyfriend. There is vulnerability and not being in control. They respect and trust each other, and value that special gift. Vulnerability and trust means that they are equal, without one or the other in more control, and that they are living with constant risk of loss, as well as the joy of being accepted, valued, and respected each and every day.
Being vulnerable is scary and freeing. Feeling important enough to your boyfriend, and to be trusted with him opening up in your hands is a natural kind of endorphin or high that comes with love.
It’s not uncommon for one guy to be looking for a buddy and his boyfriend is looking for a relationship where they are both vulnerable. This ends up being a frustrating situation for both guys, especially the one who is looking for more than just being buddies.
Some guys cannot live with being in a vulnerable, loving relationship. These kinds of guys do better with finding a buddy who they can share their lives with. Many guys will try, but when they get scared of getting hurt or are rejected, they react badly and make it difficult to have that loving relationship with.
There is no one right way to structure a boyfriend relationship. Buddies work. Being in a relationship works. Or a combination of buddies and being in a loving relationship with a few guys. They are all possibilities. They key is that relationships must work for everyone involved and be supportive of growth. Guys need to know that if they can accept being themselves and freely trust each other, then they will have a long, strong, enjoyable relationship together
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Depression impacts almost everyone at one time or another. Traumatic experiences throughout childhood involving bereavement, neglect, or abuse can increase the chances of depression. According to the Archives of General Psychiatry1, the lifetime prevalence rates of major depressive disorders among gay men, bisexuals and lesbians is 71.4% compared to 38.2% for heterosexuals.
Gay men experience more mental health issues compared to heterosexual people because of the complexities in the development of their personality, plus learning how to cope with stressful environments.
It’s normal to visit the doctor to seek medication to deal with depression. Often there is little or no in-depth look at the causes, a referral to a counsellor, or other tools used to deal with depression. With little focus, it can take years to resolve it self, all the while also having to deal with the negative side effects of taking medication to treat the depression symptoms. It’s not unusual for this to have an adverse effect on self-esteem and identity, or the additional need of psychotropic medication to copy with the world. These antidepressants make it difficult to get an erection, to stay hard, and to ejaculate. The sexual frustration leads to more isolation, and further depression.
Doctors and medical experts see depression as a reaction to anxiety. While anxiety is usually not initially recognized, the results include social withdrawal and subsequent depression. A study in the Canadian Journal of Psychiatry2 found gay and bisexual men have twice the rate of anxiety disorders as heterosexuals.
People who live full, active, social lives are rarely depressed. Social interactions with friends must be enjoyable, not just tolerated. Both anxiety and depression are major factors which impact happiness.
What to do about anxiety and depression
Recognizing the signs of anxiety and depression in its early stages is key. Anxiety and depression is much harder to resolve once a person becomes immobilized by their feelings. Seek help when you start to feel signs of either anxiety or depression. A counsellor who is familiar with gay men’s issues and gay culture can create a better outcome. If counselling doesn’t help, prescription medication could be used for treatment. As with all medications, it is best to take medication for as short of period of time as possible.
1 Bolton, Shay-Lee and Sareen, Jitender. (2001) Sexual Orientation and its relation to mental disorders and suicide attempts: Findings from a nationally representative sample. Canadian Journal of Psychiatry, 56(1), 35-43.
2 Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Cochran, Susan D.; Sullivan, J. Greer; Mays, Vickie M. Journal of Consulting and Clinical Psychology, Vol 71(1), Feb 2003, 53-61
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Everyone has different childhood experiences and upbringings. It’s what makes each person unique and different, and helps to sculpt their morals, ethics, beliefs, personalities, and more. However, many gay men often learn that their childhood has commonalities with other gay men. Understanding the challenges gay men face, from young boys through to gay men, can impact the rest of their lives.
It’s around the age of 5-10 years old that boys discover they are not like other boys. They do not understand how they are different, but they do know things are not the same. The reaction to this awareness is to try to fit it with the other boys, trying hard not to be the centre of attention. They will try hard to let people look at them too closely and discover their differences.
The emotional reaction includes fear, isolation, and confusion. Self-esteem starts to take its first big hit. They begin to self-monitor, checking if their behaviour is similar to other boys. This hyper self-monitoring leads to a loss of being able to feel comfortable and spontaneous. It’s a dangerous path, where the child spends more time focusing on what others expect them to act like rather than exploring who they really are.
When a boy realises that he is different, and that he prefers boys over girls, it can be extremely traumatic. Fears and questions begin to arise. Boys will ask themselves if other boys will find out, will they be bullied, how will his family react, will these feelings go away, and what will happen to him as he gets older.
This realization will also cause strong emotional reactions. These emotions and doubts often last into his adult life. Fitting in becomes the name of the game, requiring him to hide who he is and how he feels. Everything from appearance to gestures become very sensitive. This is when the boy will not be himself anymore. They doubt that their family and friends would accept them for who he really is, and he can become overwhelmed with feelings of isolation and loneliness. It’s about this same time that he will teach himself not to trust loving and caring relationships.
As the boy becomes a teenager, he will begin to have crushes on other guys but he is trapped because he cannot do anything about his feelings, other than to hide them. It’s extremely frustrating and lonely. There isn’t the opportunity to fall in love, go out on a date, or experience a relationship, unless it’s with a girl and under false pretences, which adds even more confusion. There are many hurt feelings seeing friends fall in love and not being able to have those same experiences. It’s a sensitive time when he will wonder if he will ever find love and acceptance.
Growing up in this environment isn’t fun; however, in spite of all these problems with self-esteem and lack of a strong sense of self-knowledge, gay youth train themselves to be alone and how to conform with the rest of the world, pleases others.
It’s not until he is in his 20’s or even 30’s that the gay man is able to explore dating and falling in love. This comes with consequence because he never experienced these feelings growing up, so it’s all new and often overwhelming. Relationships are overwhelmed with emotions. This is normal for teenangers, but because he never experienced that, he’s now battling these feelings much later in life, making him feel like a silly teenager all over again.
Gay men do survive their very difficult and trying childhoods. It’s now easy to see why early life experiences can lead to problems later in adult life. Anxiety and depression are common amongst gay men. Anxiety is an extension of the hyper monitoring, with large amounts of self-criticism. Relationships will almost always be difficult because of the lack of practice and not allowing others to get too close to him. Sexual experiences are also hampered because he wasn’t able to experiment with his sexuality and desires when he was at his sexual peak, making sex a quicker and easier way to connect with guys, rather than the long process of dating and building an emotional relationship.
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Photo credit: Vancouver Sun
Held every two years, the International AIDS Society conference is a gathering of doctors, researchers, and experts who comes together to discuss and report on the latest developments. This 2015 conference was held in Vancouver, British Columbia, and hosted over 6,500 attendees. While there were numerous presentations and findings presented over the three day event, these are the top highlights:
HIV is a very complicated subject and it is through these types of conferences that information sharing is so important. From how to treat people living with HIV, to treatment as prevention, to keeping people HIV negative, there is much the medical community is still learning and researching. Since the AIDS epidemic of the 1980’s we have come a long way. While there is still much work to be done, there is a sense of optimism that there could be a cure in the near future! We already have prevention!
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