A public silence : discursive practices surrounding homosexuality

Considerable research points to an elevated prevalence of mental health problems and suicide for men who have sex with men (MSM). Yet there is little research on how public mental health services (PMHS) does, or could, address the needs of MSM. When such literature does appear, a common suggestion is that queer staff will be necessary to improve PMHS for MSM through a process of ‘matching’. Yet, no research has specifically explored the views of queer staff or MSM clients on this. Further, a positivist trend within the existing literature contains individualising and essentialising assumptions that limit our understanding of relationships between MSM and PMHS. Adopting a critical social constructionist perspective, I argue that Foucauldian theory and its analysis of the relationships between discourses, power, and subjectivity, enables research to focus on the social and structural processes constructing mental health care for MSM. This thesis explores the discursive construction of the relationships between MSM and PMHS, and the implications of this for practice. My analysis begins by explicating commonly circulating discourses of homosexuality, and of mental health, in New Zealand. These discourses are evidenced in (but not limited to) academic literature, governmental documents, and queer and mainstream media. They provide a framework for the analysis of interviews with 12 queer staff and 13 MSM clients of PMHS. The analyses illustrate the multiple discourses informing the MSM’s subjectivities as homosexuals and show the predominant discourses they draw on to account for their mental health problems. I suggest the term ‘homonegative trauma’ to denote this. Analyses of the staff and clients’ accounts around the ‘disclosure’ of homosexuality within PMHS reveal discursive power relations which restrain staff, and some clients, from acknowledging homosexuality. I consider two strategies for disrupting this heteronormative silence within PMHS. I contend that the notion of ‘matching’ queer clients and staff is a minoritising one, with limited ability to counter heteronormativity. In contrast, a universalising approach requires all staff to initiate conversations with all clients about sexuality. Making a comparison between staff inquiring about sexuality, and the currently recommended practice of staff asking about sexual abuse, I argue that this analogy provides useful resources to support such a universalising move. I conclude by arguing for systemic and structural changes in PMHS to support staff to routinely enquire about sexuality. If done with an awareness of the discursive complexity involved, such a shift has the potential to disrupt heteronormative practices within PMHS. My analysis suggests that the power of the medical discourse in particular, will be a significant restraint to such a change. However, if heteronormative practices within PMHS remain unchallenged they will continue to silence some MSM clients, thereby, maintaining the homonegative trauma described by most of the MSM clients interviewed. This would reproduce a tendency within the medical discourse to focus on individual pathology and to evade the ways in which social marginalisation and oppression can be constructive of mental health problems.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Psychology

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2006

Author dc:creator

• Semp, David

Advisors dc:contributor.advisor

• John Read
• Debbie Payne

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/2292/276

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/276