Abstract: A worked out body has become an important icon in contemporary gay male culture and as a result has an impact
upon how many gay men feel about themselves. These issues are increasingly being discussed during the course of
psychotherapy. The following is a brief overview of some of the ways that therapists can be alert to integrating these topics
into the therapeutic conversation.
Key Words: homosexuality, gay men, gym, fitness, psychotherapy, steroids, body image, health
For about the past twenty years gay men have been flocking to gyms, working out and bulking up. It should not come as a
surprise that body image and the impact of "gym culture" often are topics of exploration during therapy. For as long as I
have seen gay men as psychotherapy clients they have worried about not being able to find a man to love and who would
love them. But currently almost every time this worry is voiced in sessions, it is accompanied by the rationale that being too
heavy, too thin, too old or not having a gym body is the reason why an individual is unhappily single. Obviously this provides
a useful opening to explore issues such as self image, meeting men, and what one brings to the dating realm.
The visual portrayal of gay men as young hunks (almost always white) is having a significant influence on the psyches and self image of countless gay men. The internalization of these images as a norm is causing corresponding psychological and emotional damage when an individual melds these supposed standards of beauty and desirability to a fragile self image. Not infrequently as these issues are discussed during treatment, feelings about aging and the normal bodily changes that accompany growing older, even for athletic and in-shape individuals. In response to fears about moving into middle age, I introduce a psychoeducational aspect to the treatment that addresses various aspects of aging.
I have worked with grossly overweight men with severe eating disorders who sought therapy to help them understand their difficulties with and resistances to keeping their weight down. I have also worked with men whose bodies are lean, yet who are obsessed with not being able to see the results of time spent at the gym, or that their percentage of body fat is more than 9%. These men describe such distorted body images that they feel fat or out of shape because they do not see themselves as resembling the pictures of young buff men who predominate in gay men's periodicals. Some of the men who have perfectly normal, and in shape bodies with a small amount of body fat, present in ways that are similar to anorexic girls or young women. They have completely distorted views of their bodies, always think of themselves as fat and as a result often have an eating disorder.
It is simplistic to equate this current fashion with so-called "body fascism," a term used by gay social critics. There are numerous complexities involved with the focus many gay men have on bodybuilding. In the 70s, many gay men were slim. There were a few very well built and muscled men, but they were a minority. As AIDS ravaged the gay community in the 80s, people with HIV wasted away and all too frequently looked gravely ill. It is no coincidence that the wide spread interest in pumping up by gay men began during the early days of the AIDS health crisis.
In an effort to stem AIDS-related weight loss and wasting, physicians began to prescribe steroids, testosterone and human growth hormones. The onset of combination antiviral drugs brought countless people with AIDS back from the brink of death. Weight training in combination with the above-mentioned drugs changed the way many people with AIDS looked. People who had once been very gaunt developed into imposing hunks.
In addition to the medical reasons for keeping fit, a pumped up body also became a symbol of health. A lot of uninfected gay men go to the gym, and keep fit as a way of announcing to the world that they are not ill. It has also become the standard for being physically attractive and sexually desirable. One way of coping with the internal attacks of the virus and the external oppression of unsympathetic and overtly hostile politicians was (and is) to work out and get "pumped." This is one tangible way gay men can regain control of their bodies and feel powerful. For the ever-growing numbers of HIV-positive long-term non-progressors and survivors, the ability to do strenuous aerobic exercise and lift weights is a potent and visceral reminder that they are not ill.
There are also several reasons for keeping fit that have more to do with general health benefits than HIV, all of which have important emotional and psychological ramifications. These include remaining centered, countering stress, increasing energy, confidence and sex appeal. Many gay men remember being skinny and awkward kids who were never strong or athletic, and cite the important emotional as well as physical benefits derived from regular exercise and lifting weights. For gay men who were athletic as children and adolescents, keeping a competitive body was a way of fitting in with a peer group and helped them cope with feeling different due to their sexual attractions for other boys. For these men, an athletic, in shape body was and often remains an adaptive and healthy coping mechanism.
Some men who equate being pumped, having a chiseled body or less than a certain percentage of body fat with being sexually desirable, often report feeling that they never achieve the desired state of bodily perfection. This creates a potent form of anxiety directly linked to a self-critical voice that erroneously ascribes body perfection with the power to guarantee that they will then magically experience much improved self-esteem and find the man of their dreams. For men who equate being found sexually desirable as the primary attribute they bring to dating and potential romantic relationships therapy has the potential to help them learn to assess what else they bring to a relationship. Upon exploration, these latest ways of feeling less than other men becomes indistinguishable from other manifestations of internalized homophobia.
At times, however, keeping fit can become an unhealthy obsession that is facilitated by a distorted body image, regardless of the initially reason behind the interest in fitness. Today numbers of men inject themselves with anabolic steroids, gain a degree of muscle impossible without this chemical assistance, and become huge. Physicians prescribe some steroids, while a majority of people purchase these drugs illicitly from personal trainers or dealers. For men who never seem to be satisfied with how big they become, it is therapeutically useful to be aware of the cultural pressures that have led to such practices becoming a misguided and exaggerated variant of a healthy way of coping. Therapists need to be alert to opportunities to help these men examine the meanings inherent to their individual search for an external way to bolster low self-esteem. Therapists also need to support the belief that changing one's body through weight control and exercise can and often does have positive emotional, psychological and physiological dividends.
Bob Bergeron, CSW, is a Manhattan psychotherapist who works with gay men examining their use of steroids. In his work Bergeron has found that individuals who have a "problematic relationship" with steroid use almost always suffer from a distorted body image. Indications of this are that they feel that even as a result of several years of mega-doses of steroids, they do not experience satisfaction in the way their body looks, or the size of the muscles they have developed. Additionally, once they stop a cycle of steroids, they feel that their body is considerably and dramatically reduced in size, and that they are not able to have as powerful workouts as when they are taking steroids. Some of these men are so obsessed with their physical appearance, that the minute they are done with one cycle of steroids they feel they have to begin another one immediately.
It is after experiencing an understandably frightening and negative physical and psychological reaction to poor quality steroids that some men seek psychotherapy. Bergeron finds a "harm reduction" approach to be useful. Rather than trying to convince a person to stop using steroids, he helps him figure out what he physically and psychologically gets from them in order for the client to develop strategies for replacing steroids with something else in his life.
An obvious danger of using illicit steroids is the lack of quality controls regarding the purity of the drugs. I have worked with several patients on steroids who did not make the connection between "unexplainable" mood swings and steroid use. These very powerful labile emotional states may occur even in individuals whose steroids are prescribed by a physician. For individuals with depressive or bipolar illness, the use of steroids very often creates a psychological and/or emotional decompensation that destabilizes them, even when they are experiencing the benefits of prescribed psychotropic medication. These mood swings may present as virtually indistinguishable from psychiatric or characterological symptoms. Thus, as part of a complete and accurate diagnostic assessment, it is crucial for the therapist to do a complete drug use assessment that includes prescribed or illicit steroids as well as "recreational chemicals" like Ecstacy (known as "X"), GHB (known as "G"), Ketamine (known as "Special K"), Cocaine and Amphetamines (known as "Crystal Meth" or "speed").
Throughout the gay men's community the term "Chelsea Boy" is used as a dismissive put down, and has become synonymous with a muscled man who is stereotyped as a circuit queen. ("Circuit Queen" refers to a man who attends a specific type of dance event known as a circuit party. Circuit parties are weekend long happenings in various cities around the United States, Canada, Europe and Australia, built around a dance party where most of the participants use "recreational chemicals" to dance for many hours. There is a lot of alcohol and drug usage with a corresponding high level of sexual activity.) For many years I used to hear a slogan that went: "Body by Nautilus (referring to the manufacturer of gym equipment) but mind by Mattell (referring to the toy manufacturer). Feminism has deconstructed the notion that beautiful, well-built women are "mindless bimbos." Similarly, it is important to challenge the pervasive view that "pumped" masculine men are dumb, insensitive, coarse and incapable of empathy.
Therapists who work with gay men need to be alert to how issues presented as relating to the gym, in reality concern deep
psychological and emotional dynamics. There are men who use the current standards of being fit, and well built to put
themselves down. These men report feeling that they will never measure up or be found good enough or attractive enough
for anyone to find them desirable as a boyfriend or partner. One man told me during a therapy session:
"I was always a skinny kid who felt different for not being athletic and knowing that I was queer. Even though, I have no
desire to bulk up, I feel different today, as if I am not properly queer since now I don't even feel that I fit into gay society
since I do not have, do not want to have and don't want a partner who has a gym body."
Clients who share these feelings reveal deep emotional places that need to be explored. As we explore the many levels of
what feeling different is really about, one observation I often make to men who describe feeling this way is that it would be
useful to explore whether these feelings are intimately related to manifestations of internalized homophobia. Then we begin
to do the work to see if my interpretation is correct, and if so in what specific ways for this person.
A client who sought treatment for his profound depression uses his ability to exercise as a gauge for how he feels about himself. At first I thought this sounded appropriate. But as we explored the specifics of his exercise patterns he described needing to be able to do three hours of intense cardio-vascular exercise at least five times a week prior to doing about an hour with weights. Upon learning this, I began to assess that perhaps his patterns of exercise were symbolic of deeper psychic constructions. His inability to return to the gym was an understandable indicator that the first antidepressant he was prescribed was not helping ameliorate his depressive symptoms, and I urged him to tell his psychopharmacologist this in order to try a different antidepressant. Once he was able to resume working out and his recovery from depression was secure, we began to look at the meaning and purpose of such vigorous workouts. I was careful to remain nonjudgmental, while we explored in what ways his use of exercise was a defensive structure.
Like other aspects of client's lives, how individuals feel about their bodies, and how this relates to their self-image, are fertile areas for therapeutic exploration. Exercise, fitness and being "buff" have a high profile and currency in contemporary American culture at large, and in gay male culture in specific. For many gay men who seek therapy, delving into these issues become an important part of the therapeutic process.