"People think that if they don't fit in here," Extein says, "then where will they fit in? So they try really hard to fit in, but it doesn't always make them feel happy."
Not much of a drinker, and not much of a follower, Extein finds his mind sometimes wandering into "dark places." His blue moods, though, have nothing to do with the stress of being a sexual minority. "It's more about the gay world than being gay," he says.
PHOTO BY ANNE FISHBEIN
Therapist Robert Weiss finds "we don't have enough research on what it means to be healthy."
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Extein is hoping that influencers in the gay community will speak up. "We need leaders to talk about these things," he says.
These four gay men's thoughts and experiences are not uncommon, especially among those coming of age in their 20s — the same group that has seen an increase in HIV infections.
The gay-rights movement is still largely focused on problems that arise from its long fight for civil rights: legalizing gay marriage, monitoring homophobic words and deeds by political and religious leaders and, most recently, boycotting Chick-fil-A fast-food restaurants because the chain's president, Dan Cathy, opposes gay marriage. A number of critics of the traditional gay leadership say these battles don't directly pertain to the daily well-being of most gay men.
"The issue of a health crisis has been totally replaced by gay marriage, but gay marriage doesn't have as much relevance to our community," says AIDS Healthcare's Weinstein, who's been fighting for HIV/AIDS prevention and health care since the 1980s. "The civil rights issue is very important, but it's not that relevant to our everyday lives."
LGBT health experts have done little research on gay individuals' internal "social stressors" — the personal attitudes and choices that John, Sweet, Mishory and Extein talk about — that rise from within and which may have more negative effects on gay health and well-being than historic discrimination.
"No study comes to mind," says Dr. Jason Schneider, former president and current board member of the Washington, D.C.–based Gay & Lesbian Medical Association, an advocacy organization.
Kellan Baker, a highly regarded LGBT health-policy analyst at the Washington, D.C.–based Center for American Progress, can't think of such an analysis, either. Neither of these experts can name a long-term study that looks into how happy, healthy gay men live and make choices — knowledge that could be a valuable tool.
That's astonishes many people, since "positive psychology," which emphasizes discovering and employing healthy behaviors that make people happy before they develop mental illness, has become hugely popular since the late 1990s.
"We don't have enough research on what it means to be healthy," says nationally recognized sex addiction expert and L.A. therapist Robert Weiss, who wrote Cruise Control: Understanding Sex Addiction in Gay Men. "We should know what a life of a healthy gay man or lesbian looks like from age 19 to 50."
Harvard University undertook just such a study for all men, not gay men — its widely cited Grant Study. Launched in 1938, it has tracked the health and well-being of more than 260 men throughout their lives. But Weiss says that when it comes to gay men, research dollars from the federal government, mental health organizations and the medical industry are funneled largely into gay pathology rather than well-being. The big bucks, he says, are tied to pharmaceutical cures for what ails gays, not prevention.
"It's hard to get attention or money for LGBT health," says Baker, who worked on the federal "Healthy People 2020" plan, a national blueprint for improving health among all Americans. But, he laments, "There's no coherent research agenda" among gay leaders and a great dearth of research. Baker takes direct aim at the established gay-rights movement, saying that gay men's mental and physical health is a low priority among gay political influencers.
A landmark 2011 report on the health of the LGBT community by the national Institute of Medicine noted that gays have "unique health experiences, but as a nation, we do not know exactly what these experiences and needs are." The report found that not enough research has been attempted or data collected — echoing Schneider, Weiss and Baker.
Yet Schneider, of the Gay & Lesbian Medical Association, is firmly in the conventional-wisdom camp, preferring to talk about Ilan Meyer's minority stress model and gay health-care politics — with their focus on outside forces. "It's very easy to come off as, 'All LGBT people are sick,' " he says, "and right-wing organizations use that against us. So we have to be careful, and note that most gay men are healthy."
As for a gay leader who is challenging this conventional wisdom, Schneider says, "I don't think we have that person talking that way now."
Cary Harrison, a syndicated radio talk show host heard on KPFK's "Go Harrison" and a longtime resident of West Hollywood, says, "A lot of our culture is based on window dressing because it's something we can sell pretty easily, and we can sell our victimhood pretty easily." He'd love to see a Tony Robbins–type character "for gay people, so we can recapture the wonderful spirit we all have in ourselves. We have such an innate, incomparable power and I'd love to see us get that back. We're capable of extraordinary things."