Traditionally, within the field of mental health, all forms of homosexuality have been viewed as pathological. This belief system reflects the larger societal attitude of heterosexism. According to Herek (1986), heterosexism is a "world-view, a value system that prizes heterosexuality, assumes it is the only appropriate manifestation of love and sexuality, and devalues homosexuality and all that is not heterosexual" (p. 925). Heterosexism is enforced by intimidation, harassment, and exclusion of those who are different (Rivers & D'Augelli, 2001).
Until 1973 homosexuality was labeled a disease in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1973). It was removed from the disease classification after research by Hooker (1968) documented that as a group, homosexuals showed no greater pathology than did the general population. More recent literature has stated that homosexuality itself does not cause or indicate pathology; but that heterosexist society's response to homosexuality, homophobia, causes severe problems for gay people. "The impact of heterosexism on gays/lesbians/bisexuals in today's society is hampering individual growth and development by instilling shame.., shame due to heterosexism" (Neisen, 1993, p. 51).
The phenomenon of homophobia is prevalent in our society. Homophobia can be defined as "fear, disgust, anger, discomfort and aversion that individuals experience in dealing with gay people" (Hudson & Ricketts, 1980, p. 358). This fear becomes generalized to a societal endorsement of negative myths and stereotypes about gay men and lesbians (Berkman & Zinberg, 1997).
Understanding lesbians, then, rests on the recognition of homophobia as an ongoing oppressive force. It is also dependent on the awareness of the specific problems faced by all women. Lesbians are oppressed not only because they are homosexual, but also because they are women. As women, lesbians face problems not faced by gay men. Lesbians in treatment therefore require a different perspective from the therapist.
According to Miller (1976), all women experience a degree of shame for being women in our patriarchal culture. Spaulding (1993) redefined heterosexism as being necessarily inclusive of sexism: "Heterosexism can be viewed as a form of social control in which values, expectations, roles and institutions normalize heterosexuality which, in turn, is promoted and enforced formally and informally by structures in which men are dominant, i.e. the patriarchy" (p. 232).
The sanctioned norm in U.S. society is that men are entitled to more control, privilege, and status than women are and that heterosexuals are entitled to more acceptance, privilege, and rights than homosexuals are. Not only are lesbians devalued because they are women, they are again devalued, more severely, because their existence is not dependent on a relationship with a man. The lesbian poses a provocation to the status quo of the patriarchy and therefore is continually devalued by the patriarchal culture as a whole to maintain the status quo.
This essential provocation to the patriarchy puts the lesbian at risk of continual denigration and stigmatization by the larger society. "Any woman can be threatened with the label 'lesbian' if she rejects male domination and control" (Ellis & Murphy, 1994, p. 52). The ever-present possibility of harassment creates continual pressure on lesbians to remain as invisible as possible.
The lesbian "exits the heterosexual assumption," putting herself outside the norm to "recognize her same sex desire and identify as lesbian" (Schneider, 2001 p. 84). The degradation in status created by this position outside the expectations of society creates a need for secrecy and hiding.
The need to hide has damaging psychological consequences. "The sense of 'otherness' results from isolation from those with similar feelings and from messages that homoerotic feelings are shameworthy" (Rivers & D'Augelli, 2001, p. …