I still remember the touch on the nape of my neck. It was one of the boiling summer nights at the height of a heatwave, when I was lying on bed alone, wearing nothing but a pair of trunks. Struggling to breathe despite the windows being wide open, I trundled out of bed to get a towel to dry my sweat-streaked face. I was close to melting. 25 degrees at midnight. I crawled back to bed after stuffing my mouth with ice cubes (it did work). Later that night, I found myself entangled with another corpus. Another sweat-bathed body enwrapped me from behind. A rising steam of carnal heat put me to heights of ecstasy as kisses traversed the length of my neck, from the nuchal point to the roof of the medial edge of my rhomboid major muscle. A comforting whisper sent tingles up my back, lips pressed against the back of my pinna. My eyes, half-closed, half-open, were greeted with gentle kisses. The searing heat of nature was replaced by the accompanying warmth of carnal pleasure. I felt the edge of my trunks being tenderly tugged. I nodded, giving my assent, indulging in the possibilities that lie ahead. I turned my head slightly, hoping to give my lover a kiss. I froze.
It was then I realised. It was myself.
I screamed myself awake, completely befuddled as to how exotic a dream could be. I was literally dreaming of having intimate sexual activity with my doppleganger. I told this story to my friends, frightened that they would see me as anyone different. Most just brushed it off as a joke. My mother was, to say the least, extremely alarmed and questioned my sexual orientation. She dropped the bomb, 'You know what, gay isn't normal.' That caught me wondering - why isn't it normal? Or, in a more biological sense, what does gay (or more broadly, homosexuality) mean anyway?
Sexual orientation is defined as 'an enduring pattern of emotional, romantic and/or sexual attractions to men, women, or both sexes'. [1] It has always been an elusive issue, since not much has been known about sexual orientation throughout history until now. In a world predominated by religious beliefs, the past was littered with references of the Devil when it came to discussions regarding homosexuality. [2] However, modern science tells us somewhat different things. We all know that we are made up of DNA. The central dogma dictates the relationships between DNA, RNA and proteins. [3] DNA is transcribed into messenger RNA. RNA is then converted into proteins. These proteins then form the building blocks of our body. Our DNA determines what we look like and how we think. DNA determines who we are. In this case, using a biological perspective, how is sexual orientation determined? The simple answer is genes. The actual answer is (and this is going to be disappointing): we don't know. Here, I propose two theories based on two entirely different views: (1) homosexuality is a condition, just like depression, and (2) sexual orientation lies on a spectrum.
We first talk about my absolute favourite and possibly the most important model in medicine: Liability Threshold Model.
The Liability Threshold Model tells us two things: (a) the tendency of one having a condition, and (b) the point where the individual has the condition. [4] However, what do we mean by tendency? More importantly, how is tendency determined? Scientists use two different domains of factors for guidance: (a) genes, and (b) environment. To be more sophisticated, there are also gene-environment interactions. However, it's probably best if we stay out of the overlapping regions now. We get a lot from our parents - this includes a huge heap of genes. Some genes are more conducive to a condition than others. These form the base liability to a disease. This liability can increase if there is a compatible environment. For instance, in breast cancer, the most lethal genes might be BRCA1 and BRCA2. However, this only means there is a 'high relative risk' of getting breast cancer. It is not 'certain'. Referring to the Liability Threshold Model, even if the base liability is high due to that you've inherited such genes from your parents, the chances of actually contracting breast cancer may not be that high provided that the environment is 'not' conducive to breast cancer. Epidemiological studies have shown that breast cancer remains prevalent in individuals with high socio-economic status and high alcoholic consumption. [5, 6]
If we see homosexuality as a 'condition'*, then it makes great sense. Firstly, we have the genetic basis of one's sexual orientation. After all, it was found that 40% of the variance in sexual orientation in men was determined by genes. It was 20% for females. [7] Using the model, an individual would be born heterosexual. Genetic factors would only determine the base liability of one's susceptibility to homosexuality. Then, with the influence of later-life environmental factors, e.g. excessive masturbation, early exposure to same-sex pornography, if one's liability tips beyond the threshold, then one exhibits overt homosexual behaviour, such as voluntarily engaging in homosexual activity and relationships.
Hurray. We then have science on the side of cynics and bigots. Homosexuality is branded a 'condition'. It then naturally follows that it can be 'cured'. The theory I proposed above could never be proven definitely wrong, since the correctness of any theory of science concerns probabilities. However, that theory is morally reprehensible by labelling homosexual individuals as people with 'problems'. What we don't need is the perpetuation of inequality.
In fact, science has long advocated the other theory, which is that sexual orientation lies on a spectrum. It is known as the Kinsey Scale. [8] The Kinsey Reports published in the first half of the 20th century remain the most influential documents in this area. The scale postulates that sexual orientation is fluctuant and dynamic. It is not a fixed concept. It does not resemble, for instance, the number of eyes of a person where that number is unlikely to change unless there is some significant pathology (I doubt). Not one single gene is responsible for controlling the trait of sexual orientation, contrary to popular belief. The only established gene that does potentially increase the chances of homosexuality is Xq28 (X chromosome; long arm; position 28). Whether certain genes at chromosomes 7 and 8 also play a role is controversial. [1] The same goes for intelligence. This is why fears regarding CRISPR-Cas9's role in artificially modifying such complicated traits are usually dumbfounded. [9] Even after the Human Genome Project, yes, we've got the entire human genome mapped out. But then, we still have broad gaps of knowledge regarding the exact genes controlling such traits, not to mention that genetic factors only play a certain percentage, not 100%. Environmental factors also play an important role. This does not concern merely the individual's physical environment - it can be the environment of the mother's womb or the individual's social environment. It has been shown that the relationship between maternal thyroid function (the thyroid gland is located over the neck, a butterfly-shaped structure which produces hormone crucial for metabolic activity) and offspring homosexuality is statistically significant (medical lingo for 'related'). The study did not show exactly why, since it's impossible to draw too many conclusions from just one study. However, it is reasonable to deduce that, since maternal thyroid dysfunction usually involves an autoimmune aetiology, such autoimmunity could have affected the neurological development of the individual. Sexual orientation, after all, concerns higher cortical functions - pleasure from sexual activity, communication and forming long-term romantic partnerships.
This is further muddled by the fact that people do experiment. There are times (this is our little secret) when I do feel I want to experiment, since it boils down to one big, shared trait amongst humanity: curiosity. Self-identified heterosexual individuals may also want to initiate sexual activity with members of the same sex, to 'try what it feels like'. This is why in medicine, we don't use the phrase 'gay men'. We use the phrase 'men who have sex with men' when describing the high-risk group for certain sexually-transmitted diseases such as HIV, genital warts (HPV-related) and anal cancer (HPV and HIV-related). The act of having sexual intercourse with a member of the same sex does not make anyone homosexual. It is rather physical experimentation, since sexual orientation also encompasses aspects such as emotional and romantic attachments.
If only we understand sexual orientation in a purely scientific way, we will make fewer mistakes when it comes to discussing it in light of social circumstances. As a shorthand, I use the law to illustrate some of the developments we've made in the liberalisation of sexual orientation. Under the Buggery Act 1533, sodomy was punishable by death. In 1835, John Smith and James Pratt were the last gay men to be executed in England and Wales. [11] Just to clear some ground, sodomy and buggery refer to anal intercourse (the physical penetration of the anus by the penis; logically speaking, sodomy can also be committed against female individuals). In 1861, the Offences Against the Person Act repealed the Buggery Act 1533, though still criminalising sodomy. It was then punishable by life imprisonment or exile from England and Wales to the penal colonies. [12] After the Wolfenden Report, male-on-male sexual activity was finally decriminalised in Sexual Offences Act 1956. However, the age of consent was not lowered until almost fifty years later, over the enactment of Sexual Offences (Amendment) Act 2000.
We can see that homosexuality is still a taboo in certain societies. The laws mentioned above are only applicable to England and Wales. There are still many places around the world which see sodomy as a crime. An ostensibly forward jurisdiction like Hong Kong only invalidated its anti-sodomy law in 2005. [13] In 13 jurisdictions, homosexuality is still, to this day, punishable by death. [14] Where bigotry and discrimination pervade, especially in more homogenous societies where difference is not even tolerated, yet alone embraced, it is not hard to conjure a reason why people are scared of having gay dreams. As recent as March this year, Singapore, a relatively homogenous island-nation (the majority of the population are of Chinese ancestry), upheld its anti-gay statute in a landmark ruling. [15]
In my case, even in the global city of London, I am still fearful of what others might think of me. Homosexuality is celebrated in London, a cornerstone of diversity and freedom. A vestige of old-school prejudices has somehow made its way into my subconscious when I was growing up. This fear originates from the loss of acceptance from others - one's tenacious grip to 'normality' (or, the majority) by 'staying in one's lane' and not acting in ways contradicting pre-established social norms and ideals. Having a gay dream, as any sensible person would say, does not indicate whatsoever one's sexual orientation. The most damaging pseudo-theory is 'closeted homosexuality', which refers to a sexual orientation hidden from view, unwilling to be disclosed. However, this only refers to individuals who already know their sexual orientation consciously, but refuse to have it disclosed. It does not refer to individuals who are homosexual even if they are unconscious of it. It is funny to resort to Sigmund Freud's baseless language of 'repressed homosexuality' to explain our impulses and dreams.
Perhaps the issue is not the dream itself. It is how we see homosexuality. If only we can see it through the lens of science, we don't need to be scared of it. After all, it is only a normal human characteristic, just like height, weight and eye colour.
* I hesitate to use terms such as illness and disease, since they mean different things. I've explored in previous blog posts that illness focuses on the subjective feeling of the patient whereas disease points towards a physiological anomaly (also known as pathology). In this case, we cannot confidently say that homosexuality is any of those things, since it does not, on its own, bring forth any form of suffering to the patient, nor does it involve any obvious pathology. To brand homosexuality a 'disease' is to further deny such individuals the right to be equal.
[1] Roselli C. (2018). Neurobiology of gender identity and sexual orientation. Journal Of Neuroendocrinology, 30(7), e12562. https://doi.org/10.1111/jne.12562.
[2] van Klinken A. (2013). Gay rights, the devil and the end times: public religion and the enchantment of the homosexuality debate in Zambia. Religion, 43(4), 519-540. https://doi.org/10.1080/0048721x.2013.765631.
[3] Nurse P. (2020). What is Life? Understanding Biology in Five Steps. David Fickling Books.
[4] Hujoel M, Gazal S, Loh P, Patterson N, & Price A. (2020). Liability threshold modeling of case–control status and family history of disease increases association power. Nature Genetics, 52(5), 541-547. https://doi.org/10.1038/s41588-020-0613-6.
[5] Krieger N. (2002). Is Breast Cancer a Disease of Affluence, Poverty, or Both? The Case of African American Women. American Journal Of Public Health, 92(4), 611-613. https://doi.org/10.2105/ajph.92.4.611.
[6] Liu Y, Nguyen N, & Colditz G. (2015). Links between Alcohol Consumption and Breast Cancer: A Look at the Evidence. Women's Health, 11(1), 65-77. https://doi.org/10.2217/whe.14.62.
[7] Långström N, Rahman Q, Carlström E, Lichtenstein P. (2010). Genetic and environmental effects on same-sex sexual behavior: a population study of twins in Sweden. Arch Sex Behav. Feb; 39(1):75-80.
[8] Diversity of sexual orientation. Kinsey Institute. (2020). Retrieved 10 November 2020, from https://kinseyinstitute.org/research/publications/historical-report-diversity-of-sexual-orientation.php.
[9] Kofler N. (2020). Gene editing like Crispr is too important to be left to scientists alone. The Guardian. Retrieved 10 November 2020, from https://www.theguardian.com/commentisfree/2019/oct/22/gene-editing-crispr-scientists.
[10] Sabuncuoglu O. (2015). High Rates of Same-Sex Attraction/Gender Nonconformity in the Offspring of Mothers with Thyroid Dysfunction During Pregnancy: Proposal of Prenatal Thyroid Model. Mental Illness. Sep;7(2):5810. DOI: 10.4081/mi.2015.5810.
[11] Law and Oppression. Historic England. (2020). Retrieved 10 November 2020, from https://historicengland.org.uk/research/inclusive-heritage/lgbtq-heritage-project/law-and-oppression/.
[12] Offences Against the Person Act 1861, s 61.
[13] The Associated Press. (2005). Court in Hong Kong Invalidates Anti-Sodomy Law From British Era (Published 2005). New York Times. Retrieved 10 November 2020, from https://www.nytimes.com/2005/08/25/world/court-in-hong-kong-invalidates-antisodomy-law-from-british-era.html.
[14] Byrnes H. (2019). 13 countries where being gay is legally punishable by death. 24/7 Wall Street. Retrieved 10 November 2020, from https://eu.usatoday.com/story/money/2019/06/14/countries-where-being-gay-is-legally-punishable-by-death/39574685/.
[15] Wareham J. (2020). Singapore Upholds Colonial Anti-Gay Laws: Being Gay Remains Illegal For 5.7 Million People. Forbes. Retrieved 10 November 2020, from https://www.forbes.com/sites/jamiewareham/2020/03/30/singapore-upholds-colonial-anti-gay-laws-being-gay-remains-illegal-for-57m-people/?sh=4f9a52777ad9.
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